There’s nothing like getting older and increased caregiving to a parent to prompt some meditation on one’s own life. I am slightly younger at 54 but am in this space too. Weight gain is so easy, it takes significantly more effort to attempt to maintain muscle tone and flexibility and cardio, plus I can no longer deny that I am closer to my death than my birth. Enjoy your time with your dad and happy Easter to you too!
Thanks, Frita. I guess I came to terms with my life probably being 75% or so behind me. The thing that's unsettling is what if I'm wrong and I wind up adding a decade or two to my expectations.
This is great! All the objective metrics begin to seem pretty meaningless after a while.
I wouldn't quite say meaningless, but they do sort of drift to the periphery once progress on the overarching long-term somewhat subjective goal begins. I think at the start of this I said my overall goal was essentially extending my health span out as close to my life span as possible, and minimize my period of morbidity before starting to push up daisies.
What a wonderful update! Congratulations. Your metamorphosis is incredibly impressive and very motivating for those of us in your age range. This kind of thing is fun to watch and is contagious. Nice work!
Thanks, Ego. Knowing that others are interested in the journey in turn increases my motivation to keep a shoulder to the wheel.
Have people in your life noticed the change in mental acuity? ...
Ha, no, nothing like that yet. There's probably two reasons for that.
The first, and I'll sound like a jerk saying it, is that in my post-professional day-to-day circle I'm "the smartest guy in the room" most of the time and don't think I've had much, if any, mental decline yet.
Second is that I was a kid that actually got beat up and hazed on occasion during early grade school for being the kid the nuns pointed to when chiding other boys to do better in their schoolwork. So I became a sandbagger, deliberately avoided straight A's, and learned to conduct myself in a way that did not show off intelligence. In hindsight, developing that trick probably did more for me exploiting and profiting from what intelligence I do have than anything else because it taught me the skill of expressing ideas in simple terms. But most people that encounter me wouldn't think I was particularly intelligent and whatever is potentially going on is out on the fringe that I've habitually kept hidden.
The group here is probably in the best position to weigh in on any changes in my mental acuity, although the format doesn't lend itself to that.
And what I reported is just a "feeling". I've not made any attempt to measure/quantify in that realm. But I'm hungrier for knowledge than I had been for a while, and I do a little better at recalling names from my distant past and such. Could be placebo effect or something I'm otherwise wrong about.
Wanted to chime in and say I’ve been a lurker on your journal but am really digging your recent health focused writing/experiences. It’s really cool to read about changes, especially as you are learning so much. Keep posting!
I let my Dad know we've seen the mental improvements from his lifestyle changes. He was a little surprised. I don't think anyone had recognized the prior drop off.
Do you plan to keep the supplement protocol in perpetuity? Or will you eventually follow some process to narrow down which supplements are efficacious, in your body? That's a lot of variables to consider, especially if some part of the system throws signs of failure.
Taking an example from my life - my annual blood work showed an alarming increase in creatinine. The number was used to estimate GFR, which is an indicator of kidney function. Mine was declining. Since my numbers hadn't yet gone out of the normal range, my doctor hadn't noticed. But the year over year trend was bad. I raised some concern.
My doctor didn't know I was supplementing with creatine. I didn't know doing so raises your estimated GFR. It took a bit before we figured out was going on. My doctor's response was to say "no creatine!" I followed orders, though as I've learned more, I don't believe there was an actual risk to my kidney function. Rather, the metabolic byproducts of oral creatine skew the test.
... Do you plan to keep the supplement protocol in perpetuity? Or will you eventually follow some process to narrow down which supplements are efficacious, in your body? That's a lot of variables to consider, especially if some part of the system throws signs of failure...
About the only thing so far that I know I want to do in the medium-long term is to do a better job of maintaining the basic lifestyle (i.e., what I'm doing aside from supplements) throughout the year. I still plan to let my hair down some during the late summer and autumn to reflect natural rhythms, just be a little smarter about it.
Regarding supplements I imagine there will be some changes. Overall I see myself paring back over time. I guess you could say at this point is that I'm throwing a lot of stuff against the wall to see what sticks. The first juncture will be when I have my pre-visit blood work done in 2 weeks. That should give an indication how the overall routine is affecting the under-the-hood stuff. I'm more likely to cycle items (at a lower duty cycle) than discard them completely. At the same time I'll probably remain open to adding new things. Good question. I hadn't really thought it through completely, been focused on the task at hand. So I don't have a process in mind at this stage.
Wanted to chime in and say I’ve been a lurker on your journal but am really digging your recent health focused writing/experiences. It’s really cool to read about changes, especially as you are learning so much. Keep posting!
Thanks, it's been a fun challenge to learn about stuff I was only vaguely aware of, and the science behind it all seems to have changed a lot in the last decade. Just hope I'm truly doing myself some broad-based good.
Sitting around trying to get my thoughts together for the day and thought blathering in here would be a pretty good way to do that.
I'm now within 3 weeks of the first visit with my new primary care doc, and 11 days out from going in to have blood drawn for the big test I've been awaiting. Unlike where I lived in Alabama, almost all the medical facilities here are part of one or the other of two large networks "headed" by hospitals. The one I'll be in has a nice feature where I can get online and see the blood test results as soon as they are available. They are large enough they have their own lab facility so within a day or two of the tests I'll be able to see the results, so at least there won't be any surprises when I go to see the doc.
After a good start in April my weight has plateaued again but I'm under 180, maybe for the first time since 1999, can't remember if I ever broke 180 during my Crossfit days. If I did it wasn't by much and not for long.
My blood pressure has started to creep back up, most notably the diastolic number. That's not necessarily a bad thing. Through the end of March and early April I recorded some numbers that would technically qualify as "low" BP in a clinical sense. Low diastolic pressure can be a sign of hardened/stiff arteries. Still, my recent average has been ~110/70, and my heart rate average continues to drop. I don't have a tracker so don't really know what my true resting heart rate is, but I feel pretty good about my sitting still heart rate while I'm getting BP data dropping from about 73 on average to 61.
One thing I noticed is when they measure my dad's vitals they always put the BP cuff on him and tell him to hold his arm out in front of him. The two home machines I've had were very specific that in order to get a proper measurement you should rest your arm on a table or something. At my old docs office the nurse would actually hold my arm up during the measurement. I experimented with my machine and imitating the procedure they've used on my dad (same health network) both my BP numbers increase by about 10. So I'm anticipating a reading in the low side of the "elevated" range per the new guidelines--something in the low-mid 120s/80ish. For some reason that bothers me. That's still significantly better than the 140-something/90-something I measured last December, but I really wanted to get an "A" on that particular test.
My activity program has tapered off slightly, mostly because of the time I've dedicated to all my dad's medical appointments over the last 3 weeks. Although I don't notice it there's probably a constant low level of stress associated with that which theoretically could contribute to the slightly higher BP readings. The good news is that there's a pretty good smoking gun to indicate the cause of the anemia is identical to something that happened to him 20 years ago where he developed some small ulcers. He was put on Omeprazole and iron supplements which cleared up the issue for 20 years. Then, whaddya know, he stopped taking all his meds for 6-8 months and the same symptoms reappear. He said he stopped taking them (and a couple others he was on) because he felt fine and thought the doctors and pharmacies were just fleecing him because he had insurance. Never occurred to him he might have felt fine because of the meds. So he's got an endoscopy (and colonoscopy just to be sure) scheduled for the first week of May. Hopefully the endoscope will confirm the reappearance of the ulcer and getting back on the meds (maybe with a temporary increase in the Omeprazole) should put him back right. I've had him back on all his prescriptions for a week or so now. I've talked about memory concerns with him for a while now, but I'm also learning he's a very poor listener. He has a habit of interrupting people and telling one of his old stories that's tangentially related. It's a little frustrating that he's perfectly happy relying on me to keep track of everything for him. That makes him sound like a bad guy--he's really not--but he never got very good at adulting. No wonder he made my mother cranky so much.
I'm also a little frustrated with my siblings' lack of enthusiasm in stepping up to help out. That's partly selfish because if his medical things don't settle out in the next 4-5 weeks my summer at the hideout is in jeopardy. They have a lot of opinions and make a lot of noise about "somebody needs to..." this or that, but then scurry like cockroaches when the lights go on as soon as a specific need with a date, time, and place arises. They all have incremental reasons why they can't help with this or that, and some of the reasons are even excuses. But even with a few weeks notice no one but me seems able to adjust their schedule to help out with something.
On a more encouraging note we've got something lined up to start in-home care. The woman happens to be the aunt of his great grandson--my nephew (deadbeat nephew's brother) and the boy's mom never married, but she's a virtual in-law. She'll be coming by for the first time next Thursday. It will initially be just once/week. She's an independent provider and that's all the opening she currently has, but a couple of her clients are mid-/late-terminal and she's agreed to prioritize Dad as openings in her schedule appear. Us kids are more comfortable having the family connection dynamic in this. She'll do some amount of housework as part of her normal duties, and has the right kind of skill/experience to spot many of the usual adverse changes older people are apt to have. It's a start.
Do you know what blood tests they will run? Do you have the option to request additional tests? Once the needle is in, an extra test is just another vial, so I'm not shy about asking for what I want. Vitamin D3, A1C and Free/Total T are all non-standard items I request. I think the Galleri test for cancer screening looks interesting, but at ~$1000 and given my age, I've not taken it.
I've noticed the doctor's office can be casual about the blood pressure reading. My home blood pressure monitor was very clear about arm support, height relative to the heart and using the left arm. White coat syndrome is another consideration. If you are excited or nervous about the appointment, the in office reading might be entirely unreliable anyways. My Mom tracks her home measurements and brings them to the appointment for reference, because of this.
Good luck with Dad's care. The in-home help is positive development.
Hopefully everything falls in place with the hideout. Leaving only gets harder next year. As my wife and I juggle wants with health concerns, that is probably the strongest deciding factor. Even when it seems like a stretch, we tend to go for it. There's no way to know what next year will bring.
I learned something interesting recently regarding measuring blood pressure, that most people (including most doctors) do it wrong. To get a truly accurate reading, you aren't supposed to do anything at all for 5 minutes before taking the reading. That might be worth trying out and seeing how it compares to how you have been doing it.
I'm also a little frustrated with my siblings' lack of enthusiasm in stepping up to help out. That's partly selfish because if his medical things don't settle out in the next 4-5 weeks my summer at the hideout is in jeopardy. They have a lot of opinions and make a lot of noise about "somebody needs to..." this or that, but then scurry like cockroaches when the lights go on as soon as a specific need with a date, time, and place arises.
A while ago I mentioned my mother's situation in another thread. She had a big family but everybody left it to her to solve all of the problems for her mother with Alzheimer's. She felt like she had no choice.
One of the things I learned from my mother's situation was that during those incredibly stressful moments when the crises came to a head, she believed she had absolutely no choice in how to respond. Action was necessary. Nobody else was willing or able to step up. So she had no alternative but to do what needed to be done.
Then her useless brother waited until the last minute to tell her that he would be unable to watch Alzheimers-Granny as he had promised while my parents traveled to California for our wedding. Acting completely out of character my mother packed Granny in the car, drove to my uncle's house, left Granny unattended on his porch, drove to the airport and let the chips fall where they may.
That's when she realized that she'd been making choices all along. She also realized that everyone else was making choices as well, only theirs were based on the knowledge that she would pick up the pieces.
Sometimes it is good to let the pieces lie where they fall. Sometimes not. Either way, it is a choice.
Consider telling the siblings that they will be responsible for emergencies during the time you are incommunicado at your cabin. Let chips fall and allow others to pick them up.
The initial list she ordered up includes a repeat of everything done last December with the addition of A1C. This week I was going to send a note asking to add fasting insulin, and one or two others that I saw recommended in Robert Lustig's latest book, though I'll have to look at it because I don't remember off the top of my head what they were. They were tests for inflammation markers. I'll check out the Galleri test, but likely won't ask for it this time. Once I feel that I have basic metabolic health optimized as much as I can get it I'll probably branch out and start considering specific diseases. Since cancer can also be considered a metabolic disorder much of what I'm doing now comes with side benefits of being protective against many cancer types.
Yeah, white coat hypertension is a thing with me. That's one of the reasons I recorded 3 months worth of twice-daily readings. If it becomes a topic of discussion in the office visit I think I can upload it to her. I might do that ahead of time anyway, along with my supplement list.
Regarding my dad and the hideout, etc., I'll just have to see how things go. Hopefully my efforts to extend my healthy lifespan are successful enough I can make up for any time missed up there in the short run on the back end. For now I'm planning to go at the appointed time. If my siblings drop the ball or the situation changes I might have to cut it short.
I learned something interesting recently regarding measuring blood pressure, that most people (including most doctors) do it wrong. To get a truly accurate reading, you aren't supposed to do anything at all for 5 minutes before taking the reading. That might be worth trying out and seeing how it compares to how you have been doing it.
The instructions for my unit mention that, although I almost always skimp on that. I try to at least be sitting down for a few minutes prior to measuring, but typically I'm doing mental tasks during that time. It's a good idea though, over the next couple days I'll be more diligent about following that and see if/how it changes things.
One thing I'm learning about these larger healthcare systems while toting my dad around is that they seem to prioritize efficiency. Time spent in waiting areas is reduced. But with my dad at least, when it comes time to take his vitals, they usually have the cuff out before he even has a chance to sit down and typically are activating their machine within 10-15 seconds of him sitting. I don't know if it's poor training, or that they are just measuring vitals to tick a box since for the visits in question he's there to treat something unrelated to blood pressure and/or just getting blood draws for labs.
A while ago I mentioned my mother's situation in another thread. She had a big family but everybody left it to her to solve all of the problems for her mother with Alzheimer's. She felt like she had no choice.
Consider telling the siblings that they will be responsible for emergencies during the time you are incommunicado at your cabin. Let chips fall and allow others to pick them up.
So far that's the approach I've taken, and my "Starting in June I'll be gone for four months and if none of you are willing or able to find the time to at least make sure he is taking his meds every day, track and get him to his appointments, etc., then we need to get IHHC in place or if he's willing, move him into a facility, by the end of May," that prompted my sister who has POA to commit to spending his money to hire someone after talking about it for 2 years.
As I've tried to piece together the saga of how we got to where we are it's becoming clear that something changed during approximately the June-August time frame last year. I found a stack of his notes to himself concerning getting prescriptions renewed and/or refilled, found bottles of meds (generally almost full) that dovetail with that time frame. Interestingly, that's also the time frame when the last phase of the situation with my deadbeat nephew wound down. Dunno what happened, probably never will, may have just been the point where slow, steady decline crossed a threshold or perhaps something like a small stroke occurred.
Rolling 12-month monthly expense < monthly annuity rate: 92% Good
Rolling 12-month monthly expense < instantaneous monthly equivalent 3% WR rate: 83% Good
Stash Assessment: Fair, trending slightly positive.
Stash still down around 6.5% since retirement but up a bit over 4% for year. April spending acceptable per my plan and still well below annuity income, though slightly higher than the last couple months.
I go for my pre-appointment lab tests Thursday of next week, and it looks like I'll be somewhere in the 175-178 lb range (177.6 as of this morning) with about 4 lbs added to it in clothing. So I'll be happy if I can squeak in a bit under 180 at weigh in, but that's really a meaningless number at this point.
I mentioned prior that average blood pressure has ticked up slightly. Comparing the last 10 days of March to the last 10 days prior to my April 29 afternoon measurement:
-systolic ave from 107.8 (high 119) to 109.6 (high 120), +2.4 mmHg
-diastolic ave from 65.2 (high 73) to 68.1 (high 76), +3.1 mmHg
Don't like the upward trend, but the numbers aren't bad. In a 'clinical' setting with a dash of whitecoat hypertension and the likelihood of the measurement being performed suboptimally, anything under 130/anything under 80 I'll feel good about and should head off any discussion of BP meds.
And ave heart rate at BP checks went from 62.5 to 60.9, -1.9 bpm, so a slight improvement.
Implied V02 max from my rowing activity has improved about 99% since my first benchmark in February although it is still nothing to brag about. Tomorrow (4/30) is my next 2K row benchmark. My dad's medical situation has cut into my workout/activity regimen, so I don't expect much in the way of improvement, but I'll probably edit this if there is any meaningful positive change.
Heading into May
Once I get my new blood work data I'm going to look at changing up my overall nutrition regimen (which includes the supplements). I'd hoped to be down in the upper 160s by my appointment on 5/12, so I'll probably continue to look at preserving a downward trend on the scale until I get to 170 or a little less, then to stabilize and very slowly build back to the mid 170s with increased strength training. Since the labs are Thursday, Friday night will definitely be a pizza night with Dad. But then back to the grind for at least 2-3 weeks. At that point I'll probably widen my daily eating window and go to 2 meals/day, but generally keeping my day-to-day food choices very similar to what they are now, unless something bad and unexpected turns up in the labs.
In some respects my dad seems to be doing better now that he's back on his meds a couple weeks. Short-term memory is still unreliable, but his overall energy level seems to be improved. We had the meet-and-greet Thursday with the in-home care specialist I'd mentioned. I learned a little more about her. Aside from the family connection, she's a CNA and has been involved in eldercare for 31 years. I liked her and more importantly my dad seemed to get along with her. Also heard back through the family grapevine (her nephew is my sister's grandson/dad's great-grandson, although the relationship that produced the kid fell apart before any in-law tags could be applied) that she really liked my dad as well, and is anxious to free up more of her schedule for him. The thing I liked most is her MO seemed to be holistic. By that I mean she was quick to pick up on their common interests (e.g., gardening) as a springboard to keep my dad up and moving around and other things they could do together away from the house (e.g., walk the short distance to visit her sister and nephew/his great-grandson. That gave me the sense she is looking towards quality of life as well as more basic survival care/needs.
I've been downplaying this, but as I had some time yesterday after her visit to digest things, now for the first time in a month I'm actually optimistic about being able to stick to my plan of spending the summer up at the hideout. Prior to that I was starting to make plans to change gears regarding that.
I'm a little behind on my prep for the summer, and with 4 appts next week to manage (3 for Dad and 1 for me) I'll probably fall further behind, but I'm hopeful things will taper after that regarding my dad's situation and I'll still have 4 weeks to get my ducks in a row. The 'scopes for my dad are coming up next Tuesday, and we're hopeful this is just a replay of what happened in 2003 and getting back on the meds consistently will be all the fix that's needed.
I'm back to feeling like I'm in a good place overall, or at least getting very close to that.
Well, lab test results are trickling in. It's a mixed bag.
I got my first ever A1C which measured below the prediabetic threshold. I'm almost certain it would have been above it last December. Fasting glucose went down 26 pts from prediabetic to normal. Happy to see those, it was one of my main concerns going in.
My ALT number went down by nearly 50%. It also was one of my main concerns going into this, being the prime marker of fatty liver. But my AST went up slightly from the edge of the reference range to one point out, which is concerning because it's a possible indication of liver scarring/damage (aka fibrosis). I'm not quite up to the time-to-panic numbers yet, thankfully. Another caveat is liver is not the only source of AST in the blood. Not sure what to make of that yet, but it will probably be one of my main concerns going forward. Fatty liver disease (NAFLD in my case) can cause fibrosis/scarring of the liver, and it may take some time now that I've apparently made substantial progress on the former for the latter to recover. Luckily the liver is quite adept at self-repair so planning my funeral would be a little premature. I'll probably lobby my new doc next week to give it 6 months and repeat the tests and if I'm not trending in the right direction by then maybe get a referral to a liver specialist to try to see what's going on.
The last of my main concerns going in was eGFR. It went up 19 points and is now just 2 points below normal.
My BUN was a little low, but I think that can reflect inadequate protein intake which has likely been the case while I've been in aggressive weight loss mode. Interestingly, one of the things I found on the interwebs indicates increasing protein intake is a way to help the liver undo fibrosis. I was planning to do that soon anyway because when I reach my goal weight the plan is to stabilize and switch gears to gain back 5-7 lbs of lean mass through increased protein intake and strength training. I'll probably start early bumping up the protein.
I was also a little disappointed in my lipid results. My triglyceride/HDL ratio went up from about 2.4 to 3.6, which is the wrong direction. I do think the December result was lower than it should have been do to a spuriously high HDL number. It was 55 in December and 47 today. 47 is still higher than I've ever measured before so I'm happy with that. In the past I've been 39-42 most of the time, once got to 44 during the peak of my Crossfit days. What is surprising is my triglycerides went up 38 points which is out of character for me when on a restricted carb regimen. I'm not going to lose sleep over it yet, my physiology is still in flux do to the ongoing weight loss. Bottom line is my cardiovascular risk has gone from the high side of "below average" to the low side of "average". That bears watching with the low fruit for improvement being to get my triglycerides down.
I didn't get a weigh in or in-clinic BP reading, but I've chronicled those since early this year, and both have improved. Was down to 175ish this morning and all my correctly executed BP measurements since mid-March have been in the good range based on the strictest scale I found on the internet. I expect a combination of my proclivity to white coat hypertension and shoddy measurement practice to produce an unfovorable number, but such is life.
All-in all given the effort I've put in I'm a little disappointed. That should provide motivation to keep at it rather than being tempted to slack off. Also unfortunate depending on ones perspective, that means I'm likely to continue obsessing over this topic during the months ahead.
I just got to the part of Guthrie's book where he says that you know it's worked if you don't need toilet paper
Do you need toilet paper?
I'm curious, even if I do find this amusing
Haha! Well, at the risk of driving away the last of the folks who still drop into this thread, the short answer is I still use toilet paper and consider it necessary when deuce time arrives each morning. However, despite not meeting Dr Gundry's success criteria, the effort to revamp my gut and gut community has resulted in some noticeable changes in that bodily function. Without getting too deeply into the specifics, there's evidence of more thorough and consistent digestion day-to-day, no occurrences of any sort of indigestion, and if one were to hypothesize a continuum between uncontrollable diarrhea and unrelenting constipation, my performances have been tightly grouped around the midpoint of the continuum.
An interesting observation that I attribute to avoiding the lectin-containing plants on his "don't eat this" list (many were staples in my diet) is that compared to other times when my regimen has been plant-heavy, my greenhouse gas emissions have been minuscule. Interestingly, cattle produce relatively little greenhouse gasses while they are out grazing, but once they are rounded up in the feed lots and stuffed full of roundup-soaked corn and other grains to fatten them up for slaughter (and antibiotics to keep communicable disease at bay in the overcrowded conditions), they produce enormous amounts of gas, or so I've read. There might be something to the notion of matching the digestive system in question with the plants said system evolved to process.
Heh, I got his name wrong, but this is interesting nonetheless, thanks for sharing, this and the bloodwork results. I'm sold to give it a try in a couple of months, once I run out of my current stockpile of legumes-not-made-in-a-pressure-cooker. No one around where I am is precious enough to have grass-finished anything, but I hope the plan will still work to an extent.
