blood sugar, no sex, no magic

As I may have mentioned, at my July 19 appointment, the diabetes doc removed all of my heart-related medicines after I'd complained about my relentless daily diarrhea, which had gone on nonstop for two months. Recently, in my entry about going to Insa-dong to pick up my scrollwork, I complained about the return of my angina. It seems there's a trade-off no matter which way I turn. My next doctor's appointment has been set for October 15, a bit short of three months later. (I kind of hope that that's the routine from now on: basically once a season.) During that time, managing my BP and my angina is totally up to me. I have no cardiac meds to support me, and should I need more nitroglycerin tablets, I'll have to ask my local doctor to prescribe them. While a part of me has wanted a radical reduction in meds for a long time, a lazier part of me is sad not to be able to rely on cardiac meds to do the heavy lifting when it comes to my heart. I also have to wonder whether the diabetes doc's decision to nix all the heart meds has to do with her bias: she's not a cardiac specialist. I'm actually not sure why, two appointments ago, it was decided that I no longer need to see a cardiac specialist. Is the medical system giving up?

My blood pressure has gone substantially up since I lost access to heart meds (133/77 this morning), so I'm doing what I can on my own to tamp my BP back down. Powdered turmeric actually seems to be helping a bit, and I've only recently gotten back into stairs training. It's too early to say, but it could be that these two factors are helping me to stave off the worsening of my heart failure, at least for now. Heart failure never gets better; it can only get worse, and that's true whether its congestive heart failure or LVSD (left-ventricular systolic dysfunction, which is what I have). But things can be done to mitigate the worsening, and I'm hoping to strengthen my heart to the point where I can walk 10 or 20K without having to stop.

With the stairs, I'm starting small: right now, I'm doing only three floors in my apartment building, from B1 to 3. I thought about wearing a weight vest and sticking in 10 kg worth of weight, but I'm worried about rapid-onset angina quickly morphing into an out-and-out heart attack. For now, three floors is good: I can handle that. At regular intervals, I'll keep adding floors to the routine, with the goal of being able to do one entire staircase, from B1 to 26, by the time I'm ready to leave for Busan. My left ventricle might have decided to crap out on me, but I can strengthen the other three chambers of my heart. (And since I'm now convinced that I was doing the stairs while suffering from heart failure at least as far back as January, I know that that's possible. Or at least, it was possible. Maybe it will be again.)

As for blood sugar, well, I've still got meds for that. My radical diet continues (sort-of OMAD + Newcastle + 24-hour fasts): eat MWF, fast on all other other days. These aren't full-on fasts, though—I don't seem to have the willpower to pull those off. So I often break down and eat a couple slices of cheese or a handful of nuts in the evening, just to get something into my stomach. It doesn't seem to matter that much: my blood sugar, lately, has been either around 90, as it was this morning, or somewhere in the low 100s. I credit the meds more than my own efforts at diet and exercise, but diet and exercise can't be hurting.

My hope is that, as the weeks pass, and I get better at my chosen exercises, I'll start to see a buildup in muscle strength that will kickstart my metabolism and have me losing more weight. Dumbbells, kettlebells, heavy clubs, bodyweight calisthenics, resistance bands, and animal flow will all help with that. I had regained a shameful amount of weight during my "break" from the diet after the 7/19 doctor's appointment, but since then, dieting has become easier because the angina, which recurs when I either strain myself during exercise or eat too much in the way of carbs, keeps me scared.

During a Skype conversation with my buddy Mike this past Sunday, I noted the actuarial statistics that say the one-year post-diagnosis survival rates for heart failure are close to 100%, but the five-year rates drop way down to about about 35-50%. My own timeline, though, may have started earlier than the diagnosis: I've been experiencing angina, on and off, for years, but I just didn't know what to call it. Breathlessness, that feeling of the skeletal hand squeezing my heart—I've been describing these symptoms on my blog since I don't know when, so it could be that I'm already past the one-year post-diagnosis mark and am now in the thicket of the 2-5-year period, when my chances of making it five years are effectively less than half. Remember when I used the analogy of the paper airplane that flies straight for a while, then wobbles, then suddenly crashes? (Again, see here, second paragraph.) That could be where I really am—the wobble before the sudden crash. It would certainly explain how I went from doing 26 floors of staircase training in January to being a wheezing, gasping mess in April. Something inside me may finally have broken.

And as I noted in a comment, I do feel a sense of injustice about all of this. Sure, I've had bad eating habits that helped to put me in this position, but there are Americans out there, many wider than they are tall, who somehow have okay blood pressure, no diabetes, and no heart failure. Doesn't seem fair. Maybe I'm just in denial about my own role in my predicament.

Anyway, God's given me several wake-up calls, and maybe I'll finally stop being stupid and stubborn about them. That's what I'm working on now. I'll still be prepping extravagant meals for my boss and coworker, but I'll be sure, from now on, to eat very little of what I make since I know the Angina Fairy will quickly pay me a visit should I step over the line. And it'll only be a cheat meal, from now on, instead of a cheat day or, as I described in a different post, a cheat week. The penance will be long and hard, and maybe, just maybe, I can squeeze a few more years of life out of my situation.

ADDENDUM: news from 2020: Farxiga (dapagliflozin) for heart-failure patients. 18% reduction in death rate. Frankly, I'd rather have a nice injection of stem cells to rejuvenate my heart, but even though people have been researching this for over a decade, stem-cell therapies for heart failure aren't quite ready for prime time yet. Oh, yeah: Farxiga is for Class II-IV heart failure. I'm between a Class II or III. See here.