Tag Archives: health

Six Months and Eleven Kilograms Later

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In July 2022, I finally decided to join a gym and hire a personal trainer and a nutrition coach. While I had used my prison-quality condo gym regularly for many years, and had held gym memberships while living in the US, I had never hired a personal trainer nor had I ever used a nutrition coach. I figured it was time to get serious and get in better shape.

The results? Six months along, I have dropped from about 105 kg (230 lbs) to 94 kg (207 lbs) and all indications are that my weight is continuing to drop. Likewise, my body fat percentage has dropped from 27% to just below 20%. I would argue that these measurements aren’t the most important results, though. Most important are three significant changes:

I’ve shifted my mindset. I’ve come to see that exercise is for building strength and diet is what affects weight. Both are necessary for good health. For the longest time, I tried to exercise myself to lower weight and every time the weight would come back once my exercise routine relaxed. At one point, I was running 5 km a day, five days a week. That isn’t sustainable on my knees! I’ve also revisited my relationship with food, which I would see as a reward or as a “cheat meal” that I would later feel guilty about. I now look at food as fuel. If I decide I want to have hamburger, pizza, or ice cream, I do so like a responsible adult rather than as a ravenous teenager. And while I still enjoy fine dining, I’ve stopped looking at food – especially prodigious quantities of it – as entertainment.

I’ve built new habits. I came to realize that I need to focus on building habits instead of worrying only about the number on the scale. Three days a week, I meet my trainer at 6:00 am. Every day, I walk at least 5,000 steps and achieve a weekly average of at least 8,000. And every meal, I work to create a balanced plate that is substantially lean proteins, lots of veggies, moderate starches, and minimal fats.

When I travel or have social events, I plan in advance and create a strategy to stay as close to my habits as I can. I use substitute workout activities if I cannot go to the gym. I load up on lean protein at breakfast if my source of lunch or dinner will be out of my control. And when going to a restaurant or social event, I approach the menu looking for appropriate fuel rather than using it to fulfill other needs.

I’ve taken a sustainable approach. I realize that I have a choice about my health and fitness; it isn’t an inevitable consequence of aging but rather something over which I have a lot of influence. As such, I am making choices with a long-term view: yes, two scoops of ice cream with all the toppings would taste good now but one small scoop will taste pretty much the same and eating less of it increases the odds I will be around and healthy enough to eat ice cream 50 years from now. Also, no fad diets or over-the-top exercise routines. My approach has to be something I will want to do consistently, year after year.

Why did I change? The biggest impetus for my change was my grandfather turning 102 this year. He still lives at home and while he is generally in good shape, I can see many ways where having a bit more strength, a bit less weight, and a bit better balance would increase his chances of remaining independent. Considering many aspects of my genetics – especially body shape and size – seem to trace back to him (my recently-departed grandmother, owing to her macular degeneration, regularly confused my grandfather and me if she viewed us from halfway across the room), putting myself on a healthier path now should increase my odds of living an active and independent life for many decades to come.

What am I doing? As mentioned, I have hired a trainer and I meet her at the gym three times a week. This has helped me in three ways: first, it creates tremendous accountability. In the past when I went to the gym by myself, I wasn’t pushing myself to my limits. Having someone else to show up for, ensures I show up. Having someone who sets expectations around repetitions and weight, ensures I reach those levels of performance. Second, having a trainer improves my form. I always had the sense that I didn’t really know what I was doing with most exercises and would often be sore or even injured afterwards. My trainer has really helped me understand how to exercise in a way that has the most benefit and minimizes the risk of injury. Finally, having a trainer keeps me from being bored. She mixes up the exercises and the areas of focus and keeps my workouts interesting.

Additionally, I hired a nutrition coach (Darren Liu of Breakthrough Body Blueprint) to help me with my approach to diet. He and his team were helpful in challenging the way I think about food. They had me start tracking my meals (MyFitnessPal is a great, easy-to-use app) which was a pain in the ass for the first two week and then easy. Most importantly, it was eye-opening. You really don’t understand the impact of what you are eating until you take the time to track it.

Darren and team set me up with calorie and macronutrient targets, significantly increasing the amount of protein that I consume. What I discovered is that protein helps me stay full longer, reducing the urge to snack. I also discovered that I can feel completely satisfied even as I only consume about 2,100 calories a day – my current target to ensure a slow but consistent loss of weight, about two kilograms a month.

I also started tracking my steps using my phone. There’s a lot of buzz about 10,000 steps a day – that felt a bit much as an average. But I have found that moving a minimum of 5,000 steps a day is very doable, with longer walks on days I don’t go to the gym or on the weekends. Last July, I averaged about 6,600 steps a day. By December, that was over 10,000 steps. Instead of riding the motorcycle from the station to my condo, I walk. I walk to the gym in the mornings, about ten minutes each way. I walk to a restaurant for lunch instead of ordering in. I stopped working from home and started going back to the office, since it automatically requires more walking from me. And the more I walk, the more I find walking doesn’t seem to be such a hassle.

What is the plan from here? So far, so good. But can I keep the weight off? Most people who lose significant weight tend to gain it back. And I shouldn’t stop here. While BMI isn’t the most nuanced measure, I’m still in the “overweight” category. The plan is to continue my habits around exercise and diet, to make them a consistent part of my life. Consistent habits should result in better overall health, better energy, better sleep, and a better sense of self. My target for 2023 is to reduce my body fat to 17% and my weight to under 90 kgs. But the numbers aren’t the real goal. It’s sustaining the mindset and the habits that lead to a long and healthy life.

Not Admitted – Thankfully

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In my previous post, I wrote that I was heading to the hospital for a follow up with the doctor and anticipated being admitted. Thankfully, that didn’t happen.

Instead, upon inspection she decided the abscess in my neck seemed to be reducing so ordered a double-strength dose of IV antibiotics and another return visit Saturday afternoon. 

If all goes as planned, I’ll receive one more IV Saturday and then move to tabled antibiotics for another four days. Hopefully, all does go as planned.

Thanks for the comments and kind wishes shared on the previous post. I will return to more interesting subjects soon!

Heading to the Hospital

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Thursday afternoon, out of nowhere, I noticed that the left side of my neck was a bit tender and by the evening, it seemed to be swollen a bit. Considering that I’ve never experienced these symptoms before, I decided to go to the doctor’s office Friday morning and have it diagnosed.

The diagnosis was that I have a “deep neck abscess” – a bacterial infection inside the tissues of my neck. Dead white blood cells accumulate, forming a mass in the tissue. Normally, this is caused by poor dental health or after an infection of the respiratory system. Neither is the case for me.

The doctor wanted to admit me to the hospital right away and get me started on strong antibiotics. A bit hesitant to jump straight to that course of treatment, I negotiated and was instead given IV antibiotics on an outpatient basis with the promise to return this morning.

While the swelling and tenderness haven’t become noticeably worse, they haven’t improved, either. I suspect I will have to cave in and be admitted for what will be the second hospital visit in my life.

Thankfully, it is happening at the start of a weekend, so the timing is only a minor inconvenience. Will have to cancel a trip to the farmer’s market Saturday and brunch plans for Sunday.

What I find interesting is that I never had to be hospitalized until I moved to Thailand. I wonder if it is coincidence, the fact that I am getting into my middle years, or perhaps I am really exposed to more bacteria here in Thailand.

The Hidden Verdancy of Bangkok

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The thing about Bangkok is, it isn’t a very pretty city. Being in a tropical climate, I always expect that it will be a lush, verdant city. Even though I’ve lived here more than seven years, I still have that expectation somewhere in the back of my mind. The reality, though, looks a lot like this:

At least, that’s how it looks from the street level. The buildings are built close to the roads, with only narrow footpaths that are only occasionally dotted with trees. Those trees are usually subject to harsh pruning by laborers armed with sharp saws and little horticultural knowledge.

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Over time, my understanding of Bangkok’s relative verdancy has evolved. What I have come to see is that the city has a lot of green space, but that most of that green space is not public. Sure, as you walk down the alleys and streets, you may see some trees and bushes. For the most part, though, they are on private property, peeking over high walls. As a result, you walk in the full heat of the tropical sun.

Compare this with Singapore (pictured above) or even Kuala Lumpur, cities with mature trees lining the public footpaths, providing shade, cleaning the air, and making the city more pleasant. Now, don’t worry – I’m not about to turn this into a Bangkok-bashing, Singapore-loving entry. I just find the comparison to where our greenery lives interesting. 

When you rise above the street level, as in this view from the Conrad hotel in the particularly lush Wireless Road neighborhood, you can see that there is quite a bit of greenery in Bangkok, although as mentioned before, much of it is not visible from the streets.

In fact, some of the grander houses live in a lush, tropical paradise. Except for the high rise buildings looming overhead, you would think you were in a jungle!

Sukhumbhand Paribatra, elected this past Sunday to a second term as governor of Bangkok, has promised to radically increase the amount of park land. By most estimates, Bangkok has less than one-tenth the amount of green space per resident compared with an average city. Let us hope that some of this green space can be expanded out of parks and into our everyday lives.

Somnoplasty to Treat My Snoring

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A few weeks ago I wrote about undergoing a sleep test in March to determine if I suffered from sleep apnea. Sleep apnea is a potentially health-threatening condition where you stop breathing for extended periods while sleeping. As it turned out, I did not have sleep apnea – just good old-fashioned snoring. Since my snoring disturbs Tawn (and I also feel that it may keep me from getting a restful night’s sleep), this morning I underwent a procedure at Bangkok Hospital called somnoplasty.

Nasal Cavity and Mouth Annotated
Like the graphic? I made it myself using PowerPoint, then captured and annotated it with SnagIt.

Somnoplasty uses radiofrequency ablation to tighten up the tissues that cause snoring. “Ablation” is the removal of tissue through a variety of means. In this case, a metal probe that looks like a very narrow fondue fork pierces the tissue. Then the heat of very high frequency alternating current burns part of the tissue below the surface. As the injury heals, scar tissue forms, causing the surrounding area to tighten up and shrink. As a result, the area is firmer and less prone to vibration – which is what causes the noise of snoring.

Research on the procedure shows that 85% of patients experienced significant reduction in snoring, with their average “snoring score” (a 0-10 scale measuring the intensity of the snoring) dropping from 8.9 before therapy to 3.5 after. The procedure is significantly less invasive than other available procedures and my doctor was confident that a single treatment should be sufficient to essentially eliminate my snoring.

 

A walk-through of the procedure, in case you are interested:

(Warning – there is a small picture of the inside of my mouth further down the post – something you may not wish to see!)

Once seated in the exam room, Dr. Chidpong placed pieces of gauze soaked in a light anesthetic in my nostrils. He also applied a bitter-tasting medicine spray into my mouth, which started to numb the tissues immediately. Within a minute, my ability to swallow was gone and my teeth were numb. The doctor warned me that I would get the sensation that something was stuck in my throat – and indeed I did – and told me not to panic. A few deep breaths and I overcame that sensation.

After about two minutes, he gave me a series of shots – one in each nasal cavity and then three in the soft palate of the mouth. Along the way he asked if there was any pain. The nasal cavity shots were painless – in fact, I couldn’t feel any sensation at all. The shots into the soft palate were mildly uncomfortable, but brief.

The shots were a medicine that restricts the blood vessels, so that there would not be any bleeding during the procedure. While giving me the shots, he explained that I would notice my heart rate increasing and within a few seconds, that is what happened.

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About four minutes into the procedure he took the probe (the two needles are about a half-inch long) and inserted it into one nasal cavity, then the other. If I understand his explanation correctly, he ablated the middle nasal concha (also known as the turbinate), one of three bone shelves that protrude into the nasal passage. Each ablation took about ten seconds.

There was no pain nor any smell. Along the way, I did hear a few “pops” that reminded me of when a bug dies in a bug zapper. A couple of times, a feeling of mild panic rose and I had to remind myself to focus on breathing through my mouth. Each time the doctor inserted the probe, he first said “excuse me,” which I found very funny.

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(Click for a larger version.)

After the nasal passages, the doctor ablated three spots on my soft palate – left, right, and center. The picture above shows the injuries about twelve hours after the procedure. The resulting injuries look like canker sores.

The entire procedure took seven minutes. The doctor explained that earlier versions of this technology used less power and the procedure took about thirty minutes instead of seven. Thank goodness for advances in medicine!

Post-Procedure

After the procedure, I returned to the waiting room. A nurse checked my blood pressure a few minutes later. It had jumped from 120/65 at check-in to 150/85 after the procedure. As I waited, I noticed that the anesthetics were rapidly wearing off and the back of my throat and my nasal cavities were itchy. Within thirty minutes after the procedure started, I was downstairs picking up medicines and paying the cashier.

Twelve hours later, the sensation is similar to having a bad sore throat. Eating is a bit uncomfortable and I keep clearing my throat, reflexively trying to clear what feels like some phlegm. Of course, the sensation is caused by the wounds from the procedure and no amount of throat-clearing will help.

The pain should subside within about three days. I am taking paracetamol for the pain, an antihistamine for any nasal dripping, and an antibiotic as a precautionary measure. The pharmacist also gave me a medicinal gargle with mild anesthetic qualities. I was also advised to eat lots of ice cream, to help reduce the swelling.

It will take a few weeks to observe the full effects of the somnoplasty as the scar tissue develops and the surrounding area tightens. I will have to ask Tawn for his perception over the next few weeks, whether or not the snoring has appreciably lessened.

 

Undergoing a Sleep Test at Bangkok Hospital

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I snore. I snore so loudly that it keeps Tawn awake. After trying various remedies such as weight loss and sleeping on my side, I decided to visit an Ear,Nose, and Throat specialist at Bangkok Hospital. After sticking a probe up my nostrils to inspect that things were roughly in order, he suggested I come in for an overnight sleep test.


(The volume on this video is just a little low… sorry.)

The purpose of the test is to get an accurate read on the quality of your sleep including your sleep patterns, physical movement, brain activity, and breathing. Sleep apnea is a condition often associated with snoring. You stop breathing for extended periods of time (more than ten seconds), which can lead to many health problems including irritability, fatigue, and high blood pressure.

P1200799 I arrived on a Thursday evening at the hospital. After having my vital signs taken, I went for a pair of chest x-rays. (I have to say, before coming to Thailand, I had never had an x-ray in my life. In the six years since, I’ve had close to a dozen. They really like their x-rays here.) Then I headed upstairs to the sleep clinic.

My room for the evening resembled a regular hotel room, but with linoleum floors and bedside equipment that reminded you that this was a hospital. The room was also outfitted with two cameras, one of which was infrared, that would allow the sleep technician to observe me throughout the night.

After changing into my hospital scrubs, the sleep technician started wiring me up. This took about thirty minutes and my recurring thought was that this must be roughly what a condemned man goes through leading up to his execution. Grim, no?

Electrodes were attached to various parts of my body. Having a shaved head made this process easier, I think. A tube was inserted into my nostrils. Straps around my belly and chest held wires and monitors in place. Finally, all the wires were pulled together like a ponytail and wrapped with medical tape.

When it was time to go to bed, I had to carefully position myself on the mattress. The technician stretched the wires across the bed to a trio of small devices, which then fed the data directly to the computers in his hidden control room. After saying goodnight to Tawn, I read for a little while until sleepy, finally turning out the light and shutting my eyes.

Once the thoughts of imminent execution left my mind, I kept repeating the question, “How can this really measure anything useful?” With this number of wires, electrodes, and monitors, my range of motion was limited. Add to that the unfamiliar bed and pillow and the fact that I usually fall asleep on my side before rolling over onto my back, and I was carrying more negative, skeptical thoughts than usual. I had been offered a mild sedative if I thought I would be unable to sleep, but declined it. After not too many minutes, however, I did manage to drift off to dream land.

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Sometime in the middle of the night, I awoke for about thirty minutes. I was thirsty and had to stretch awkwardly to reach a bottle of water on the bedstand. Instead of fully quenching my thirst, I merely sipped because if I subsequently needed to use the toilet, I would need to call the technician and be unplugged first.

I slept a restless few more hours before finally waking at 5:30. It didn’t take long before I decided that I had had enough of this experience and wanted to get up. I was surprised when the technician, perhaps reading my brain waves, entered the room about fifteen minutes after waking to unwire me without me having to ring for him.

Afterwards, I showered and changed into my street clothes, letting the nurse know I would skip the included breakfast and was ready to be discharged. By 6:30 I was home, taking care not to wake up Tawn who was enjoying a peaceful, snore-free night.

A few days later I returned to the hospital for my follow-up meeting. While I didn’t feel like my night had produced a representative sample of my sleeping habits, the doctor was confident of the test results. He explained that I suffer from a condition known as “regular snoring” and that I have no sleep apnea. All of the measures – blood oxygen, brain waves, sleep modes, etc. – we within a normal range. Whether I do anything further to treat the snoring is up to me, but it is posing no health risks at this point.

In retrospect, I have to give the Bangkok Hospital staff high marks for professionalism and attentive service. While I think the package might be a little steep at about US$500 (Why do they need to x-ray me, for example?) the experience was a positive one. My doubts about the effectiveness of the test may linger, just slightly, but at least I know that my health is in no immediate danger.

 

A Birthday Message

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Today I turn 41 years old.  This seems to be a popular time for birthdays.  Two friends here in Thailand share my birthday, two other friends have birthdays the day before, and a dozen other friends have birthdays within plus or minus a week.  Perhaps St. Valentine’s Day provides a good explanation for this mini-bubble of mid-November Scorpios.  That’s speculation, though, and beside the point.

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I’ve heard of “peak oil”… does “peak hair” also exist?

To give you a brief update, life is going quite well.  Yesterday, as part of a habit I would like to create, I visited the doctor for an annual physical.  By chance, I was seen by Dr. Nina, an Indian-born doctor whom I had seen a few years ago for a suspected case of Dengue Fever (which, thankfully, it was not).  I’m glad I reconnected with her as she has a wonderful manner and I will make it a point to have her as my regular physician.


In any case, the general conclusion is that I am fine, health-wise.  My cholesterol, which had dropped from about 260 three years ago to only 165 a year ago, has since climbed back to about 250.  We’ll have to monitor this and see if some diet and exercise changes can bring it back under control.  Other than that, a clean bill of health.  If I can lose a few kilograms over the next year, we’ll all be happier at next year’s check-up, too!

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Celebration-wise, I don’t think Tawn and I will do that much to celebrate.  We had a large sausage making, cooking and eating dinner this past weekend with some friends (see “lose a few kilograms,” above), so that was probably enough hoopla to celebrate.  Instead, a quiet evening at home with Tawn should be celebration enough.

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From a general happiness standpoint, I realize that despite the few gripes and frustrations that arise in life, I have very little about which to be unhappy and a very large amount to be thankful for.  Yesterday, in what I interpret to be a nice bit of serendipity, a university friend of mine posted a quote from poet Gunilla Norris that I think should be my birthday prayer:

“Guard me against the arrogance of privilege,
against the indulgence of feeling that I don’t have enough,
and the poverty of spirit that refuses to acknowledge what is daily given to me.”

Beautiful and timely, isn’t it?  When I think of all the wonderful people, experiences, and opportunities I have had thus far in my life, I can’t help but be grateful to everyone and everything that has played a role.

 

Trying to Eat Healthy

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Most weeknights, Tawn and I try to eat dinner at home.  Whatever I cook, it almost always includes a salad with lots of vegetables.  This is our attempt to fill up on veggies, rather than on meats and carbs.  Sometimes, I try for something a little fancier like this steak salad with thin slices of American sirloin, roasted red peppers and onions, and shavings of Parmesan cheese.  Most of the time, though, the salads are a little less ambitious.

Weekday breakfasts are also eat at home meals, usually oatmeal with a combination of dried fruits and nuts, sometimes with a little quinoa, which provides some protein to start my day.  Since I work from home, my lunches are also usually eaten at home, often leftovers from dinner the night before.  From time to time, though, I will step out for lunch, stopping most often at a neighborhood ramen shop for some noodles.

All this weekday eating at home is offset by frequent social events on the weekends, when we end up eating out for most of the meals.  On both Saturday and Sunday this past weekend, we had engagements for lunch and dinner.  The odd calculus of this pattern of socializing is that while my wallet gets thinner, my mid-drift gets thicker.

 

A Healthy Start

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In an attempt to add a little (relatively healthful) variety to my usual breakfast of oatmeal, I bake batches of granola made of rolled oats and barley, nuts, wheat germ, dried coconut, and flax seed, all of which is lightly moistened with a mixture of canola oil and maple syrup and then roasted until lightly browned.  After cooled, I add raisins, dates, or other dried fruit.

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Served with some plain yogurt and some fresh fruit – in this case, passion fruit pulp – it makes for a nice breakfast, no?  I’d like to believe it is also a healthful but in addition to the whole grains and good fats, I think it is pretty high in calories.  Thoughts?