2024 seems to be going by in a relative rush despite my time-slowing trip to the hospital earlier this year. We're already in August, which is unbelievable. You may recall that, for me, January started off with my committing to thirty days, uninterrupted, of stairs training. I went at it for all of January, getting to the point where I could do a full staircase (from B1 to the 26th floor). In February, I pushed past the one-staircase limit, getting to at least 1.25 staircases (B1 to 26, plus B1 to the 6th floor). In March, I got COVID for the second time, then in April, I had the breathing problems that I thought were lingering COVID symptoms, but which turned out to be something much worse: heart failure ("severe left-ventricular systolic dysfunction"), which I may have already had for years.
I'm still here, but I'm beginning to think my continued existence on this earth is increasingly dicey (see here, second paragraph). When I made my July meal for the troops, I had enough carby leftovers to eat slowly over the following week, and I didn't do myself any favors by eating them. If anything, I may have damaged myself even further: the Angina Fairy is back with a vengeance, and I've used another three of those nitroglycerin pills to tamp down the chest pain.* I get angina when walking only 500 meters now, and those long walks I'd done after coming out of the hospital—the one to Gimpo, then the one to Hanam—feel unreachable and unrepeatable right now.
Last night, I finally did a 5K walk around my local park, which has a 940-meter trail. Despite the track's being a tiny bit less than one full kilometer in length, five loops is nevertheless like walking 5K because I factor in the 500-meter walks to and from the park from my building's front door. As I walked each loop, I could feel the angina building up in my chest, and the reason I chose to walk in the park was the number of more or less evenly spaced benches everywhere, allowing me to rest like a tired, old man. It's no longer the case that I can rest once, then get up and briskly do the rest of a long walk. Now, I have to rest at regular intervals as the angina builds up again and again. I'm going to keep walking, of course, in an effort to strengthen my heart and minimize my symptoms. I'm also looking into natural blood-thinning foods to add into my diet. Anything to open up and soften the blood vessels.
My diet, since we're talking about it, has also become almost monastically restrictive. I'm no longer doing a loose Newcastle; this now is more like a stricter-than-Newcastle Newcastle. Basically, I eat on Mondays, Wednesdays, and Fridays, then fast the other days. It's a water fast, and I break it on occasion. And what I eat is mostly salads, not even with several chicken breasts like three years ago. Is this sustainable, or will I go crazy? Yesterday was supposed to be a disciplined-eating day (OMAD), but last night, I broke down and had several slices of cheese, which supposedly doesn't spike (or only minimally spikes) your blood sugar, but it did. I paid for my indiscretion this morning: after two days with my BS in the 80-97 range, this morning's BS was in the 140s. The general rule is that anything, even foods with a low glycemic index, will spike your blood sugar. The mere act of ingestion is enough to provoke that response. And with the spike in blood sugar comes the body's response: a spike in insulin. And while insulin does reduce blood sugar, it's also a fat-storing hormone, so insulin spikes don't help you lose weight, which is why they need to be minimized. And if you're not losing weight, this affects your blood pressure. See how it's all connected?
Anyway, we're well past the year's halfway point. I can't wait for summer to be over, and I hope I live to see the end of the year, at least. I'll keep you posted on my walking progress. If I'm really going to do this walk in the fall—and the Nakdong River trail has two or three nasty hills—I need to get myself back up to being able to walk up to 35 kilometers with only a few rest breaks. If I'm sitting down every 500 meters by the end of September, I may have to cancel this year's walk. Expect more news on all of this as I continue the discipline.
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*This is a bad thing. In reading about nitroglycerin, a vasodilator that opens up your spasmed blood vessels to relax the pressure and pain of angina, I've discovered that using nitro too often pretty much guarantees that, if and when a heart attack comes, it'll be much worse than it would have been had I not taken any nitro. Now, if I have a heart attack while walking, I'll at least die doing something that makes me happy. And I've been thinking a lot these days about the things that I value, that make me happy, and that I still want to do.
It might be time to make a bucket list.
Kevin, that was an eye-opening and very candid post. We don't shy away from the heavy, existential stuff here. First read it yesterday, but spent a day trying to articulate a response instead of commenting immediately.
ReplyDeleteSome random thoughts. It's hard to believe you went from summiting over 30 floors to needing to stop after walking around 500 meters in the space of a couple of months. Perhaps your second (or third) bout of COVID did play a role in causing endothelial dysfunction that lead to the very sudden worsening (the decompensated heart failure that landed you in hospital for a week) of an underlying, non-symptomatic heart failure?
I think all of us food lovers (yours truly included) suffer from the early stages of congestive heart failure in the making. Your symptoms just appeared sooner, but we're all headed in the same direction, only primed to arrived at different times.
Curcumin is a great addition to your supplement stack, just be sure to buy one that has high levels of bioavailability to aid absorption. Unfortunately, you are also likely to need some heavy duty pharmaceutical help to alleviate and reverse (if possible) some of the symptomatic heart failure.
Since I want to read about not just this year's walk but subsequent ones as well, I offer the following missives that just might help you reclaim some of that old vitality.
In no particular order:
1. It's not just the carbs but the dietary fat as well that triggers heart disease. If I were your doctor, I'd have you on high-intensity statin therapy (atorvastatin 80mg with ezetimibe 10mg daily) to drastically reduce your apoB/LDL scores. Can't believe the hospital didn't prescribe one. Medical malpractice.
2. SGLT2 inhibitor (metabolic regulation + cardiac remodeling in CHF patients) + Hydralazine (to widen blood vessels)
3. GLP-1 agonist (Wegovy/Ozempic/etc.) Most of your CHF symptoms would improve if you could lose 10~20kg before the walk.
4. Tadalafil (Cialis) 5mg daily - Yes, you read that right. The longer-acting, once daily older brother of Viagra (sildenafil) cuts heart failure hospitalization and overall mortality in diabetic men with heart disease by anywhere from 25~81%. (by improving nitric oxide and blood circulation in the bloodstream, among, ahem, other parts of the body...)
I have never been able to shed my excess pounds, but I think it's pretty much now or never if you want to complete this year's walk without unstable angina.
Low-fat/low-carb, low-everything monastic diet of pretty much only non-starchy vegetables (we're talking 5~700 calories a day) and lots of fasting, which is what you're doing anyway.
And on a subsequent visit to Samsung, I'd recommend a cardiac angiogram to check for heart function/plaque buildup (they run about 3~500k, unfortunately, if you don't have supplementary insurance). As much as I hate surgical procedures, stent placement or balloon angioplasty might improve both your symptoms and lifespan considerably.
Links for further reading:
https://drc.bmj.com/content/8/1/e000940
Statins & SGLT2 inhibitors cut overall mortality for type 2 diabetics by 40~80%
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5099221/
Independent effects of 15 commonly prescribed drugs on all-cause mortality among US elderly patients with type 2 diabetes mellitus
https://academic.oup.com/jsm/article/20/1/38/6986842
Effect of phosphodiesterase type 5 inhibitors on major adverse cardiovascular events and overall mortality in a large nationwide cohort of men with erectile dysfunction and cardiovascular risk factors: A retrospective, observational study based on healthcare claims and national death index data
https://pubmed.ncbi.nlm.nih.gov/36233511/
Effect of Statins on All-Cause Mortality in Adults
So, TL:DR: No, it's not to late. The five-year survival rate in people with late stage heart failure is still over 50%. But radical, immediate pharmaceutical/surgical options are needed. No more saturated fats or diet drinks. No joy in life, period, pretty much. (I feel your pain because I love the fizzy stuff, too.)
I appreciate the advice. My impression of Korean health care, based on the several people I know who've either died of terminal illness or been related to terminally ill people, is that Korean docs tend not to try very hard. There's no MD Anderson level of aggressiveness in treatment here, maybe because of the underlying cultural tendency to fatalism. I'm personally fairly stoic about the prospect of an early death: I've been half-joking for years that I'd never make it much beyond 60, and it looks as though that was more prophetic than I'd initially realized. It's been a good run, and if I die soon, I'll at least die fairly content. Like anyone else, I have a million things I'd still like to do, but what is life if not the amassing of counterfactuals—the should'ves, could'ves, and would'ves? I'm not suicidal: I have no particular desire to die, per se, but if there's one thing I've learned from a superficial study of Buddhism, it's the value of nonattachment. Death comes for us all sooner or later. It is what it is.
ReplyDeleteThe only thing that really bugs me is the issue of how much I'm at fault for my own predicament. The moralistic, finger-wagging Korean perspective would be to take one look at me and think one knows everything, i.e., that my eventual fate could be read just by looking at the surface. Meanwhile, in America (and even in my office where I work), there are people who look as though they're in way worse shape than I am, and they've got no BP problems, no heart failure, nothing. So how much of this is me and my habits, how much is a genetically bad hand, and how much is just the universe itself shitting on me? Hard to say. All I have is a cosmic shrug in answer.
I'm a good way through JD Vance's book. It's gotten a bit more interesting, but you have to slog through the first 25% to get to the interesting stuff about his early life. The first quarter of the book introduces us to the important characters in JD's existence, but it's also a textbook overview of Appalachian culture, the hillbilly honor code, and Ohio/Kentucky demographics, especially the Scots-Irish population. Even once you're past the first 25%, the book is a depressing litany of people doing drugs, getting drunk, screaming at each other, threatening to shoot each other, and sometimes traveling to other states and realizing how different the culture is (and the accents are) outside of one's own narrow little valley. I'm having trouble relating to the hillbilly mode of existence; even the old people seem to have the emotional maturity of five-year-olds. All that screaming and yelling and bitching. I never grew up around that sort of nonsense, but there were some hillbilly-ish family acquaintances who occasionally brought around their miasma of unpleasantness. Christianity factors in, too, but not quite in the way the stereotype goes.
I'll be sure to write more in my review once I finish the book and eventually watch the movie on Netflix. The book, thus far, feels less like a narrative and more like an extended flashback sequence sprinkled through with lectures on history and demography. It's getting more personal, more narrative-y, as the focus narrows on JD's own life and less on his background. I imagine the people who made the movie had to figure out how to turn this meandering series of images and impressions into a coherent story. On that level, I'll doubtless find the film to be quite interesting.