Lemur Journal!

[Lemur]

I was improving until I wasn't. Flared up again around March 5 ish...real bad. To point of once again having a straight week or so of only getting 2-3 hours of sleep, being a zombie, can't stand up straight with large bump on my lumbar spine, begging for mercy as I'm in fetal position with sciatica. Fortunately this time around, I'm recovering much quicker from this flare-up.

Indeed, and fascinated by some strange enlightenment , I came to recognize this flare up as a blessing in disguise because by luck this lead me to deep dive my issue a bit more and I ended up discovering something called the biopsychosocial model of pain management. "The biopsychosocial approach describes pain and disability as a multidimensional, dynamic integration among physiological, psychological, and social factors that reciprocally influence one another."

Mostly I've been reading a lot of articles and watching videos and podcast interviews with Greg Lehman and Peter O'Sullivan. This is a pamphlet from Greg titled "Recovery Strategies - Pain Guidebook" https://static1.squarespace.com/static/ ... 202017.pdf . Peter has a podcast and Greg has a really nice set of YouTube videos that dispel all sorts of myths regarding spinal pain and recovering from those injuries. (example: https://youtu.be/tolxdFQ35j8?si=GfvKvFXZ5Gvk2a3e). Also started physical therapy finally - which helps.

Big concepts I've learned regarding herniated discs and recovery strategies in general ...

• Spinal discs do adapt and respond from loads and movement. They're not fragile. Flexion, Extension, and sideways bending should not be avoided.
• Unless you've a spinal tumor or a fracture - back pain is rarely serious even if it feels like it is. In fact, all else being equal, more pain does not necessarily mean more biological tissue damage. Pain is very subjective.
• Indeed many people can have herniated discs and bulging discs show up on an MRI and experience no pain symptoms whatsoever.
• People with back pain do not suffer from spinal instability. In fact, and contrary to popular opinion, people with chronic back pain actually have overactive responsiveness to their injuries and are actually overly stiff and stable and need to loosen up through movement.
• It is okay to experience pain during recovery. In fact, pain is almost necessary for gauging response. "Working into pain" can help desensitize nerves. Some level of pain acceptance goes a long way towards recovery.
• Poking the bear means to slowly adapt to uncomfortable positions and movements through graded exposure (aka progressive overload in the weightlifting world). For example, suppose squatting hurts your right knee. How to recover? Drop the weight and do bodyweight squats. No Pain? Add 5 pounds. Continue on and use pain as a gauge. A little bit of pain is okay. The body responds to stress and loads!
• Flareups are actually normal and part of the recovery process. They happen when you "poke the bear" and accidently get mauled. Practice helps you find the right balance. The worst thing you can do is adopt fear/pain avoidance behaviors and do nothing*.
• Doing Nothing* is only required in very acute stages of an injury. Afterwards, its almost always better to get more active and return to your life's activities - yes even if they hurt a little.
• When dealing with chronic pain, ask yourself what other factors might be at play then just the injury. Are you getting enough sleep? What life stressors are you dealing with? Are you avoiding activities due to fear of pain? Are there different ways you can frame your injury?
• Sleep is underrated and necessary for recovery from a biological and psychological perspective... Drop caffeine sources before noon and get on a stable sleep schedule. Nothing wrong with taking pills if you've absolutely must in the interim (I started taking Unisom and its a godsend). Akin to getting back on track from jetlag.

This is a quote I came across from Nassim Taleb (famous for his love of deadlifting)

“I once procrastinated and kept delaying a spinal cord operation as a response to a back injury—and was completely cured of the back problem after a hiking vacation in the Alps, followed by weight-lifting sessions. These psychologists and economists want me to kill my naturalistic instinct (the inner b****t detector) that allowed me to delay the elective operation and minimize the risks—an insult to the antifragility of our bodies.” ― Nassim Nicholas Taleb, Antifragile: Things That Gain From Disorder

Months ago I would've said this was ignorant but I'm finding a lot of wisdom from Taleb's approach to dealing with pain. I've spent many years avoiding sitting too much and avoiding flexion/bending my spine and I've been overly cautious with my back all this time - all sorts of psychological responses that stem from my initial injury in 2011 (that I regrettably had surgery on). Spent years exercising and keeping active but also avoided "aggravaing my back." This added up. Fortunately - I am 100% positive this can be reversed and I can adapt. My body is not fragile.

Pragmatically all this to say fu*k my back problems. A few days ago I started daily cardio sessions on an elliptical and mixed it up with sprints on the machine. I went for a jog yesterday too. It hurt a bit and I hobbled and I had to mix it up with walking. I have not gone for a run in months (since November I believe before my back gave out). Slept like a baby though last night and woke up this morning feeling better and more determined then ever. Will go swimming this weekend. The sciatic pain in my right leg has died down immensely and this flareup is basically almost over in about 10 days where the previous flareup took just over 2 months.

As always a disclaimer that I am not a medical professional. Neither is Taleb.

[delay]

Thanks for your journal update. That matches well with my experience. I've come to think of pain as my body talking to me. It can tell me where my limits are, that a bodypart is being changed or repaired, the maximum amount of alcohol has been reached, and so on.

Congratulations on your jog and best of luck with your health!

[ertyu]

Recently I too have had occasion to be grateful for the wealth of resources on youtube. It takes some finding - most content producers are either chiro influencers or gym bros branching out in search of topics for the content mill, and there's a lot of crap content out there. But there are also actual qualified physical therapists and sports medicine profs sharing truly great content, e.g. the guy responsible for the PT of the belgian olympic team has an excellent channel. I also recommend boomertube: Bob and Brad's content is quaint but solid. Greg Lehman sounds interesting, I'll be checking him out. Thanks

[Lemur]

First time reading of this:
https://en.wikipedia.org/wiki/Nocebo

A nocebo effect is said to occur when negative expectations of the patient regarding a treatment cause the treatment to have a more negative effect than it otherwise would have.

Basically its the opposite of a placebo effect. So if one has the attitude that physical therapy, exercise, and movement is just going to exacerbate their pain rather then help aid in the healing process, then well...they will reap that thought.

The deep dive on the biopsychosocial model of pain management continues. Happy to say I'm 99% pain free and sleeping good . Everyday is an increase in flexibility, mobility, and strength. Also dropped some bodyfat and weighed under 180lbs again at 179lbs so even starting to lean up.

Spouse and I also planned our 10 year anniversary to spend a week in Puerto Rico this summer. We wanted to create a novel and memorable experience. I wouldn't be where I am today without her. My spouse is truly my second half.

[AxelHeyst]

Super glad to hear the pain management is going well! I wonder if you've read the book "You Are the Placebo" by Dispenza, and what your opinion is if so.
Enjoy Puerto Rico!

[Lemur]

Hey Axel - I haven't read anything about Joe Dispenza but he seems like an interesting character from a quick Google search. I gotta say I was a bit skeptical when I came across this quip:

Dr. Joe Dispenza believes that many of us are living in a state of constant anxiety. The fight-or-flight responses that evolution has hard-wired into our brains cause us to be constantly on alert — and that negative mode of thinking triggers genes that can cause all kinds of problems from panic attacks to cancer. But if we learn how to change our thoughts, the mind can heal the body. It happens all the time — it’s called “spontaneous remission,” and even people with stage 4 cancer can be totally cured.

Immediate thought - meh. But then a quick Google search on that: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8271173/ . I also came across an idea that stress itself might even be associated with autoimmune diseases and rheumatoid arthritis. https://www.health.harvard.edu/blog/aut ... 8071114230

We learn something everyday don't we? I had zero idea that spontaneous recovery of stage 4 cancer was a documented phenomenon lol. That is awesome! I think it goes to show I still very much live in a materialist/rationalist mind though. I'm always a bit skeptical when it comes to the spiritual/meditation stuff though (that is the sense I get from Dispenza but I'd actually have to read one of his books to get a better idea of what he is really preaching) but I do believe in a two-way street that the mind influences the body and the body influences the mind. Some see these as separate but I think they're very much connected.

I can relate to these ideas though. On my walk today I was thinking about what analogy I could use to describe chronic pain. Especially the kind I've dealt with. I liken it to a check engine light on a car. Despite its annoyance, that check engine light serves a very important purpose. To alert us that something needs fixing. Many people would respond accurately: "Okay well, just need to change the oil or get a code scan" and move on with there lives. Some might even ignore and just wait for the light to go out. Others will run into a problem - despite various treatments the light stays on. Anxiety builds...something is wrong. Anxiety about anxiety is even a thing for some people. Kind of like when you can't fall asleep and you start to get more anxious because you know your losing sleeping before that damn alarm clock.

The patient spends months, perhaps even many years, not being able to shut off the check engine light. They convince themselves they're forever broken. More drastic measures are taken to resolve the issue - guess we need to replace the entire part or even the whole engine. What was completely missed this entire time was not realizing its possible that nothing is really wrong at all.

It was just the sensor this whole time that needs fixing. Our brains are the same way when it comes to chronic pain. Structures and nerves can sometimes become oversensitive after the acute phase of an injury has long past and small movements and exercise trigger an overactive response. The patient comes to believe that this pain is always a bad thing and forgets that this pain actually serves a useful purpose.

Our minds are certainly powerful constructs. I think if I wasn't open to the idea that psychology plays a large role in pain management, I would still be in a bad state right now. I reframed the way I think about pain and not that long ago I came up with this idea that tons of cardio through walking, elliptical, and stationary bike can desensitize the nerves. I wanted to send my brain data that it is okay to move - nothing is wrong and the these structures and nerves will respond to graded stress and load. The cure was to fix the sensor. Today I have no pain whatsoever.

[Lemur]

New Concept I learned recently:
Wittgenstein’s Ruler: https://coffeeandjunk.com/wittgensteins-ruler/

Also a neat proverb I came across in Spiral Dynamics book:

No more prizes for forecasting rain; only prizes for building an ark.

Lastly, speaking of SD, if you want to watch a really awesome Red/purple show then check out Shogun (2024). Haven't read the novel. I had an anime nerd run back in 2011-2012 so Japan related things will catch my ears occasionally lol (I still check in on Berserk). But that show is great all-around...the English protagonist is more Blue/red so he quite often finds himself shocked by the rituals & customs of the Japanese Lords and their subjects.

Lastly, despite the excitement in the market, I've managed to stay out of the FOMO. No touching of stocks / options for I think over a month now. Maybe longer. It has been nice to sit back and see all the dividends come in from just dividend etfs, value etfs, treasuries, etc. from the various accounts. Its not as exciting, but it feels much more robust then leveraging and has allowed me to to think and do other things then check the market constantly.

[Lemur]

March 31 ,2024

Net-worth:
$873k (Up $43k)

Finances: Insanity to see our portfolio making these month to month increases. Seems unsustainable lol.

Spending/SWR: Another spendy month $3,483.77 due to our planned trip this summer for plane tickets, Air BnB, and rented car. Annualized and divided by current net-worth gives a SWR is 4.79%. Not bad at all considering. The hard part is done. No more grind...finally living a little bit on the fruits of our labor & savings.

Health: It is like getting out of debt and then actually building wealth. I'm finally completely out of back and leg pain and I'm fully back to building up my strength & cardio. Still doing PT. Neurology appointment canceled. I also dropped a significant amount of body fat from 185lbs to 176lbs as of this morning. . Extra motivated for the upcoming vacation so Spouse and I are both leaning up. My preferred method is simple: Track Calories < 2000 daily, tons of walking (10K+ steps daily), strength train 3x a week, and get at least 100 grams of protein. That is it. Consistency and good sleep is key. Going to bed a little hungry is a good sign that everything is working just as intended.

Learning / Reading: Still reading through Spiral Dynamics but haven't done much in this department outside of that. My focus has been getting my health back on track.

Job: Now off probation and I'm a full-time permanent Gov't employee. Just makes it more difficult to fire me now. Original plan was 5 years to hit pension. Have 3 years to go. Not sure if I can make it the full 5 years tbh. 33 year old Lemur is ready to retire to pursue dreams of living in foreign country, seeing other foreign countries, and having all the time in the world to do whatever with no more alarm clocks. Ironically, don't even need to hit those years. I worked out some math where if I pull out the retirement contributions to the pension plan, rollover to an IRA, and then expect 7% growth until 62; I actually have a good shot of coming out ahead (4% rule on that ending balance > pension plan payments).

Will get Spouse on board one of these days but again my job is easy and is a money faucet and her business is thriving. Mrs.Lemur says lets get to 1.35m first. My Spouse likes the idea that $4,000 a month can cover living expenses and $150k can cover the future home. They're well rounded numbers though...a bit arbitrary I think but Mr. Lemur thinks goal posts just gonna keep moving. Definitely not worth a serious argument anyways (I have always considered this a true first world problem) but I'm hoping I can start getting some better traction in the early retirement discussions. There is also the matter of considering what is best for our 8 year old. Its a complex topic actually and I think its easy to fall back on just keep doing what we're doing because nothing is broken. With the way our net-worth keeps growing like a weed, it might not even be a problem at all.

I've considered the word "retired" is a scary word for my Spouse. I may consider reframing to something else. I'm also open to the idea of building some sort of side income stream to alleviate some of the scariness. Maybe a YouTube channel dedicated to teaching a programming language? Idk. I never have the energy for that sort of thing. Part laziness, part why bother. Tbh, I am not 100% sure if I am ready either.