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Overall my surgery went well last Friday. But my surgeon found extensive damage that wasn’t visible on the MRI. The rotator cuff tear was worse than he thought plus I had also torn my biceps tendon. So I have 12 screws instead of the 4 I was expecting. I’ll see him Thursday to get more details and to get him to explain the photos from the arthroscopic camera.

The recovery is going well so far. Pain was severe on Saturday but controlled well by the pain meds. It has gotten better day by day.I’ll give another update Thursday.

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I go in for my rotator cuff surgery today at 2:00 pm. After that I’ll be in a sling for 4-6 weeks. I don’t type too well left-handed and don’t know how soon I’ll be allowed to use the right hand for typing (I’ll find out at follow-up with Doc next Thursday). I do have a backlog of posts from my Stayventures so I’ll be posting those, along with any updates an how rehab is going.

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I like to read about the adventures of intrepid endurance athletes. Long-distance hiking, multi-day ultrarunning, paddling, and cycling are among their activities. Some adventures are in pretty remote and exotic places. For the most part the authors seem to be enjoying themselves, although they definitely go through some rough patches, so I find it inspirational. But I’ve always wondered if a tamer version could be done locally. There is the concept of a “staycation” where you take time off and relax and enjoy the activities near home instead of traveling somewhere. So I wondered about “stayventuring”, or bagging a lot of local adventures as day trips while sleeping in my own bed instead of wild camping or trying to sleep in an ocean-going rowing boat.

Another way to look at it is when I plan my endurance exercise. It seems excessive to plan more than a couple of hours a day for multiple days in a row. I know triathletes, cyclists, and ultrarunners in training do it. But it seems a bit much if you’re not pointing at some competitive event. But people who hike long-distances, such as through-hikers on major trails, hike all day. Day after day. People who ride their bikes across the US bike all day for many days. And there are guided cycling tours you can go on where you cycle for hours a day. I wondered why I couldn’t do this locally, “stayventuring” for hours a day for a few weeks. But I never got around to actually doing it.

That changed recently when I found out on may 21 that I needed rotator cuff surgery. I was scheduled for June 14th, which was just over 3 weeks out. I had just gone through a period of rehab after breaking my collarbone where I couldn’t exercise as much as I’d like and had gained some weight, which for a few weeks I’d been bouncing back from. I knew I’d be exercise-limited again while rehabbing the shoulder. I thought, “it would be great to get in as good shape as I can in the time remaining before the surgery”. What if I tried my stayventuring idea out, doing some kind of local adventure each day for 3 hours or so? Also, I knew I might be typing-challenged with my arm in a sling during rehab, which would put a dent in my blogging. It would be nice to have a backlog of trip reports I could put out as blog posts during that period. So for the last couple of weeks, and this final week leading into the surgery, I’ve been doing day trips to local adventures. For the first couple of weeks it was exclusively biking because I was nursing a strained achilles tendon, but I’ve started throwing some hiking in too (actually combination bike-hiking) this past few days. It helps that my hybrid bike has electric assist which lets me cover a lot of ground. But some of the adventures have also been local rides on my new bike, without assist. Two of my recent posts “Nice Ride With New Bike- Big Wheels!” and “A Nice 3 Hour Ride to The Southwest” were the first of my stayventures. I’ll be reporting on the others starting next week.

I can say now that overall I’ve enjoyed the process a lot. I’m getting in great shape, I’ve revisited some of my favorite haunts and discovered new ones. And this fits a lot better into a relationship than me going off somewhere for weeks on an adventure. My wife is less interested in participating in activities of this level, instead she enjoys walks closer to home. I can still fit those in also, because my stayventures are all in the morning. She does her own thing while I’m out gallivanting, then we have a nice lunch together and spend the rest of the day together.

My 3 weeks of stayventuring have ended and it’s on to a few weeks of a tamer lifestyle, rehabbing the shoulder after my surgery Friday.

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It was a beautiful day today so I headed into the hills south and west of Morgan Hill. I took the bike path along Little Llagas creek and the drainage through an adjacent neighborhood on the way out of town:

Next I went south on Santa Teresa Boulevard towards Gilroy, then right on Day road for a beautiful ride into the hills:

Further up Day road is one of many wineries in southern Santa Clara county. We may not rival Napa valley but there is good wine from down here too:

Another one, right at the corner of Day and Watsonville roads:

South on Watsonville, some more vineyards, and the fog is creeping in over Hecker pass:

These shoulders aren’t super wide and some of the traffic is fast, but by and large the drivers are courteous, and it’s not too trafficky.

Further along is Chitactac-Adams Heritage park. It is a very nice setting with Uvas creek flowing through it, and has Native American artifacts including petroglyphs and grinding rocks:

I turned up Redwood Retreat road, a gorgeous ride that also leads to the back entrance of Mt Madonna County Park. But I decided to save it for another day:

Instead I did an out-and-back on Burchell road to see if the alpacas were out at their farm. Sometimes they’ll get curious and come check the humans out at the fence. No luck today. But on the way back I got another nice shot of the fog:

I passed lots more good scenery on the way home, but time was getting short and I didn’t take any more pictures. Decades ago when I was going to Stanford I used to commute home through beautiful roads in the foothills in Los Altos Hills. When we moved to the southern part of the County near Morgan Hill when we came back from Colorado, I was glad to find that there are equally nice places to ride down at this end. I never tire of them.

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I sold my Bike Friday Superpro. It was a great bike for travel and smooth roads which served me well for six years. But it’s more suited for less clumsy riders. For me, it’s big wheels from now on. I bought a Specialized Sirrus expert carbon with the proceeds. This has 700C wheels (about 28″) instead of the 451 wheels (20″) on the Friday. And it’s specifically designed for rough roads.

This is my first bike with a carbon fiber frame. I did run into one odd quirk. The first long ride I went on, there was a lot of a rattling which sounded like something loose inside the frame. I didn’t notice it on my test ride nor did the folks at my shop. I tried taking the seat out and shaking the bike upside down but nothing came out, it turns out the seat tube is sealed from the other tubes on this frame. So I took the bike back in and the mechanic said “oh yeah, I’ve only seen this a couple of times before. There was probably a piece of the mold jammed in the tubing which has come loose”. He had to remove the forks to get to it, and voila, this fell out:

Problem solved! And now I have a souvenir to go along with the bike.

Specialized pioneered the “plush” road bike category with their Roubaix model several years ago, inspired by the rough cobblestone roads of the legendary Paris-Roubaix road race, nicknamed “the hell of the north”.

A rider on the cobblestones in Paris-Roubaix on a nice day:

And another section, the Arenberg forest, on a not-so-nice day:

Specialized engineers designed a bike just for these conditions which absorbs vibrations well. It was found this was not just a comfort issue, riders can actually perform better on rough roads with a smoother ride. The commercial version of this bike, the Roubaix, went on to become a success. My bike, the Sirrus, is very similar to the Roubaix but with flat handlebars instead of drop bars, which is a more comfortable setup for me.

I took the new bike out on some rougher country roads today to try it out. First I paid homage to the designers by riding by Specialized’s headquarters at the south end of Morgan Hill.

Then it was west up into the hills. Some nice country and horses on Sycamore road on the way:

I road past the sight of my collarbone-breaking-crash. Here is the pothole that was my undoing. Actually it wasn’t a pothole, just a rough edge of the road:

I intentionally rode over this section again today, and the new bike sailed right over it. Didn’t even rattle my fillings. This gives me confidence I’m now less crash-prone.

Down the road is the Machado school, a one-room school house from 1895, now used for special classes and events. A dance class was going on today.

A little further along, the start of Paradise Valley, an unincorporated part of our county west of Morgan Hill:

A little further along are the orchards of Ward’s Oak Glen farm, also established 1895:

The road is Oak Glen Ave, aptly named, there are a lot of beautiful specimens of California Oaks along it. It is a favorite road of mine, especially now that I don’t bounce up and down so much on it’s sections of cracked pavement.

I toodled along down nice country roads like this for a couple of hours. I love how the new bike rides. I have to get as many rides like these in as I can the next couple of weeks until my shoulder surgery. Then it will be back to the indoor trainer. I got some good tips from friends on that. The most important is to have a tv or computer monitor to help pass the time. I’ll just use my laptop on a table. There are a ton of online bike workouts on youtube including many from the good folks at Global Cycling Network in the UK. I’ll give them a try.

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I just read the interesting book State of Slim: Fix Your Metabolism and Drop 20 Pounds in 8 Weeks on the Colorado Diet by Dr. James Hill, Dr. Holly Wyatt, and Christie Aschwanden. Overall, I recommend this book for motivation and good tips. Actually following their program to the letter is optional but it’s still good reading if you don’t ( (I chose not to, I’m already doing something similar).

Dr. James Hill is Director of the Center for Human Nutrition at the University of Colorado Health Sciences Center. Dr. Hill is also one of the founders of the National Weight Control Registry (NWCR), which keeps track of people who have successfully a significant amount of weight and kept it off. His colleague Dr Wyatt is is a physician and clinical researcher at the Anschutz Health and Wellness Center (AHWC) on the Anschutz campus of Colorado University. She also runs the Metabolism and Obesity clinic at CU Anschutz where she treats overweight and obese patients. Christie Aschwanden is a journalist and poultry farmer in Colorado who is also the author of Good To Go about recovery methods for athletes.

The title comes from the fact that Colorado is the “slimmest” state in the US (among other statistics, 25% fewer adult Coloradans are in the obese weight range according to bmi charts than the US average). The motivation for the book is answering why this is so, what is different about the lifestyle in Colorado? Also the authors have considerable evidence from their clinical experience and research. A final interesting tidbit is that while not everyone in the NWCR has the same diet or activity levels, there are definite trends. And on average, the lifestyle of people in the NWCR, who are from all over the country, is quite similar to that of the average Coloradan.

Having lived in the beautiful city of Boulder for 3 years, I was intrigued by this book. I can attest first hand that the call to the outdoors is quite strong in Colorado, because of the beautiful scenery and weather. Walking, hiking, running year round, skiing and snowshoeing in the winter, all in close proximity.

The Flatirons and thousands of acres of the mountain park system just west of Boulder, Co

So not surprisingly, one of the salient aspect of the lifestyle is a higher level of physical activity. The other is healthier eating habits, with more emphasis on whole foods and less on processed foods. These are average trends. Not everyone in Colorado is active, and there is as much junk to buy at “King Soopers” as there is in grocery stores in other parts of the country. There are also plenty of fast food joints in Colorado. I remember the amusing sight of a McDonald’s and Burger King peacefully coexisting right next to each other on 30th street in Boulder. There was no need to fight because there were lots of customers to go around. Nevertheless, on average Coloradans move more, eat less junk, and eat more healthy stuff. As does the average person in the NWCR, which shows this lifestyle can be followed anywhere.

There are a couple of interesting anecdotes in the book. In the first, a colleague of the authors at the Anschutz Center moved to Colorado from another state, and ended up losing a significant amount of weight. He described how he thought he had moved to a “planned fitness neighborhood” because there were so many people walking all the time on a nearby path. Then he found out “that’s just what people do around here”. The healthier eating habits of his neighbors rubbed off on him too. He pointed out that in retrospect there’s no reason he couldn’t have followed this lifestyle back in Ohio. The second anecdote is about Dr. Hill’s son, who was fit and healthy until he moved back to Mississippi where he gained about 20 pounds. The main difference was most of his friends in Colorado got together to do something outdoorsy, while the lifestyle with his friends in Mississippi revolved more around eating. But he caught himself and found ways to be more active in Mississippi and regained his former weight and fitness.

University of Colorado Anschutz Medical Campus 

Interestingly as I was reading this book I came across an entire book on the “Colorado phenomenon” entitled The Colorado Weight Loss Fix: How I Dropped 30 Lbs In 40 Days Copycatting The Secrets Of America’s Healthiest State by Tatia Cerrone. Tatia grew up in Mississippi and attended Ole Miss for college. She was considerably overweight and inactive at the time, and described the favorite foods she grew up on, which are delicious but rich. She happened to have a roommate from Colorado who was slim and participated in various sports, and noticed her eating habits were different. When Tatia graduated she did not have any immediate job opportunities locally. So she decided to visit Colorado, and her roommate was happy to let her come stay with her. You see the results from the title, she learned to eat healthier and get active, doing various outdoorsy activities inspired by her roommate, including rock climbing! During this period she related her experiences to her sister back home, who was inspired to start eating better herself and joined a gym. By time Tatia moved back, her sister had lost a good amount of weight as well, and Tatia intends to continue on with the new lifestyle along with her sister. There’s no reason you can’t be healthy in Mississippi.

Returning to State of Slim, the authors devote a large portion of the book to the diet and lifestyle program they teach, “The Colorado Diet”. The lifestyle part is moving- a lot. They want you to get the equivalent of at least brisk walking for 70 minutes a day, 6 days a week. Or substitute whatever brisk activity you enjoy most, swimming, biking, running, skiing, etc. Or if you want to accumulate some throughout your day, go for 35 minutes of formal exercise 6 days a week, but make sure you also get 7000 steps a day. If this seems excessive, bear in mind that this is probably still less than what the average adult got in the pre-automobile era. The authors give lots of tips on how to move this amount, including the usual ones you hear, like park your car further away or take the stairs instead of the elevator. I was surprised they didn’t mention active transportation, such as walking or biking for commuting or errands, but I would certainly recommend that.

The diet, long term, is pretty much what most mainstream nutritionists would agree with: minimize overly processed junk, eat lots of fruits and veggies, get adequate protein and healthy fats. But if you are currently above the weight you’d like to be, they recommend introducing it in three phases. They make the analogy that most people who have been eating the typical modern diet have “clogged” metabolisms. The calories you bring in are like a faucet, but calories out are too low because of the clogged drain. Just reducing calories turns the faucet down but does not unclog the drain. I would have liked it if they had given a little science on what the clogged drain represents. I assume it’s similar to the various mechanisms discussed by Dr. David Ludwig in his book Always’s Hungry which I’ve talked about previously. The first phase of the proposed Colorado Diet is intended to unclog the drain by keeping fat content low, protein high, and starchy carbs low. This lasts a couple of weeks. Then you loosen it up a bit, introducing some starchy carbs in phase II, which last for a few months while you are losing weight. Then you transition to phase III, which is the long term way of eating I described above. Phase I was interesting to me because it differs from Dr. Ludwig’s approach to “reset your metabolism”, which I’m assuming is the equivalent of “unclogging your drain”. The two approaches agree on minimizing junk and keeping starchy carbs low in the phase. Dr. Ludwig recommends adequate protein and fairly high fat, while the Colorado Diet recommends higher protein and lower fat in this phase. It is possible that both approaches work for fixing your metabolism if it is minimizing junk and starchy carbs that is the key.

Following the formal Colorado Diet plan is optional. From the anecdotes it seems that you can be healthier just moving more and making better eating choices. And as I’ve argued in previous posts, health is the most important thing to focus on. If your new lifestyle is also accompanied by weight loss that is “gravy”, or “icing on the cake” (sorry, I don’t know any whole food expressions for this).

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I just reached 250 followers. Thank you all for your interest in my site! I remember months ago when I was doing a lot of work to gain new followers, such as finding other sites with similar content, about the outdoors, exercising, good nutrition, etc. I’d comment and like their posts diligently. Doing that I finally got up to 100 followers. After that I relaxed, and the next 150 just happened over time. So for those just starting out, don’t worry it will happen gradually.

If anyone follows me, I do like to check out their sites as well. Almost invariably I’m interested in their content and follow them back. Most of my followers are fellow WP bloggers. I sure like this community.

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I went to a followup with my Orthopedist yesterday. This was also the first time I saw him after my recent fall.

He concluded after a lot of manipulation and “push on my hand this way, does that hurt?” that I had further torn my rotator cuff. He had been on the fence about whether to fix it, but this pushed him over the fence. Time to repair it or it will just keep getting worse. So surgery will be on June 14th. Interestingly, as I was getting ready to post this I came across one by fellow bloggers London Shoulder Specialists: “When Is Surgery Absolutely Essential For Rotator Cuff Injury?”. I qualify based on their criteria under ” Lifestyle considerations”, as an active individual. They describe this as “getting back into the sport they love is essential”. In my case it’s not that so much. It’s more “because doing the activities he loves, he keeps falling on the damn thing and making it worse”, which I guess we can call the “clumsy oaf” criterion.

Fortunately this is an arthroscopic fix. My surgery will be similar to what is shown in the video in the link. I’ll first get the inspection, and debridement if needed. But I’ll get 4 screws into the acromion, with an x-shaped sutures connecting them.

Compared to hip and heart valve replacements, piece of cake! It’s outpatient surgery, then I’ll be in a sling 4-6 weeks. Doc says you feel good a lot sooner than that and will be chomping at the bit to take the sling off. But it keeps you from doing something dumb like instinctively grabbing something heavy at a bad angle on the surgery side.

After that it’s months of PT to get full ROM and strength back. No sweat, I’ve worked around worse limitations than this. Don’t worry if it sounds like I’m being naive about this, my Mom had this surgery, and I know what she went through, and I’ve talked to friends who have had it recently, so I know rehab is a lot of work. But I’m kind of experienced at rehab. I’m excited about getting back better functionality in this shoulder. It has actually bugged me for years. I think I might have torn the rotator cuff about 15 years ago: I was doing a chest press with heavy (for me) weight and actually heard a tearing sound from the right shoulder. Freaky! It has bugged me doing certain activities ever since. For example, I can only do push ups until the upper arms are horizontal. If I do chest to the floor the shoulder hurts. I think I have just made an existing tear worse with my two recent mishaps.

So no paddling for a few months, strength training left side only, and no biking outside at least for a few weeks. I’ll get in as much as I can between now and June 14, then it’s back to the trainer and cardio machines at the gym. Also brisk walking. Given my recent history of clumsiness I think I’ll avoid hiking until the shoulder is 100% rehabbed. This would be a good time to work hard on balance too.

In my last post I mentioned that my weight had crept up recently because I didn’t monitor it during my recovery from the broken collarbone. No problem, I thought, I’ll just bump up my exercise volume, which I enjoy anyway. But events seem to be conspiring against that.

But I’ve been through a similar situation of needing to lose some weight without doing a ton of exercise. In early 2017 My doc was unhappy with my triglycerides and also thought I needed to lose about 15 lbs. I couldn’t exercise my way out of it, because my aortic stenosis was advanced enough at that point that intense and high volume exercise were both not a good idea. That was when I got better about nutrition, especially being extra strict about avoiding junk and sticking to minimally processed healthier foods. The weight came off steadily over a few months. It is time to repeat that process. The fact that I’ve already lost a chunk of the weight, and I’ve got 3 more weeks to do so until the surgery, helps me not to be too worried about it.

This time an important lesson needs to stick: stay healthy and maintain your weight through good nutrition and a reasonable amount of physical activity. More activity is fine for fun or adventure, but it should never be used as a crutch for weight control.

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TAVR stands for transcatheter aortic valve replacement. It is a minimally invasive procedure where the replacement valve is inserted through the femoral artery. No heart-lung machine or opening the chest. The new valve is actually jammed right inside the old one, which is shoved out of the way.

Needless to say, this is a great option which has the potential for less side effects and shorter rehab. Until recently it was considered only to be suitable for patients for whom the conventional procedure would put them at higher risk. It was also thought to be only suitable for people with normal three leaf valves that had aortic stenosis, but not the congenital condition of a bicuspid valve. At least that was the status quo at the time I got my valve replaced in August 2017.

But the times they are a-changin’. I don’t know the status internationally, but in the US, TAVR has been approved for clinical trials for low-risk patients, so should not be that far away from more widespread use. And it can now be used for bicuspid valve replacements. I learned of this in Adam Pick’s heart valve surgery newsletter where the story of a yoga enthusiast, Jean Frank is told.

Low-Risk TAVR Patient Success Story: Jean Frank - YouTube

She is doing fine after her TAVR, and says ” I had heart surgery.  It was too easy!” Now well along in her recovery, she is back to enjoying her yoga and plans to become an instructor.

For impressive visual evidence of how well TAVR works, there’s Mick Jagger dancing vigorously (at 75 years old) 6 weeks after his TAVR. Six weeks after my heart valve replacement, I was just starting cardiac rehab and finally getting over the hump about fluid retention around my lungs. I could exercise pretty well at moderate intensity but may have been gasping if I tried anything as intense as Mick Jagger’s routine.

Mick Jagger dancing after heart surgery - YouTube

This procedure is definitely looking good and hopefully will get full approval for more widespread use soon.

So how do I feel about all this? Am I jealous that I went through a more invasive surgery with longer and more difficult rehab? Nah! First of all, along with my replacement, I got the Cox-Maze III procedure done to fix my afib, which is still the “gold standard”. If I had fixed the valve with TAVR, I still might have had a problem with afib, and have had to do a followup procedure such as ablation or the less invasive “mini-Maze” to address it, which may or may not have had as good of an outcome. Certainly I would discuss those options with my surgeon if I needed the replacement now, but I don’t think it’s useful to dwell on “might-have-beens”, especially since my outcome was just fine. Anyway going through the longer and more difficult rehab motivated me to right a book about my story and start this blog. All’s well that ends well.

I do take comfort from how well TAVR is working though because I may have it in my future. Tissue replacement valves like mine have a finite life, so in 15 years or so I may need a new one, and TAVR has been shown to work well for that purpose.

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