A Journey of Mindfulness--the Remaking of Life in Midstream.

[Scott 2]

What numbers would have left you satisfied?

From the outside, I see new patterns leading to a positive overall trend. Maybe even aging backwards. I wonder how often your doctor sees that. Any quibble I'd raise, would be around easing up on restrictions and creating sustainable behaviors.


Two thoughts:

Would you consider a liver ultrasound, to address your disease concerns? I believe at an independent imaging facility, cash ultrasounds are in the $100-$200 range.

I wonder what kayak season will do to your cholesterol numbers. Exercise can be a powerful lever. In my n of 1, a high volume of Zone 2 cardio correlates with very low triglycerides.

[IlliniDave]

What numbers would have left you satisfied?

From the outside, I see new patterns leading to a positive overall trend. Maybe even aging backwards. I wonder how often your doctor sees that. Any quibble I'd raise, would be around easing up on restrictions and creating sustainable behaviors.

...
Would you consider a liver ultrasound, to address your disease concerns? ... I wonder what kayak season will do to your cholesterol numbers. Exercise can be a powerful lever. In my n of 1, a high volume of Zone 2 cardio correlates with very low triglycerides.

Good questions.

Numbers-wise, I would have liked to see AST go down rather than up (albeit just barely up), and I would have liked to see triglycerides go down rather than up. I'd expected HDL to go down because I thought the December number was errant.

As far as an independent ultrasound, it's not something I'd say I'm ready to do just yet. The huge improvement my ALT assuages any urgent concerns at this juncture. If the doc says I should have one now, fine if I can schedule it before June. Otherwise I'm content to give it 6 more months and check again.

I went for a "training hike" this afternoon in the hilliest spot around here with overland trails. Spent a good chunk of that time thinking about my regimen while I'm up at the hideout, what will necessarily change, what won't. I think all in all it will be good for me, and as you alluded to, it will encompass the months where I settle into a long-term/sustainable routine. Paddling the kayak around in the fresh air will certainly be more enjoyable than hitting the rower in the basement, the hikes there are much more challenging, and I'll bring the bands to keep up the resistance training. I'm optimistic even though there are things to watch. I tend to aim high, and trying to fix everything all at once as I've attempted these last 4+ months was bound to leave me disappointed in some regards. Fortunately, disappointment doesn't stick with me as a negative thing, I usually turn it into positive motivation, and if not I just forget about it.

That's a god point about the doc. I don't know what she'll think. But I suspect you're right that only a minority of her patients in my demographic make a serious multi-front effort to reverse lifestyle disease, much less have success on several fronts as I have in a fairly short time. Most of my contemporaries just try to walk a couple times a week and fill dutifully their pill caddies. Thanks for the encouraging words!

[IlliniDave]

Had my establishment visit with my new primary care doc.

Cliff's Notes version:

"You're fine. Go away and come back in a year."

Not that it was a surprise, basically no interest in what I've been doing, what my goals are, etc. Medicine 2.0.

[Scott 2]

Sounds about right.

I've had luck raising concerns, such that ignoring them would be negligent. IE - my family has a history of diabetes, I've been feeling dizzy lately. I know A1C is a trailing metric, is there something else we can check? Maybe my insulin levels are already out of whack and my body is starting to lose the fight?

But it's almost all me leading the way.

My wife has access to concierge medicine through MDVIP. They do attempt medicine 3.0 tests and screenings. But the annual fee, before any care is billed to insurance, is $2k. While I don't like the business model, it's probably worth it for someone who can spare the money.

[IlliniDave]

... But it's almost all me leading the way ...

It always comes down to that, across more domains than just health care.

She was actually a very pleasant woman, I think I just didn't meet the typical patient profile. I think a lot of patients go to their MD with various complaints looking for exogenous quick fixes, with the other main group being people like my dad who go because they are forced to (first it was my mom who made him go, now it's his children) and are resistant even though they have bona fide conditions that can and should be addressed and that are within the scope of Medicine 2.0 to at least manage.

Then I show up with no complaints about how I feel, no under-the-hood conditions recognized by Medicine 2.0 except elevated cholesterol (an arguably specious condition), but very motivated to "optimize" measures that are not out of whack based on the so-called reference ranges (and sometimes pretty good considering my demographic) while being disinterested in standard therapies (pharmaceuticals). I could tell by the end that she was either frustrated with me, or maybe even intimidated by me, most notably once I tried to engage in a two-way adult conversation after the obligatory statin mention. I recognize my expertise on such things is probably sophomoric (i.e., "sophisticated fool"/king of Mt Stupid), and maybe I should be more deferential to the "Doctor" title. But then again no one has as much skin in the game regarding my health as I do, and even though in many facets of life I tend to be somewhat passive, once I latch onto something I get compulsively proactive.

The most useful thing about the visit was that I learned I'm a full 6' 2" tall. The last time my height was properly measured was sometime back in HS when I was 6' and 1/2" and I've been using that ever since.

Despite it being an anticlimactic moment it does mark the end of the first chapter of my 2023 healthspan journey. Even though I'd hoped for somewhat broader improvements, it would be hard to not chalk it up as a win, which is what I will do.

Going forward I still want to drive my weight down a little further. I weighed in at a little under 179 lb (meaning actual body weight of around 176 lb. So I'll continue running a bit of a deficit with carb restrictions until I hit 170 or so, mainly to make sure I flush out any residual liver fat and/or visceral fat, then look at going back to more normal-for-me protein consumption and ramp up the strength training to get back to something close to my present body weight by adding some lean mass.

To put together a summary scorecard:

Gut health restoration: No real metric for this, but anecdotally based on how I feel day-to-day, this was a substantial success.
Mitochondrial/cellular health restoration: No direct metric for this, but anecdotally based on how I feel I'll say moderate or better success.
Move away from the brink of Type-II diabetes: Clear success with clinical numbers to back it up.
Reverse fatty liver: Success based on the main enzyme marker. although the other main liver marker did not improve, it is stable and "okay".

Some other things that are intertwined with metabolic health:

Weight loss: ~37 lbs
Clinical setting BP: from 144/86 to 130/75
Estimated V02 max: more than doubled
Belt notches/visceral fat: Moved from first notch on belt to fourth, and can now wear size "L" shirts without them looking like they are painted on.

The only metric that I felt like I truly went a little backwards was triglycerides. Historically, restricted carbs substantially lowers them, and this time they went up slightly. No sleep will be lost over it, but it's a watch item going forward because they are a surrogate inflammation marker.

In the short term my goal is just to maintain my current healthspan regimen while my mental energy will turn to a combination of handing off day-to-day aspects of looking after my dad to my siblings and his in-home care provider as she ramps up the frequency of her visits; and towards preparations for migrating to the hideout for four months. A fair part of that is working out how much of the regimen I can port up there, and how to accomplish that.

But first up is taking my yak's little electric motor apart and performing the annual maintenance, and making a decision on whether I should put a new prop on it; and to relearn how all the gear mounts on the boat to recreate my little fishing cockpit. Luckily I took some photos to document where everything was once I got it arranged to my liking last year. Then, hopefully early next week I can get it out on the water locally for a seaworthiness test and a little fishing. My MacGyver project will be to find a better solution to pulling the boat around on it's little portage wheels that attach to the stern. Long story short is that with all the mods I made I don't have a good handhold to pull it around with all the gear onboard. My only choices are one that is painful because of some sharp angles digging into my fingers, and another that is too slippery. I'm going to try to adapt a sled pulling harness to transfer the weight to my shoulders (have to get the bow up off the ground for it to roll) so my hands/arms will only be needed for balance. The other fun test will be slinging it up on top of my Pilot to see if my shoulder-centric strength training has done any good. Those activities are much more fun than planning a multi-course menu for my gut bacteria.

[Scott 2]

Pension plans hate this one trick. Imagine if you could sell those results as a pill. It would upend the entire retirement system.

Time to re-project the FIRE numbers. I think health is under represented in retirement literature, especially during accumulation phase. There's so much value to capture.


Given the rapid ascent to a very successful peak, I question if continuing to push weight loss is your optimal strategy. Personally, I'd rather take a longer time window for the shift into maintenance calories. Gradually change behavior, instead of an abrupt stop and restart. A weight valley might still happen, but a soft transition could transfer momentum into the next goal.

[jacob]

Not that it was a surprise, basically no interest in what I've been doing, what my goals are, etc. Medicine 2.0.

Perhaps a DO (cf an MD) would be more into optimizing the marker vector?

Otherwise, given the range of uncertainty of the outcomes, the general attitude is likely somewhat like an investment portfolio check-up with most professionals distinguishing between "obviously bad" and "probably good enough" when judging "self-directed accounts".

[theanimal]

Otherwise, given the range of uncertainty of the outcomes, the general attitude is likely somewhat like an investment portfolio check-up with most professionals distinguishing between "obviously bad" and "probably good enough" when judging "self-directed accounts".

I think the more apt analogy would be like you are hoping to visit a financial planner (that has a CFA and other relevant certifications) to improve your portfolio but end up being shown a bankruptcy lawyer that has no interest in improving your portfolio, only there to help if you were to get into serious financial peril. One has training in what you're looking to do, the other is throwing darts at best. Anyone who goes through medical school only has 3 hours (!) worth of education regarding nutrition. There is a near equivalent focus on exercise. So you are left with doctors that are likely parroting the CDC or some other 3 letter agency saying that you need to exercise for 30 minutes a few times a week or make sure you are eating X, Y, Z. Why? How? What exactly should I be doing? Just exercise and eat some veggies! No need for questions. Any doctor that knows and implements individualized, targeted nutritional/exercise regimens had to seek out either additional training or learning on their own beyond medical school. And since it is not normalized they are rare and $$$$. Otherwise most of the doctors are deer in the headlights when it comes to this stuff. They can tell you what the standard treatment plan is once you are in the red zone, but if you don't want to hit the red zone, good luck. Prevention is not an option. Medicine 2.0 indeed.

[IlliniDave]

Pension plans hate this one trick. Imagine if you could sell those results as a pill. It would upend the entire retirement system.

Time to re-project the FIRE numbers. I think health is under represented in retirement literature, especially during accumulation phase. There's so much value to capture.


Given the rapid ascent to a very successful peak, I question if continuing to push weight loss is your optimal strategy. Personally, I'd rather take a longer time window for the shift into maintenance calories. Gradually change behavior, instead of an abrupt stop and restart. A weight valley might still happen, but a soft transition could transfer momentum into the next goal.

I hear you on smoothing transitions. As of a week ago I've already started easing out of full weight loss mode by opening up my eating window to 6 hours/day and adding a second meal, albeit a small one. I haven't changed food choices yet, still working with the plant paradox list.

I've already started considering the implications of extending healthspan, and even lifespan to an extent. I thought I mentioned a little about that in a prior entry but maybe I forgot. It's not hard to imagine that certain interests wouldn't team with the government to ban longevity enhancing protocols/procedures should any come along that reliably and significantly extend lifespan. The financial implications could be significant. I don't really expect to live an extraordinary length of time, but I'm hopeful that I'm increasing the number of robust health years ahead. Luckily I 'oversaved' which should give me a buffer against unexpected longevity should it happen but it wasn't explicitly part of the plan. But knowing what I do now, if I was 25 and just getting started, I'd plan differently.

[ertyu]

It's not hard to imagine that certain interests wouldn't team with the government to ban longevity enhancing protocols/procedures should any come along that reliably and significantly extend lifespan. The financial implications could be significant.

Such longevity enhancing protocols won't be banned, they will just be so prohibitively expensive so as to only be meaningfully available to a select few. I've heard friends call this the China approach - it's not forbidden, it will just cost you. One friend who lived in China before Covid says the license to drive a large, petrol-fueled motorbike through central Shanghai costs 100,000k USD. (I have no idea if this is actually true, but it came up to illustrate the above point)

[IlliniDave]

Perhaps a DO (cf an MD) would be more into optimizing the marker vector?

Otherwise, given the range of uncertainty of the outcomes, the general attitude is likely somewhat like an investment portfolio check-up with most professionals distinguishing between "obviously bad" and "probably good enough" when judging "self-directed accounts".

A while back I reached out to a local 'functional medicine' practitioner in my area. Don't recall whether he was an MD or a DO. I think MD. I never had my call returned so kind of dropped it, but intend to pick that effort back up in October after returning from the hideout. When I do I'll expand the search to explicitly include osteopathic docs.

[IlliniDave]

...They can tell you what the standard treatment plan is once you are in the red zone, but if you don't want to hit the red zone, good luck. Prevention is not an option. Medicine 2.0 indeed.

Yep, right now the medical system appears pretty overwhelmed with an epidemic of Western lifestyle diseases which will only worsen under allopathic protocols. It's a $4T/yr industry in the US and I don't think everyone involved wants to change things.

[IlliniDave]

Such longevity enhancing protocols won't be banned, they will just be so prohibitively expensive so as to only be meaningfully available to a select few. I've heard friends call this the China approach - it's not forbidden, it will just cost you. One friend who lived in China before Covid says the license to drive a large, petrol-fueled motorbike through central Shanghai costs 100,000k USD. (I have no idea if this is actually true, but it came up to illustrate the above point)

Call me a cynic, but I think they would be banned, yet still be available to the elite. That's the only means by which the cost could stay high. If they would be open to anyone who could afford it, eventually market forces would drive the costs down to increase 'sales'. In the longevity world there's a bit of a debate going on, one I haven't followed, about the implications of substantially increased lifespan. Some argue it would be a huge drain and others argue it would be a productivity boon. I suppose the difference would be whether 'retirement ages' change and/or what 'retired' people do.

[IlliniDave]

I took the yak out for its 2023 seaworthiness trials. The strength training paid dividends. Much easier to wrestle it around now. The fishing was sort of sucky, just got one white bass, It was the biggest white bass I ever caught, but only about 12" long.

[IlliniDave]

Preparation for my seasonal migration is in full swing and going pretty well. Last year, my first full season, was considerably more stressful. Partly it was my first multi-month stay, and partly because I was throwing together and transporting the kayak for the first time. Regarding the kayak, things worked well enough on the water last year, that this year was mostly just checking to make sure everything still works, giving it a good cleaning, applying UV protectant, and picking up a couple of spare parts so I can make better bush repairs. regarding the length of the stay, my plan for this year is to bring enough clothes up there (and leave them) so that in the future I won't have to haul anything but my specialty jackets and shoes back and forth. I'm now looking into buying a second kayak next year to leave up there--very similar to my present one: same manufacturer but a slightly improved design that's more optimized for fishing rather than dual-use fishing and hunting like my present one. Not sure I'll actually do that.

Things with my dad are going remarkably well. It's very obvious his health has improved substantially over the last 7 weeks. For a while I was concerned it was going to be the beginning of the end for him. I think we hit a home run with the in-home healthcare person we found. Starting next week she'll be coming twice a week and the two of them get along well, so I won't spend a lot of time up at the hideout worrying that I'm not being enough of a helicopter kid.

Not much of an update, but I'm killing time this morning and was a little bored. I've been caught up in a surge of gratitude. Things are not perfect by any stretch but I feel like the hand I've been dealt is pretty okay, and I've played the hand reasonably well. Lately I've been more sensitive to the amount of negativity so many people I encounter are carrying around. Sometimes I feel guilty for having enough going right that I can have gratitude, sometimes I don't. Right now I don't, yet another thing to be grateful for.

[IlliniDave]

May Scorecard

I'm posting this a little early--next week is going to be a relatively busy one as I intend to be en route to the hideout a week from today. I don't think the next four days will change anything materially.

Rolling 12-month monthly expense < monthly annuity rate: 100% Good
Rolling 12-month monthly expence < instantaneous monthly equivalent 3% WR rate: 92% Good
Stash Assessment: Fair, trending slightly down.

Stash down around 7.4% since retirement but up 3.4% for year. May spending acceptable per my plan, well below annuity income, and on track for lowest monthly spending since January 2018.

Nutrition and Health

This section is going to drastically slim down or be eliminated starting next month. I think the horse has been beaten to death.

I detailed what happened regarding the May labs and office visit with my new primary care doc in prior entries.

My weight leveled off during May. That wasn't really my intent, I'd wanted to drop another 7 or so lbs before creeping back up to where I'm at now (~176-177 lb). But my most recent check was identical to my 5/1/23 number. I didn't change my nutrition all that much, mostly just upped my protein moderately and extended my eating window from 4-6 hr to 6-8 hr.

Despite leveling off on the scale my waist circumference is still going down. At the rate things have been going I'll be ready to move to the fifth notch of my belt within a couple weeks, meaning that in 2023 I'll have dropped 4 inches. Actually a little more than that as back in January even on the first notch the same belt felt like a tourniquet. In the last week or two I've crossed a threshold where I'm struggling with my wardrobe and will have to consider dropping some $ on new pants/shorts/etc if I stay this size as my lifestyle progresses to steady state. Good problem to have, I suppose.

Despite better proportions I don't look all that good. Part of that is simply being an old dude. Part is that apparently my fat metabolism has finally outrun my autophagy capacity, especially insofar as my midsection goes. Over the summer I'll probably cycle back into OMAD occasionally and assuming my weight stays fairly level and I stay active maybe the housekeeping processes will catch up. For now I'm looking slightly pug-ish in the abdomen. Luckily my retirement plan wasn't predicated on maintaining a profitable side gig as a fitness model.

I stopped measuring blood pressure every day, mostly to give myself a mental health break--I don't want to get too far down the rabbit hole of obsessing over numbers. I'm confident that with my lower body weight and increased activity level my blood pressure is pretty good for an old dude, despite the pesky white coat hypertension. Going forward I'll probably randomly pick a week every now and again and check daily to make sure no drastic changes occur.

My activity level has tapered off over the last couple weeks. I'm still diligent about my strength training and my HIIT workouts on the rower. Mostly the decrease is from a decline in hiking/walking due to preparation for the summer, both getting ready to travel and stuff surrounding handing off some of the day-to-day monitoring of my dad to my siblings and his IHHC provider. So I'm not lazily camped out in front of Netflix, but not a workout warrior either.

Heading into June

I'm in the throes of getting ready to migrate to the hideout for the summer and planning to head up next weekend. It's a much easier process this year compared to last simply because last year I was still throwing the yak together for the first time. Now that I know the outfitting I've done with it is solid, it's just a matter of making sure everything is operational and ready to travel. I'm looking forward to the increased sense of freedom I have up there.

I've set a goal by the end of June once I get settled to ratchet my activity up to the next level. I sense it's important to hit the ground running in that regard because it will be very easy to get to focused on the enjoyment part and lose all the momentum I've built up over the last 5 months.


Hope everyone in the US is enjoying their holiday weekend.

[llorona]

Well, damn! Congratulations on taking such proactive steps and keeping it up! Especially the weight loss -- 37 pounds down is huge!

[IlliniDave]

Well, damn! Congratulations on taking such proactive steps and keeping it up! Especially the weight loss -- 37 pounds down is huge!

Thanks, llorna. It's a little like pursuing ER: little steps executed consistently over time. It's a nice number, but the real benefit from my perspective is how much better I feel on an ongoing basis, and a little newfound confidence to take on challenges of a physical nature that in recent times I'd shy away from. Feeling alive and being alive go together very well--like sesame oil and ginger (sorry already thinking about what's for supper, ha).

[IlliniDave]

Just an unscheduled mid-month check in...

Today is day 10 up at the hideout. The first 7 days I mostly let myself be on 'vacation' in terms of just eating whatever was convenient/easy and limiting activity to whatever was needed to underwrite my recreational whims. I also suspended all supplements for the first 7 days. I can't say I did myself any real harm in that week, but I could detect a difference--a slightly duller feeling overall. Again, I'd say it's 70% due to degraded nutrition, 20% to reduced activity/exercise, and 10% to stopping supplements. I'm most of the way back to the straight-and-narrow, just have a couple things in the fridge to finish off.

One thing I learned is that the Concept2 rower was maybe not as effective a surrogate for paddling a fishing kayak as I'd hoped. I've been good about doing a good chunk of my commuting via paddle rather than relying on the electric motor, and it seems like my comfortable paddle speed is up to about 2.2 mph from about 2.0 mph last summer, although those numbers are highly dependent on wind. Having spent most of the winter stretching resistance bands I'm a little more aware of individual muscles that tend to function in groups (specifically shoulders and back) and it's pretty apparent nothing I was doing really captured the essence of the paddling motion. I can fairly easily replicate the movement with bands, but I really don't see myself trying to use bands for endurance training during the offseason. For now paddling is a relatively unique movement that complements the other things I'm doing which makes exploiting it for exercise more appealing.

And speaking of bands, I've added some anchoring hardware to my garage/storage compartment and now have a set up for the bands that's even better than the on I have IRL. Haven't fully got back into the swing of the workouts yet. I've substituted some manual chores in the two days since I finished the project. Spent a few hours one Monday swinging my weedeater around. All the band work definitely made that chore easier--usually the first two times I have it out results in significant DOMS is forearms, biceps, and shoulders. Didn't even feel appreciable fatigue, much less DOMS.

Yesterday I started a project of clearing out some scrubby trees between the cabin and lake. I'd intended to dig out as many out as I could, but it turned out that for those small enough to dig out, just yanking them out of the ground was more efficient time wise, although more difficult. Most of the scrub trees are balsam firs which are under assault by (I think) spruce bud worm here in Superior National Forest making them de facto matches just waiting for a spark. There were a number of fires in the region during 2021, providing much of the motivation for my 'landscaping', but aesthetics is part of it too. Last summer I cleared everything from around a couple of wild serviceberry trees and they are thriving this year and loaded with berries. During yesterday's cleanup I found a pair of cedar or maybe arborvitae saplings, a white pine sapling, and two more serviceberry saplings, all of which I'll nurture. Removing the scrubby firs along with some dogwood bushes and wild roses was a pretty fair workout, and it was bugs not fatigue that prompted me to pick a quitting time for the day. Another win for the bands IMO.

So from an older dude's perspective, it's pretty cool to be on the cusp of an age after which everything is supposed to rapidly fall apart, then behave like a younger man without any adverse effects.

Fishing has been pretty slow and I've had the yak out of the water the last few days due to too much wind from the wrong direction to keep it moored to the little dock. Pulling it up the bank from the water was problematic for my lower back last year. Was a breeze. The Concept 2 gets some love for that, along with the bands. So I'm behind when it comes to catch/releasing enough fish during the season to theoretically supply myself enough protein for a year, but plenty of time to catch back up.

My only gripe is with the four projects I've hired out for. Some progress on one of them, very little on the other three. The foundation work from last fall held up pretty well over the winter.

As always, internet is sketchy here so I thought I'd throw in an update on a good day.

[Scott 2]

It's cool the play is physically easier. More meaningful than a blood work high score.

When I tried kayaking last Summer, my experience was similar to yours. It didn't matter what my v02 max was. The constraint was upper body muscular endurance. The movement was too physically disadvantaged. My heart rate would barely raise. As a novice, I assumed that was a skill issue. It was nothing like taking my Concept 2 work onto the water.

I did wonder how much practice would be required to bridge the gap. I had a similar experience on the bike, only with my legs. That took just a couple weeks to sort itself out. But kayaking around here is hassle. So I never found out.