May Check-in

Me, in mixed white stripes on a sunny day.
It's important to have contrast, thus red shoes.
And for accessories, my black-and-white dog.

Today starts my 13th week on the weight loss meds. I started February 12. How am I doing? So far, so good! Things are going pretty well!

As of today, I've lost about 15 pounds. This is fuzzy, because I waffle on what my starting weight was. My weight is volatile on a daily basis. But since there is no official registry of my weight or weight loss, I have decided to measure from the single highest weight I have been this year, on January 24. That was right after my January vacation and about three weeks before I started the drug. But it's a choice that makes me feel good, because it shows today's numbers in the best light. And who am I accountable to for this? No-one, that is! So let's go with the feel-good choice!

Speaking of feelings, how do I feel overall? Pretty good, that's how! This is a big change from a couple of weeks ago. I got home from France having over-exerted myself and with a head cold, and felt crummy throughout the body a lot of the time. My internet buds tell me often the GLP-1 drugs lead to a decrease in arthritis swelling and pain, both for rheumatoid and osteo forms (I have osteo). But I felt crummy throughout my joints and muscles, all.

But that was two weeks ago! Now, I feel SO much better! What am I doing that might be helping this? 

- Prioritizing sleep. Rigorous go-to-bed times. On those occasions I'm awake in the middle of the night, tossing and turning, and I end up with less than six hours sleep, I take a nap. But that's happening less, the past couple of weeks. I've racked up some super slumber time.

- Prioritizing exercise. I've been doing a functional strength workout with a trainer twice a week for some time now, but I'm pushing myself harder and volunteering for heavier weights. And, significantly, I've added back a cardio component. I did this in February, then fell off the bandwagon in March and early April. On the trip, I was appalled at how out of shape I was for all the walking I did. So back onto a cardio machine four times a week now. It's for just 15 minutes right now, but I'm pushing my heart rate up high and keeping it there for most of the time. After three weeks of this, I'm able to keep up a much higher intensity for most of the ride. Nothing motivates me quite like actually seeing the improvement!

- Taking a supplement and a longer-term anti-inflammatory. For my frequent body pains, I take tylenol. I can't take ibuprofen because it ruined my stomach. Tylenol helps quickly with pain, but does nothing to change the underlying condition. But let's not discount dealing with the pain! I also had in my medicine cabinet from my knee doctor a vial of a prescription anti-inflammatory, Celebrex. It doesn't act quickly, but over time it is supposed to be very good at treating inflammation. I've got a couple of months supply on hand for daily consumption. In addition my doctor recommended, in an off-hand way, taking a supplement I'd never heard of, Co Q10. I still don't know what it does or how it does it, but I'm taking it daily. Of course I've googled it, but evidence on supplements is scarce and shaky. But it doesn't seem to be hurting me, at least.

Sleep, exercise, and tylenol make me feel better right away, and the first two also have longer-lasting positive impacts. But I'm not sure I'd stick with them without the immediate impact. I've always had a hard time believing in the impact of vitamins, supplements, and long-term remedies. You have to take them on faith, faith in the science and studies. But tracing how I feel right now to these longer term remedies is tenuous at best.

So I feel good right now! Yay! But I am suspicious, and I don't trust that this will continue. But I'm continuing with both the supplement and the drug, as an experiment. It's an experiment with a flawed design, since I changed a few things at once. But just in case it's making a difference, I'll continue for now. 

They say that 15 pounds is about a clothing size. The truth is, I was in denial about how heavy I was for the past year - I assumed I'd lose the weight in a week a or two. So I had bought very few clothes for my large size, and instead wore clothes that strained a bit. So now, those clothes are fitting much better! 

My wardrobe in retirement consists mostly of clothes in which I can hike, garden or sail. I have in my closet wedding/fancy clothes, but not much of nicer but not dressy clothes. When we went casual at work many years ago, I was wary of specific prescriptions of what constituted suitable clothes. I suggested a test: if, when you got home, you were going to mow the lawn, change the oil on your car, whip up a huge batch of floury bread from scratch, or hike a few miles on the Appalachian Trail, and you didn't feel a need to change from your office attire first, then your office attire was incorrect. Those very slightly nicer clothes are the ones I've been digging out of my closet and trying on. The picture at the top is an example. I'm still not sure I'm suited for white clothes, because my impulse to just drop to my knees outside and start pulling weeds is somewhat incompatible. I don't want to look like a fashion plate, but I'm trying to not look like I'm about to hike when all I'm doing is meeting someone for lunch.

How's it going?

 

Picture yesterday.
I have a "start day" photo, but it's so
unflattering - not so much in the body,
but in my expression. I forget to smile!

This is week two of the weight loss meds. Today is Friday, and injection day is Thursday. I have found that this blog is very useful to me as a journal and a reference, keeping me honest in my memories. It's so easy for a memory to become a story, and as it does so, it morphs and changes. That's not all bad, but it's good to also have a reality check on the past. And so I think it's worth capturing what's going on with me even when I feel like the answer is "not much".

The first week on the meds was fine. I had a great deal of trepidation, but all I have felt is minor versions of classic side effects. My stomach feels full quickly, and remains that way for a while. I'm gassy (and I was gassy before, too!) and sometimes those burps seem to carry some acid with them. I am often cold - no more am I embracing the weather in full Scandi style. Instead, I'm huddling in layers, under electric blankets, and not going out as much as I was before. (My tiktok girlies tell me this is a common symptom.) My sleep varies, with several periods of being wakeful in the middle of the night, other mornings the wakefulness starts at 5, and I just get up. (One night I peed FIVE times, leading me to adjust my hydration schedule!) Don't know if this sleep disruption is a symptom, as this sometimes happened anyway. I'm consistently getting to bed earlier, which helps.

Wednesday, the day before injection day, I was truly hungry for the first time. And for the first time that week I went over my daily points. (My WW reset points week is injection day.) Weekly points had been accumulating, from leftovers and activity, so there was plenty of buffer in the budget. I am focused on the protein and fiber numbers, and it is truly an effort to get there. I just added "calories" to the summary stats WW posts for each day, and I find most days have been below their suggested minimum of 1200. I don't want my body to go into starvation mode, start digesting my own muscles, and become hyper-efficient, requiring heroic efforts to lose any weight. I've been at least close to the targets every day, but I'm now planning to add an evening snack every day I seem to be falling short. My work is to have an inventory of snacks that move me in the right direction, not ice cream or Trader Joe's treats.

The injection paraphernalia I have to assemble for
the actual injection. I had the instructions out for this,
the second injection, not trusting to memory. 

I'm trying to undo years of a habitual after-eating flop to the couch and instead get up and move around after eating, which is really helpful in reducing any discomfort. I'm also trying to slow down my eating, and I'm breaking meals into smaller pieces - stopping partway through a meal, but coming back to the leftovers after an hour or two. I'm eating, but I'm on a major campaign to preserve or even build muscle through this, and so eating enough is really important to me. For the first time, I'm really using the WW app to plan in advance in detail. I try in the morning to build a day that will reach the four-way optimization of enough protein, fiber, and calories, while staying below the total points.

I've talked to my trainer about the WL meds, and she's on board with upping the weights and really going for improvement, not just maintenance, to fight muscle loss. I've had great workouts, and right after the workout I'm drinking a protein shake. They are excellent sources of protein and fiber, and I've found a brand that is fine. It tastes good, and I'm able to eat a tangerine or something afterwards to do away with a not-terrific aftertaste. I'm also sticking to my 15 minutes of cardio on the days I don't lift weights (so 2x weight training, 4x cardio, one day off). I was exhilarated yesterday on the Nordic Trak, and again today on the stationary bike, to find it had gotten much much easier.  The purpose of the cardio is to improve my cardio-vascular fitness, and the last two days were the highest I've gotten my heart rate up in a long time. I'm trying to hit the cardio commitment for the entire month of February and I've tied the purchase of some fun new tech to achieving that. When I talked about a newer, higher commitment for March, my trainer wisely suggested seeing if I'm still improving with the 15 minutes - and I am. So we'll see how it goes.

What has happened to my weight, by day 9 of the meds? I believe I have ranted before about how I think about my weight:  it is not really the number that appears at any one moment on the scale, but an average based on the trend. Variation around that trend is caused by water, and other transitory factors. And certainly the weight has been as volatile as ever this week. Here is the picture:

My weight in 2026- turn phone to landscape
The small green dots are daily scale readings. The dark blue line is the weekly average of those.
The big red dot is the first day of injection. 
The orange fuzzy lines are the 5-pound range I've been in since midway through 2022. 

 My weight was at the top end of my range since the beginning of the year (including my mid-January vacation). My daily scale readings have certainly gone down since the first injection. This is not uncommon, in my first week of trying to lose weight. But I won't really consider I'm well on my way to actually losing weight until I consistently see numbers below the bottom orange line - out of the past few years' range. 

But it certainly is nice to see the trend line going down!

 

 

February Tidbits

Brand recommended by my girl.
Tasty, and very little aftertaste

I don't think I'm in the mood today to write a long and meaningful or at least witty essay on anything - too scattered. So some notes.

• I did my first injection yesterday. TL;DR: mostly a non-event. I planned to exercise first, then eat, then inject. Somehow, while getting ready to inject, I suddenly realized how very important it was to clean my coffee pot - I've had it a while and never cleaned it. So I had to find the on-line users manual, make up a citric acid solution, and run through the iterative process to get the mineral scale out of it, and then to rinse it clean. (Pro-tip on coffee pot cleaning - citric acid is just as effective as white vinegar and much easier to rinse out afterwards.) Finally I assembled everything for the injection at the dining room table: glass vial from the fridge, syringe and sharps box from high up in my bedroom closet. Then, I remembered a tiktok that said to leave the vial out of the fridge for a while to let it warm up before injecting it. So another chore got done instead. Finally finally, I opened the syringe package, filled the syringe from the vial, and injected into my belly. Couldn't really feel it, as everyone says. Totally a non-event.
• How did I feel? Yesterday, I felt a bit queasy from time to time, and had some ginger. I have even more gas than usual. Nothing big. Yes, stomach seemed a bit full, and getting up and moving around was helpful.
• Speaking of exercise, I'm trying very hard to do 15 minutes of cardio every single day. Cardio hard enough to raise my heart rate significantly. Today marks two weeks of doing it, every day I don't do weight training with my trainer. This was a recommendation from my primary care doctor last year, and my neurologist confirmed that 15 minutes a day seems to be sweet spot for migraines - less exercise leads to more attacks, more exercise is good for your body but seems to have no impact on migraines. If I get through February with doing this every day, I'll treat myself to something.

• 

  Clockwise from top right: 
  Mussels, Steak, Chicken, Butter, Andouille 
  Sausage, Hot Dogs, Ravioli

  
  I joined a butcher's club! There is a butcher shop in Takoma Park, Soko Butchers, with fabulous local food. They have a monthly box - I got the smallest available. And you get what you get. I thought of an Athena Scalzi-style long post all about it, but never mind, here's a quick recap
• Mussels! Kind of ironic after my rant about fish in the house, but I cooked and ate them last night, and cleaned up and got the garbage out. High protein!
• Tenderloin steak - aka filet mignon. Tonight or tomorrow, going with the sear-and-then-roast approach. (My boys did that (in my kitchen) before Christmas, and started a fire and filled the place with smoke for over an hour. But it tasted good!) 
• Airline chicken. Who knew that was a thing?  I've got a plan for the air fryer.
• Hotdogs and sausages, I love them.
  Local VERY tasty butter, may last a while given how I'm trying to eat
• Heart-shaped ravioli 
• So I'll be cooking for bit.  

•  Today, I definitely feel bloated, full in the abdomen. If I was wearing a belt instead of elastic waist pants, I'd be loosening it. After early morning exercise, I had a protein shake instead of oatmeal for breakfast, followed a while later by tangerines to get the taste out of my mouth. It's sunny and not too cold, so I need to convince myself that 15 minutes of exercise before breakfast is not a reason to sit around the rest of the day.

Weight-loss Meds Eve

That's a little bit optimistic. My meds are going to be delivered, probably Wednesday or Thursday. I'm tracking via UPS. Hopefully no more snowstorms to upset the schedule!

 I'm all ready for this. I've been preparing since late last year. I waited until after I got back from my big vacation to set this in motion, and it's taken a little bit longer than I had hoped. But they're on their way.

I've done a ton of research on this. I'm doing this via Weight Watchers, based on the experience of my pathfinder and an on-line look at reviews for other places. I've read pretty much everything on the WW site, met on-line with their doctor, and got approved. I spent time on social media and with ChatGPT (surprisingly useful for very specific questions). So I have a plan, which will of course be modified as soon as I get some practical experience. In the meantime, I'm staying away from anymore online input. I've got what I need to get started. 

A couple of notes about what's happening and my plans:

I'm getting Zepbound (tirzepatide) vials direct from the supplier, Lilly. Bit of a story, but the cost for vials from which I fill a syringe is half or less than getting pens. I've watched a ton of videos, from Lilly and others, about how to do it. I bought a sharps container for disposal, and read the regulations for my state. I'll have the Lilly video in front of me the first time I do it. I'll refill the scrip on-line, based on my experience at delivery timeframes.

I'm not too worried about what sites on my body to use, I'll rotate. I've thought a lot more about time of day and day of week for the weekly injection. While you can adjust the day after you start, it's better to stick with the same day, and it seems even the same time of day. That means I don't start as soon as they are in hand, but where and when I think I'll end up for a schedule. And apparently, a reason to focus on the schedule from the start is the med's effect on body and mind is greatest shortly after the injection, and it wears off during the week. There are also greatest chances for side effects early on in the weekly cycle.

One of the major concerns about these meds for old people such as myself is muscle loss. I already do the recommended weight training level of twice a week. But there are recommendations about timing of injection and exercise. For example, don't exercise directly after an injection (duh). More interestingly, the recommendation seems to be to do weight training on days 2-4 of the weekly cycle (injection day is day 0). Since my standing convenient weight training appointments are Monday and Wednesday mornings, I think I'll be injecting Fridays or Saturdays. (In contrast to some folks, since I'm retired and have retired friends, weekends are not often very different than weekdays as far as eating and social events go, so that's less of a consideration.) My initial shipment should be here by this Friday.

The intensity of the weight session recommended is interesting: sets of 8-10 reps (calibrate the weight so that is appropriately challenging), if exhausted, reduce sets not weight. Keep the intensity up to keep those muscle fibers feeling like they are needed! This fits with my trainer's philosophy, and we agreed a few weeks back to try to up the overall intensity and progression.

Recommendations for cardio for seniors on weight loss meds are weaker. There is the standard "150 minutes a week" recommendations, but most sources say if you need to choose between cardio and weight training, choose weight training every time. And cardio should be lighter in intensity. No marathon training or blowing through VO2 max. I've just upped my intentional cardio to try to use each of my machines every day I'm not weight training. I'm trying to do 15 minutes every single day, and once I've got that as a baseline, I'll up the minutes. But I'm trying to build the consistency habit first. And it's only 15 minutes! I should always have time for that. In contrast, when I rely on a walk as my main cardio, I have to set aside much more time. I have available to me from the Apple watch "time in heart rate zones" and I'm trying to build up time in a higher zone. 

There are also recommendations, sometimes conflicting from different sources, about timing of eating with weight training sessions. Apparently it affects how efficiently a body metabolizes the protein eaten. After discussion with my long time trainer (who just finished a certification course for fitness for seniors and who has a slew of other training and certifications) I'm going to plan to eat something high protein right after we finish a session. I never eat beforehand now, and my early training timeslot wouldn't lend itself to finishing a meal a couple of hours before our session. They also say don't do a cardio session after a "long fast" (eg overnight). I think my little fifteen minute session isn't a huge concern, even with some intensity, but I will definitely plan to eat shortly afterwards. This will have to intentional. My current habits sometimes have me eating more like a brunch, sometimes exercising, then spending time grooming and dressing, then looking at my ipad, then finally getting around to preparing something to eat. One thing I think I'll try to keep on hand is low fat cottage cheese - a little container has 18 grams of protein and just enough carb to provide some short term fuel.

I haven't settled on a time of day for injections yet. One school of thought is that evenings allow sleeping through any nausea. Others say the injection at night prevents them from getting a full night's sleep. I'm curious about how this will make me feel, so I'm inclined towards a day time injection, at least to start, so I can actually pay attention to what is happening to me.

 I'm laying in supplies of easy-peasy high protein and high fiber foods. I've been using the Weight Watchers' app for a few months and I fully intend to continue using it.  I already had a big supply of ginger candies and teas for nausea - used for preventing or dealing with sea sickness, so that's in place. I've been experimenting with bottled protein shakes. I go down the supermarket aisle with my phone out, snapping barcodes with my Weight Watchers' app. It's easier to use the WW points as a shorthand for how useful the bottle is, rather than analyzing the nutrition label myself. One bottle I bought I sampled was a chocolaty flavor, and the first sip surprised me with how good it was. But then, the very bad aftertaste remained in my mouth for a long time - until I ate something else. I poured the rest of the bottle down the drain. Yuck! That's why I need to experiment.

My experience with the WW app has definitely geared me already towards protein and fiber, and my habits have adapted. There is a "GLP" switch in the app which I'll flip soon, I'm not sure what it does, but I'm guessing it emphasizes the protein and fibre more than it does point totals.  Dehydration is apparently a concern, but not so much for me. I don't track it, because I am the water queen, always with a glass or bottle next to me. I will maybe use a refillable measured bottle for a while to make sure I don't slump in this. I connected my watch to the WW app for the purpose of getting more points for activity, but I didn't connect any of the other areas like sleep. I don't see that changing.

 Food shopping tomorrow and Wednesday, different stores. Then, the adventure begins! 

How Active Am I Really?

Or, Keeping Myself Honest

One of the reasons I started this blog is because I know how fallible my memory is. I cannot rely on my memory of how active I've been, what I've eaten, or how much I weighed in the past. I've been thinking that I'm pretty content with my fitness level. For a while this spring, I felt strong! This feeling is absolutely real, but it has faded over time. Now, I feel mostly ok, but I know I'm doing so much less than I used to do.

When I retired, I developed a report card for myself.  It tracks a variety of things about my life, from how many steps I take to how many books I read. I don't keep it up rigorously every month, but I actually do keep track of all of the components to be able to bring it up to date whenever I decide to update it. The last time I posted about the report card was about a year ago, where I only posted the comparison to the year before. Because I was still within six months of knee surgery, I gave myself a pass on the activity statistics, which at that point were looking not too bad.

Well, yesterday's comprehensive review of the data revealed a different picture. I looked over a longer period time - basing everything on 2019, when I retired halfway through the year. Pretty much every single way I look at activity has gotten significantly worse, trending further down each year. Sigh. I slice and dice my data, looking at different measurements, averages and peaks and valleys, but it pretty much tells the same story. 

What do I track? Here are my activity measures:

• Average daily calories
• Days with more than 2,200 calories (very active days)
• Average daily steps
• Days with less than 5,000 steps (very inactive days) 
• Stand time in minutes (new in 2023 with Apple)
• Minutes rowing (new in 2023)
• Minutes stationary bike (newly tracked last year after knee surgery)
• Minutes Nordic Track  (new this year)
• Miles walked (while "taking a walk", not incidental distance) 
• Gym workout days (tracked manually)

All but the last of these are from my Apple Watch. When I switched from the Fitbit in 2023, I noticed the calorie counts were substantially different (higher on Apple). I don't really care what exactly the number is or how accurate it is - but I do care that it correctly captures trends up and down. I redefined "active days" to not overstate them with the more generous estimates.

But all of that detail just above can obscure the main fact: I am substantially less active now than I was in recent memory.  I want to tell that story clearly and unambiguously, to convince myself that I need to get off my butt and move! 

So, after bringing the data up to date, digesting the big impact, I took a long walk. Then, I picked up the computer again and made an infographic to show the sad, sad, facts. Remember, I worked in data analysis all of my working life, and using data to tell a story is something I enjoy. So I amused myself quite well, learning how to make a totally new type of graph, and how to present it so it tells my story. So below, here it is:

So what is this?

I simplified my measures to the five comparable measures since 2019 (clockwise from top): Calories, Steps, Active Days, Miles Walked, and Workout Days. I scaled them all relative to 2019, as if that year were perfect. (It wasn't bad.) I display them on a "radar" chart. 2019 forms a perfect pentagon. Each year since then is another pentagon, with this year's data so far in red. We see that calories don't vary much, and neither do gym workout days - in fact, both are slightly better than in 2019. But daily steps and active days are only slightly more than half of what they were back then, and miles walked is less than 25% of what they were. 

Steps, miles, and active days are all increased by getting off my butt more. The more I get up and move, the closer those red corners of the pentagon move towards the 2019 pentagon. 

So it all boils down to this: make the red pentagon as much like the big blue one as possible. 

 

 

Cardio

I love the routine I have for functional strength training. I've been working with my trainer for years now. When I met her she referred to her "boyfriend", and it was a big deal when she moved in with him (in his parents' house). Now, they are married, own their own house, and have a three year old! Adorably, the three year old is often on the other end of the video call, and she sometimes copies my movements. I love the movements, the strain on my muscles, the stretching and moving in every direction. I work out on my own between our twice-a-week sessions, but for my trainer I work harder than I do on my own. So this is a success, and I won't tamper with it.

But I need to work my heart harder, according to my doctor. I need cardio! She gave me specific targets of time and effort: twenty minutes of high intensity exercise five times a week!

I have not enjoyed high intensity exercise for a few years. I used to love it! My first brush with using machines, the basement Nordic Track, was the first time I consciously felt how good the body feels during and after working hard. It can be exhilarating! I believe the machine got me to a high enough cardio fitness level that finally I could start running. And I loved running! No, not every day, and not ever for the first 10 minutes. But the way it made my body feel was great! 

I was an early adopter of a heart rate monitor, back in 1998. I'd read about appropriate training intensities, and here was a gadget to help! My first one had a chest strap and a watch that displayed time, heart rate, and elapsed time. Nothing else- GPS hadn't downsized to live on wrists yet, and phones were flips that couldn't even text. I propped the watch up on the Nordic Trak so I could see it all the time. I learned that perceived effort each day did not tie to heart rate - I could feel like I was pushing myself to the limit, but some days the ol' heart just didn't want to pump fast. Interestingly (to me, any way) the day before I got sick was always a day the heart was sluggish.

I also learned that walking didn't get the heart rate up high enough to be in the high intensity zone. Nordic Track, swinging my arms in time to my legs, quickly did raise the rate. A walk has many benefits, but I cannot hustle enough to accelerate the pumping of my heart. Only uphill - which in the absence of a mountain to climb, is always going to be brief - begins to approach my target zone. My first tentative jogging steps taught me there is no comparison to walking - my heart got excited and pumped away! The mechanics of walking and running are really distinct from each other (jogging is simply slow running - no technical difference). I might be a slow AF runner, with young men passing me while walking, but the cardio benefits are real even at my pace.

When I stopped running, I stopped ever exercising in that intense zone. The last year I ran anything more than a token amount was 2019. My Nordic Track had long been retired, in a dusty heap in a corner of the basement. I still did small amounts of cardio on the machines in the gym, but that all came to an end in March 2020. 

But now I have machines galore! My BIL lent me (effectively gave me) his long-unused stationary bike. I bought a rowing machine in January 2023, and used it a lot the first couple of months, and only intermittently afterwards. I started up again this autumn, since I started on this cardio bout, and also because now I have a friend who is also starting to row. I have a mini-trampoline, which I use to bounce a bit in front of the TV. But on the tramp, I can't get going enough to get the heart rate high - my balance isn't what it was, and so I don't have the exuberance I used to, not getting a lot of air on the bounces.

Detailed stuff about heart rate:

When I first started using the heart rate monitor, I used the classic formula for maximum heart rate: 220 minus your age in years. So I was about 45, and my max heart rate was calculated to be about 175. There is a formula more accurate for old people, seventy percent of your age subtracted from 208 (208-(age*.7)). The two formulas give the same answer for age 40 and from then on the "208" formula gives a higher number as your max heart rate, and is said to be more generally accurate.

The reason for knowing your max heart rate is to be able to calculate training intensities. Cardio benefits really kick in at the higher intensities, 75-85% of max. Fat burning benefits kick in at somewhat lower intensities, 65-75% of max. 

But here's a wrinkle I only just learned - biking (an exercise that doesn't use your arms) will lead to lower heart rates than running (a whole-body exercise), but can yield big benefits at a lower number. Who knew? 

But I found that even though I was working very hard on the rowing machine, my heart rate (on the Apple Watch) was consistently lower than on the bike! I was confused, because the rower certainly uses my whole body. Was it a measurement error from the watch? I googled "why is my heart rate so low on a rowing machine" and found links into Reddit, where this very question was being addressed by the helpful nerds who hang out there. Basically, they said we must be using the wrong technique. We must be using our back and shoulders more than our legs, which is inefficient.

So here's the rowing technique tips in english: the first part of the motion is pushing back explosively with your legs. During that, your hands and arms are just along for the ride, with your legs doing the work to pull the bar you are holding. Only after your legs are fully extended should you lean back, and in the final part of the stroke use your arms to pull the bar up to your chest. The return is rest, no effort expended. And, do not try to go faster by returning faster! That should stay the same, a passive ride, until the legs are bent and you can explode back again. The faster you push back, the more strokes per minute. But strokes per minute doesn't need to get too fast; instead, raise the resistance.

So I tried that one morning, and the difference in my heart rate was signficant! I went up to a higher zone quickly, and stayed there the whole time. And felt my whole body aerobicized afterwards, a great feeling! It feels like a break through!

Stronger Next Year

My gym! Rowing machine along the back.
I just installed the bar to help with balance exercises.

I did not have a great year physically. It started with recovering from my knee surgery, carried on through a summer of increased migraines and still not up to snuff on my knees, and crashed and burned as a result of my vigorous (but fun!) sailing vacation, where I injured my rotator cuff and generally burned out my whole body.

Through it all I tried to keep moving and working out in my basement gym. (I love my basement gym, and I enjoy working with my personal trainer there.) But there were definitely days on the couch where I hardly left the house. I felt old. I felt feeble. I was fat, and nothing I did seemed to affect that. I woke every morning feeling like the Old Red Woman, bent over, stiff, wobbly, and in pain. I felt frustrated that my body was so frail. I was preparing myself for a new reality of being old and feeble. I told myself that I actually was old, almost seventy years old. Any time there was a news article that another celebrity had died, the first thing I did was check their age. So many of them younger than me!

But by late fall, I felt myself getting better. Stronger. More capable. Actually doing things. Feeling competent and capable. Walking still did not feel good, but I adjusted and spent more time in my home gym working with weights or my rowing machine or on the stationary bike my BIL gave me. I went back to the mental disciplines I had learned over the years of dealing with pain, meditating and observing the pain with kind curiosity. I had some adventures, on the water and on the scoot. I had some actual good days, where I woke up feeling good. Not stiff. Not bent over. Not feeble. Ready to face the day, get out there and do things.

The election results hit me like a gut punch. As I got out of bed the following morning, I was initially fine, but by the time I had walked the length of the house to let the dogs out, my back had tightened into a full fledged spasm. SPROING! I was bent over, leaning on furniture like a toddler doing her first cruise around the house. I pulled out my tool kit, things I know, deep down in my body and mind, to be true. First, mentally: "there is nothing wrong with you. You are safe. You are fine. Yes, the back is clenched, but it's not broken. Yes, the world has gone to shit, but you are safe. Your body is safe." Then I started my series of exercises/ stretches that I know deep down are going to help. I also reached for the tylenol, because comfort is an important part of feeling safe. 

This worked! It took a couple of weeks - the back clenched every morning for a while - but it got fainter, and gradually went away.

Around this same time, my primary care doctor told me that based on my testing, I have great lung capacity and a strong heart, but I have shit endurance. She prescribed aerobic exercise, specific amounts at specific heart rate levels of effort. The next week, my neurologist reinforced this - certain levels of aerobic exercise seem to have a protective effect on migraines.

The view my trainer has from my phone while we video.
I have all the toys! I bought my first weights in 1995,
and I've been adding equipment ever since.

So I'm all in on the cardio now, added to my twice-weekly strength training and daily warm up stretches. I have the devices to keep me going indoors this winter- a rowing machine, a (bottom-of-the-line no bells-or-whistles) stationary bike. I have a mini trampoline in front of my TV. And I dusted off my original, built of wood in Minnesota, Nordic Track ski machine from 1993! Using the NT was the first time in my life I enjoyed indoor cardio, back in the day. It needs refurbishment, but it turns out that while the old ski machines are no longer made, there are enthusiasts and through a sub-reddit I found a guy who sells refurbishment kits with the most common replaceable parts! It's on my list to get it fixed up - probably a few hours work.

I found that walking can't get my heart rate up high enough to meet my PCP's exercise prescription. I try hustling along, but the heart stays stubbornly beating slowly. Only up very steep hills does it go up- and I can't currently sustain that for long enough. This all may change as I get more aerobically fit.

On the Road Again

This morning at Lake Artemesia

I don't exactly know how or why, but I seem to have got my mojo back on several fronts! And now, stand back, because I'm on the go!

I parked my Vespa scooter several years ago. First, I had a vertigo outbreak in the early spring, before I had put my bike on the road for the season. The vertigo lasted about a week, with two very bad days when I couldn't walk for some period of time due to total loss of balance. I totally lost confidence in my ability to deal with gravity even after the attack subsided - not a great attitude for leaning around curves on a two-wheeled vehicle! Also, the type of vertigo I had, BPPV, is likely to recur. (But it hasn't, so far.) So that took me off the road for a year. Then, no surprise, the bike wouldn't start when I tried it after sitting for a year. I bought a new battery, and last year made another attempt to get it going, to no avail. 

This spring, I determined I had to either ride it or get rid of it. I had been thinking an electric bike might be a better proposition. But I really couldn't see buying a expensive new toy while I had a very similar one parked in my driveway already. In addition, where the bike is housed is one of the sunniest spots in my yard - I was eying it as a place to put more plants if I got rid of the Vespa. A dear friend, a motorcycle maestro, came over last weekend and he got my bike to start right up! I rode around on the street and it seemed sound and appeared to be running well. At the least an oil change seemed necessary before really relying on the bike, so I made an appointment to take it to the dealer for a tune-up (no user-serviceable parts inside). 

The dealer is about 15 miles (and two states!) away, in Arlington, Virginia. I worked myself up to it riding around the neighborhood some, to get both my muscle memory and my systems memory fully back up to speed. My body seemed to know what it was doing (I first started on motorcycles about twenty years ago) but I needed to resort to the manual to remember how to work all the buttons. I really was keyed up for the ride to the dealer, studying maps and trying to memorize the routes, as I wouldn't be able to look at my phone during the trip. To get to Virginia, I would have to go into DC and across the Potomac. The District of Columbia into Virginia can be very confusing, with a plethora of roads going in very strange directions. It would be easy to accidentally end up on an expressway and be stuck there for a few miles. With a top speed of around 60 mph (and cruising capability around 50) technically I could be on an expressway, but remember, this was the trip to make sure the bike would be reliable to try to go that fast. I also certainly need more practice and confidence before doing that again!

The day of the service drop-off dawned rainy. I had scrounged through my closets and found my old riding jackets didn't fit, as the Vespa idle period coincided with my gaining 20 pounds. I scrutinized my weather apps and set off between deluges. I had an uneventful 40 minute drive, dropped off the bike to a nice Italian service guy, and treated myself to a wonderful lunch in a cafe in upscale Arlington. The DC metro has lousy service these days, with the local line closed down entirely right now, so I also treated myself to an Uber the whole way back.

I picked up the bike on Saturday ("we don't often have to remove a mouse nest from the engine!" they said in that charming Italian accent, and charged me about 20% of what I originally paid for the bike) and I had another uneventful and confidence-building ride home. So I'm ready to go! Small local errands, fun rides, perhaps even going off with the scooter gang I rode with pre-pandemic! I call it "fresh air without the exercise" and I've remembered how much of a smile this puts on my face.

But in other exciting road news, I have gone back to running! At least, I've stuck my barest toe in! 

Both knees are currently in an ok state. They hurt, but at levels I can stand. And so far, most activities have not caused them to hurt worse than they feel just sitting around. On my trip to Bellport, I walked more than four miles in sand, and I've been trying for three mile walks two or three times a week. I have a New Year's goal of making it 10 miles in one day by the end of the year. But walking takes a long time to get the miles in - a three-mile walk by itself takes me slightly more than an hour, and I have to get organized, get the right shoes on, put the dogs away, and maybe drive somewhere first. So I decided to try running again.

I've actually had a bit of a Thing about running. It seemed impossible to do again. The mechanics of running are distinct from walking, and I I couldn't make myself do it. My knees hurt, but all the muscles of my legs have been tight. Crossing the street, needing to hurry, I couldn't go into a jog. I would lean forward, then tense up and not be able to do it. I had an image of a face plant in the middle of the street from a leg collapsing under me. 

When I was running regularly, I ran intervals between walks. The length of my running intervals varied widely, from a mile of non-stop running all the way down to 30 seconds, but the technique, of running and then walking for a minute or two for recovery, is sound. The theory of very short intervals, especially for beginning runners, is that you can sustain the mix for much longer than you can sustain just running, and so your body gets more thoroughly conditioned to running. Your heart and breathing rates repeatedly go up to running levels, and then recover before you do it again. I also had a couple of sessions with a running coach who specialized in a technique known as "chi running". It is supposed to lead to fewer running injuries. The essence of the technique is to lean forward from your ankles (not your waist) and a foot will automatically lift up and move forward to keep you from falling. A fast cadence is stressed, with a faster pace leading to longer steps but the same cadence.

After hitting the turnaround point for my three mile walk one day this week, I decided to see if I could overcome this Thing and run. I leaned forward, and my foot lifted up, and then I was running! To the untrained eye, I was "just barely jogging" but to me it was everything. I could feel the muscles in my thighs waking up in surprise! "What's going on here? I remember this!" The form came back to me, and it felt good. I ran just three short intervals interspersed with walks, and then swaggered my way back home, feeling quite a bit taller and more confident. The Thing was gone.

I went out this morning to a nearby trail that makes a mile and a half loop in a pretty setting, equipped with my running watch and running playlists. I walked a lot, and ran my structured intervals for a bit, totalling two loops. I'm highly satisfied with where I am with this, even though I barely kept up with a (young) person walking while I was running. I hope to work up to doing 5K races again, but even if I don't, it's all good. My body is capable, I am capable, and if the body starts to decline, it's possible even at the advanced age of nearly 70 to recover some of the mojo.

I'll leave you with this: schedules and weather finally combined to get us out on the Bay! Yay, sailing! I'm on the go, on two wheels and four, and two feet, and by sea! Stand back, here I come!

Report Card

 The last time I published a report card was in January of last year, looking at 2022. I actually have kept up tracking myself primarily through apps and devices, and from time to time I sit down and go through the data trying to glean some meaning or insights. I haven't felt like I've learned that much recently, certainly not something worth sharing. I still haven't got any wisdom to share, and it's not that pretty a picture, but the data is what the data is, and there is a certain value in simply showing it. Keeps me honest with myself.

First, to get it out of the way, my weight is high and stable. No need to share a graph. I gained a bunch of weight in 2022 (Fuck You, Intuitive Eating!) and it's stayed on. I haven't been motivated to any kind of a big push to change it. And it's been remarkably stable - plus or minus four pounds. I do plan and track my food most days, but it's more part of planning how to spend my time than trying to morph it into fewer calories. And then, keeping me conscious of what I'm doing, to do away with mindless eating. I still weigh myself every day and it gets recorded on the internet, for whenever I feel like reviewing the history in detail. I chuckled one day recently when I got up and peed several times during the night and found the next morning I was two and a half pounds down from the day before! That's why I can't get excited about day-to-day fluctuations, the range I'm seeing is just water weight. 

First up: Activity. As always, darker is better. January was knee recovery time, and I give myself a pass for everything but workout days. My "workout days" focus on functional fitness, either in my home gym or with physical therapy (my PT experience the past couple of years has been a solid hour of working out followed by 15 minutes of massage and stretching). With PT from the knee replacement added to working out in the home gym, I was really doing a lot. It also paid off, as now my calories and steps are back to where they were last year (which was NOT a stellar year for activity, I admit). The walking mileage shown here is from taking a deliberate walk where I activate my GPS, not an accumulation of steps during the day. I'm currently pretty active in the house and garden, which keeps my steps up, but I haven't been feeling the walk as a way to spend time (and I only do short and slow training walks with the dog, not worth tracking.) I've added a new row since the last time I posted, "stand time". My apple watch tracks this - how much time do I spend on my feet all day. It seems worth looking at, since my goals involve being less sedentary. Here, I'm moving in the right direction!

Next, some health parameters. These are both controllable and uncontrollable things. The big worrying trend is migraines, which are up. I have fallen off the meditation bandwagon, and that might be a contributing factor. But my doctor thinks that perhaps allergies are acting up - and there is a connection between respiratory inflammation and migraines. So I'm trying to be more faithful on OTC allergy remedies. "Alone days" (still looking for a better descriptor) are days I don't talk to anyone. I might be texting or emailing, but it only counts if I talk to someone either in person or on the phone. I really enjoy days on my own, but I am aware it is not healthy to have too many. And besides, I enjoy my family, friends and neighbors! I continue to be a sleep champion, with a normal seasonal variation of less sleep with longer daylight hours. (These sleep hours are separate from time in bed, as the watch purports to distinguish between lying awake versus truly asleep. I am awake at least 45 minutes during the course of the night - but apparently, that is less than average for a woman my age.) Heart rate variability is meant to be an overall measure of stress, with a high number being better. I haven't been looking too much at it, but the apple watch keeps track, so I decided to add it to the list. Resting heart rate, as a reminder, measures resiliency, with a lower number better.

Lastly, how do I spend my leisure time? (Ok, it's all leisure time. I do a minor amount of volunteer work, but I'm not tracking that here.) This whole category is not necessarily "more is better", but it is what it is. I also struggle with whether the "year" column should show an average of the months, or a cumulative total for the year. It's currently a mixed bag. I've actually wanted to read fewer books this year, because I read a lot of fluffy entertainment and it gets in the way of doing more productive things. My TV watching is up recently, as I indulged myself with a season of my only reality TV show, "Below Decks". I haven't been watching movies, neither at home nor out. I have been traveling a modest amount this year, more shorter trips, which is suiting me right now. And I'm hoping for more sailing, as my partner has retired, which multiplies the number of possibilities of aligning our two schedules and the weather.

So that's the story in numbers. Looking at this does motivate me to move, so I'm off to do that now.

Excelsior!

Five Things for 2023

Snapped right after a new color in the hair.
Also shows the hips, as big as ever!

The month is nearly over, but I'm finally getting around to sharing some of my notions for 2023. I like to use milestones to take stock and think about changes, whether or not they fit the mold of "resolutions", and whether or not you are doing it at year end. So here I am. New hair and all.

I am very influenced in how I'm doing these things by Gretchen Rubin and her podcast, "Happier". For several years, she and her sister have been promoting ways to think about what you want to accomplish and tools to get that done. So some of this is borrowed.

There is not a word about weight here. I've tied with the highest weight of my life. I can't say I don't truly care, but it is not my focus right now. What is my focus is getting stronger and getting out there and doing things.

1. Word of the year
   Funny, this word just came to me yesterday. I'd been mulling it over, various iterations of how to describe being more active in a single word that would resonate. Maybe because it's movie season, it finally clicked: "ACTION!". Less sitting on the couch planning to do things, more actually doing them.
   
   
2. Outside 23 for 23
   This is pure Happier podcast. For several years, they have been promoting a specific action to be done for a certain amount of time every day for the year. They did things like "walk 20 minutes in 2020". This year, it's be outside for 23 minutes every day in 2023.  There are so many benefits to being outside, proven often. And, one is more likely to do things outside if you are trying to be outside anyway.
   
   The only rule to participate is there are no rules - just do something that is meaningful to you. So passing between house, car and stores can count if you want it to. I had a very low energy day where I sat in the sunshine in back wrapped in blankets watching Bixby. Definitely counts.
   
   I have to confess that despite the lax rules, by any construction I have failed at this three times already this year. Each of these was a nasty cold day with solid rain and wind. Still, I think I can do better. I do have a covered front porch - I could swaddle in blankets and sit out there. Even better, I have rain gear, and it works.
   
   
3. Minimum Baseline
   This is an idea I got from a running coach. She used in the context of "every run feels like crap as you start". And so the idea is to get out there and tell yourself there is an absolute minimum you can do no matter what - even if it's just put on the running clothes and jog 100 yards. In my case, it's not about running goals, but overall activity for the day. I've tracked my daily steps for more than a decade. For the past several years, in addition to looking at monthly average steps,  I've looked at the metric of how many days had fewer than 5,000 steps. If you look at my previous report card post, you will see that December had 15 days where I walked fewer than 5,000 steps! That is an all time high! An all time low for sluglike days! Without an office to go to, and with fewer and shorter dog walks in the works (see below) I do have to work at 5,000 steps. But it is ridiculous to be that inactive. I do need to walk my feisty little dog. In addition, while I did succeed in getting rid of my treadmill (yay!) I still have my little trampoline. That gives me about 1,000 steps for every 10 minutes of bouncing. Bouncing is definitely a workout - generally gets the heart rate up higher than just strolling. That is my backup if it's a nasty day where neither the dog nor I want to go out.
   
   So I've only had one day so far this year where I fell below 5,000 steps in a day. I think what happened is that it was a nasty day, I was thinking I'd get a chance to bounce my way to the finish line, but then I discovered I had to be on the phone or zoom from 5 pm to 9 pm. When I finished with talking to people, I was 2,000 steps short of the goal and not prepared to work that hard for at least 20 minutes instead of going to bed.
   
   But having been caught up once, now I'm alert to this. I can manage my time better and make sure this particular trap doesn't catch me again.
   
   
4. Bixby Training
   Bixby is the snuggliest dog in the world, for me. But he is very barky. He lives in a high state of arousal, which is not good for him nor for me. He can get into a barking frenzy, and he moves into Rumpelstiltskin mode where I think he will simply explode if he doesn't stop.  (He appears to have a very solid bite inhibition so I don't think there is any danger, but it's a lot of barking and lunging.) I am working on training him out of this. I have known general approaches to this for years, but I've decided to really buckle down and work on this right now. Very specifically right now, I'm working on the leash reactivity, rather than a big focus on the home barking. My trainer recommended to pick one where I can be consistent and focused. I decided that right now, it's more important to me to be able to take him on walks than to calm him down in the house.  During this time, it's better to avoid ever getting him over the reactivity threshold when we're out on the leash, so it's close to home, with a full pouch of very high value treats, and a close eye on what is going on around us. I believe I'm making progress with him. Today, I took him down into the park (at 7 am!) for the first time in a while. I was able to keep him calm the whole time despite seeing some dogs from a bit of distance, but he was very near the threshold when we got home. But, progress!
   
   So I also am striving for a Bixby minimum baseline, on leash and off our property for at least ten minutes every day. More short sessions is better than long ones like today's more than 30 minute walk.
   
   
5. Have Adventures!
   I love staying home and reading about other people's adventures. But when I get out there and do something different than usual, I love it. My threshold for "adventure" is very low. A trip I took to a resort/shopping development in January for a couple of hours counts. Hiking in new places count. Participating with a bunch of strangers in an usual performance art activity will count, too, if it comes together. Actual objective adventure also counts!
   

Let's Put 2022 to Bed

 Let's wrap this puppy up. While I didn't do a lot of posting about the metrics of my life, I did keep up my spreadsheets and graphs. I find it is helpful to have a "just the facts" look at how my life is unfolding. Memory is unreliable, and these numbers tell a story.

Here is 2022 by month, and yearly totals for the last four years. In general, darker is better. 
I put migraines in red and reversed this (darker is worse).  And in the bottom (yellow) section, I'm not sure more is always better - more books, for example, is not always better.

 The whole overview of the year is above, complete with context from prior years. Looking first at the yearly trends, look at the first section - activity measures. It's been downhill since 2019 (when I retired partway through the year). But I managed to turn around the downhill trend on some of these things - 2022 was more active by some measures than 2021. This was and is a hard fought battle. I didn't bike at all, I ran one whole mile, but I did get out there and walk! But not every day, by no means. I had more low activity days (days with less than 5,000 steps) than ever before, by a fairly wide margin.

The next little section shows the sad story of my weight - after holding it steady for the previous three years, I put on fifteen pounds and tied with my previous all time high. Let's just leave that there for now.

The next section contains some measures of wellness. I fell off the formal meditation bandwagon big time, this year. I believe I incorporate moments of mindfulness throughout my life in ways I didn't before I started meditating, but I don't sit for a practice much any more. In fact, many of the times I show I meditated, I put on a recorded meditation in the middle of the night in order to try to get back to sleep. In good news, migraine hours continue to decline! Two months with NO MIGRAINES at all! Woohoo! Sleep is relatively steady, and resting heart rate bounced around during the year, but the overall average didn't change that much.

The last section tracks various enrichment things. Again, these are not necessarily the most important things, but are things that are relatively easy to track and do show some softer aspects of my life. I was a reading machine this year, I wish I'd seen more movies, I hardly blogged at all, and likewise I failed to enjoy the delights of the city and city friends. But I traveled a lot, and I got a decent amount of sailing in. 

I've found the story of the ups and downs of the year are best captured in a graph of my daily steps throughout the year.

The dots are the daily step totals. The dark blue line is a running monthly average, and so shows the longer term trend hidden within the noise of daily variation. The lighter blue line is a running weekly average, so shows a shorter term trend than the monthly one.

So follow along the graphlines to read the story of my year. We start with an optimistic and motivated January, with several very busy days, followed by a steady decline in late winter and early spring as the bad weather and my bad knees dragged me down. There were some high points, but the trip to the Utah desert in March was disappointing as the weather kept us in. The weather got better during spring in Maryland, and I went out to California in April and I walked my brains out. Back home, I tried to get off the couch to train for my trip to the Nordic Isles in June and July, but pretty much I just hoped for the best and as a result I failed to enjoy the trip as much as I could have. I overused my knees and was often in pain.

I vowed to do better for my planned trip to Greece. We see a steady increase in average steps, facilitated by cortisone shots in my knees at the end of August, and steady physical therapy during September and October. Greece went really well, until I got covid. 

So the rest of the year was in the cellar, with constant struggles to get off the couch and move. The month of December has the lowest average steps of any month in years. It also has the most number of very low activity days. So I went on some walks, but consistency is lacking.

Steps are clearly a proxy for overall activity, but I think it's a pretty good substitute. I know that studies have shown that there is a clear relationship between few steps and all-cause mortality. From 4,000 steps a day to 8,000 steps a day, there is a clear relationship where more steps and better health are very tightly correlated. This is a correlation, and there is NOT a clear demonstration that moving from fewer steps to more steps results in better outcomes. It could be that folks in an unstoppable decline walk less. Is there such a thing as an unstoppable decline?

I don't want to end on a sour note, so let me say that right now, in the beginning of January, I feel pretty good, and very motivated to keep moving. I know deeply that moving more makes me feel better - there can be a virtuous spiral upward. So let's leave last year behind us, with maybe a few lessons learned, and go forward to the new year.

Go As You Mean To Follow

We've had delightful weather so far this year (creepily warm). I'm taking advantage of it to get out there and walk. I plan (hope) to do a post recapping 2022, and share my current thinking about goals for this next year. I've got a little data collection to do for each of those, so I thought I'd start off by bragging about my streak (THREE WHOLE FREAKING TIMES IN A ROW!!!!) days of walking. None of these are marathons, but it's good to get out there at all.

The first, on a crisp and sunny New Year's morning, is my "normal" walk - the mile and and half that goes down to the creek and back up through the neighborhood. I'd like to make this my minimum.

 

The following day, Monday, I went up to check on the boat and took a walk in the county park near-by.

And today, I dropped my big boy off at the airport this morning, and went exploring to a new-ish development, National Harbor. I had never been there, though I think it may have been open for a decade. It's got a Gaylord Resort, a convention center, and a mixed retail/restaurant/residential development built as a brand-new playground along the Potomac River across from Alexandria, Virginia. It was drizzling, I moseyed along looking at things, I didn't stay long, but I'm glad I scratched my exploring itch at least mildly.

I think I'll post these on my Quick Log, and I'll pick up posting these kinds of things there.

Doing my Best to Move

Tuesday's hike was filled with wildlife!

My knees still feel better, but it's not perfect. There is some pain, especially up hill, and my muscles definitely are weak and also I'm stiff and inflexible. The more I read about Greece (coming up in November) the more steps I hear about... so I'm trying. In addition to my twice-a-week hour with my trainer, I'm doing 45 minutes once a week in physical therapy, and I have a 75 minute tap dance class once a week. But I'm still trying to walk every day, and run through the basic knee exercises on days without either form of PT (personal training or physical therapy). I'm not quite making that goal, but I'm doing much much better than I was a month ago.

I've found joy in the walking again! And that helps me to get out there!

Taking a page from both K's blogging and also from my earlier years, I'm posting a quick update every day in a special blog for that purpose. The link is on the right side of this blog, but here it is as well:

Nan's Quick Log

I'm using the automatic posting from different devices and apps I have that keep track. So far, I've only posted when I do a deliberate exercise walk, run, (or in one case) kayak, not my incidental movement. I'm still experimenting with what works. I was looking for something I can do from my phone, because the apps that make the record are on my phone, and I don't boot up the computer every day. Because it's not a complete habit yet, sometimes I'm posting a day late.

I don't expect anyone to comment there, but knowing that maybe someone will see it is part of the motivation to do it.

I used that blog years ago - the last previous post before I started using it again was 2014!

Knees Are SO MUCH Better!

Today I took what I want to be my "normal" morning walk - out the door, down into the park, back up through the neighborhood, about a mile and half, with some significantly steep but short hills down and up to the park. I've been doing this off and on for years, but recently I've fallen way off. The fact that it hurts before I even start, and will hurt more once I get going, has been one of many barriers. (Other barriers include my reactive barky dog, any weather less than optimal, having to get dressed, and sheer inertia.)

But this week, I've had to head out first thing, just as the sun comes up, to do a daily vacation backfill on a citizen science project, hyper-local network of national precipitation reporting, CoCoRahs.  It's on the "normal" route, so some days this week I've kept on going to complete the loop. Today was the first pain-free day in months! 

My knees have steadily deteriorated over the past several years. I tore my meniscus and had it repaired back in 2018. But now, it's a loop. The more the knees hurt, the less I move. I went to physical therapy a year ago, after they were really bad. Symptoms included not only pain, but also restricted mobility - I simply couldn't bend them all the way. The PT really helped with both pain and mobility. I was then motivated to keep moving by active vacations, in March and April. But perhaps from overuse, the knee pain grew enough worse that it grew increasingly easy to blow off the daily walk, despite my fantastic Iceland vacation coming up. After all, I had satisfied myself with what I could do in March and April, Iceland in July would be just as good, no?

Well, no. A couple of months off from active training eroded both the quality of my knees and also my aerobic fitness. I did a whole lot on the Iceland trip, but it was hard. I didn't do as much as I wanted. There were often options for different activities and I backed off the most active ones, hiking up volcanoes for example. I spent a fair amount of time in my nice little cabin, with my feet up and knees bent, popping tylenol and rubbing stinky and persistent but effective voltaren gel into both knees. They never once didn't hurt on the trip, and haven't really stopped hurting since.

When I got back from Iceland, I signed up for a trip to Greece. More about that another time, but everything I've read suggest all the places I'll want to go will involve stairs with no handrails. Time to fix these knees!

(As an aside, I am fully bought in to the mind-body approach to pain management. I can minimize suffering I have from pain, and even reduce and even eliminate some pain, through mindful meditation and somatic practices. It has really helped me avoid catastrophizing about issues, and my back pains and even migraines are less of an issue. These practises also help avert physical symptoms manifesting in response to external or internally generated stress, something I clearly used to do a lot. These practices include breathing, visualization, and self talk approaches that really help keep things on a more even keel. 

The way I think about these practices and my knees is this: my knees have mechanical issues that send messages to the brain. I can interpret these signals as pain, or call them sensations, and I can observe them from a distance with kind curiosity. All this helps, but there is value in also trying physical and mechanical things (exercise, strengthening, pain medications) to reduce the volume and urgency of the messages being sent to my brain.)

My previous sports-medicine doctor retired, and so I found an orthopedic surgeon to consult. My basic questions were, what could be done to help the knees short of replacing them, and was I damaging them them further as I used them? I wanted another prescription for PT because while I know many exercises for the knees, I find the skilled supervision helpful. 

The doctor said no, I couldn't damage the knees with movement, was happy to give a referral for PT, and also suggested cortisone shots in each knee, which he did right then and there. The actual shots were quite painful, but it only lasted for a few minutes until a local anesthetic kicked in. Then, over the past few days, the local anesthetic wore off and the steroid gradually kicked in. 

And hooray, they seem to be having an effect! 

The doctor said, and my independent reading confirms, that the only proven interventions to actually improve the knees (as opposed to alleviate pain) are exercise and weight loss. No supplements have been shown to have more than a placebo effect. So I can do whatever I want in exercise, if done correctly it will help, but the pain will likely be there. If I can bear it, I can do it, and if I keep doing it, I can keep doing it!  As to weight loss, that is a topic for another day.

I celebrated this improvement by putting in for a place on a short overnight sail on my schooner, about a month from now. I had held off, thinking about all the ladders on the ship. But now I'm ready to go for it!

Guinea Pig

 I decided to dedicate my brain to science. Why wait until I’m dead?

Actually, I have applied several times to be included in various medical studies and trials. As the National Institutes of Health are nearby, there are bunches of trials around. I was turned down for an early Covid vaccine trial, due to my migraines. The migraines have knocked me out of several trials.

A year or more ago I applied for a study on the effect of exercise on memory being done at the University of Maryland. I was disqualified because I was already an active exerciser - they were looking for sedentary old people who would start an exercise program. They would be studied longitudinally, for at least six months. 

I was contacted again by the same folks this February, where they were conducting a related study, looking at short-term effects of exercise on memory. For this, they needed old people who had a basic fitness level, so we wouldn’t drop dead exercising for the experiment. I was excited to be included this time! There was no compensation for participating, but also no expense. Three visits to the nearby University of Maryland campus, at least two hours each. 

It was an interesting experience. I had to be cleared by my primary care physician for exercise, and by my dentist for the MRI machine - to verify I didn’t have any big metal things in my mouth. The first visit was to get a baseline of both my fitness and cognitive level. I was met at the door by a personable young man, Dan, who was in charge of this experiment for his doctoral research. I was led into the basement of the School of Public Health, into a bleak cinder block and linoleum room with just a Formica table and a couple of plastic chairs, where I signed a whole bunch of releases. I was run through a number of standard memory and cognitive tests: “remember these five words” and “draw a clock face and put the hands at ten minutes past eleven” and “name as many words starting with “F” as you can in two minutes”. I don’t have a great memory, but I’ve done these tests before. I knew it was just to establish a general baseline to qualify for the real test - make sure I wasn’t impaired - but of course I really put a lot into it, wanting to do well. Then, we went down the hall to an exercise lab. They strapped a mask on my face, a heart rate strap around my chest, and put me on an exercise bike. I had to pedal until my heart rate reached 85% of my predicted maximum, to get a “VO2 Max”, used as a proxy for overall fitness. Again, they were only interested in establishing a general category of “fit enough”, but of course I asked to see my numbers and figure out what they meant. (Dan told me I was “toward the top” of his test subjects, but I was then disappointed when I got home and did more research to realize the number put me in the “average” category for my age and sex. I want to be above average, of course!)

The next two visits were to involve a lot of time having my brain scanned in an MRI, while performing a cognitive task and also scanning before and after and the task, while simply lying there in the tube. The difference between the two visits was that one time I would first pedal on an exercise bike for 30 minutes, and the other time while sitting still for 30 minutes, before going into the tube. The MRI was in a different building on the edge of campus, adjacent to  a veterinary facility, betraying U of Md’s land grant college roots. The MRI is a scarce resource - Dan told me several times that it was costing nearly a thousand dollars an hour, so he was excited to have a grant big enough to handle 40 people with two scans each. But also, the scheduling had to be exact, with no wasted time. They have sorted through a lot of test subjects that can’t do the long MRIs, either because of metal in their body or inability to tolerate the confined and noisy space. So Dan was very pleased that I was able to do this. There were a long list of requirements for clothing - besides the obvious of no underwire bra, but apparently a lot of exercise leggings that are shiny have metal in them. So cotton sweats and tees are the preferred attire, unless you are willing to be put in scrubs or a hospital gown. Even some tattoos are problematic for MRIs. Who knew?

The first day, I found the test site, arriving early, just as Dan was also pulling up in his car so he could lead me in. MRI machines are often below ground, always shielded from outside interference, so of course there was no cell or internet reception there. The building seemed empty except for us - me, Dan, another grad student assistant, and the MRI operator. I was the second subject of the day, starting at 10 am. That first day, I sat and pedaled on an exercise bike, in an empty cinder block room with no music or entertainment and my seat got sore - I haven’t been biking in a couple of years. Every five minutes they took my heart rate and asked me for my relative exertion level. After my exercise, I went into the control room for the MRI, where I was stripped of my watch and glasses and shoes, and then the MRI operator wanded me down with a metal detector, like a TSA agent. I was insulated with ear plugs and pads, effectively rendering me deaf. We went into the room with the MRI itself, where I lay down on the pad and had my head caged in and a display fastened on top. I was handed a small keypad with three buttons to use with my right hand for the task, and a bulb to squeeze in case of emergency, and a finger tip heart rate monitor anchored my left hand. I was slid into the tube, and they communicated with me by typing messages that appeared on a display above me. After a moment, they started with the scans. Each was announced with a typed message, like "this first scan will be 20 seconds. Are you ready?"  It took me a beat to realize there was a microphone in there, so while I couldn't hear them, they could hear me if I talked, and they needed to hear me agree each time.

I recall some previous MRI scans as being mechanically noisy, with whirring and banging. These scans were all noisy, but in a more electronic way, beeping and booping and squealing. I couldn't really assess how time was passing, except by what they typed about how long each scan would be. There were some shortish scans, and then I did my "task". They showed me a series of pictures, and I had to push a button indicating whether the picture was new, a repeat of one previous, or similar to one previous. The "new" versus "similar" was nuanced and a bit difficult. I'm not sure how long each trial was - five or ten minutes? - and there were two different trials.Of course I worked really hard to get them right. And then after the trials more scans, some really lengthy, with at least four that were eight minutes a pop. During each scan I made an effort to be truly motionless, and in between I could flex my fingers and squeeze my muscles a bit, but all told it was 75 minutes in the tube. After my task was complete, I relaxed and just drifted while they continued to scan. And each scan had its own song, either high pitched or low, steady or syncopated rhythms, monotone or two or three notes. Finally, they told me we were done and slid me out, uncaged my head, and I got to sit up. I was stiff from staying still all that time.

The second day was just like the first, except instead of peddling on the bike, I sat on it for 30 minutes. My seat got sore again! And they took my heart rate and my perceived exertion every five minutes. They strove to make the session as similar to the first as possible, except for the actual exercise part.

The scan was long and tedious again, except for the tasks. I had been feeling sluggish all morning, and I know I didn't do as well on the tasks - I was conscious of mistakes right after I made them. I don't know if the difference was at all due to the exercise, but I'm sure they'll be able to see a difference. After my tasks, I was nearly able to fall asleep inside the machine, despite the beeps and boops, but I thought actually going to sleep would be a bad thing for what my brain looked like, so instead I mentally sorted through my mess of tools in the basement, trying to come up with a better way of storing things so I can find them again.

So I did my bit for science. I am on a list of potential test subjects for future tests as well - they are always looking for guinea pigs, and apparently I was a good one for them.