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Thanksgiven: Sunday musings…11/27/22

1 Thanksgiven. What you’ve accomplished over the Thanksgiving weekend if you’ve done it right. Should be a word.

2 Hurt Locker. One of the things I am thankful for is that my IT band appears to have forgiven me, and my surgeon, for initially making my right leg almost an inch longer. My IT band and all of the muscles that reside in the vicinity of the Tensor Fascia Lata (TFL), the muscle that tenses the IT band, have been in full revolt since post-op day 9. That would be 10+ weeks ago for those of you keeping score at home (or suffering along with me).

What turned the tide? Beats me. Might be stopping all of the traditional PT I’d been doing, all of which was particularly vexing to that rat bastard, the TFL. Perhaps it was my dedication to using the very space age red-light laser gifted to me by research partners at the time of my left hip replacement in 2019, or the professional grade ultrasound unit I’ve been using on the daily for a couple of weeks. Beth has continued to lend her elbow for some (VERY) deep tissue massage each night.

More than likely it’s the fact that my right leg is now at least a quarter of an inch shorter than it was right out of the gate after surgery. Less lengthy seems to equate to less cranky. All I know is that it only takes 5 minutes for the “wake up pain” to subside now, and I can walk all of my required daily distances without pain.

Now if the pesky groin muscle I pulled while putting on my socks would just let me get on with my life…

3 Ritual. Another Thanksgiving weekend has come and gone for the White family. By most measures it was quite a nice weekend, thank you very much. We had our entire little family together for a couple of hours on Thanksgiving Day, complete with all of the grandchildren, and even our “extra son” Alex. There were lots of opportunities to spend time with smaller groups over the weekend as well. Beth timed everything perfectly, and the amount of food was so dialed in that we will be through all of the leftovers by the end of dinner tonight.

Pretty much crushing the post-Thanksgiving dining rituals of days on end of turkey, stuffing, and pie.

As I wrote in the “Thanksgiving musings…” we are a family of rituals. Do something twice and it’s a tradition; once more and it’s as much a ritual as anything you see on the altar at Sunday mass. Many of the White Family rituals were observed at my brother’s house this year as he hosted my Mom and one of my sisters and her family.

Here? Bit of a mixed bag to be honest. Change is the order of the day as our children and their families grow. However, the one ritual that remains in place is the ritual of coming together in real life. Being together in “reach out and hug” distance as much as possible over the weekend. For all of the wonders of our modern modes of communication, assembling as a family on this Holiday of thanks remains, for now, the essential ritual of Thanksgiving.

May we always have Thanksgiven for this.

I’ll see you next week…

Thanksgiving musings, Revisited…

Sunday musings…

Here is my annual Thanksgiving “musings…”, lightly edited to be up to date.

Thanksgiving is by far and away my favorite holiday. Not even close. Maybe it’s because I’ve always had so much to be thankful for, always had pretty much everything I need and at least a bunch of what I (thought I) want. Seriously, I can’t really remember a single Thanksgiving in my entire life where I thought the ledger was tilted to the minus side, where I just couldn’t find so much more to be thankful about than not.


Oh sure, there’s always something to gripe about. I’m not really sure what it is at the moment, but Beth called me out last night for basically being an edgy grump. Guilty, but cluelessly in retrospect, even though I managed to come up with a reasonably coherent attempt at an explanation at the time. Still, it’s almost Thanksgiving, and I’ve gotta get my…ahem…stuffing sorted out.

One of the attractions for me to the day is that there are no real obligations. No gift giving. No “X shopping days until” stuff. Heck, I’d love to see a bit of Thanksgiving cheer around town, in stores and restaurants and such. Like we didn’t know all of those Christmas lights were already up the week before Halloween just because you didn’t plug them in?! Sheesh. Throw me a bone. Gimme a turkey and maybe a pilgrim hat in the window, just for a couple of days. Let me revel in the holiday where there’s really no revelry, just for a moment.

Oops…edgy grumpy again. Sorry.

Thanksgiving is so much more precisely because it’s so much less. Your family, such as it is at any given time, gets together and you eat turkey. Simple. You gather around a communal table, pass around whatever traditional fare constitutes your family’s meal, and talk all over each other with your mouth full. Everyone is more pleased to be together than not, even your cranky aunt who always–ALWAYS–tells you to swallow your food before you answer. Even she is OK on Thanksgiving.

There’s a sameness to Thanksgiving, at least in our minds, and I think that’s part of the joy, the comfort of the holiday. Close your eyes, sit back, and just for a moment think about Thanksgiving at your house. Don’t pick a particular life stage, just let it happen. What do you see? Man, it’s like seeing my life scroll out before me in countless little pictures and video snippets. My timeline is notable for one very important thing: at no point, in no image that flashes before me, am I alone.

What do you see? There’s football in mine. Lots and lots of football. The first memory in line is football. It’s so cold at the Southbridge/Webster HS game my hands feel numb typing. I had my first cup of coffee that day; they were all out of hot chocolate. You played and then came home, or went to the game and then came home. Yup, football and fires in the fireplace, and so, so much food. And there’s always that one, strange, once-a-year food, right? Peanut butter filled dried dates, rolled in pure sugar for us. Like a bite-sized PB&J. That’s the one I remember. It was always up to just one or two of your family members to make that weird little treat, too. I flash on my youngest sister as she rolls the dates in the sugar, feigning anger as her siblings snitch them off the plate as quickly as she rolls them. My tongue sticks to the roof of my mouth at the memory of those little sugar bombs.

As you sit there and move through your Thanksgiving montage you begin to notice something, though. At intervals that are not really regular, but they are there just the same, something changes. Maybe you moved, and the dinner table is different. There are some new characters around the table, a girlfriend here, a husband there. Sometimes something is missing. You run back the tape. You look and you look, but try as you might, someone isn’t there. All kinds of reasons for this, of course, but the first time you scroll through a significant change–venue, menu, cast–it shakes you a bit, right? Your brother got married and has to share the holiday with another family. Your sister was deployed; no Skype, FaceTime or Zoom back then to sorta, kinda, fill the space. Mom or Dad, Grandma or Grandpa, someone is no longer here to be there at all.

Here, I think, is where edgy, grumpy Darrell is probably coming from. If you’ve been around long enough, and Heaven knows I certainly have, you’ll scroll through more of these changes, these inflection points if you will, than you really realized were happening at the time. New families. In-laws. Another generation arrives. If you could somehow go back even further, before your own little Thanksgiving memory tree started to grow, you’d find that there’s nothing really unique at all in this little part of Thanksgiving.

Change, growth and change, are also part of the magic of the Holiday. What was it like for my Mom to move with her new family to a Thanksgiving in her own home? Family lore has it that my Dad’s family was more than a little unhappy with his move all of one county away from the hometown that still housed his relatives. What was he thinking those first couple of Thanksgivings at my Mom’s house? For that matter, what was it like in their homes at Thanksgiving when they were the same age as their grandchildren are now?

Did they have peanut butter-filled, sugar-rolled dried dates?

Every day is new. Each one is different from the last, and Thanksgiving can be no different. This week there will be much that feels like so many Thanksgivings of yore, yet it will be new as well. New babies and new lives and new places. New additions brought into our oldest traditions. Things and people to adopt and love as much as all we’ve loved before. Edgy? Well, it’s almost certainly because so very much will be new this year in our little Thanksgiving at Casa Blanco. New brings a bit of uncertainty, doesn’t it? Yes, for sure, it does.

But with certainty I can say that once again, as with every Thanksgiving, I will have much more to be thankful for than not. The ledger will be long on thanks, needs comfortably covered, wants undoubtedly as well. I will be surrounded by those I love; when the scroll is run in the years ahead I will see my people. Of this I am quite certain.

And there will be dates. Sticky, gooey memories to begin the next generation’s Thanksgiving story.

Happy Thanksgiving. I’ll see you on Sunday…

At Work: Sunday musings…11/20/2022

1 Rafter. The name of a group of turkeys. Another nonsensical, can’t make it up animal fact, however appropriate the timing.

2 Bullseye. “That’s like drawing the bullseye after you already shot.” Dr. Vinay Prasad.

It almost doesn’t matter what facts you are espousing, this one rings true, especially in this fraught world in which even basic science has been politicized. Prasad was discussing research on cancer in this instance; he is a noted scold of the scientists and physicians who have been in the public eye with all manner of science driven by expedience, not the scientific method.

This applies to any and all research. Literally anything you can measure or test. Science, real science, is declaring your hypothesis, your target if you will, BEFORE you shoot.

3 Diversity. Oh my. Oh my, my, my. As quoted in the WSJ on November 5th, David Lat said the ultimate “quiet part” out loud on diversity in highly selective schools at all levels. In an essay first published on Substack.com he describes what “diversity” actually means for elite preschools and elementary schools in NYC, ancient prep schools in New England, and the likes of Harvard and UNC which are now appearing before the Supreme Court defending their diversity efforts.

These schools are seeking “visual diversity”.

Mr. Lat has done the heretofore unthinkable by saying this out loud and giving us his thoughts at a skin-deep level (Mr. Lat is Asian-American; he opines that White-Americans have greater visual diversity than do Asian-Americans and other people of color). I’ll let you search for the essay on WSJ or Substack if you wish.

4 4-day. As in 4-day work week. Or, for that matter, remote work. Pundits of all sorts have been bleating about the elevated “humanity” of the 4-day work week and remote work. As if any employer who fails to acknowledge that their workers can achieve whatever their job entails in less than 5 days each week is somehow inhumane. That the workers will be more empowered, more “seen” if they can do their job from whatever spot on the planet they may find more to their liking than the home base of their employer. I’m calling BS on this point of view coming from the navel-gazers of the intellectual crowd, the “digital class” who simply refuse to acknowledge that a massive percentage of people with jobs do not simply sit in front of a computer and think.

Like the lovely woman who did such a fantastic job cleaning the hotel room I stayed in last weekend in NYC.

I work in healthcare. My day job is eye surgeon. Like almost everyone in healthcare, in order to do my job I must be physically present. There is nothing inherently of greater importance or somehow more noble about my particular “gotta be present” job. The EMT who was killed in Cleveland last night, run over while tending to a car accident victim, could not have done his job from behind a screen at home. The police officers at the scene, likewise. The butcher, the baker, and the candlestick makers? Ditto. And if we all only go to work 4 days each week instead of 5, either someone else must fill that slot or the work doesn’t get done.

This has been sticking in my craw for a very long time. There is an unspoken but very real dismissal of work done face to face by at least the most outspoken of the digital class. It borders on contempt in some instances. In the command and control world that these folks wish they were running it’s as if each one is the proverbial engineer designing the cockpit for a new fighter jet and failing to remember that in order for it to fly there needs to be a pilot sitting in that seat. Woe be it unto the test pilot who is the first one to point out the effect of this oversight to those same engineers.

We may begin to make more stuff in the United States now that all of the keyboard captains of industry have realized that a far-flung supply chain may not be in their, or the country’s, best interests. Surely there will be more robots in the factories that build our stuff than there was at the start of the Industrial Revolution, but to make the factories run men and women will need to come out from behind their screens and, you know, build stuff. With their hands. Right there, on the line, in person.

They matter, too.

All work has nobility. If one worker works less, another must be there to complete the job. In the service industries such as retail, hospitality, and yes, healthcare, on location is where the job gets done. Please don’t try to tell me that we should be more concerned about how inhumane it is to make an engineer at Facebook–I’m sorry, Meta–work 5 days a week in the office. Doctors and nurses, firefighters and police officers, and that lovely woman who made my stay in a tired, old Mid-Town Manhattan hotel a bit brighter all deserve to be acknowledged, supported, and celebrated.

We are all there when you need us.

I’ll see you on Thanksgiving…

Every Vacation Is Too Short: Sunday musings…10/30/2022

1 Gallimaufry. A confused jumble or medley of things. Not a new word for “musings…”, today pretty much how I see every airline or hotel booking.

2 Booking. Pretty sure I’ve done this before. While adding stuff to my Outlook calendar, you know, in case I don’t have my stapled 8×11 stapled pieces of paper with me, I noticed a tiny, completely distressing detail I’d missed while booking a flight: I’m on a PM flight when I needed to be on an AM flight.

See #1 above.

3 Re-Booking. At the moment I’m in an airport getting ready to head home after a vacation in the Low Country visiting Megan (see below). Seeing my distress after my discovery above Beth gently took my computer away from me so that she could try to re-book my flight. This is the point in “musings…” where I usually gasp in awe at the power of Beth, of remote computing for, well, everything.

About that.

Turns out you can’t go directly to the airline if you used, say, Expedia to change your booking. No worries, unless Expedia isn’t working. Gallimaufry, again.

4 Short. As in cut short. Having taken a month off to recover from my hip replacement we weren’t able to get out of Dodge on the Thursday flight last week as planned. You see, all of the airlines that once had a direct flight from our hometown airport to Savanah and Megan have up and left town. Seems the landing fees at CLE are outrageously expensive. So if we wish to have a direct flight, and given #’s 1-3 above trust me, we do, we now have to drive 1.5 hours to another airport. This limits our options if I have to work on a Thursday morning because I was out of the office for a month.

Fewer options equals less gallimaufry I suppose, but in this case it makes “Short Vacation Syndrome” even worse.

5 Vacati. Every vacation is too short. There should be a word for this. Simply cutting off a couple of letters at the end of the word “vacation” seems kinda lame, but you get the picture.

I think the phenomenon is particularly if you are visiting someone you love like our daughter and son-in-law. Or going to a place you really love like beach or the mountains. Or headed out on a dream trip like an upcoming vacation we have planned to knock off state number 49 on Beth’s lifetime list, Alaska. Or…oh come on, vacation is always too short.

We were all set to put this conjecture to the test in 2020 when I was celebrating my 60th birthday and we were honoring our 35th wedding Anniversary. Seriously, when I decided to say yes to literally everything I was totally out of control. There must have been 8 or 9 trips of varying lengths added to our regular schedule of vacations visiting family. Just nutso. Of course we never got a chance to test the theory since all but one of the trips was canned by COVID.

This past week was kinda hard, and yet it still seemed too short. At the moment I’m struggling with IT band issues from my hip surgery and walking more than 20 yards or so is really painful. Our routine when we visit the Low Country is to start each day with a walk on the beach, and maybe end up at a breakfast place before heading home. Sometimes we head back to the beach later in the day to sit and read, or to exercise the pups if they are along. Sadly, all of that was impossible for me this time.

And yet, even though I like my job (my boss is AWESOME!) and I have family (GRANDKIDS!) to come home to, there’s something about not waking up to an alarm, to not having any real agenda other than maybe what time and where you’ll be fueling your body during the day. You can do the same thing all day, every day–all we do is sit on the beach when we visit the Cape–and you feel like you need a couple more days to do whatever that is when it’s over. Massively crazy vacations just chockablock filled with activities and tight schedules? Same thing. We once had a trip to London with the kids when they were younger and would have gladly suffered more exhaustion for a couple more packed days.

We probably don’t need to visit more wineries when we are in wine country, but there’s something to be said for being on vacation while you dry out.

There’s no real point to any of this. Seriously, none at all. I’m just whining about the fact that I’m sitting in an airport, sore leg and all, feeling like I’m here too soon at the end of another vacation that was just too short.

I’ll see you at home next week…

Fresh Cut Grass: A “Sunday musings…” Update 10/9/2022

Randy texted me about the exciting finish to an NCAA football game. It made me smile. Not the result, not even the topic, but the excitement. A parent is only as happy as his least happy kid, and at that moment one of my kids was very happy. Randy’s football playing days are long behind him, but the game still brings him joy. Me? Not so much. I can’t shake the image of that young Dolphins quarterback drunk walking off the field after getting his head slammed to the turf.

The FIRST time. He got pole-axed again 4 days later and is now sidelined for who knows how long.

Oh sure, there was a time when football never seemed to be any lower on my list of wonderful things than 2 or 3. I was a medium-sized fish in a puddle as a high school football player, but I didn’t have the game out of my system when I graduated. Accepted at one Ivy League school and waitlisted at another, I turned down both because I was too small to have any chance of playing football at that level. Instead I went to a very old, very small school and played a bit each year all 4 years. Now done as a player I was nonetheless still enthralled by all other things football.

Many of my closest friends were met on the freshly cut football fields of my youth. Wins and losses followed on those fields, most of which I’ve long forgotten. Indeed, I’ve written before that it is only the losses I remember, especially those that resulted from some personal failure in a game. A fumble, perhaps, or a blown coverage. And yet there is no escaping the fact that those countless hours at practice, in the locker room, and on the field are in large part responsible for who I am, the adult I’ve become.

It’s a powerful thing, football. The game itself is exhilarating to both play and watch. At least, it was. I find myself finding all kinds of reasons not to watch football games now. Not consciously finding “big picture” reasons so much as tiny reasons, like Beth wants me to tag along to the barn, or Sasha and Bohdi, the world’s smartest (and most easily bored) dogs, would like an adventure kind of reasons. Football of all sorts played at any and all levels has sunken to a kind of triviality, easily trumped by a trip to the grocery store.

No one thing is responsible for this falling out of love, as it were. This fall is different from the last, and the one before only in that it is now glaringly obvious that football holds for me no essential attraction by itself. Looking back my only surprise is that it took me so long. Why didn’t I begin to turn away as my friend the ER doc buzzed through my son Dan’s shoulder pads with a saw in order to get him into the MRI? Or when I walked onto the field after Randy knocked himself out cold with a helmet-to helmet tackle, his first concussion? I was still young, still sure that the game would bring my sons what I thought it had brought me. CTE had yet to be discovered.

I see them now, both of my boys, face down and immobile, and I shudder. I started to see them each time I saw a player go down in high school, or college, or the pros. I saw them all over again each time I saw the replay of Tua being carted off on a stretcher. I began to see that I valued those young men nearly as much as my own boys, and I started to notice that the game of football had become The Game. Those entrusted with The Game at all levels did not–do not–appear to share my feelings about the players.

The junior high coach carries the star running back to the bench, there to wrap a sprained ankle in the hope of returning him to the game. In a high school freshman game, a rout, the first string defense is still on the field in the fourth quarter, the opportunity to play in a game slipping away for kids who may never get another chance, when the starting safety goes down with a severed spine on a play he should have been watching from the sideline. What was the first string defense learning at that point in that game?

Alumni and athletic directors and coaches at colleges noted for academic excellence openly opine that they cannot win without lowering the admission standards for football players, and just as openly run those kids off the team and out of their scholarships when they are no longer needed to win. The game in the NFL becomes ever more violent, with ever more gratuitous violence magnifying the carnage wreaked upon the bodies of the players. Ex-pros roam the earth as a kind of walking dead.

When did football become The Game? When did the keepers of the game become keepers of The Game? When did football players as young as high school become a modern stand-in for gladiators thrown into the arena for little more than the amusement of the many and the benefit of a tiny protected few? I’d like to think that there was such a time, an inflection point, when it did change, but I fear it has been ever thus. If that is so then I, too, bear some responsibility for what The Game has become. I did not turn away, or turn my own sons away, at the time of my own dawning awareness that The Game and its keepers cared naught for our sons at all, but only for themselves and their respective place and privilege.

Need evidence? Count the number of quotations from college coaches bemoaning the coming doom from “Name, License, and Imaging” money vs. the safety of the players? That kid from Miami is already yesterday’s news.

There was a time when my playing days were long over when I still found myself on edge as the weather chilled and the smell of cut grass filled the autumn air. It was time to get ready to play football. Those days are long past, and I find that I no longer even think about watching, indeed can no longer see myself watching, except as a vehicle with which I can channel the joy of a child, or perhaps foster a friendship. And that is perhaps why: I can no longer watch a game whose keepers have lost sight of the fact that someone’s child plays in The Game.

One wonders about the parents of gladiators past. Did they see then what is so easy to see now?

Today is Sunday. The local team is on and most of the community has tuned in. They talk about yesterday’s game in which the flagship state university defeated a conference rival. The debate a controversial quarterback and the reckless off-field behavior of their best defender as they dine on brats and beer. Me? I’m about to head out into a sunny autumn day and take my dogs and my bionic but balky hips out for a whiff of fresh cut grass. I won’t be thinking about the score or the decision go for it on 4th and 1.

I won’t be watching the today’s gladiators playing The Game.

Communicating: Sunday musings…10/2/2022

Yesterday I read about the relatively new popularity of using something called “voice texting”. In short, you record your part of a text thread and send a verbal message. The WSJ article went on to describe how to do these, to whom to send them, and how to receive them. My friend Lee has been doing this for several years, much to the chagrin of most of the people who are on the receiving end of his missives. Me? I think it’s a very “Lee thing” to do; it fits his image as an iconoclast, or even a little bit of a rebel. I don’t mind getting “voice texts” from Lee, but frankly I really wouldn’t be all that enthusiastic if this became a more widespread “thing”.

A small poll done by the WSJ shows that I am firmly in the majority on this one.

Thus far today I have communicated with a couple dozen folks and it’s only lunch time. Awake to a string of texts from my “play group” buddies. Answer a few emails and look at pictures from the sources of my weekend’s double FOMO, our annual major professional conference and a once in a lifetime celebration of a life saved at my Alma Mater. WhatsApp spoke up with more news from the Chicago conference, and messages trickled in on both Twitter and Facebook. I chatted with Beth over coffee and a couple of newspapers. All of this culminated in old school phone calls–real live, talking on a phone to a live person phone calls–with my Mom and closest friend from college. The only thing missing was opening a letter or getting a telegram.

Have you seen that commercial, I think it was a Heineken commercial, where people with diametrically different points of view were put together for one-on-one discussions. You know, the one with the bigot talking with the immigrant from Africa, and the arch conservative going over local social policies with the liberal activist. In front of their keyboards and in pre-conversation interviews they were openly disdainful of the people with whom they would soon be chatting. Not the opinions or viewpoints of those people mind you, but the people themselves.

It makes you think. How much of our social discord is driven by mode of communication?

One of my tiny morning rituals is to glance at the “Memories” that come up each day on Facebook. Turns out I’ve written about this general topic more than once. Indeed, the first time may have been more than 10 years ago. There are a couple of new modes of communication around now, WhatsApp and SnapChat for example, but spending a few moments with my earlier posts leads me to conclude that the both the macro and the micro issues remain the same.

Nothing trumps “in person”, or as the more modern lingo would have it, IRL or “in real life”. Everything that makes us human has ultimately evolved from how we communicate in person. For one thing, it’s impossible to dehumanize a human who is standing right there in front of you. It’s just kinda hard to dismiss the existence of a person when they are sharing the air you are breathing. When you are engaged IRL everything you do is part of the communication. The words you choose. Your inflection and tone. How fast or how slowly you speak. What your face is doing and how the rest of your body is moving as you speak. And while you listen. You are words and all of the emojis in the world, right there in your whole self as you stand or sit across from another.

Nothing compares with this.

All of the Zoom and Zoom-like platforms are really as flat as the screens on which they appear. Oh sure, a video chat is much better than anything other than IRL. Give me FaceTime with my Mom over even a phone call, for sure. But still how much we get across is still measurably less. An old school phone call gives us tone that we cannot really convey via text, PM, Snap or WhatsApp. I confess that I am at a loss as to whether “voice text” is closer to Ma Bell or Meta, but any conversation carried out through your thumbs is definitely lowest on the evolutionary scale, however technologically advanced it may be.

On the micro scale I have long held that you actually begin the conversation when you choose which of the communication modes you will use for your conversation. Think about it; you are sending a bit of a message through your choice of venue. It would be awfully disrespectful if I insisted that most of my conversations with my Mom be via text. Heck, she doesn’t really even text at all; she calls emailing from her iPad texting (sorry Mom!). By the same token, I am aware that younger folks, my kids’ age for example, often find an unannounced phone call to be an intrusion bordering on insult. Knowing this I text first with a request to hear their voice. At any moment you may be on either the accommodating or the accommodated side of this decision, of course. Just thinking about it makes you better at communicating.

I don’t think I will be adopting “voice texting” into my daily communication menu. For as much as hearing from Lee in this manner amuses me, I really don’t want a steady diet of this particular comms. I appreciate the convenience of texting, although as a “senior” texter I am likely not replying with the same degree of urgency I detect among those younger than I. Likewise, email has a place when I wish to expand on an idea, especially if I wish to have a concrete record of my conversation. All of the other “Keyboard Comms” are simply more than I need; I choose them infrequently, and almost never initiate a conversation via something like WhatsApp, for example.

In the end I think my Mom and I would agree that the best conversations, those in which we express the best version of both ourselves and our message, are those that involve evolutionary developments that supersede the appearance of the opposable thumb. Hearing a voice with your ears is ever so much better than “hearing” what’s been written. If you can pull off a chat IRL, right there in person, well, it really doesn’t get more effective. Both sides of the conversation are at their best and more likely to be giving their best. Doesn’t get any better.

And for all of the time I’ve spent over the years thinking about how we communicate in this not always so brave new world of communication technology, that really hasn’t changed a bit.

I’ll see you next week…

Healthspan Recipe v2.0: Sunday Musings…9/25/22

How did I spend all of the spare time my hip “gifted” me with over the last several weeks? Well, I did do a little bit of stuff on the intellectual side of my day job. I spent a bit of time working formally as a consultant, helping companies with new product development and working on writing projects in areas that interest me. Much more enjoyable were the couple of opportunities I had to interact informally with colleagues who’d reached out and requested a bit of wisdom from the mini-silverback in their midst. Both versions of this part of my professional life are very satisfying.

Neither, it turns out, is enough to fill all of the hours that would normally be taken up by going to work. After my daily PT was accomplished I was left with 5+ hours of “free” time, and I just couldn’t see spending it all on bingeing TV. Even something as noteworthy as “The Wire”, which I still regret missing and am still promising myself I will watch (Beth has no interest). What I did, instead, was indulge my interest in the field of lifespan and longevity research, an area I’ve wanted to explore for some time.

Now, my little combination of whimsy and drivel here is not the place to do an exhaustive review of the science involved in extended your lifespan by adding healthy years of living. For that I will save you the trouble of trying to find resources and once again recommend “Lifespan” by Dr. David Sinclair of Harvard. I will be sending copies of this around to friends and family who wish to know more than what I’m about to share, or the “why” behind my suggestions. If you just want to read his conclusions yourself there are about 100 pages that will do the trick. More interested in the potential social and societal ramifications of having a meaningful percentage of our populations living actively for 20 or 30 additional years? Sinclair shares his thoughts on these as well.

In a nutshell we can distill Sinclair’s (and other’s) conclusions down to two straightforward strategies that work at the cellular level. First, in order to enhance cellular vitality it is beneficial to maintain cell processes that function during times of deprivation in an “on” mode. Second, while doing so, one must enhance each cell’s ability to identify and repair defects and errors in both our genes and the “epigenetic” mechanisms that turn those genes on and off. Again, if knowing what this means in a more granular fashion is your cup of tea, “Lifespan” is excellent.

How, then, do we accomplish these goals at macro level? The stuff we choose to do in our day to day lives? Some of this you likely already know, especially if you have spent any time here in my Restless Mind. Deprivation is in many ways a synonym for stress. Tactic #1 is eat less. At a cellular level this, in and off itself, turns on the “save for a rainy day” mechanisms that extend the healthy life of the body’s cells. Honestly, your macro dietary move could be just that. Eat less. “Eat to promote results in the gym, not fat.” Yes, all of the research showing the effectiveness of particular forms of fasting are largely correct. You can turbocharge the effect of eating less with pretty much any version of fasting that you can, or are willing to adopt.

Let me step outside of “stress” for just a moment to discuss what to eat. Sugar is still the enemy. Processed food high in added sugar, especially manufactured sugar such as high fructose corn syrup, is a pro-inflammatory agent that works at cross-purposes to our goals here. Attempting to get as many of your daily carbohydrates from non-grains and non-sugars is STILL part of the prescription. Sinclair and a litany of others have repeatedly shown the deleterious effects of eating mammalian protein. Meat, especially red meat, is associated with higher rates of both heart disease and cancers of all sorts. Do you have to become a vegan to increase your healthspan? Heavens no. Just realize that with the exception of post-intense exercise recovery, our need for gobs of protein is lower than we think. Obtaining that protein from plant sources and fish is easier than you think.

Returning to the the concept of “stress”, you gotta get up and move. The couch is STILL your nemesis. Literally anything is better than nothing. Brisk walking works, and by brisk I don’t mean meandering behind your pug as he ponders the placement of his, well, you know. Wanna run? Sure. Why not? Just remember that you don’t need to run 10 miles/day to increase your healthspan. Turns out the health benefit is probably the same if you run 3 miles, and you might get almost the same with that brisk walk. The key is to elevate your heart rate and get a little bit out of breath. Nothing seems to be more effective than high intensity interval training or HIIT. No matter what you think about CrossFit, done properly it is simply the most efficient and effective way to inject physical stress into your recipe.

Lastly for the macro stuff is the truly macro: you have to build some strength. Old fashioned, full-bodied functional movements during which you move meaningful (meaning heavy to you) weight. Sure, you can use all manner of exercise machines that produce resistance that targets individual muscle groups, but healthspan necessarily means the absence of decrepitude. Doing movements such as the deadlift, squat, or press that cannot be broken down into component parts, and doing them while moving a load that is meaningful without being dangerous, is what will make it more likely that you will be able to rise unassisted in (much) later life.

But you knew all, or most, of that already, right? What’s new, at least for me, is what we can do on a daily basis with supplements and a common medication to enhance our body’s functions on a cellular and genetic level. There are a ton of things that have been proposed to slow aging at a cellular level. Many of them have been controversial, at least in part because the research has been less than overwhelmingly positive. Sinclair takes far more of these things than I am comfortable suggesting. I’m going to make it super simple, distilling everything I’ve read about “what to take” down to 4 substances, 3 of which are over the counter.

Let’s start with the simple science of the one medicine that has a direct effect that counteracts cellular aging. The ends of your chromosomes are protected by structures called centromeres. The longer the centromere, the physiologically younger the chromosome, and therefore, the cell. Metformin is a medication that is routinely prescribed as a first-line treatment for Type 2 diabetes. Metformin has been called the closest thing to the Fountain of Youth yet discovered. One of its notable “side effects” is that is elongates those centromeres, presumably increasing the lifespan of the cells themselves. An older medication, metformin is available as a generic for, like, $5 a month. Sinclair takes 1,000mg per day.*

You may have heard about Sinclair’s next suggestion, resveratol. Sinclair and his labs became famous for the findings on resveratol in 2006 that formed the backbone of the so-called “French Paradox”. The French supposedly were living longer despite eating a diet high in saturated fat because of the liberal partaking of red wine with those “unhealthy” meals. While reading “Lifespan” I found it interesting that the people living in the Sardinian “Blue Zone” routinely drink meaningful amounts of a local red wine, Canonnau, that contains high amounts of resveratol. Not all of the early enthusiasm about resveratol has survived deeper testing, but it appears to have little or no downside when taken without the alcohol chaser in the red wine. Sinclair takes 1000mg/day*.

The last supplement is a kinda two-fer. Nicotinamide mononucleoside (NMN) is a potent producer of NAD, the energy source for the activation of the “stress genes” as well as the proteins that function in cell repair. Again, the science is cool and it is well-described in “Lifespan” if you wish to explore it in greater depth. Theoretically the production of NAD results in a depletion of methyl groups that are necessary for other significant basic cellular activities. Sinclair suggests that, if this is so, this can be counteracted by adding trimethylglycine (TMG or betaine) to your supplement cocktail. Sinclair takes 1000mg of NMN and 500mg of TMG daily*.

So there you have it. A recipe that, coming from me, begins appropriately with something that sounds an awful lot like the original CrossFit prescription, “Fitness in 100 Words”, found in the CrossFit Journal Vol. 1 #2 2003. Eat less. Eat better. Move in such a way that you get a bit out of breath and do that regularly. Get and stay stronger by doing full-body functional exercises where you move weight. Do your homework and consider taking some or all of the supplements that David Sinclair and his family and co-researchers are taking to extend the lifespan of the cells in their bodies.

In so doing you will also be joining me, and my family, as I add Sinclair’s regimen to the pescatarian diet suggested by my daughter, and head back to the gym after my rehab from hip surgery. May we all increase our personal healthspan, adding many healthy and vibrant years to our lives.

*Reporting on these findings is not a medical recommendation. Note that you need a prescription from a doctor for metformin. Discuss metformin with your medical doctor.

Onward Toward the More Useful Metric Healthspan: Sunday musings…9/18/2022

1 Quiver. A group of cobras. Normally a totally icky thought, but Beth and I finally started watching Cobra Kai, so…

Why isn’t this what the Cobra Kai kids call their team?

2 Announcers. I no longer really watch sports of TV unless they are spectacles. Super Bowl, NCAA championship games, Majors in sports such as tennis and golf. However, as I find myself at home, often alone, with hours to burn, I have had sports of some sort on in the background these last couple of weekends. The games are still not very impressive. Honestly, it seems as if the quality of play in all of the major sports leagues has declined over the years. The individual sports, on the other hand, continue to amaze as one GOAT after another arises to thrill us with their exploits.

One thing, though, is amazingly consistent: the teams of announcers who are not the top teams are uniformly terrible. As I write today’s musings I have our local team, the Browns, filling auditory background. They appear to be on their way to blowing a 2 score lead in the last 2 minutes, and the announcers are simply awful. Their banalities are entirely devoid of insight, provided without an iota of style. In what turned out to be a rather exciting game it sounds like a snoozefest. They add nothing.

I suppose I can sorta, kinda understand why I’m left to suffer at the hands of these end-of-the-benchers. The Browns are not exactly NFL royalty, after all. But the same thing was on tap yesterday for the Notre Dame home game. NBC has spent a fortune buying the rights to these games and they can’t find better announcers? Seriously. Snooze fest.

It’s enough to make you pine for the CrossFit Games feed, ca. 2015 or so.

3 Healthspan. Given the luxury of time to myself I’ve been doing what I’ve done each time this has happened: do a deep dive into something that has appealed to me but escaped me due to time constraints. This is how I spent my time during my recovery from carpal tunnel surgery in 2003 (resulting in the launch of SkyVision), the early days of my new practice in the 2000’s where I just wasn’t all that busy (the start of my CrossFit immersion), and my first hip surgery in 2019 (a re-set of my nutrition and sleep study). During my post-hip rehab I’ve been looking into the ultimate form of increased longevity.

Healthspan, the measurement of healthy, vibrant years lived with a relative absence of both disease and decrepitude.

This is really the ultimate expression of the quest I’ve been on since discovering CrossFit in 2005. The ultimate goal I’ve sought as I’ve tried to develop a single measurement of health that encompassed both fitness and traditional health measurements. Whether or not we decide to measure our true biological age (actually possible, albeit pretty expensive at the moment), we probably should be adding to our quiver (regular use!) of strategies some of the things that the pioneers in longevity research have already uncovered.

For a CrossFit OG this is really the next logical phase. Work capacity across time and modal domains extended across a longer lifespan unencumbered by disease or infirmity = healthspan.

Do your self a favor and pick up a copy of “Lifespan” by the Harvard professor David Sinclair. If you are of a scientific bent you will thrill to the explanations of the first section. If you lean toward the more social engineering side you will likely find yourself nodding along with Sinclair’s thoughts on not only the expected effects of more people living not only longer but better, but on why this is likely good for everyone and everything. Most of you, I suspect, will jump to the “what to do” sections in which Sinclair lays out what we can, probably should, be doing to apply the science right now as I did (going back to read the science afterward).

Allow me to save you some time. I actually read several other books on both longevity and maintaining one’s mental faculties as we age, but all you really need to do IMO is read Sinclair. “Lifespan” not only covers all of the meaningful ground, it lays out a playbook for the next part of the journey. If I get a little inspiration and set aside a little bit of time I’ll expand on both the “soft” and “hard” interventions available right now to almost all of us to expand something much more meaningful than just a lifespan.

It’s time to work on expanding our healthspan.

4 Stethoscope. So, how did I end up faring on the other side of the stethoscope? As you may recall I had my right hip replaced about 10 days ago by a surgeon and in a facility where I was known to no one. Just one more middle-aged ex-jock with a busted up hip and a big prostate. Short story: surgery was uneventful and my recovery got off to a great start despite the fact that no one bothered to listen to the sad, sorry story about my prostates efforts to spoil the party last time. No matter. I was out after about 30 hours total.

What came next is the indictment of our increasingly consolidated healthcare system I thought I’d escaped. After 5 days of simply all-world recovery spent on the farthest righthand side of the Bell Curve I suffered a bit of a setback. On Post-Op day 8 my IT band and abductors went into full revolt mode and I was thrown back to day 3. I didn’t feel comfortable calling or texting either the nurse of PA who sat between me and the surgeon, opting instead for the PT who’d been with me the day before the wheels came off. Is that because I “normally” would have been able to just pick up the phone and buzz my surgeon buddy? Sure. Of course. But the vibe of a large hospital system where the system protocols reign made me wait days before I eventually texted the PA.

That’s probably the lesson for your buddy the Eyeball Boy. If there is a psychological barrier that is effective against someone as confident and plugged in as I am, what must it be like if you really ARE jsut one more middle-aged guy with a busted hip and a big prostate? It’s the big system, not the location of the big system, that creates the distance between doctor and team, and patient. I’m left with the realization that my experience would have been largely the same had I been here in the neighborhood and cared for by either of the big systems in town.

In the end I will surely be just fine. The PA responded to my Sunday text and seemed nonplussed by my symptoms, a response that will eventually make me feel better I’m sure. The big system is able to see me on Thursday, four days from now, if I get worse (no information about what to do if I get worse in the mean time), something they don’t foresee. The reality that a 3 or 4 day delay in my recovery will upset hundreds of apple carts does not register at any level in a large healthcare system. Honestly, I never would have known this had my recovery continued on its early course. My “review” of my journey on the other side of the stethoscope would have been mostly self-deprecation at the notion that I would notice any difference at all.

What I learned is that it’s not the distance between your house and your hospital that matters.

I’ll see you next week…

Mercy At The Finish Line: Sunday musings…9/4/2022

“If not for the pain, how would we know that we were alive?”

Who uttered this profound statement? Was it Rousseau or Rochefoucauld? I confess that I can neither remember the answer, nor conjure up enough Google-Fu to find it online. Rochefoucauld is famous for “We all have strength enough to bear the misfortunes of others,” which seems somewhat inconsistent. Perhaps it was Rousseau, then. No matter.

A few weeks ago I wrote about my very short encounter with a man who cried “Uncle”. Injured at 20, kept alive by an implantable defibrillator for some 22 years of unremitting pain, Billy Ray had no one to live for. All he knew was pain. He was imprisoned by his pain. Truly an island, he shook the shackles of his torment when he turned off his defibrillator.

For several months now I have had near constant pain that has been bad enough to impose itself on my minute-to-minute consciousness. Not like Billy Ray, mind you, and it’s only been 3 or so months. I am reminded of my friend Steve, one of the nicest, kindest, friendliest humans I’ve been privileged to know. He suffered the same pain from the same cause, but for myriad reasons he chose to carry the burdens of others and did not address his own for many, many months. He, and those closest to him, say that the pain changed him. His general bonhomie declined along with his patience and good cheer. Thankfully, surgery cured his pain. More thankful, still, is that the removal of his pain returned to us the friend we’d come to know and cherish.

I’ve given a lot of thought to this over the last several months. What makes my situation different is that I have a finish line. I can see ahead to the date when there is a 99% chance that the pain will be alleviated and I will be able to return to a life that is generally free from that type of burden. My time in this bubble has been relatively short, many months shorter than Steve and years shorter than Billy Ray. The finish line has been close enough that I hope I have been able to avoid any change in who I am, with the exception of the physical limitations that I have had that will also be alleviated.

Seeing the finish line ahead has meant hope, which has been a balm to sooth the pain.

My part of the medical world is mostly filled with caring for people whose lives will improve because they received that care. Indeed, that’s part of why I chose ophthalmology in the first place. There is a very small subset of my Dry Eye patients for whom relief is not possible, at least not from me and what I have to offer. This short stay in the dark world of chronic pain has given me a different perspective on that part of my practice. While it is not the same at all, doing what it takes to work through and around pain that does not go away will likely allow me to bring more light to that small part of my practice world.

For me, though, the answer lies just ahead at the finish line. The date is set, and all that remains is a phone call confirming the hour. I have people to live for, people whose misfortunes I will once again be strong enough to carry. Relief awaits at the finish line, along with all of the friends and family members who have been strong enough to bear my misfortune and carry me there.

I’ll see you next week…

The Other Side of the Stethoscope: Sunday musings…8/28/2022

1 Chicago. Great little town, especially if you have a native friend to give you pointers.

2 Chicago. Great little band. Went to see a regional cover band last night with friends. Very good musicians, but as is so often the case the lead vocals are what separate the Major Leaguers from Triple A. Still, some music is just so good that you go just to sing along.

3 Whoop. As I sit on the porch at Casa Blanco there is an infomercial on the tube taking up space before the FedEx Cup begins. Whoop, as you may know, is the activity tracker that is the darling of professional athletes of all kinds. Unable to track activity-specific metrics (like a CrossFit WOD, for example), it is really little more than a steps tracker with a heart rate monitor, sleep tracker, and what looks like an HRV (heart rate variable) tracker. The schtick is that it provides you with a recovery “number” that you can use to determine your level of fitness and your readiness for the next work-out.

This particular informercial joins Justin Thomas, a PGA tour pro who is arguably at the top of his game, with Michael Phelps, the 20+ time Olympic gold medal swimmer. Phelps, like so many retired athletes before him, has used his newfound spare time to fall in love with golf. On the infomercial the two are playing a casual round of golf, goofing around in a hotel-like gym, and talking about the importance of recovery for all athletes. They are hawking the Whoop as the way to do so.

I have nothing against the Whoop. Heck, it may be the only stand-alone fitness tracker that I haven’t tried. There are a couple of points to be made after watching Thomas and Phelps talk about recovery. First, they are correct. Not only from the viewpoint of the elite athlete but also for washed-up ex-athletes and never-was newcomers to athletics of all kinds. I once wrote (although I’m sure it wasn’t original) that under-training and over-training both result in a reduction of your ultimate outcome. HRV-based recovery data is the best option I found in my 15+ year odyssey in the fitness tracker world.

The second point is that we have reached a point in the evolution of the tech that prices have fallen. Whoop is expensive. The business model is to pay a monthly subscription fee of $30 or so in perpetuity. I think that’s a lot of money. You can pay less than $360 once and get everything you need to track the same metrics with most trackers. I use one called a Biostrap which I like very much. As an aside it will also do an adequate job of tracking exercise specific activities if you add a shoe-worn monitor.

Bottom line: the pro golfer and the pro swimmer have similar needs when it comes to tracking sleep and recovery as do the amateur golfer and the CrossFitter.

4 Stethoscope. Everyone except the unlucky will eventually find themselves on the other end of a stethoscope. While my life has been filled as much as anyone with visits to that place, for the first time in my life I, a physician, am about to experience the entirety of what it feels like to be a patient in the U.S. healthcare system.

Let’s be super clear about the background for what comes next. Since entering medical school as a 22yo in 1982 I have been treated as a VIP at the very least. As the years have gone by it has been more akin to a B-list celebrity if I’m being honest. I’ve never waited for an appointment in my adult life. Obstacles of any and all types magically disappear when I need to see a doctor or get a test. When I’ve needed surgery my docs and their staff have bent over backward to make sure that it happened when and where it was most convenient for me. In return for taking care of our colleagues patients, doctors of my era and the one that just followed us took loving care of each other (and their families). We no longer get comped when it comes to fees, mind you. But when able the docs who have shared patients have taken a deep interest in not only our mutual care, but also how we feel while getting it.

So what’s different now? Well, first a bit of a preamble. My right hip, the good one, has failed me spectacularly over the last several months. Where once I had minimal pain in my left hip that accelerated with activity and prompted a replacement in 2019, this one hurts all day every day. Like the left hip it doesn’t keep me from doing my job, it just hurts this time. No big deal, right? Just get this one replaced just like the other one and go on about your life. Sadly for me, and wonderfully for him, the surgeon for my first hip retired 3 months before I needed him again. I would have to have someone else do this next hip, but my friend picked out the guy he planned to have do HIS surgery when the time came. A surgeon from another system across town who literally has no idea who I am, and wouldn’t care less even if he did.

Welcome to American medicine Eyeball Boy.

For the first time in my adult life I will be a regular patient. Number whatever, hip number X on the day of the surgery headed for Room Y. Show up at the appointed time. No, we can’t tell you what time that is before hand. Why? Because. Pre-admission testing WILL take place live and in person on this particular day at this exact time. No, we cannot change that because you have a full schedule of patients to see in your office that day. Did you reply to our daily reminder email? Did you? Hey, we’re talking to you. We don’t care that you’re a doctor over there; you’re not one over here. Reply or your slot can go to the next number on our list.

Has it really been like that? Well, in the beginning, sure. Why wouldn’t it? That’s what my patients complain about when we have to refer them out to large institutions because we have so few private practice referral options remaining. But to be honest, I understand the system very, very well, and as soon as I started to find my way to a live person on a phone stuff started to loosen up a bit. It surely helped a bit to be assigned to a PA who is an ex-college athlete raising elite athletic children; we’ve got tons to talk about, including her very strong thoughts on whether I should return to CrossFit after my recovery. And it surely made me feel a whole lot better when my cardiologist came in for a visit and scheduled me for a pre-op stress test on his phone before he left my office. When it came back suspicious he worked me in for a cardiac cath, and the cardiologist who would be doing it did my informed consent after we finished with HIS appointment in my office. (It was negative. Phew).

It may sound like I’m complaining, whining even, but I’m really not. It’s not that I’m worried that things won’t go well with the surgery. This is still the U.S., my surgery is one that is done hundreds of thousands of times each year, and the buddy who did my first hip handpicked my surgeon. Medically it will likely be a non-event. No, after all of this, the really crazy hard part about being just a regular patient will be not knowing a soul where I will have my surgery and where I will recover. No one. No nurses I’ve taken care of or physical therapists whose Mom I just did cataract surgery on. No one who has had a glass of wine at Casa Blanco is gonna be there if I have trouble with my bladder. I will be mostly alone in my room; Beth will be kept out like all family members because of the institutional madness around the Pandemic.

It had to happen someday. Despite years of medical attention directed at various and sundry stuff, ailments and health risks, with multiple surgeries along the way. After 40 years I finally find myself in the most usual and normal place for a 62 year old man. I am, for the first time in my adult life, fully and completely on the other end of the stethoscope.

I’ll let you know how it goes…

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