How are you? Fine, thanks. That's the EZ answer.

Today I realized that 'fine' is a very subjective concept.

As Ms. G ages and has had various health challenges, family and friends often ask how she is doing. Often, my response is, "Fine." And most days she is fine, based on the current subjective definition of 'fine' in the objective situation we live in.

A fine day for G means that she woke up feeling good and relatively alert. After arising, she walked safely to the kitchen. Hungry, she ate from the breakfast prepared for her. On a fine day, she can (and will) shower and dress herself and take care of her dental hygiene. She can get her morning medicine from the daily dispenser with only needing help to remember what day of the week it is. She will want to listen to the audio version of her scriptures for at least 30 minutes on a fine day--she can't read them anymore due to failing vision. A fine day may find her spending most of an hour in our community gymnasium working on the stationary bicycle and the exercise machines, after safely walking the 100 yards from our front door to the community center. Later, on a fine day, she may enjoy the lunch prepared for her and then an audio book before a nap. She may call her sisters or one of our kids. On the occasional days that she is better than fine, she may unload the dishwasher or fold a basket of laundry. 

On a fine day, she doesn't ask what city we live in, or what year it is. Or how many children we have or if her father is still alive. She doesn't faint from orthostatic hypotension on a fine day, nor stumble and fall while walking. On a fine day she doesn't sleep for 18 hours, or get lost in our yard. 

Not all of our days count as 'fine.' But most do.

The golden years may not be EZ.

I really, really want to rant. I know this has to be near the acme, the epitome of a privileged, first-world problem. I know I should sit down and shut up. I know how blessed we are, still, this hurts.

Photo credit - Heather Cowper, Flickr. Used under Creative Commons license.

The number one item on my bucket list of earthly delights has been, for some time, a Danube River Cruise with my sweetheart. Deluxe top-of-the-line service on a world-class ship, an upgraded stateroom with a balcony, evening drinks watching the sunset over the river from the shaded upper deck, guided excursions in Southern Europe's historic capitals and art musea, dining with the locals, symphony concert in  Vienna's  Musikverein Orchestra Hall, first-class air travel round trip, two nights in a luxury hotel in Budapest before the cruise.

Photo credit - Alex Talmaciu, Flickr. Used under Creative Commons license.

Importantly, to be most enjoyable, this trip needs (or needed) to happen while Glenda and I still enjoy good enough health for the travel, the walking tours, and such.

I have saved my pennies for years for this trip. YEARS.

Finally, in 2020, we can do it, we thought. Over a year before the trip, in July of 2019, we sought out a travel agent to help plan and arrange the travel. I have normally done all of our own travel arrangements, but this trip is complicated, with many international requirements and connections not to be missed. With the agent's help, we selected and booked a cruise with Avalon Waterways. We would leave Phoenix on August 3, 2020, and fly by Delta's best class of service to Budapest, Hungary. There we would spend two nights at the JW Marriot hotel, giving us time to overcome jet lag and to enjoy the relative luxury of the surroundings. After two nights of rest, we booked an escorted private tour of Budapest, concluding with a formal catered candlelight dinner for two on a balcony overlooking the 17th Century Chain Bridge crossing the Danube between the sister-cities of Buda and Pest. The next morning would begin our 8-day cruise with Avalon, visiting a new European treasure of a city each day with appropriate tours and such. Nights aboard the boat as we sail to a new city.

Then came Covid-19.

Today, May 12, 2020, Avalon notified us that all operations are canceled through August of 2020, including, of course, our August Danube Cruise. They really have no choice, as the government of Hungary is not allowing any international travel into the country right now, anyway, and it's unknown how long that will go on. They are allowing us to use our paid fares, along with an additional $400 credit, through 2022. Delta has also said that our airfare can be used as a credit for rescheduled travel through, I believe, September of 2022. So while the money is tied up with Avalon and Delta, it is not lost.

Photo credit - Krisijan Brkic, Flickr. Used under Creative Commons license.

So nothing is lost but time, right? Yes. But time...time becomes so precious when most of your time is certainly behind you. Or, as Bonnie Raitt puts it, "Life gets mighty precious when there's less of it to waste." Nick of Time (1989)

I made it EZ-ily.

I made it through my partial daily fast to 4:00 pm, at which time I consumed a small plate of leftovers followed by a quarter-cup of cashews as a treat. Nothing, then, until dinner at 6:30 pm, which was about three ounces of roast beef and some vegetables in brown gravy from Sunday's pot roast--no seconds, no dessert, and nothing but water afterward. I met my goal for the day! While not EZ, it wasn't as hard as I expected, and I surely consumed fewer calories and less bulk than I normally do. Yay, me! I'm going to try the same tomorrow. I think I'll plan a regular breakfast and light lunch on Thursday then another partial fast on Friday. Saturday is likely to be a heavy eating day as we are having family over and I plan steaks and baked potatoes.

Fasting? But eating is so EZ!

Of late, much has been written about the benefits of fasting. You can easily find an embarrassment of riches of opinion and stories extolling the sweeping and unexpected benefits of fasting. Such is available online at sites such as Medium, Pocket, and Facebook as well as in scores of books and articles, both electronic and print. A recent perusal of Amazon found over 4,000 books available on the topic of fasting—a Google search identified over 50,000 references to fasting on Medium.com. Healthline.com lists six popular ways to fast: 

1. The 16/8 method: you fast for 16 hours each day. I've often used the inverted 16/8 method where I eat for 16 hours each day;
2. The 5:2 method: you fast for 2 days per week;
3. Eat-Stop-Eat: you do a 24-hour fast once or twice a week. If you do it twice, does this also count as an application of the 5:2 method?
4. Alternate-day fasting: you fast every other day;
5. Warrior fasting: you fast during the day, eat a huge meal at night. This is particularly popular in the Middle East during Ramadan. and, finally;
6. Spontaneous meal skipping: you fast when it's convenient to skip a meal. This is also known as the "I've got a life" method.

Depending on what you read and who has written it, the possible benefits are broad and deep. Claims include that fasting:

•          Reduces insulin resistance;
•          Fights inflammation;
•          Improves blood pressure and controls lipids;
•          Boosts brain function;
•          Prevents neurodegenerative disorders;
•          Reduces calorie intake while boosting metabolism;
•          Increases growth hormone secretion;
•          Delays aging; and
•          Aids in cancer prevention and increases the effectiveness of cancer treatments.

Note that the listed benefits are “possible.” The science around fasting is not yet settled. And while there is a ton of anecdotal evidence and there are apparently supporting studies for many of the benefits from prestigious bodies such as the University of Michigan, Harvard Medical School, the National Institutes of Health, and Dr. Phil. It is also easy to find published studies and opinion that claim that fasting can be harmful as well as unpleasant and can even worsen your breath and body odor. These negative claims come from prestigeous bodies such as the University of Michigan, Harvard Medical School, the National Institutes of Health, and Dr. Phil. 

I don’t know if there has been an unusually large number of such articles directed to me in 2020, but it certainly seems that way. Perhaps it’s just the annual New Year’s Day resolution rush. There’s a good chance I’d find a similar spike in the publication and discussion of the benefits of less alcohol, regular workouts, running, meditation, ample hydration, and safe sex as well. For this New Year, I have made my usual resolution. I’ve even written it down: “Don’t make promises you can’t or won’t keep.”

Still, my reading this year has me pondering fasting. Should I try it? Could it be right for me and my health? There are lots of reasons for and few against fasting.

Arguments For Fasting:

Since my retirement at the end of 2017, my weight has continued to creep upwards. I now weigh in the vicinity of 236 pounds and that’s too much. My muscles, bones, and joints as well as my heart, would be happier if there were less of me to carry around. Fasting may help with some weight loss. In a study published in December 2019, Harvard found that intermittent fasting, defined as severely limiting caloric intake for about two days a week, may be as effective for weight loss as long-term calorie-restrictive diets.

It could be good for others for a couple of reasons: (1) My professed religion teaches the value of fasting for a 24-hour period once each month. We are asked to abstain from food on one Sunday of each month then donate the cost of meals not consumed to a fund used to provide assistance to the less fortunate. The church uses these funds to operate a huge international welfare program which PBS called “the world’s best” in 2016. We are taught to fast with a spiritual purpose and to pray and study about that purpose during the fasting period. Other beliefs, spiritual and secular, also ask for self-denial, giving to others, and meditation, so this is not an unusual teaching. (2) In August of 2019, NBC News published an article by Dr. Samantha Cassetty claiming that the best way to protect the planet from the scourges of overpopulation is to simply eat less. CNN and the BBC have published similar popular science pieces. Lose weight and do good for others at the same time.

Fewer dishes to wash and reduced time grocery shopping.

So if I could lose weight, improve my health and my spirituality, and help others all in one action, why wouldn’t I? Irresistible!

Arguments Against Fasting:

The discomfort of hunger. That’s about it. A day of fasting isn’t going to have negative health impacts. Humans don’t starve to death that quickly. An old survivalist saw called The Rule of Threes said something along the lines of, “A person can survive three weeks without food, three days without water, three hours in extreme heat or cold, three minutes without oxygen.” I wouldn’t plan a fast of anywhere near three weeks in duration.

Still. I hesitate. Remember that poor impulse control I mentioned earlier? A lot of that plays very closely with my enjoyment of and appetite for food. I’ve never even been very faithful at fasting the one Sunday each month as I’ve been taught to do since my youth. And my New Year’s resolution? I don’t care for the idea of trying something that I’m not convinced I can succeed at. I’ve always been a believer that success builds success so I have often limited myself to things that I’m pretty sure I can succeed at. Why would I want to promise myself a fast if that is setting me up for failure? I ate today’s breakfast three hours ago and I’ve had a snack of cashews since then. And I feel hungry. And there’s food available…

Winter wasn't EZ.

TL;DR: Among the many things your body may need, oxygenated blood is rather high on the list.

I have, once again, begun the C25K (Couch to 5K run) program. You may note the word, “again.” The word is appropriate because I first started the program in early February of this year, but failed in that attempt. In case you are not familiar with the C25K program, I offer the following from the C25K Website [http://www.c25k.com/]: “C25K is a fantastic program that's been designed to get just about anyone from the couch to running 5 kilometers or 30 minutes in just 9 weeks.”  There, they claim, “Josh [Clark] wrote the C25K program in 1996. Since then many thousands of couch potatoes have become runners because of Josh's work.”  As stated, the program intends to help get people up off their butts and into a better state of fitness. That goal is reached by providing promptings that lead the participant through an increasingly strenuous 30-minute-three-times-weekly exercise routine. It starts off being seemingly really, really, easy. The first day of week one includes a 5-min warm-up walk and a 5-minute cool off walk at the end, with short periods of walking and jogging interspersed through the other 20 minutes of the routine. Initially the walking periods are longer than the jogging periods. The C25K app on a smart phone (I use an iPhone 5) provides verbal and vibration prompts like, “OK! Let’s jog now.” and “Whew, now let’s just walk.” in a soothing and encouraging voice in the gender of your choice.

So, if it’s so easy (and as I completed Day 1 of Week 1 yesterday it did seem quite easy) why did I fail in February?  I’ve had a rough winter. I’ve written in an earlier post (January 31, 2016) of my run-in with cancer and the initial surgical treatment that I received. As part of my patient education, my oncology surgeon told me that among the side effects I should expect would be fatigue and shortness of breath that would likely last a “few months,” but would get better with time. The more I walked and exercised, he said, the more quickly those side effects would pass. So, by early February, still suffering from fatigue and shortness of breath, I decided to try the C25K. In my suburban San Antonio neighborhood February weather is often perfect for outdoors exercise and I’ve got a great around-the-block route of just over ¼ mile on flat land right at my front door (and observant neighbors to call 9-1-1 if I drop out); perfect conditions for a beginner. So I downloaded the app and spent some time configuring and getting to be familiar with its features. I bought some new running shoes and pulled some running shorts and a t-shirt out of my dresser. By golly, let’s do this!

And I could not. The five minute warm-up left me puffing. I could not sustain the first minute and 30-seconds of jogging. Before I had completed the first ¼ mile lap around the block, I was stopped, leaning on my knees, gasping for breath between gagging and hoping somebody would call 9-1-1.

A little background: By February of 2016 I was 65 years old. My BMI is greater than my doctors would like it to be by about 10 or 15% (at 5’ and (nearly) 11” tall, I weigh about 215 pounds which puts my BMI at about 30 to 31—right on the border between overweight and medically obese). I’ve never been a runner as it’s not something that I’ve found pleasurable. But, prior to my surgery, I was not exactly just a couch potato, either. I have always walked a LOT and enjoyed that. On travels, I could generally walk younger and thinner companions into the ground while touring places we visited. For several years I had been doing a morning routine at least 5-days-week that included about 30 minutes of yoga-like stretching and light exercise (I’ve even taken a couple of yoga classes – call me Yogi). I had been using a pedometer app on my phone to encourage and track walking for about a year. In fall of 2015, my youngest daughter, Jennifer, and I successfully completed a 20 mile bicycle ride as part of the Tour de Cure raising funds for diabetes research and treatment. So, not an athlete by any stretch, but not totally sedentary either. The recuperation from my December, 2015 surgery had put nearly all of my physical activities on hold. By February I had decided it was time to get active again, hence, the C25K. But I failed—after that first attempt at Day 1 Week 1, I could not get myself to try again.

Over the next few days and weeks, the fatigue and shortness of breath did not get better, if anything, it seemed to be getting worse. On a cool and blustery Saturday, while on a shopping trip with Glenda, I was unable to walk up a slight incline 20 meters from our vehicle to the store. Finally, by mid-March, I determined that there must be something other than the side-effects of the December surgery bothering me and made an appointment to see my primary care physician. After a cursory unremarkable exam and her review of my records, she said, “It’s been nearly 13 years since you’ve had a complete cardiology workup, why don’t we refer you to the cardio clinic and get that done.” So a week or so later, on the 22^nd of March, 2016, off I went for my appointment at the cardio clinic. As is normal procedure for a medical appointment, my vital signs were checked and recorded. Then, as the first step of the cardio evaluation, I removed my shirt, laid back on the exam table, and was wired for an EKG. As the machine began to hum, I noted the technician’s eyebrows quickly raise, and she asked, “How long have you had atrial fibrillation?

“What? Never, that I know of. I had an EKG prior to my surgery in December last year and it was normal then.”

“Well,” she said, “You’ve got a pretty severe case of it now.”

A few minutes later I was visited by the clinic’s lead cardiologist. She explained atrial fibrillation (A-Fib) to me. Basically it’s when the upper and lower chambers of the heart are not working in the proper rhythmic order. This diminishes the heart’s ability to supply the body with enough oxygenated blood. Symptoms: Fatigue and shortness of breath. Huh. Some people can feel palpitations in their chest, and, if it gets severe, tingling or numbness in the extremities or light-headed feelings. Because the blood pools and is not moved properly, clotting can develop and that can be fatal. So A-Fib is something you don’t want to ignore, and, this diagnosis goes a long way toward explaining why my fatigue and shortness of breath had only gotten worse rather than better after my surgery. So, what’s next?

After a thorough review of my health and medical history (including the very complete cardio workup from 2003) the cardiologist prescribed a procedure called an electrical cardioversion (CV), where the medics basically stop and then restart the heart with electric shock much like that delivered by an automated external defibrillator (AED) device. The procedure is done as an outpatient day-procedure and the patient must be on blood thinner for at least two to three weeks prior to the procedure to prevent blood clots (and lawsuits) that might occur with the CV. So I was prescribed twice-daily oral doses of 5 mg of apixaban, told to confine myself to “gentle” exercise—but to walk as much as I was comfortable with, and scheduled for the CV procedure at that same clinic on April 29, 2016. In the meantime, the doctor said, if you feel tingling in the extremities, light-headedness, or sever palpitations in the chest, get to the emergency room as quickly as you can. The date of the scheduled CV was significant, as Glenda and I had planned to leave on or about the first of May for a three-week long trip visiting family across the Intermountain West. If the CV went well, we could still go. If not, the family could all gather here in San Antonio.

Crank the clock hands forward to Sunday, April 24, 2016. On the way home from church, I told Glenda, “I am feeling truly exhausted, probably just tired from overwork on the yard Saturday. When we get home I don’t want to eat, I just want a nap.” Which I got, but after sleeping two hours I didn’t feel any better. We retired early that night and I slept nearly 10 hours but got up Monday morning feeling, if anything, worse. By now all of my long muscles were aching—surely an artifact from all that Saturday yard work. I went to work anyway as there were things I needed to get done. By 9:30 AM in my 72^o F. office I felt like I was freezing. I had the shivers so bad that my gut was shaking internally. I thought to myself, “Well, it’s warmer outside (this is San Antonio, after all) I’ll go out and walk a bit, stretch my muscles, warm up, I’ll feel better.” Walking outside did NOT make me feel better. In fact, I noticed that I was feeling a tingling in my fingers, felt a little bit light-headed, and could feel the palpitations of my heart racing in my chest. Let’s see, what was it the cardiologist said, if I feel….or….or, wait, I’m feeling all three symptoms at once! So, being the sensible fellow I am, I drove myself the 11 miles or so from my workplace to the hospital’s ER.

At the ER, the triage nurse did not ask me to have a seat in the waiting room. She seated me in a wheelchair and immediately took me to a treatment room where I was stripped and gowned and, again, wired for an EKG. The EKG tech asked if I knew I had A-Fib, and I was able, this time, to say that, yes, I did know. Reviewing my medicine list, he asked if I had been taking my blood thinner per instructions and I answered in the affirmative. “OK, he said. We’ll get you on a gurney and a monitor and I’ll have the cardio doc on call come see you soonest.”

Lying on the gurney, under four blankets, I was nearly asleep when the cardio doc came to see me. After a few cursory checks and discussion, he said, “Well, you seem stable. Let’s send you home now and we’ll see you back on Friday morning in the cardio clinic for your CV.” With that he left.

Less than five minutes later, he was back: “We’ve changed our minds. We are going to admit you overnight and do the CV here tomorrow morning.”   OK. So, I’ll be spending the night in a hospital for only the second time in my life. The first was last December when I had the prostatectomy.

During the admission process, the staff finally got around to checking all of my vital signs. Wait, repeat that temperature. Let’s use a different thermometer. 104.8 ^o F.! Note, reader, that my normal is around 97 ^o F. As a result of the fever, the medics decided they needed every possible diagnostic sample to look for the cause of the fever so I was stuck, swabbed, drained, and swiped everywhere you can think of (and a couple places that surprised me). I was moved to an isolation room on the ward and sedated with a saline solution IV and there I drifted off to blissful sleep.

Shortly after awakening in the morning, the entire cardio doc team showed up in my room. My hospital is a teaching hospital so there was a cadre of students, interns, residents, fellows, and attending physicians. The attending physician introduced the team and told me, “We have good news and we have bad news.” Great.

“Give me the good news first—I need some good news.”

“The good news is there is nothing wrong with you that would have a negative impact on the CV. We will still do the CV this morning, probably around 9:00 AM.  The bad news is that the tests confirm that you have influenza-b and it will take you 10 – 14 days to really feel well again, no matter what we do.”

Another note for the reader: I had been administered a flu shot in October of 2015. I have not generally made it a practice to get the flu shot, but happened to be in a clinic one day when they were being administered at no cost, so... Alanis Morissette would see the humor in the situation as it developed.

So, true to their word, I was taken for the CV by way of rolling gurney 9-ish. I was prepped by a nurse-practitioner with the connection of the necessary IV tools for administering the sedative and the shaving of my chest. The electrical terminal pads are adhered to the chest in front and on the back just opposite rather than paddles to the left and right as with an AED. Shaving minimizes pain later when the terminal pads are removed. With some additional explanation, then introduction to the physician and team who would be administering the CV, I received some sedative through the IV and drifted off to sleep.

Now, for those who have never been anesthetized, it is not like regular sleep. When you sleep, upon awakening you have a sense that time has passed. You may not have an accurate sense of how much time, but you will know that time has, indeed, passed. When you awake from anesthesia there is absolutely no sense of time having passed. It is as if you had simply not existed from the time you lost consciousness until awakening. Death must surely be something similar. On that day, when I awoke, still achy from the flu, the very first thought in my head, fully formed but unbidden, was, “Wow! I have not felt this good in weeks!” I almost wanted to jump up and run around. It is absolutely amazing what a difference having a decent blood supply to your entire body makes. I highly recommend it!

The rest of the recuperation was unremarkable. During the day, after the CV, an echocardiogram and other tests were done to evaluate my heart health. At the end of the day, the docs told me that all was well. The heart and valves seemed very good for my age; no artery blockages noted. The hospital staff sent me home later that same day. Glenda and Derek’s family came to take me home, and they were a welcome sight! My only new restriction was to wear a breathing mask to reduce the chance of spreading the flu. Within a few days I was back at work. At the advice of my cardiologist, I bought a FitBit and started tracking my walking – 4,000 steps per day, increasing to 10,000 as a goal now. And yesterday, I, again, started the C25K challenge. This time I was able to complete the full 30 minute workout without undue distress. The app tells me that I covered 1.92 miles in the 30 minutes. My FitBit tells me that I ran for 24 minutes, burned 293 additional calories, and had an average heart rate of 124 bpm during the exercise. I feel pretty good about that. I also did my morning yoga routine today for the first time in ages and ages. It wasn't pretty (it never was or will be), but I got through it.

So, that’s why the word “again” is important in my lead sentence. And, as usual, shows that nothing truly is ever easy.