A Mass Message From My Doctor

Thought I’d pass this along in case your doctor isn’t as good as mine. Unsolicited, fantastic advice that everyone should read.

“Coronavirus and Clinic Updates:  

…The crisis of Coronavirus is the exponential growth. The number of cases are increasing 30% per day. So however many cases we have today, we will have 10 times as many in 10 days and 100 times as many in 20 days. We worry about having enough hospital resources to care for folks if the outbreak spreads too fast. As you can imagine our health care system will be challenged. Many of us are taking extra shifts in the hospital. This week is calm, but I suspect the next month will be difficult.  

As long as a sick person does not cough into your face, masks won’t help much. The way most of us will get this virus is by touching it with our hands and then touching our face. It seems to be spread by mucus on hands, and its also found in stool. So basically it’s spread like the flu (respiratory droplets) and spread like norovirus (stomach flu). And it’s much more severe. And it can be spread before you feel sick. So it’s basically a perfectly designed virus. Not good for us.  

Many patients will be contagious for days before they ever feel sick, and can spread it by touching doorknobs or preparing food for others. [Note: The CDC says there isn’t any evidence that coronavirus can be transmitted through food. He’s a good doctor, but no one’s perfect.] This is why hand washing and staying away from other people are the two primary ways to avoid covid. Masks help the sick person not spread covid, but they don’t prevent healthy people from catching it. So please save the masks for health care workers.  

If you get a cough and fever, you could have COVID and you should call to discuss. Especially as flu season winds down, the likelihood of COVID as the cause of fever will go up. Most patients don’t need to be tested, you just need to self quarantine and stay away from other people. As testing becomes easier to get, we may start testing everyone – but we are not there yet. Still a huge backlog. The major reason to get tested is if you have to work; Or if you are risk factors for a poor outcome: age > 60, diabetes, heart disease, lung disease, cancer, HIV, weak immunity.

If you get severely short of breath, you should call our office or go to the ER. Generally, this would not happen all of a sudden, it’s usually after being sick for 7 days. Patients with covid who get sick, go from initial symptoms to needing the intensive care unit on day 7 -10. So it takes some time. Most young healthy people will never need to see a doctor. We are sending the majority of covid + patients home…Mortality in the USA is still only 1%. Mortality is greater when older than 60. And especially over 80. So keep grandchildren away from grandparents[.] Young kids do not seem to get sick, they can still carry the disease and transmit to others who might have risk factors.

A new symptom being described is loss of taste or smell. In South Korea where they tested widely, 30% of covid patients had loss of taste or smell, even without fevers. So if you have that symptom, you may not get sick but you are contagious, so avoid people for 14 days, wash those hands like crazy. Most people get sick within 5-6 days of exposure, but some take as long as 14. Which is why we’re using 14 days as an estimate for quarantine.

Information and thoughts about moving forward are changing every day. I encourage you to get your medical information from Dr. Fauci and other medical and public health experts, not from politicians or pundits. The CDC’s website has great (and scientifically accurate) information. I hope this has helped…”

2020 Experiments: Exercise & Running Program

Open Question: What is a reasonable program for people to follow to develop a good level of fitness?

I’ve been thinking a bit about the 2018 Experiment: HIIT Burpee and Running Program. The challenge of that program was to met a minimal standard for health, which I define using the American Heart Association standards:

  • 25 minutes of aerobic activity, 3 times a week
  • moderate intensity muscle-building, 2 times a week

Aerobic Activity

I prefer running for cardiovascular fitness. I have always wanted to run a sub-20 minute 5K. So, I was thinking that a speed program at the desired speed, 9.0 on a treadmill or 6:40/mile pace on Monday and Fridays, incrementing as the current level becomes easy.

  • 0.25 miles with 0.25 mile recovery walks, moving up one from 4 to 12 reps
  • 0.5 miles with 0.25 mile recovery walks, moving up one from 2 to 6 reps
  • 0.75 miles with 0.25 mile recovery walks, moving up one from 2 to 4 reps
  • 1 mile with 0.25 mile recovery walks, moving up one from 1 to 3 reps
  • 1.5 miles with 0.25 mile recovery walks, moving up one from 1 to 3 reps
  • 2 miles with 0.25 mile recovery walks, moving up one from 1 to 2 reps
  • 2.5 miles with 0.25 mile recovery walks, moving up one from 1 to 2 reps
  • 3 miles at one rep.

On Tuesday & Thursdays, it’s an easy 4 miles. On Wednesday, it’s either a easy 6-10 miles, an easy 4 miler or a rest day, depending on how I’m feeling. I’m not sure how long this kind of program will take, but I think taking two years seems like an achievable time frame.

Moderate Intensity Muscle-Building

But, the burpee program I came up with was positively brutal. I wanted to avoid making the same mistake this time, and keeping this easy.

This year, I spent some time revisiting The Hacker’s Diet, and I think his idea of having a low-intensity, low-time commitment exercise regime that can be done daily and anywhere is a good one. I took his program, and modified it to include a stepped program that increases 7% from 10 up to ~200 of bends (hands over head, legs spread, touch toes and return), sit-ups (hands across chest), skydivers (one rep, 4-count, hands to head and legs), push-ups, scissors (one rep, 4-count), jump squats, planks (front, back, each side for X seconds and 20 second rest period in between each), and jumping jacks (one rep, 4-count).

Each exercise is done for one set. The first rung takes less than 15 minutes. It’s easy to start, but it has the potential to become seriously challenging as you progress.

Modified Hacker’s Diet Exercise Program

Rung Bend Sit-up Skydivers Push-up Scissors J-Squats 4-Planks Jacks
1 10 10 10 10 10 10 45 10
2 11 11 11 11 11 11 50 11
3 11 11 11 11 11 11 50 11
4 12 12 12 12 12 12 50 12
5 13 13 13 13 13 13 55 13
6 14 14 14 14 14 14 55 14
7 15 15 15 15 15 15 60 15
8 16 16 16 16 16 16 60 16
9 17 17 17 17 17 17 65 17
10 18 18 18 18 18 18 65 18
11 20 20 20 20 20 20 70 20
12 20 21 21 21 21 21 70 21
13 20 23 23 23 23 23 75 23
14 20 24 24 24 24 24 75 24
15 20 26 26 26 26 26 80 26
16 20 28 28 28 28 28 80 28
17 20 30 30 30 30 30 85 30
18 20 32 32 32 32 32 85 32
19 20 34 34 34 34 34 90 34
20 20 36 36 36 36 36 90 36
21 20 39 39 39 39 39 95 39
22 20 41 41 41 41 41 95 41
23 20 44 44 44 44 44 100 44
24 20 47 47 47 47 47 100 47
25 20 51 51 51 51 51 105 51
26 20 54 54 54 54 54 105 54
27 20 58 58 58 58 58 110 58
28 20 62 62 62 62 62 110 62
29 20 66 66 66 66 66 115 66
30 20 71 71 71 71 71 115 71
31 20 76 76 76 76 76 120 76
32 20 81 81 81 81 81 120 81
33 20 87 87 87 87 87 120 87
34 20 93 93 93 93 93 120 93
35 20 100 100 100 100 100 120 100
36 20 107 107 107 107 107 120 107
37 20 114 114 114 114 114 120 114
38 20 122 122 122 122 122 120 122
39 20 131 131 131 131 131 120 131
40 20 140 140 140 140 140 120 140
41 20 150 150 150 150 150 120 150
42 20 160 160 160 160 160 120 160
43 20 171 171 171 171 171 120 171
44 20 183 183 183 183 183 120 183
45 20 196 196 196 196 196 120 196

So, I’m going to give this a try next year, and I’ll report back on how it worked out.

Army Fit

I’ve argued before about the value of a periodic fitness test. These are the current United States Army standards, perfect and passing, for each exercise, courtesy of Outside Magazine.

Deadlift

Lift the heaviest weight you can three times.

Max (100 points): 340 pounds
Pass (70 points): 180 pounds

Power Throw

Launch a ten-pound medicine ball over your head and behind you.

Max (100 points): 13.5 yards
Pass (70 points): 8.5 yards

Hand-Release Push-Ups

Perform as many reps as possible in two minutes.

Max (100 points): 70
Pass (70 points): 30

Sprint-Drag-Carry

For 50 meters each, sprint, drag 90 pounds, side-shuffle, farmer’s-carry 80 pounds, then sprint again.

Max (100 points): 1 minute 40 seconds
Pass (70 points): 2 minutes 9 seconds

Pull-Up Leg Tucks

While hanging from a pull-up bar, hoist yourself until your arms are at 90 degrees while bringing your knees into your chest, then lower. Complete as many as you can.

Max (100 points): 20
Pass (70 points): 5

Two-Mile Run

Finish as quickly as possible.

Max (100 points): 12 minutes 45 seconds
Pass (70 points): 18 minutes

From Outside Magazine, November 2019

Suggestions for Good Health

Blue Zones is a good place to start. However, if I were to give advice to my younger self, I’d focus on:

  • Sleep: Get a full night’s sleep and take a midday nap for a total of eight hours.
  • Food: Limit eating to four consecutive hours a day. Eat mostly plants. Drink powdered psyllium and water to stave off hunger feelings in the off hours.
  • Exercise: Walk/run for 16,000 steps a day or 8 miles, incorporating a full range of movement. Include some weight-bearing activity or physical training twice a week.
  • Social: Cultivate a social environment for flourishing among family, friends and your larger social circle. Be a positive, creative person and look for the same in others. Relentlessly prune relationships that are predominantly negative.
  • Being & Doing: Find something to do that leaves the world slightly better than you found it and promotes good sleeping, eating, exercise and social habits. The Buddhist idea of the Noble Eightfold Path is a useful model of how to be and what to do.

Good Ol’ Goiter Days

When we think of the good ol’ days, lets also remember they also included smallpox, polio, yellow fever, typhoid, rubella, rabies, hib, tetanus, mumps, hepatitis A/B, varicella, tuberculosis, malaria, syphilis, anemia from hookworm, and a high instance of dental caries.

Prior to 1795, it was a given that half of all sailors on a voyage during the Age of Sail would die of scurvy. With international trade and industrialized agriculture, famine has moved out of living memory of the people in most economically developed countries.

And as these problems move out of living memory, we forget what life was like before they were solved. Iodine in salt is just one example among many.

Do X. Evaluate. Do X Differently.

“Why don’t you just try X for 30 days and see if your life gets better?

Today, roughly two-thirds of the population will make New Year’s resolutions. The most common resolutions:

  • Eat healthier
  • Get more exercise
  • Save money
  • Take better care of ourselves
  • Read more
  • Make new friends
  • Learn a new skill / hobby

Looking at this in the context of having recently read James Clear’s Atomic Habits, he makes a really interesting point that these kinds of improvements require tackling three aspects of the problem: identity, systems and goals.

For example, instead of resolving to eat better, we might resolve to become vegetarian. This is adopting a new identity that shapes the kind of food choices we make into healthier alternatives. You could also make it smaller, and maybe adopt an identity as a “water-drinker”.

You can extend these to the other resolutions. Instead of resolving to exercise more, decide to become a runner. Instead of saving money, you could become a person that pays cash or pays your entire credit card bill every month.

Identity feeds into systems. If you are going to become vegetarian, will you eat dairy and eggs? If you will occasionally eat meat, say during Thanksgiving, how often will you need to eat a vegetarian diet to think of yourself as vegetarian? What does a healthy vegetarian diet look like?

Same goes for running. How many miles and how many days per week do you need to run to think of yourself as a runner?

These, in turn, lead to goals. If you run sporadically, then setting a consistent schedule will result in more exercise, just as consistently eating vegetarian will result in eating better.

Goals have the problem that life gets in the way, and we give up on them. If your goal is to run a marathon, you cannot continue if you get injured or develop a cold that prevents you from following a training program. If you think of yourself as a runner, being sick is only a momentary set-back. But, the minute you know you can run again, you need to start. Otherwise, you aren’t proving to yourself your identity that you are a runner.

The start of a new year is an excellent time to think through the kind of person you want to be and the identities you want to adopt. But, the beginning of the month, of the week or each new day are good times to start trying to be a different, better person too.

Don’t let the inevitable failures that life throws in the way of each of us stop you from pursuing being the kind of person you want to be. The question isn’t whether you always eat healthier, but whether, in the main, you are eating better than you were before. You need to have systems and goals in place to get feedback on your progress, and you need to build in flexibility to change course. Do, evaluate, and do it differently. The goal is to be the person you want and not the number of miles you ran in a given week, that’s just the feedback.

Bad Gyms

When some one enters a gym for the first time, what are they looking for? If they are young, the driving force is often performance. Athletes want to be better at their chosen sport, and the gym provides a training ground in which to improve.

For the non-athlete entering the gym later in life, the focus may be on a particular goal – such as losing weight, cardiovascular fitness, or strength, but these too are performance goals. A desire for improvement is the motivation.

But, there is an interesting disconnect between the user of the gym and the gym owner. The concern of the gym owner, particularly if the gym owner is a corporation, is to reduce their risk of liability and reduce costs.

Enter any “fitness center” offered as an amenity by a corporation and you will find a wide variety machines that are designed, primarily, to prevent people from injuring themselves. These machines encourage repetitive, defined movements that limit the range of motion and the potential for injury. Free weights, if they are available at all, are confined to low weight dumbbells.

The simple fact is exercise machines are less effective forms of exercise than exercising with free weights. Yet, machines are the only options on offer because they are safer, and machines are cheaper than paying for staff to help people learn to exercise with free weights safely.

As a result of this typical safe gym environment, we almost never hear the simple truth. The overall best exercise for improving fitness is lifting heavy weights over a complete range of motion. If you wish to improve your health and fitness, deadlifts and squats are the single best way to do it. People using the gym need to learn how to do these exercises safely. A good gym trains people to do effective exercises safely. A bad gym provides machines to do less effective exercises that are safe and cost effective. Almost all the gyms we have are bad.

Amazon Health – Stratechery by Ben Thompson

“At the same time, the U.S. healthcare system is inextricably tied up with the post-World War 2 order; indeed, the entire reason employers are so important to the system is because of World War 2 regulations that instituted price controls on wages, incentivizing employers to use benefits as a means of attracting workers (this was further enshrined by making healthcare benefits tax-exempt)…

…My expectation, then, is not that the Internet methodically disrupts industry after industry in some sort of chronological order, but rather that the entire edifice lasts far longer than technologists think, only to one day collapse far quicker than anyone expected.

The ultimate winners of this shakeout, then, are not only companies that are building businesses predicated on the Internet, but just as importantly, are willing and able to build those businesses with the patience that will be necessary to wait for the old order to collapse, particularly if that collapse happens years or decades after the underlying business models are rotten.

There is no more patient company than Amazon.”

—Ben Thompson, “Amazon Health.” Stratechery.com. January 31, 2018.

2018 Experiment: HIIT Burpee and Running Program

Background: Maintaining a minimum fitness standard is a challenge, particularly as we age. American Heart Association (AHA) recommendations focused on HIIT strength training and running suggests two sessions of HIIT strength training and three sessions of running for twenty-five minutes each.

physical-activity-in-adults

HIIT program criteria:

  1. It can be done anywhere.
  2. It requires no equipment.
  3. It takes less than 20 minutes.

This program is an experiment to see what kind of results can be obtained from HIIT training using one program with one exercise in combination with an easy program of running. It is as simple a plan to meet AHA recommendations for physical activity as I could come up with that incorporates strength training and meets a minimum running goal of 10 miles a week, which is a very low weekly mileage for runners.

Methods: Use the Bats! HIIT Interval Timer. Set up eleven phases. Work, break and rest are in seconds. Blk is for block or number of sets. #/Blk is number of timed intervals per set. Min. is total number of minutes required to complete.

Phase Work Break Rest #/Blk Blk Min.
P0 10 60 30 12 1 15
P1 15 60 30 12 1 16
P2 20 60 30 12 1 17
P3 25 60 30 12 1 18
P4 30 60 30 12 1 19
P5 30 55 30 12 1 18
P6 30 50 30 12 1 17
P7 30 45 30 12 1 16
P8 30 40 30 12 1 15
P9 30 35 30 12 1 14
P10 30 30 30 12 1 13

Do each phase for a month, twice a week. For the work interval, do burpees (standard or an easier variation). During break time, I plan to rest completely. Then, rinse and repeat until complete.

Initial plan is to do this program Tuesday and Friday. After HIIT training, do an easy run/walk of 25 minutes. On Monday and Thursday, do a minimum run/walk of four miles or approximately 40/80 minutes, respectively. Wednesdays, Saturdays and Sundays are rest days.

Experiment will be considered a success if Phase 10 is done four weeks in a row. If I go for four weeks without doing the strength training or reach December 31, 2018 without completing Phase 10 for four weeks, I will consider the experiment over. On completion, I’ll write up a post mortem with results and conclusion and if I want to try it again, how it should be modified.

Results: For four months, I followed this program. I got to phase 3. At the end, I completed 6 burpees for 12 sets for a total of 72 burpees in 18 minutes for 6 weeks. There were dramatic improvements in cardiovascular fitness. Strength was improved. I also gained 15 pounds, which was the reason I stopped doing it.

Discussion: If I were to do this again, I’d focus on the number of burpees per work set and bring down the number per set and add sets over time. For example, I’d start with doing 1 burpee per minute for 10 minutes. As able, I’d add 2 minutes a session until I was at 20 minutes, then I’d drop down to 2 burpees per minute for 10 minutes and repeat the process.

I found that I could do 1 burpee every 3 seconds. So, you could work up to 10 burpees every minute and still have a 30 second recovery period per set. If you did that for 20 minutes, it would be 200 burpees. This is enough fitness for the vast majority of people.

The program above, in contrast, required doubling the amount when you go to the next level. It was very difficult. There needs to be a more gradual adaptation. Using the program outlined in the discussion section, I suspect it would probably take two years to start at 10 burpees in 10 minutes and work up to 200 burpees in 20 minutes.

Two sessions per week is reasonable. As long as you were doing the more gradual program, you might be safe doing as many as three.

The major issue is that doing this kind of exercise is going to fundamentally change your body composition and your weight is going to go up. I think it is worth doing. But, if your goal is to lose weight, then you’ll need to do that first and then do this program when you are ready to build your strength and fitness.

Conclusions: Properly modified per the discussion session, this technique is worth exploration as a way to maintain fitness and strength. But, it should not be confused with a weight loss program. This program will put weight on you, a lot of it.