When The Music Stops

This is my current column, included here just because I felt like it. Also, I get to use my own paragraphs; it feels more important than you might think. Could just be me.

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It’s been a longstanding practice of mine to stop listening when someone near me starts talking about the past in a particular way. This would be a nostalgic way, tinged with bitterness and resentment aimed at people who had nothing to do with the future. This would mostly be young people.

I stop listening because I’ve heard it all before, and because I think it’s nonsense. I’m as nostalgic as anyone, and there are things from yesterday that I might prefer to their 2016 versions, but I suspect most of us, if dropped back into the past, let’s say 30 years ago, would be mad.

You can’t pay for gas at the pump. You certainly can’t use a debit or credit card at the grocery store; cash or check, please. You have to rewind video tapes. I could go on.

Or let’s just be mean and put you back two centuries, to 1816, and tell you to head out from here to New York. Have a good trip. I hope you know how to make shoes and not get eaten. It should take you most of your life, too.

Today, it’s a little easier. You have to take your laptop out of the suitcase and maybe get x-rayed, thus clearly giving 2016 the win.

And if you’re one of those people who complain about the rest of the world going through life looking down at the screens in their hands, I have no idea what world you grew up in. What did people do in public before smart phones that was so wholesome and healthy in your eyes? If I mention that when I was a teenager, Americans watched an average of nearly 8 hours of television a day, would that change your mind about the good old days?

Never mind. I’ve just never understood why certain people find the activities of other people so alarming, or worth commenting on. And why they seem to lack the perspective one would hope comes naturally after a few decades of life, showing us that things always change, and that we’ve never had it so good.

We haven’t, either. We are safer, healthier, wealthier, smarter, taller, and in some cases fatter than in any time in human history.

We also have a million other problems, some threatening our very existence, but that’s nothing new. We’ve figured out solutions before; maybe we’ll do it again. But it won’t have anything to do with how much time we spend playing Minecraft or texting.

I will say this about time and change, though: Enough is enough.

I’ll say what we’re all thinking anyway, which is that too many people have died this year. Famous people, whose lives overlapped with ours in mysterious and also expected ways. People who made a difference in our culture, which makes a difference in everything else.

This happens all the time, of course. That’s why we have those “In Memoriam” films every year. People die.

And 2016 started out the usual way, with the death of Pat Harrington, Jr., a comic actor who entertained several generations. He was in his 80s and suffering from Alzheimer’s.

Doris Roberts, Abe Vigoda, Nancy Reagan, George Kennedy, Joseph Medicine Crow: These were people who amused and enlightened us, who were part of our lives and had their own ones, rich and long and full.

But the first quarter of 2016 will be remembered, I think, for the unexpected losses. The ones that froze us in place, numbed by sudden knowledge and in some cases struck with sudden grief.

Patty Duke? Garry Shandling? Alan Rickman? They were in their 60s, young by today’s standards, accomplished by any standards, and we lost them to mortality and bad luck.

But it’s been the musicians. We all know this. We were rocked, and rocked early.

David Bowie died, at the age of 69, on January 10, our shock intensified by the passing of the beloved Mr. Rickman five days later, but it didn’t stop there. Maurice White, Paul Kantner, Glenn Frey: This was the music of my life, and probably yours.

Frank Sinatra, Jr. held not only a strong tie to the most famous singer of the 20th century, but was an excellent musician himself, even with understanding the shadow he would stand in for a lifetime.

Sir George Martin, on the other hand, might have influenced the music of our era more than any other single person. His artistry was all over the Beatles, and the Beatles were all over us.

Merle Haggard was a road warrior from the old days, when country music had little glamour and quite a bit of steel guitar. I’d suggest that his influence and output surpassed even Johnny Cash, but no one wants to compare. We just know that he’s gone now, and something with him.

But Prince is enough. Thank you, Universe, for all you do, but Prince was enough.

Part of the triumvirate of pop all born in 1958, the same year I was, along with Madonna and Michael Jackson, Prince Rogers Nelson was our Mozart with no Salieri even close. Nobody was close.

So that’s enough, I think. Let us listen to the sounds of lost musicians, and grieve no more for a while. Let us remember the night last week when the whole world, it seemed, was momentarily bathed in purple, reminding us that for 57 too-short years, it had been.

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Rope A Dopamine

I knew last August that the next President of the U.S. was going to be Hillary Clinton. By Christmas I knew that her opponent would be Trump, which doesn’t really change anything except the scope of her victory. Otherwise, yawn.

I’m not particularly happy about this, but I don’t really mind and there’s nothing I can do about it. Ergo no interest to speak of, or at least not the kind of interest that leads me to speaking. Just this here is all.

———

A month of limited Facebook time has been interesting. I don’t think I’ve missed much, if anything. It keeps me even-tempered and away from temptation to comment or police the Internet for falsehoods and folklore. Be as gullible as you want, America.

I think that’s the issue, by the way. I suspect there’s something intrinsic to living in this country that takes something good – hope and optimism – and twists it into believing the baddest stuff out there. I’m not sure why or how this works, but it seems to. And it takes on the air of a paradox or puzzle, as intelligent people decide to believe the guy who says I’m the only one who tells the truth! and therefore ignore the others, some of whom might well be telling the truth.

I’m not talking about an actual guy. More like a network of guys (generic; lots of women).

But it also leads us to believe that Bill Gates is handing out a million bucks to everyone who hits “Like” on a Facebook post.

As for the rest, the quizzes and the reposts and the shares of bizarre things no one should waste time with? Nothing to miss there, either. I’m better off.

————

And I am better off, now that I’m swimming in serotonin. I don’t care much for this, since I suspect this isn’t just supplementing a strange lack of that particular neurotransmitter, but increasing it. This isn’t unfounded speculation, although it’s not especially founded. Just a suspicion.

I just felt I had to do something, and for the time being I’ll stick with this. I’m fairly certain I won’t stay on it for very long, but I’m practicing compliance and so I’ll be a good patient for the time being.

And six months will come and pass, including my 40th high school reunion, a couple of political conventions, surely some surprises, and then an election. I can see this summer stretching out before me, actually.

This is a new thing, by the way. Seeing ahead. Yay for serotonin, I guess.

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Remeron

People have been helped. This is an important aspect, and one I don’t take lightly. Antidepressants, as troubled as the science seems to be at this point, has a degree of efficacy that makes lives easier. No argument here.

The other arguments I’ve heard. A lot I file under “crackpot” and ignore, but I can’t help reading. It is maybe not best for us, we human types, to be messing around with the self-correcting chemistry that our brain employs to keep us functioning. To keep us human.

That said, we come back to efficacy and pain. And serotonin, the magic happiness neurotransmitter, has a questionable side effect profile. It’s really complicated, and while I enjoy reading about brain chemistry it’s not my strong suit. I understand a little.

I’ve been taking mirtazapine (brand name Remeron), which is unlike the standard SSRIs (e.g., Paxil, Zoloft, Prozac). It heads right for the receptor and lets our brain swim in serotonin. Mirtazapine is atypical in this regard, as it doesn’t prevent reuptake; in simple terms, it activates receptors and produces more.

There other differences, but in general mirtazapine is used to treat major depression, along with side effects such as loss of appetite, loss of libido, and insomnia. It’s very difficult to overdose, and the drowsiness it produces in some (me) is alleviated by taking it before bed, and the fact that this seems to be an effect that becomes more tolerable as time goes by.

It also has a quicker antidepressant effect in many people, sometimes as quickly as a week. It’s been over a week for me. I may feel better. I sleep very well. There’s been some appetite increase, but not alarming and handy at the moment.

Still, I agreed to take it because I needed to do something. I fight my tendency toward rejection of this medication – actually, most medications – and try to be compliant. If I don’t care for it, we’ll stop it.

In the meantime, I’m groggy as hell in the mornings, remember nothing of dreams or the night, and have moments that I recognize as happiness.

This could be the golden ticket, the secret to keeping me stable and level, with less lethargy and more movement. With luck, I’ll start to feel creative again, and not quite so muted.

Again, I tend to be skeptical but also empirical: If it works, it works. This is a tricky business, and I know all about it. I’ll watch and wait, stick with my philosophy of harm reduction, and welcome my serotonin overloads.

And as much as I hate the idea of being on chronic medication, and a powerful one, there are other things I hate more. Some of those I can see in the mirror.  I stay with the program for the time being. The mirror is the message, at least for the moment.

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21 Days

On the last day of March, reeling a little from the experience of my past 35 minutes with modern medicine, I somehow made it upstairs and out to the parking lot before glancing at the lab sheet in my hand.

So back inside to get blood drawn, but an interesting flashback: Several times over the years, after a physical exam, I’d take similar lab orders with me and just go home. I didn’t want to know what my liver was up to, and I certainly didn’t want anyone else to know.

That was just a little nuance thrown into the denial stockpot, nothing remarkable for an addict who needed to protect his use.

And my liver is fine. Unremarkable itself, my liver is, after all of these years. At least for the moment.

The telling thing is that I went back inside. Of course. I wasn’t interested in protecting my self-destructive behavior; I was alarmed, frightened, and embarrassed by it, but I wasn’t consciously aware that I was doing something bad. Which is also kind of frightening.

But I wanted that part to stop. The self-destructive part. The part that had stopped eating so much and couldn’t figure out how to fix it until I started answering questions and heard the answers with my own ears, from my own mouth. Funny how that happens sometimes. The pieces are all there, waiting.

Behaving dangerously in this way for that long isn’t a warning sign to an alcoholic, at least not to my particular recovery philosophy. It’s not a sign at all. It’s a relapse.

That may even be a little theatrical, although I can make the case. A lot of us realize, after the chemical is gone and left in the dust, that the process remains. Here’s where we break ranks, some of us who probably think about it too much, but the theory is still sound, eloquently explained years ago by Dr. James Milam, a Northwest pioneer in treating alcoholism. Sure, he said, we all know that lots of cops have issues with alcohol. Doesn’t that seem obvious? Stress, fear, heightened senses, heightened everything. Trauma. It’s a tough job.

Milam says, yeah but. But, how about we look at what kind of people become cops? All sorts, I imagine, but I also imagine, as Milam did, that they share qualities that might shake up the stress=risk assessment. They might have been born at risk. They might actually like that risk.

I don’t have answers for what happened to me, just suspicions of possibilities. Schrödinger Syndrome starts to sound even more right.

Here’s what I think, though. Last year, I was at my daughter’s house and grabbed a can of diet coke from the fridge, popped the top, and took a big swig of what turned out to be bottom-shelf beer. Not good beer. And, beer.

I spit it out, yuk. No big deal. But there are people in recovery circles that would be eager to jump on that moment – a crowded refrigerator, similar labels, a simple and obvious mistake – as significant and a milestone. That is, they’d say, you have to start over. You’re on Day #1 of sobriety again, mister.

Seriously. There are people exactly like this.

I never understood it, not even in my early days. Someone with years of sobriety experiences extreme emotional distress, coupled with suddenly easy availability of alcohol, such as at a wake or other sad occasion, and they grab a bottle or carafe or glass spontaneously, wanting the alcohol for the same reasons others in the same situation would.

Then they drag their sorry selves back to a meeting the next day and say, I’ve got one day.

And I’d sit there with my 54 days or whatever and think, really? I’m more sober than this person, just because he had a moment of pain and wanted to numb it?

Anyway. Something happened. It felt, eventually, similar to compulsive drinking. Just different at the same time. Was my pleasure center, where the receptors for such fun things as nicotine, caffeine, booze, weed, opiates, and stimulants reside, tickled and activated by numbers on a scale that kept going down? Dunno. Maybe.

I just knew something was wrong. But it turns out – and this took me a few days at least to start to see – that I know how to fix wrong things now.

The existential stuff is still there. Getting older, worrying about money, etc. Not going anywhere.

Neither are the lab abnormalities, which are still hanging around as of the last tests, although probably OK. Still, I’ll give more blood in another three weeks and we’ll see. It’s possible something else is also going on.

I don’t think about that much, though. It does no good and I’m busy, anyway. Eating. And walking. I’ve been this way before. It’s always one foot in front of the other that gets the job done.

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Here Comes The Sun

You know we had a wet winter, right? Up here, I mean. Wetter than it normally is. I picked a good season to give up on outside.

We technically had drought conditions last year, although it was pretty technical. We just had much lower than normal snow accumulation, which of course runs off into rivers and is a major source of water.

BUT WE LIVE IN WASHINGTON.

Anyway, very wet winter, with records approached and then lapped. Not that big of a deal, at least for me, and now, as it turns out, we don’t have winter anymore.

Also, the groundhog was right.

But winter is gone, and I assume will stay gone, with maybe the occasional dip day just for nostalgia’s sake. Last week, a gigantic high pressure ridge and all sorts of factors combined to give us some summer warmth in April, pushing 80 degrees instead of 57. And there’s been plenty of sun. Take that, vitamin D deficiency.

—————-

I pick up my antidepressant today. Nobody tell Tom Cruise.

And you know why? Even though I’m dubious, and from what I read the research is a little dubious, there are people who have obviously been helped. I’ll keep a close eye on potential side effects, monitor my mood, etc. If it works – or I think it works – I’ll be a willing pill taker. No problems with that.

But the sun helps, and more food helps, and lots of support helps. People were worried, a situation that in the past would drive me to despair. Seriously. I hate that. I hate the idea of whispered concern, smiles of sympathy but also some worry in their eyes, which of course I didn’t catch. I was waiting for someone to say it, not trusting my reflection in the mirror, but people are polite.

That 24-hour urine collection came back essentially normal (there were a couple of numbers that were slightly high, but barely. We’ll recheck in a few weeks) for protein. I could maybe tell a funny story about that process, but urination is a difficult comedy subject. It takes tact and care. Some other time.

But I’m feeling much better. We’ll leave it there for now.

—————

I had to buy a new lawnmower and also replace the brakes on the Pontiac (seriously, replace: Six months ago we were told they were OK; suddenly they went from that to metal on metal. You don’t want to know either the sound they made or the sound I made when I got the bill), which is the kind of amusement the universe seems attracted to.

My experiment with staying off of Facebook for the most part has been fascinating, and kind of a relief. I can always check on people if I get curious, but given my mood for the past few months it keeps me from all sorts of bad behavior. I get a few pictures of kids and grandkids.

And I suppose my Year Of Not Eating might make a story, someday; it’s hard to say. It can’t be that unusual, although maybe in my particular situation I can find something to spin. It’s on the back burner.

So, since I mentioned pictures of kids and grandkids…if you’re two years old, I’m not sure there’s anything better than a warm beach and parents (and one grandmother, who is making the other grandmother envious) to play with you. That there is a picture.

Cam and Bix on beach

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Hope Springs

To minimize our problems, our fear and worry, seems to me to be a very rational thing to do. We have to function, despite whatever is bouncing around in our brains.

I’m not saying it’s smart. Just rational. Understandable.

I have been at times a world-class minimizer. I’ve also been, probably more often, a dangerous person armed with lots of information but not so much knowledge.

All of this has to be considered, of course. I mean, in my current situation.

As I mentioned to my doctor, I seemed to be cycling through periods of low appetite and other, maybe erratic but overall consistent decent eating. Decent. Weird word in this situation. Maybe I’m minimizing.

Numbers are numbers, though. As I mentioned before, I’ve tracked my intake for nearly a year (a lot longer than that, in fact, which opens up another can, but let’s stick with my past year for the time being). I know exactly what happened, and it happened the way it was supposed to.

I was already heading back to normal when I saw my doctor two weeks ago, although the day before was a very light day, as Wednesdays sometimes are (very busy days, lots of driving). But I was moving back toward a more normal eating schedule, and then there’s the whole Fear Of God instillation. I finished that week (counting Sunday as the last day, not the first) averaging 2400 calories a day. Some were much more than that, some less, and there’s plenty of room for variation (which is where averages come in handy).

So I’ve gained nearly 2 pounds in the past couple of weeks, although the scale is usually higher, more like 6-7 pounds (since I’m eating constantly, small meals but consistent, so that food and water are usually present, wandering around my body before being utilized the way we utilize that sort of thing). If I cut down to, say, 1500 calories a day for a couple of days, that scale would drop several pounds (even though the actual weight loss would be in the tenths of a pound). Scales are weird, but understandable. Again, I need the data; it could be just me.

I feel pretty good, in fact. I’ve taken a few short walks, not enough to burn off hundreds of calories but to reverse some obvious deconditioning. I eat what I can find, just to reach a number, so that involves a fair amount of carbs (refined sugar, unfortunately, just because it’s a quick fix, but I’m working on it).

I’ve opted to try an atypical antidepressant (i.e., not an SSRI like Paxil or Celexa or Zoloft), mostly because the only therapist I could find in my network was my daughter’s age. I made the appointment, but after a few conversations with wise friends, including a retired therapist, it seemed as though the dynamic would work against me. I’d feel fine about having this woman take out my appendix, or fix my car, or run a company that might need my meager services. I just thought the age difference would make it awkward, with unspoken references and empathetic shortcomings, no fault of hers. She’s still working on her doctorate. I’m sure she’s nice.

I’m not crazy about taking medication, and I suspect that mostly has to do with reluctance to accept a chronic condition. I haven’t had anything resembling depression in a decade; before that, plenty. But then I was drinking. Abstinence was an effective mood enhancer.

And, again, who knows? I was stressed because I didn’t have enough work. I honestly was trying to improve my diet, partly because duh, partly just to make a change to ward off the blues.

This is just what happened. About 1 in 10 men and boys are diagnosed with an eating disorder, although given our cultural baggage that number is probably higher. Sports like wrestling, in which weight is important, don’t do us any favors. A marathoner looks for less resistance and thus less mass. These are all pretty rational, too, but that doesn’t keep problems from popping up.

And then there’s depression, and other mental illnesses.

I don’t feel depressed. That probably isn’t all that pertinent, how I feel, at least to me: I’ve long since paid more attention to my behavior than what my brain was telling me to feel. Thus the data, and the records, and the odd awareness of what I was doing while I was doing it.

So, eating disorder of some sort? Quite possibly. Depression? Plenty of situational and existential reasons to be depressed. The only problem is that my judgment seems to be shaky, so I go back to the numbers. If I only managed 600 calories one day, I’d just plan on making it up the next day.

I seem to have problems picturing the next day, that’s all.

And that’s very familiar.

But now that we’re confident the abnormal blood tests were a result of malnutrition, and they’ve resolved, I think that hope is alive and well. I wasn’t close to death, or even a dangerous weight. I was just heading toward a bad place, and with luck I’ve arrested that.

Now if only I believed in luck. Right now, I mostly believe in cookies. As I said, working on it.

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Reprieve

Photo Mar 08, 10 38 51 AMIt started with this guy. Or I’ll start there, anyway.

I had a Facetime conversation with him the other day. “Whose that?” his mother asked, and he looked at my face and raised an eyebrow just like Spock. “Grandpa,” he said, clearly and how silly was that. Of course it’s grandpa. I just saw him 5 weeks ago. Five weeks isn’t what it used to be, not to a little boy who’s 2-1/2. He remembers, and he gets prompting privileges.

He doesn’t remember being 17 months old, I’m sure, although maybe not that sure. He was rushed to the hospital in diabetic ketoacidosis, which is how a lot of toddlers present when they’re first diagnosed with Type 1 diabetes. Because toddlers are weird anyway, and they can’t tell you what’s going on.

He doesn’t care for doctors or hospitals that much, though. I’ve seen this sweet, good-natured, perfectly happy child scream bloody murder at the prospect of being weighed. So maybe there’s more to memory than we think.

He’s fine, though. We’re the ones who remember.

***

That’s nowhere near being the whole story, but it’s part of it. I’m not the only one whose diet changed because his had to, or what there was of one at the time had to. Sugar began to seem like the enemy, and we adjusted. My daughter is thinner than she’s been in a long time. Pretty thin. Not in a bad way.

Not in my way, I mean. But then she’s halfway through her 32nd year and I’m wrapping up my 58th, and I’m a guy, and so on. There’s more here than diabetes.

So to catch the new people up: On June 29, 2015, which was a Monday, I started an eating plan that was designed to be healthier and less sugary. I thought I weighed around 188 pounds, but I hadn’t been on the scale in a while and it was actually 195. Still, that’s a fine weight for a man, and a man my age, and a man my height. It would have irritated me in my 20s, even though I saw that weight many times at that age. I could show you pictures. I looked fine.

I was fine, in that respect. I just wanted to eat better, really. If I dropped a few pounds in the process, I wasn’t going to complain. I had a couple of shirts I wanted to wear.

I did, too. Drop a few pounds. About 8 of them in the first 5-6 weeks, nice. I was walking a lot and fitter than I was at 22, no question. Hadn’t I walked across the entire city of Seattle, 30 miles, in May? I had.

My appetite dimmed. A few weeks later I was nearly 20 pounds lighter than when I began, and feeling pretty pleased with myself, appetite not withstanding.

Whoops. Make that 25 pounds. By the time September came around and I was in Austin, visiting that little boy up there, I was nearly 170 pounds. I went to the bathroom and saw myself in the mirror, and thought, hmmm. Definitely different. I took a picture of my reflection. It looked very different. I mentioned this.

“I’m wondering when to decide if this is a cry for help,” my daughter said, a little snarky but right on the money. Nothing wrong with 170 pounds, though. Just different. A different look. Leaner. But fine.

I just couldn’t keep it fine. Slowly but definitely, I kept losing. A pound here, a pound there; it adds up. The next time I saw my grandson, in late February, I was struggling to keep my weight above 160, although I ate well on that trip. Just not enough. Not enough to undo what had been done, and continued. It wasn’t unexplained weight loss; I knew exactly what was happening. I started tracking calories and then macronutrients and then everything. I have plenty of data. I was starving myself.

I made an appointment for a yearly physical exam, and thought I’d mention it. The morning of that visit, I weighed 155. I was 43 pounds lighter than the year before. I didn’t have to mention it.

I took a short patient questionnaire and it looked like maybe there was some mild to moderate depression going on. My doctor wanted me to start medication, but I opted to go talk to someone first. I made that appointment, too. I was very compliant.

A lot of blood tests were done. My vitamin D level was in the toilet, 6.8 when the lower limit of normal is 30. I’m surely not alone, here at the beginning of spring at this latitude. No help from the sun, and not much from diet, even if I ate a lot of dairy. Which I don’t. My doctor put me on a megadose, 50,000 units once a week for 8 weeks, then 5000 units forever.

My lipid (fats) levels have always been good, always. They were better this time; I had a triglyceride level, optimally less than 150, of 60. That was also the level of my HDL (good cholesterol), curiously. Again, this is a good thing. No problems there. None expected.

But my white count was on the low side, and there were elevated protein levels. Something was wrong, somewhere. I scared myself trying to figure it out on my own. My doctor ordered more tests. I started eating more, a lot more. I forced myself, fighting my brain, which was telling me I shouldn’t eat cookies. I ate cookies. I needed the calories.

I hadn’t walked for exercise, by the way, in months. I couldn’t afford the energy loss, not when I couldn’t make it up with appetite. I probably couldn’t afford the endorphin loss either, but that part wasn’t what was scaring me.

They did a serum protein electrophoresis, breaking down the proteins into smaller units to see what was going on. I also peed into a jug for 24 hours just to see if my kidneys and bladder were behaving themselves, but before that was finished I knew.

The only thing that really made sense was malnutrition, and maybe some dehydration to boot. I’d been eating better for a week. The SPEP came back normal. My protein levels had corrected themselves, thanks (imagine this) to food. The urine test probably will be unremarkable. You need to eat.

I know how to lose weight. I don’t know how to reverse it, other than getting used to eating more, but even then the numbers are against me. Unless I switch to a diet of cake and ice cream every day, my best option is maintenance. And hope. Hope will be big. Maybe by next September I’ll be back to 170. That I could live with. The alternative, not so much.

Nobody should scream bloody murder when they’re getting weighed. Sometimes it’s necessary, though.

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Schrodinger’s Syndrome

“It looks like someone has drawn blood here recently,” said the young woman at the lab, who was right. It had been her, actually. You see a lot of patients some days.

This was for a serum protein electrophoresis, a more detailed look.

I’m a little proud of that last sentence. It ended where it should have, even though I had more words.

I could tell you why an SPEP was done and what it measures (i.e., proteins in the blood), but no more than you could find out yourselves. I really don’t know what I think I know, and now I know that. There is no report so far. No news is no news. See how well I’m doing.

That was Tuesday. Yesterday I mowed the lawn. Today I pee into a jug for a solid 24 hours (a joke about urination can be inserted here, feel free). I don’t know what that’s about either, same thing. I’m just being compliant.

From the perspective of abnormal lab tests, I am the cat. Like in Schrodinger’s thought experiment. Everything that could be going on is going on at the moment, although of course there’s an answer. Even if it’s never known and stays a mystery. It’s a mess of probability at this point.

For the record – and this is the record at the moment – I don’t think it’s anything to be concerned about. That’s sort of theoretical too; I wouldn’t be writing about it if I weren’t concerned. But you know what I mean. I think it’ll all be OK. I wasn’t eating very much.

I was aware of this, but in the Schrodinger sense: I was also unaware and everything in between. I kept very good notes, but that guy was not communicating with the other one. I look back and see insane eating behavior, when my intention was to eat better, although I have no business talking about intentions at this stage of the experiment.

There are answers. Again. We just haven’t come across them yet. I don’t have diabetes, or prostate cancer, or thyroid issues, or anemia. Despite the dissociative behavior, I don’t seem to have a particularly obvious form of mental illness other than probably some depression. I don’t hallucinate or have manic episodes or hear voices telling me not to eat.

But even that is guessing. I decided to stop. I’ll just wait.

And pee. My day is pretty set. No theoretical physicists will be harmed.

Photo Apr 05, 5 15 00 PM

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The Tautology Of Not Knowing

I got an email yesterday from a newspaper reader, wanting to take my side in the battle against too much engagement with the rest of the world (translation: Too much Facebook). She felt my pain.

She was appalled at the personal details some people drop on an unsuspecting world, and while I agree I’d note that somebody is reading, too. That was really my point: We’ve all become inadvertent voyeurs, and it’s hard sometimes to look away. Better, I thought, not to look.

And that’s working out fine. Unless you’re someone who keeps his own counsel by nature, it seems hard for us not to jump into the conversation and then regret it. I’m trying to minimize the chances of regret.

I’m not sure what this nice person who wrote would think of my tendency to shake my head at the damage I can do to myself, and shake it in public. I dunno. It’s about as private as anything can be.

Not that I’m broadcasting. It’s here, though. It feels almost dishonest for it not to be somewhere.

Five days of eating, for a good reason, things I never eat. For a good reason also. Cookies? Cookies are amazing, and awful for anyone who has problems with maybe impulse control, or compulsive eating, or maybe who just likes cookies a lot. They’re easy to eat by the dozen, at least the store-bought ones, although nothing is particularly easy to eat these days.

But the calories are much appreciated, and that’s worth noting: With all of these diagnoses floating around, puzzling my doctor and freezing me in place, nothing at this time but questions and musing on correlation-causation, chickens and eggs, it seems pretty clear that psychology has a big role and so I have to wonder. Even mild depression can cause us to lose our appetites, a little or a lot, but this was a bizarre way to eat and a reasonable person could call it a disorder.

So there’s that. I recently read an article about new treatments for adults with anorexia nervosa, people who’ve suffered from this eating disorder for decades and managed to stay alive. This is not me. I have no body image issues. I don’t look in the mirror and see imaginary fat. I see gaunt and scrawny. So I have no idea. Just imagination.

It stays a mystery at the moment. More blood tests have been ordered and my doctor is more serious, which means she’s reverted to best-practices mode. Don’t alarm the patient. Stay casual.

She’s always like that, and without nearly 20 years of experience with her I probably wouldn’t catch the difference, but it’s there. Usually she’s making fun of me for alarming myself. None of that is happening.

I’m not as alarmed, either. What it is, it is. And the odds still say to me, at least, that it’s lack of nutrients; the body can spit out strange numbers when it’s grasping stray energy from wherever.

Off to the lab. What it is, it probably still is.

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Charles Does Not

Every night from Sunday through Thursday, a group of us would arrive at a Central Phoenix healthcare facility around 10pm, ready to work. We were a mixture of college-age people who were working their way through school, some in graduate school, and older people, mostly women in their 30s with families. We either had a tendency toward late nights or else accepted the necessity, depending upon our stage of life. Impromptu naps were not unheard of.

Our job was to grab an armful of charts, sit down at a computer terminal, usually a receptionist desk or nursing station normally occupied by a non-vampire human, and enter data into a patient’s medical record. Some of this involved just filling in template blanks for vital signs, etc., and some required typing some physician’s or other provider’s handwritten notes.

Once this data was entered, we moved on to another chart. At different times during the night, these entries would be printed as hard copy to be manually placed in a physical chart, but the information – the entire chart, in fact – was instantly available to anyone on the network, which spread out across the city. It was an electronic medical record.

In 1978. This isn’t a new idea.

I’ve always been surprised that it’s taken us so long to reach now, when many of us have easy access to our medical records, finally, from the comfort and privacy of our homes. Lab results pop up as alerts in my email box a couple of hours after the blood is drawn. I can download a summary and use the data in any way I like, I guess, although my data has been unremarkable for quite a few years. Stopping bad habits has a way of normalizing the numbers, and with some genetic luck on my side there’s nothing in my chart that doesn’t point toward a remarkably healthy, or unremarkably, person. Knock on wood.

The last time I went to see a doctor for something other than a well check was in 2008, when I had elective surgery to repair a small umbilical hernia, a little belly button bulge that caused no problems but might someday. Otherwise, it’s been once a year, the annual preventative medicine review that my insurance allows without copay or deductible fulfillment. It’s free, although nothing is free; I pay $7000 a year for 30 minutes of cursory examination and fun conversation with a professional who now feels like an old friend.

“How many times have I raised a red flag for you in the past 10 years?” I asked my doctor the other day at our visit, and she laughed and understood. Like, never.

Flags should consider themselves raised.

As with other technical if personal information, a medical record is not particularly useful to the layman, and probably causes more anxiety or confusion than it’s worth.

I’m not a layman, though, and I don’t need Google to navigate a chart. I can tell you what medical personnel look for, and in what situations (in an emergency, for example, allergies and medications will be crucial, along with preexisting conditions). I usually just gloat over my lipid levels (cholesterol, etc.) and keep an eye on my glucose level (even before my grandson was diagnosed with Type 1 diabetes, I worried that my eating habits weren’t doing my pancreas any favors, although my blood sugar has only been mildly elevated once; I don’t have diabetes). My blood pressure is good. Nearly 58 years of living under the influence of earth’s gravity has left me at just a bit taller than 5’11 now, barely above normal, and even though my weight has fluctuated it seemed stable on these latest visits, usually between the upper 190s and a bit above 200 pounds. This is much better than the 260s I remember from the early aughts, although I note my brief flirtation with the 170s a few years ago and it’s annoying. Since my wife’s medical problems began, though, or at least that’s when I pinpoint it, my tendency has been toward comfort eating. Habitual daily walking kept me fit and possibly added some muscle weight; in any case, no red flags get run up the pole at 200 pounds.

That’s what it was last March, exactly 200 pounds. That’s about where it was a couple of months later, when I took that crazy 30-mile walk across Seattle, north to south. I was sore for a few days but there’s no arguing with 30 miles. I climbed a total elevation of 2500 feet during that walk and averaged about 3-1/2 miles an hour, no huffing or puffing allowed. I’m not a runner or an athlete of any kind, just a walker, but again: 30 miles on a warm day and a 56-year-old body is an exercise tolerance test that was passed with flying colors. None of them red. I can live with 200 pounds. I’m the only one who cares about the pockets of flab I see in the mirror. A healthcare professional would find the whole thing boring.

I find it pretty boring myself, and it’s about me. I rarely look at the chart notes online, just the lab results and a nod to the treatment plan, which is normally nothing. Come back in a year, or as needed. Continue doing what you’re doing. Blah blah blah.

I looked at the chart notes for this latest visit. I’ve read them many times. I downloaded them.

I can break down a chart note for you, although it wouldn’t be interesting. It has sections, as you can imagine. Lots of them are boilerplate stuff. A 12-point review of systems, a checklist for any potential problems, gets spit out of the software in stilted, truncated English. Allergies and medications are easy, particularly if the answer is “None.” Habits are standard (tobacco, alcohol, drugs) and my history is well known and referenced. We know where I’ve been and where I am now. Nothing new, nothing to see here, keep moving.

Go down to “Exercise.” That’s a habit, too. Or a lack of one. Mine is pretty simple, another variable activated by a keystroke and resulting in a notation, my first name snatched from the database without an ounce of friendliness or familiarity.

“Charles does not exercise.”

Charles does not. Lots of people don’t. Everybody should.

A year ago, Charles was essentially defined by exercise. He walked 30 miles at a time.

Gosh, what happened, Charles? You’ve been doing this for the past nine years, this constitutional, this walk on the wild healthy side. Let’s lift that red flag a little and look some more.

Don’t bother. I’ll tell you. I stopped walking because I didn’t want to burn the calories. I changed my diet back in late June, partly because my grandson has diabetes and I was engaging in sympathy deprivation, and partly because I was suddenly underemployed and leery of binge watching and eating ice cream by the quart with all the spare time. I didn’t mind the idea that I might lose a few pounds, either, although I couldn’t imagine sticking with an ice cream-free lifestyle. Just looking for moderation.

Oh wait. I’m an alcoholic. I don’t do moderation.

Some weight loss would have been nice, not necessary and not necessarily my goal. I lost 43 pounds anyway. I weighed 157 at my visit last week. My height has not changed.

Charles does not exercise.

Charles is scared. Charles is ashamed. Charles is not used to these feelings, but he remembers. Fear and shame were last seen in the summer of 2006, when Charles was drinking himself to death. It had a happy ending. There’s a book.

This is why they weigh us, you know. It’s not to give us grief.

Charles doesn’t exercise because Charles doesn’t eat much. Charles has lost his appetite. Along with those 43 pounds he didn’t need to lose.

There’s nothing wrong with weighing 157 if you’re a guy my age and size. It’s not close to being clinically underweight, or even marginal. It’s just skinny. Some people are skinny. Not me, but some people.

Now me, though. It’s interesting, or it would be under different circumstances. But this is worthy of many red flags, all of which were raised from the beginning of my visit, most of which point to clinical depression. Well. This makes sense.

Many lab tests were done. Some of them are alarming. An occult malignancy is a possibility, even with no objective signs or data, although no further tests have been ordered as of today. Which is Saturday. Monday will be here eventually. I get a weekend of wondering. Some instructions to make an appointment with a psychotherapist about the depression, and consider medication.

A differential diagnosis is just a fancypants way of listing possibilities. In my differential are all sorts of nasty things, I imagine, and my imagination seems to be just fine. That said, Occam’s Razor needs to be applied in this situation. Those lab tests most likely point to a simple and obvious, if odd, diagnosis.

In 2016, in the United States of Obesity, a 57-year-old man is malnourished. I know, right? Can’t this just be a (very late) midlife crisis? Instead of what it is, which is a guy who feels ashamed and scared because he’s been starving himself for a year. For unclear reasons, let’s just say.

I’m not used to fear and shame, as I said. I remember them, as I said. Monday will come, as I said.

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