I’ve often said that Montaigne is a role model for me, but I didn’t realize that an overly-literal Fate would take that to mean that I wanted to develop gallstones at the same age as he developed kidney stones. Yes, I’m back in the hospital this week, waiting to part ways with my gallbladder tomorrow morning. I already knew that I wasn’t the writer Montaigne was; now I’m aware that I could never be the equanimous Stoic that he was. No Italian spa waters for me, thanks; I’ll choose morphine, heated blankets, wifi, and an adjustable bed while I get caught up on some reading and writing. Only fanatics seek misery for its own sake; pragmatics take things as they are. I’d like to think that ol’ Mike wouldn’t have been too philosophically attached to suffering to sit here with me and enjoy streaming German soccer games while listening to new music from Beck and LCD Soundsystem.
battling personal entropy
It is more difficult to write interestingly of good people than bad; villains are generally more memorable than heroes. A newspaper that reported only acts of kindness and generosity would be insufferably boring and would go bankrupt faster than those that relay only disaster caused by defalcation. To adopt very slightly Tolstoy’s famous aphorism, good people are all good in the same way, but bad people are all bad in their own way.
To write of good people is often to sound either naïve or priggish; whereas to write of the bad is to appear worldly and sophisticated. One of the reasons, of course, for the difficulty of writing interestingly of the good is that there seems so much less to say of them than the bad. The good act according to principle, and are lamentably (from the literary point of view) predictable. Once you know how they behave in one situation, you know how they will behave in others. The bad, by contrast, have no principles beyond the pursuit of short-term self-interest, and sometimes not even that. They are therefore unpredictable and their conduct is infinitely various. As I discovered in my medical work, the variety of human self-destruction is, like the making of books, without end; and even the least imaginative and inventive may discover new ways of exercising malignity. Since variety is the spice of prose, the bad are lingered upon with affection by most, if not by all, writers.
— Theodore Dalrymple, “Beauty and the Beast,” Farewell Fear
The city where I was born and raised to adulthood has been the subject of worldwide interest recently, thanks to her christening as a major battleground in the Weimar America wars of political religion. Now I see and hear her name being casually advertised and barked all along the seediest streets in the red-light clickbait district of the web, inviting all sorts of scumbag pundits to come in and enjoy a cheap fondle of this small, virginal college-town for a moment’s political pleasure. Should I parlay my insider advantage into a topical piece of my own to cash in on the trend? Or should I be more noble, like the narrator of Iron Maiden’s “22 Acacia Avenue,” and brusquely demand that she pack her bags, she’s coming with me back to a life of virtue? Instead, I find myself sitting in my hospital room, reflecting on the quiet heroism of registered nurses.
Just a short way down the highway, over hill and dale, the chattering classes are busy crafting lurid narratives of violence and hatred. Here, nurses are being attentive and supportive, to their patients and each other, even over the smallest things in the wee hours. There, journalists and pundits are marching along in search of new angles, new interviews, and new perspectives, much like how I singlemindedly stride the mountain trails in pursuit of whichever arbitrary endpoint I’ve chosen that day. Here, nurses are skillfully and quietly mending the damage done to countless individuals, like the uncomplaining spiders who patiently rebuild the webs I carelessly brush aside on my hikes.
I’m not romanticizing the profession, of course, just granting it some poetic burnishing. I’m well aware that office politics apply here as to any other workplace, and even the best of us can only briefly pose as selfless angels. But like Dalrymple says, it’s far too easy to wallow in the salacious details of the latest atrocity, soon to be supplanted by the next one. It is indeed almost impossible to say anything truly compelling about the simple, obvious, and yet so necessary, acts of unacknowledged compassion and generosity that go on around us all the time. No, this feeble effort is merely my attempt, as I sit here recuperating in the pre-dawn hours, to reach out and take hold of just a few of those anonymous acts before they slip gently away with another good night, smile, and express my deepest gratitude for their existence.
Ill health — which had granted me quite a long spell of leave — has attacked me without warning again.
— Seneca, “Asthma”
I feel Seneca’s pain, and then some. For while I don’t doubt that the inability to fill one’s lungs is a harrowing one, I might be willing to trade him for the acute pancreatitis that I’m currently enjoying. I’ve been ensconced at the hospital since last Saturday, which, coincidentally, is the last time I ate anything. Still, I’ve managed to gain eighteen pounds of water weight from all the IV bags they’ve emptied into me, which has led to the excruciating edema afflicting my belly and all points south. How much I would have loved an enforced week off from work to do nothing but read and write! What’s that, you say? I can have that? All I need to do is wish upon this monkey’s paw? Great! Hey, wait, the pain is too distracting to focus! And the painkillers leave me in a drooling stupor!
A couple of summers ago, I landed awkwardly while jumping into the pool. I had placed my hands on the deck, turned, and dropped down into the water, landing with my arms up in a sort of goalpost-stance. Perhaps my feet landed a little too squarely. Whatever it was, I assume I got what they call a “stinger” — a sharp jolt up my spine, flowering out beneath my shoulder blades, like burning electricity. I stood frozen for a moment like that until I caught my breath, then gingerly moved my arms and torso around to make sure everything was still functioning.
Ever since then, I’ve had some chronic soreness and weakness in that mid-back area. Still, it didn’t prevent me from being physically active — I walk on the treadmill for a few miles at a stretch several times a week, I do a thrice-weekly routine of push-ups, pull-ups, chin-ups, sit-ups and dips, I hike most weekends, time and weather permitting, and I do up to an hour of yoga every day. I assumed a little nagging back pain was just one of the inevitabilities of middle age, possibly even a casualty of misdiagnosed-and-therefore-untreated rheumatoid arthritis from ages 28-31. Walk it off, champ.
Last week, on my way home, I started to feel some discomfort in my mid-back, which also made its presence felt in my stomach, in an almost-nauseated feeling. The pain increased steadily for the next half-hour or so, until it felt like my stomach was violently contracting. Then my arms and legs started to tingle and go slightly numb. When I stumbled in the door, the Lady of the House took one look at my chalk-white face, now streaming with cold sweat, and assumed I had food poisoning. I dropped to my arms and knees, groaning in pain, writhing around in an attempt to find some sort of posture to relieve the pressure, and, in between gasping for full breaths, managed to convey that no, it wasn’t food poisoning, something was wrong with my back. After a few minutes with my back rounded and my chin tucked, I felt stable enough to make my way back to the car, where I re-assumed that posture in the back seat while she drove to the ER.
After two hours in the waiting room, and a further three waiting in a room to see a doctor, all spent leaning forward with a rounded back, the pain had largely subsided on its own. After an EKG, blood tests and a CT scan all came back with nothing to show, the doctor was left scratching his head and grasping at the straw of a possible gallbladder problem, which he conceded was very unlikely. He agreed with my suspicion that I had probably pinched a nerve, but there was little he could suggest. I arrived home at one a.m., no closer to a solution than I’d been eight hours earlier, though at least I knew I hadn’t herniated a disk or something drastic like that.
The next day, I called a masseuse/physical therapist I’ve seen before and asked him his advice. He said the numbness and tingling definitely suggested a neural problem, not a muscular one, so a massage wouldn’t help. He suggested a chiropractor, and when I said I didn’t visit one, he recommended the one he works with. Now, I’m not exactly enamored of the wide variety of practices conventionally grouped together under the rubric of “alternative medicine” — like the related joke goes, there is no “Eastern medicine” or “Western medicine;” there’s “medicine” and there’s “stuff that hasn’t been proven to work.” I’ve been to chiropractors before, and while I have always thought, based on those experiences, that there certainly is a correlation between certain pains and the misalignment of vertebrae which can be relieved by manipulation of the spine, I didn’t trust them much beyond that point. Some of them seem a little quackish when they try to pronounce on matters outside of their specialty, which I’ve heard them do often. In my experience — again, as someone who has spent a lot of time in doctor’s offices dealing with autoimmune disorders — my “conventional” doctors were open-minded and well-informed while readily admitting when they didn’t know something for sure, urging me to trust my own judgment. My chiropractors, in contrast, have seemed unprofessional in their scorn for “mainstream” medicine, while making sweeping judgments and proclamations on the efficacy of this or that treatment based on scant evidence. The last one I visited first suggested that rheumatoid arthritis wasn’t really a disease, before later claiming that it was all caused by diet, and urging me to take various over-the-counter supplements. When I asked my rheumatologist about the diet and supplements, he said that there was a lot of smoke about those sorts of claims, no real fire, but if I noticed that eating something made me feel worse, I didn’t need him to tell me to avoid it. As for the supplements, they were more for osteoarthritis, and wouldn’t do much for me. I appreciated that sort of straightforward common sense. In my opinion, there’s probably some sort of inferiority complex going on, where the alternative practitioners feel compelled to rush into the gap any time conventional medicine steps back and says “we don’t know for sure”, looking for any advantage they can get. Unfortunately, that kind of dogmatic certainty is a Pyrrhic victory at best.
Still, humbled by what was probably the most intense pain I’ve ever felt, I was willing to try just about anything, especially since the hospital wasn’t offering anything beyond cortisone injections to the spine. It turned out that this chiropractor uses what’s called the Gonstead method, which is much gentler than the usual kind — no twisting of the neck or hips. She had me sit on a stool while she rocked me very slightly from side to side, feeling along my spine from my sacrum to my neck for any misalignments. She identified three — in my right hip, my T6 vertebra, and my first rib, which was causing shoulder and neck pain. The adjustments were so mild, especially in the neck, that I could hardly believe anything had been done. One soft “pop” from the T6. The neck adjustment was me leaning my head back a bit while she pressed quickly but gently with the knife edge of her hand into my trapezius muscle. I barely felt the pressure, didn’t feel anything change, but the difference has been astonishing. I could feel the positive effect in my hip while walking out of the office. You don’t realize how much a chronic ache has been affecting you until it suddenly disappears. I still keep turning my head to the left just for the novelty of not feeling any pain along the left side of my neck and spine.
While reading up on the spine later, I learned, interestingly, that the T6 vertebra being close to the stomach, if injured, could cause heartburn, dyspepsia and indigestion. In hindsight, I realize that I came close to having similar problems on a few occasions, where I felt that same combination of back pain and nausea. In those instances, I had been able to move around and shift my posture before the nerve got terribly impinged, but there were a few times where I took some antacids, wondering if I had heartburn or something (I still don’t know what heartburn actually feels like). I also recall that Kurt Cobain famously claimed that he started taking heroin because of a persistent stomach problem. In Michael Azerrad’s biography of Nirvana, friends described Cobain as rolling on the floor in agony while dry retching, a condition that was recurrent enough to make him suicidal. He claimed that heroin cured him of this problem, but some of his skeptical friends, like Buzz Osbourne of the Melvins, argue that he never had a stomach problem to begin with, that it was just a typical junkie excuse for using drugs he’d always intended to use. But Azerrad’s book also mentioned that not long before he finally did commit suicide, a doctor had diagnosed Cobain’s ailment as a nerve problem related to his scoliosis. From this side of my trip to the ER, I look back on that old story with new appreciation — if I experienced excruciating pain like that on a regular basis with no apparent hope of relief, it might drive me out of my mind with desperation too. It’s strange to ponder how Cobain’s life might have been different, or longer, if only his spine had been straighter, and it’s humbling to realize how easily any of us can be reduced to utter helplessness by our own skeleton and nervous system.
Educating the general public about the trials of being a larger woman is a worthy endeavor. But calling thinness a “privilege” presumes that thin people do not understand the suffering of anyone deemed by the western world to be “fat,” or do not have their own struggles. West and her brand of pro-fat feminism also wander into the rocky territory of oversimplified identity politics, trying to equate dress size with other oppressions such as racism, sexism and poverty, and ignoring that one’s weight is not an inherent privilege.
Last fall, I aggravated a recurring knee injury. Apparently I got a small tear in my meniscus. I say “apparently” because an MRI would have been expensive enough even without factoring in surgery to fix it, so I was content to just take my doctor’s best guess based on a physical exam. Not long after that, I began to feel the stirrings of an inguinal hernia on the left side, a year and a half after having the right side repaired. This was all on top of a very painful ganglion cyst in my wrist that had made weightlifting too onerous. Suffice it to say, this was demoralizing after having gotten back into a regular exercise routine, so I was feeling quite sorry for myself through the winter.
In late April of this year, I went in for an appointment with my rheumatologist. I complained about my ankles, knees, hips and back aching more than usual, expecting that he might suggest my arthritis meds were losing their effectiveness, as they are known to do in many patients over time. Surprisingly, though, he said my bloodwork looked perfectly normal. My body wasn’t showing any signs of reacting to inflammation. Honestly, he told me, the best thing you can do then is to lose more weight. Take more of those pounds-per-square inch off your joints, which have already taken enough abuse from the arthritis.
Had you asked me that morning why I wasn’t working out regularly anymore, I would have complained that I was in too much pain, and that I would probably need more effective drugs to get me to the point where I could start up again. Now I didn’t have that excuse anymore.
When I got home from work, my inamorata and I sketched out a brief meal plan based on reducing calories to around 1800-2000 a day and incorporating more fats and protein at the expense of carbs (this is something I never had the discipline to do on my own, but I’ve come to see that it is far and away the most important thing). Then I went out to the porch to begin my stretching routine before getting back on the treadmill.
Five minutes in, the muscles alongside my shins were starting to cramp. Shortly after that, my feet were protesting. By the end of a half-hour walk, I had reduced my speed and needed to grasp the handrails to keep steady. It was painful and humbling.
Still, the next day, I did it again. And the day after that. And every day since then. Having started by struggling mightily to walk two miles, I now walk four or five easily, at an increased pace. The minor aches faded soon enough, the knee healed well enough, and the hernia has benefitted from having less weight pressing down on it. I’ve never had any overwhelming hunger cravings or needed to exceed my calorie budget. I’ve lost thirty pounds in those three months, and aim to lose as much as thirty more (which would put me back to skinny soccer-playing weight). Even if I eventually ease off on the exercise, I think I’ve acquired enough knowledge and discipline about meal preparation to keep from overeating again.
I won’t pretend to know exactly what it’s like to be genuinely obese. Even at my weightiest, thanks to my former athleticism, I never showed more than a slight paunch and love handles. But it was enough to be disappointing in front of a mirror, and it certainly felt awful from a physical standpoint. Nonetheless, the point I’m making is that nothing at all changed on that spring day except my mentality. I could eat sugary snacks or pizza with the best of them, but after that, I simply stopped doing it. Those foods didn’t become less tasty, I just cared more about losing weight and feeling better. I’m not superhuman, I’m just motivated. It wasn’t like I got some grim warning that I needed to lose weight or else face an imminent demise. It was just a suggestion. I just decided to act on it. The rest is all rationalization and procrasturbation.
The average guy wants 15-27 more pounds of muscle and a three to four percent decrease in body fat. And a new study published in JAMA Pediatrics in January found that 18 percent of boys are very concerned about their weight and physique. Failure to attain these unrealistic body goals can lead to depression, high-risk behaviors (like drinking and drugs) and eating disorders. Though about 15 percent of boys concerned with their weight are worried about thinness, about half are concerned with gaining more muscle and an additional third are concerned with both muscle gain and thinness.
Many of these changes are thanks to media images—and the 300 movie series is leading the way in the promotion of unrealistic male body standards (buttressed by video games and clothing ads featuring scantily clad men).
Now I feel guilty for admiring my abs after a round of crunches the other day!
I’ve put on about ten pounds of muscle since last fall when I started lifting weights regularly again. I mix that with treadmill walking (got a new one, no thanks to you cheapskates) and running through old soccer drills outside, with some yoga and Pilates thrown in as needed. Still, if any of those angsty young men are reading this, looking for advice, I’d say the same thing as before — it doesn’t really matter what exactly you do, just make sure to cultivate your stick-to-itiveness and do it consistently. Slow and steady and all that.
If there is a disease at work in the obesity epidemic, it is the disease of laziness. People want a quick fix to solve all their problems, and they don’t want to have to do anything differently… even though the things they have always done are what caused them to end up being overweight and unhappy with themselves.
The desire for a magic answer ends up creating a psychological barrier to progress. Because people want a quick, magical solution, even good medical advice is translated into bad, ineffectual behaviour.
The science of obesity is not complex, but cutting through the noise requires some common sense. If you are obese, then losing weight is simple. You need to gradually decrease the amount of food that you eat, and gradually increase the amount that you exercise, so that over time your body adapts to having less “fuel”. If you do this, you will gradually lose weight.
But there are no short cuts. There is no special food that you can eat, or exclude, and have the pounds melt away with no other change in your lifestyle. Eating organic or “additive free” food won’t help you if you eat 4,000 calories a day. There are no magic pills.
To hear the twitosphere tell it, seven out of every four people run a triathlon every week while restricting themselves to 500 calories a day, but still somehow manage to become obese by the biased standards of Western so-called medicine. Well, as in so many other areas, I find that good ol’ David Hume’s rule of thumb regarding miracles applies here: which is more likely, that basic laws of physiology suddenly cease to function in modern society, or that people tend to bullshit themselves in flattering ways to avoid facing up to uncomfortable truths? If you’ve been reading this blog longer than five minutes, I’m sure you know what my opinion of human nature is. Rare exceptions exist, I’m sure, but like it says on the label, they’re rare.
For those of you who can’t be arsed to watch the video (it’s okay, I’m right there with you most of the time), Louis goes to the doctor at 40 years old with a sore ankle. The doctor suggests doing certain stretches for half an hour each day. Louis wonders how long that will take to fix it. The doctor says, no, this is just a new thing you do now. Regular, necessary maintenance to stave off the worst of the inevitable decrepitude until death’s merciful release. Comic exaggerations aside, I’d basically agree.
Half a lifetime ago, in peak physical condition, when I did yoga, worked out (got a Soloflex for Christmas when I was sixteen, and I still use it today) and played soccer regularly, I was about 160 pounds. In community college, there was one phys ed course I took which gave you three credits for essentially having a gym membership at the school. One day, the instructor, Steve M., walked in the weight room while I was finishing some bicep curls and gave me an appraising look. “You know, Damian, I envy you,” he said while wagging his finger at me. Uh, say what? “No, seriously. You have the kind of body that you could sculpt into anything you want. A lot of people don’t have that. I couldn’t do that. You’re very lucky.” I’m not sure what he was basing that opinion on, but ah, youth, if only I had been able to fully appreciate my apparent good fortune then.
In the course of three and a half years of undiagnosed rheumatoid arthritis, I was getting treated mainly with steroid injections, which caused some fluid retention, and, thus, weight gain, up to around 182. After I had recovered enough flexibility and mobility thanks to medication, I converted the sturm und drang of a prolonged breakup with my ex into exercise fuel and dropped as low as 149. A few years after that, heartbroken over the deaths of two of my dogs in quick succession, lethargic and giving no fucks in general, I got as high as 207. Moderate exercise after that lowered me back into the lower 190s, and during the summer I worked as a satellite technician, I starved and sweated away more than fifteen pounds in a month and a half, back to the upper 170s. This past summer, I started the new job, one of the biggest benefits being the reliably steady schedule, which meant I could finally set up a consistent workout routine and stick to it without interruption. I quickly dropped fifteen pounds in the first month just through treadmill walking and a reduced diet — I’ll usually have a smoothie for breakfast (I especially like Bolthouse Farms), followed by two or three miles of walking, then something light for lunch, like bananas, tofurkey sandwiches, and/or more smoothies, and a regular dinner in the late afternoon. If I absolutely must snack at any point, I’ll have another piece of fruit or yet another smoothie. As I’ve added weightlifting back into the mix every other day, feeling sufficiently recovered from hernia surgery, I’ve noticed the weight dropping off more slowly, though I can obviously eat more without it turning into fat. Eventually, I’ll probably start spending some time kicking a soccer ball around the yard and practicing some old drills, to get some more aerobic exercise and get all the muscles working in concert again.
All of which is to say: my own experience tells me in no uncertain terms that if I don’t want to feel bloated and flabby, I have to make time to exercise and eat well. Barring the most incredibly fortunate genetic inheritance, or the most physically strenuous job, anyone who doesn’t want to gain weight will have to do that. Yes, that means setting aside at least six to eight hours a week to walk and lift weights. Yes, that’s time that I could be using to read and write more. Yes, yes, processed foods, lack of time, arbitrary cultural beauty standards, etc. No, it’s not fair, and no, it’s not always fun and invigorating. It is, however, what it is, and like Louis’s doctor said, it’s just a thing you have to do now. Deal with it or don’t. All that stuff my dad used to say about the necessity of discipline and cultivating good habits was right on, however bourgeois that may sound.