I Beat Cholesterol. It Really Does Come Down to Diet and Exercise

Yes. I am astonished. I had no idea. For years my doctors have told me to take statins to lower my sky high cholesterol. I even tried once, about 12 or so years ago, and had a miserable side effect-Burning Mouth Syndrome. My mouth and lips were on fire. To add to my misery, I was living in South Korea at the time, and the good food there is spicy hot. I could only eat bland food, and I was still miserable. That was the end of my experience with statins. I figured with diet and exercise I could control the numbers, but I wasn´t disciplined enough about either. Well, I have spent long periods of time when I have swum a lot and hiking and biking, but the numbers only got worse.

Losing weight is really hard and my weight was in a range where I didn´t really feel a great compulsion to suffer. Besides, all my other heart and health factors have been good. I take thyroid medication and have for many years, but that is all. I´m fairly strong and fit, so I have just suffered the reminders every couple of years that my blood was fatty. And then I would forget and go get another of those lovely Thai sausages.

My only limiting issue has been my knees, which have endured every sort of insult from skiing accidents, 10 K races and daily runs till I was told to stop, falls, and even torn menisci from swimming (breast stroke with frog kick, bad news for knees). My orthopedic surgeon in Bangkok, treating my knees after some serious damage done in Nepal, which resulted in a fall and a broken foot, told me, many times in fact, that the best thing I could do for the knees was lose weight and strengthen my quads. But, I whinged, I am trying to lose weight, and I am always hungry, and I don´t seem to lose anything but my temper. Kindly Thai doctor that he is, he told me that suffering from hunger is a very good thing because it helps you sympathize with the hungry of the world.  I exercised more once I was back on my feet, but my knees hurt and my weight stubbornly increased.

I think most of us of a certain age have heard it: lose weight and all of your health factors will improve. It is good for the blood pressure, cholesterol, aging joints, yada yada. But there is no magic bullet to improve these things, right? It is just a matter of age, and I have felt lucky that my only real problem was my knees. Well, and those nasty cholesterol numbers.

So, what happened that my most recent cholesterol test came back with results in the excellent range, without the use of medications?

As my few darling regular readers know, I headed out at the end of January, with a back pack and a small pension, to explore South America. I have been traveling by bus and in the 4 wheel drive truck of some friends I met along the way. I have hiked my way around major cities and little villages. I have walked for hours every day. And meals have been what can be grabbed along the way, and what fit on my budget. In South America the big meal of the day is between about 1 and 3 in the afternoon. I fell into the habit of eating then and either skipping dinner or just having a snack. My evening meal shrank and disappeared. I accidentally fell into the habit of intermittent fasting before I knew it was a thing. The new diet science (fad of the day?) suggests that if you limit your eating to a 8-12 hour period each day (there is disagreement on exactly how long) you will lose weight even if you eat the same as you would in a normal day. New research indicates that it can be as long as 12 hours. I was doing my eating most days within a 6-8 hour time period.

Last month in Cuzco I started having tingling in my lips when I walked for very far, and soon it spread to my whole right side. It got gradually worse, and finally in Antigua, Guatemala, I went to see a doctor. I was convinced that my high cholesterol had finally caught up with me, and I was going to have a stroke or a blood clot. I was scared to get on my next flight. The doc ordered up lots of tests, and I went back to the hotel and skipped eggs at breakfast. I figured I was going to have to give them up anyway.

The doc and I went over the results. Blood pressure, slightly high but okay, as I was stressed and my BP is normally a bit low. Clotting factors, okay. All other blood work, just fine. Sugars, fine. Cholesterol levels? In the mother fíng excellent range! Damn. I haven´t ever, since having it checked for the first time, had such good numbers. Oh, and I had lost almost 30 pounds! I knew I had lost weight, as my clothes were really not fitting and I had had to buy a new belt to hold my pants up, but, wow! I had not been on a diet. I had just changed my habits to accommodate constant travel.

The immediate problem, the tingling and right side numbness, seems to be my thyroid, and that medicine has now been adjusted. So I am still only on thyroid medication, and I am not taking statins. I am so thrilled I never started them.

So, my friends, it is possible to get cholesterol under control with diet and exercise. I personally think the weight loss and exercise are the most important aspects, because I have been eating eggs and pork all summer, but only in that 6-10 hour window of time. I would highly recommend taking a year off and trekking the world. But of course, that is not practical for everyone, and it is not practically as a lifelong life style. Going forward I will have to manage the exercise and diet while not traveling. But at least I now know that it works, and that I really must make that commitment.

 

Travel Theme: Transport

What a difficult choice! I have so many pictures of transport. Here are a few. I think my photos tell stories more than demonstrate technical skill. I like to go back through the archives and look for stories.

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Jalsamer, India. Around 2004

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Morocco, around 2006

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My hardworking rickshaw driver waiting for me in the rain. Bangladesh, 2015

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Rajasthan, 2008

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Motorbikes, Vietnam, 2004

 

Am I too old to learn a new language?*

*http://www.theguardian.com/education/2014/sep/13/am-i-too-old-to-learn-a-language

This year, as I travel through South America, I am finding my limits. A one mile swim followed by a 5 mile hike takes all that I have and I am rendered exhausted beyond words. (It didn’t help that after the 5 miles, we arrived back home to find the power out and a 5-floor stair climb awaiting.) My recovery time is much longer, as well. It is frustrating.

My language learning skills are equally challenging. I admit to never having been good at second language learning, but I have been studying Spanish online now for over a year, and tested at intermediate level when I started my course at Cuenca University this winter/summer here in Ecuador. Being a “false-intermediate” (I haven’t every taken a course, so my intermediate skills are spotty, with big holes) I was probably overly confident. My class has been a huge challenge, and has been getting increasingly discouraging.  My false confidence was probably encouraged by the kindness of Ecuadorians, who are very pleased when anyone tries to learn their language, but there I sit in the classroom feeling that my brain is impermeable brick. Sometimes I have to fight back tears of frustration and embarrassment. I am starting to appreciate better why so many immigrants to Ecuador, and Mexico as well, fail to learn the language.

Those immigrants most often are “mature” adults of retirement age. I suspect many of them have not been in an education environment for 40-50 years, so learning is even more of a challenge. At least I have been an educator for my career. We older people get the message from society too much that we are past our prime. This message is reinforced by our experiences with our bodies and minds. In an episode of Frankie and Grace, Frankie has a hard time passing her driving test. She has let her license expire because she was afraid of failing the physical part of the test-vision. But what turns out to be the obstacle is memory and the written test. As her doubts deepen, her sons get worried about her mental capacity.

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But Frankie is wiser, of course. She remembers learning in university that the human brain responds to similarity of conditions when trying to recollect information. Since she usually studies with a bong-full, she replicates the conditions and goes and takes the written test while high, and passes with no problem. Yes, her memory was slipping a bit, but she had strategies for overcoming the problem. She had many years of learning and experience.

I recalled this episode (my memory is not that bad) while I was struggling with my Spanish class. I’m only encouraged when I see my fellow student, who is young and Japanese, struggle with cognates (cognates are words in two languages that share a similar meaning or spelling). Though her brain is young, fresh and retentive, it lacks the ability to connect new words to words from her native language. For me, some Spanish vocabulary is a small step from my existing English vocabulary, and Spanish is not such a “foreign” language to Americans, especially those of us who have lived in communities in the US that have a large number of Spanish speakers. This is an advantage of both culture and age, and it is an advantage I have.

According to the article in the Guardian, “Am I too old to learn a new language?,”Picking up a new language’s vocabulary is much easier for adults than learning the rules that govern its grammar or syntax. This is because new words can be easily mapped on to a learner’s pre-existing knowledge.” I think we also have more mature social skills, and can understand speakers of other languages better because we can read the environment and body language better. This is a real advantage for me, as I have spent the last 14 years living in non-English speaking countries.

But how can I learn Spanish when I get frustrated and demoralized? In English language teaching most instructors rely on the “communitative approach:”

The communicative approach is based on the idea that learning language successfully comes through having to communicate real meaning. When learners are involved in real communication, their natural strategies for language acquisition will be used, and this will allow them to learn to use the language.(source)

This approach emphasizes the use of the language being learned in real life situations, and “success” is measured by the ability to communicate. Prior to taking my current class, I was gaining confidence in my Spanish. I was increasingly able to communicate effectively in my dealings with a monolingual Spanish environment. This successful communication increased my confidence, and thus my courage to continue, and, hence, my learning. Despite the kindness of my teacher, I feel my confidence and skills have actually deteriorated. We have been studying, from a book, grammar. The emphasis has been on verb conjugations and especially irregular verbs. Irregular verbs are highly unlikely to have English language cognates. They seem to hit the side of my brain like bugs on the windscreen. Dead on arrival.

Yes, we can learn a new language in our 60’s and beyond. It takes patience, and the right approach. If you are looking for a language school, pay careful attention to their methodology. An emphasis on rote learning and grammar is clearly not the best way for us to learn languages. We need to be able to build on our strengths and develop confidence by way of successful communication.

An important added benefit to language learning is that we also are strengthening our brains in the process:

Learning a new language may not always be easy for adults, but there is research to suggest that doing so is beneficial for brain health. As we get older, most of us experience an age-related decline in mental functions such as attention and memory, and in some people the acceleration of this process leads to the development of Alzheimer’s disease or some other form of dementia. A number of recent studies suggest that learning a foreign language can slow this inevitable age-related cognitive decline or perhaps even delay the onset of dementia. (source)

Just as we need to actually increase our physical exercise as we age, so it is the case for mental calisthenics, “”Learning a language later on in life might be more beneficial than learning it earlier, because it takes more effort,” Bak continues. “It has parallels with physical exercise – a stroll is good for your health, but not as beneficial as a run.””(source)

Next month I’m going to Machu Picchu with a couple of friends who are 10 years younger than I. They will climb the mountain. I will be very grateful to be able to hike the site and climb the stairs, and communicate with the patient guides in Spanish.

 

 

Ecuador, Arrival and 1st Impressions

I will start this by admitting that I had seen so much written about retiring in Ecuador that I was prepared to not love it. Yes. Not necessarily a confession, but an acknowledgement that I can be a bit of a snob. How can that many people like something without some of them having relinquished their critical capacity? So I arrived with a bit of an agenda-a desire to find the spider under the bed that everyone else had overlooked.

Otavalo

I had myself rather unceremoniously dropped by the side of the road in Otavalo with a couple of much younger backpackers after taking a long raucous bus ride from the Colombian border. We stood there for a few moments and then I went and found a taxi, as I already had a reservation. They didn’t, so I invited them to come with me to my hostel.

When we arrived it seemed as if the hostel was closed. It was darkish, towards sundown, and seemingly lifeless. Finally a young man came to the door, after we rang a few times, and showed us into a dimly lit entry. Yes, I had a reservation, no, the couple didn’t. No problem either way. The partner of the young man arrived and scooted the young couple to the “honeymoon suite” at the top floor. I was taken to a smaller room on the second floor off from a bit of a library. It was getting darker, and the largely unlit building was empty save the 5 of us. I have to admit to visions of the Bates Hotel. I have learned along the way not to judge the accommodations too harshly when arriving after a long bus ride, especially from another country.

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The Hostel sat a little uphill from downtown, and every level offered views of volcanoes and the city. At the top was a kitchen the size of a small apartment, with volcanoes from every direction. The hostel was the loveliest I’ve stayed in, and the young men running it saw to everything quietly and with a very patient graciousness. At $15 a night for an ensuite single with a view, it was perfect.

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The big white building in this picture is the hostel.

Otavalo serves as the eponymous city core for the indigenous people native to Imbabura Province in northern Ecuador. The streets are filled with Otavalans strolling and taking care of business. Poncho square functions as the city center, close to which is the Saturday animal market and the fresh foods market.

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This is a favorite snack of tiny snails.

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I stayed in Otavalo for a week-probably out of laziness and the pleasure of a good kitchen in which to cook the market findings. I still was unconvinced about Ecuador, but it was early days. Walking the streets every day in Otavalo was a pleasure, and the people were kind and warm. It certainly meets the criteria I have for a place to retire, but I didn’t feel it, as it were. Maybe it was just too entirely other, and I felt like an interloper and a bit of a voyeur.

But I appreciated the striking difference from Colombia, which has a very small indigenous population. It was a good introduction to Ecuador, and I warmed to the country. While there I visited Cotacachi twice. I’ll write about that another time.

 

 

 

 

International Retirement Migration

I just finished listening to an NPR (National Public Radio in the US) report on retirees in Cotacachi, a rural town in northern Ecuador. (http://latinousa.org/2015/10/09/rural-ecuador-americas-new-retirement-spot/) The report talks about the arrival of American expats to this small Ecuadorian town which has a very low cost of living, great views and an easy way of life. It also talks about one of the great engines of expat ingress to Ecuador, International Living, an online magazine which markets all sorts of services to expats, such as real estate, attorneys, local experts, etc., as well as its own premium services, seminars and webinars. To read International Living is to be convinced that fairy tales come true, even at $1000-1300 a month.

International Living is the top hit every time on Google when looking up retirement abroad, and they are the go to bad boys of unreasonable expectations. The report on NPR mentions them several times, for good reason. But they have tapped into a market, they didn’t create it whole cloth. They have probably single handedly  doubled the number of American expats in Ecuador, but if you think about it, it takes a lot to convince a person to leave their home country and their lives and move to a strange country where they speak a different language.

Why We Leave

Why would people want to leave their homes and families and everything that is familiar to them, to go to a new country, any new country? 

The main reason for the current retiree diaspora is financial. Most of us older people are now, or soon will be, living on fixed incomes that are no match for the US cost of living. We live in the richest country on earth, but we can’t afford it. It is that simple. When you take into account what is required in the US: housing, food and clothing, medical care, transportation and other basic needs, there just isn’t enough in the pension. According to a 2006 Princeton University Working Paper by Thomas Methvin, “As the Migration Policy Institute attests, “The skyrocketing cost of medical and nursing care paired with increasing life expectancies have led to growing doubts that Medicare, Social Security, and private retirement plans will be sufficient for a decent retirement living for all but the most fortunate of retirees” (Migration Policy Institute 2006).

The second reason is lifestyle. This is in large part related to finances. If you can paste together an existence in the US on your pension, it will be a rather spartan one-maybe one your puritan ancestors would approve of? Probably in the US, if you are on an average SS retirement, you will continue to work to supplement your pension. From the same study mentioned above:

“Migrants leave, even from the so-called “core” [developed nations], because they are embedded with lifestyle expectations that they cannot fulfill given their present living conditions, much like those who may leave the periphery [developing nations]. This happens for example when retired migrants living in the “core” make a calculated association between differentials in the cost-of-living in so-called “periphery” regions, causing them to seek locations that allow them to stretch their resources and attain (or come closer to) such a lifestyle.”

So, let me explain that a bit. In one dominant explanation of immigration, it is argued that people migrate to the developed nations (the “core”) because of the penetration of advanced consumer lifestyle ideas and desires into the developing nations (periphery) and people migrate in search of the better life they believe they can have, or at least give their children, in the most modern nations. In other words, they are driven by the desire for a consumer lifestyle. I think it is fairly clear that this is often the case (with many economic migrants, but of course not the case with refugees).

When it comes to the migration of retirees from the developed nations to developing nations, it is ironically the same operation in reverse. We in the rich countries all grow up with consumer desires mostly driven by media. We want a good, comfortable life-style and actually feel quite entitled to it. Many retirees feel cheated when they realize they can’t play golf and lay about at the beach in their retirement. We want our own homes and to be independent. Moving in with the grown children and watching the grand-babies is neither desirable nor an option. So just as the migrants from the developing nation are seeking a good life-style, so are the retirement migrants moving to the developing nations.

A reason quite related to the above is disenchantment with the American way of life. I have found that a lot of retirees I’ve met abroad, or whose blog articles I’ve read, feel alienated by contemporary American culture and society. This critique comes from the right and the left, as if you could divide the expat retirees along the lines of Sanders and Trump. There is a general malaise, even if it is interpreted differently. Again, it would seem that those migrating out of developed countries are driven by similar forces as those who are immigrating into them- the American (or western, or developed) way of life.

The promises of the life of leisure in the perfect climate with all the amenities obviously overstates the possibilities. Just as the immigrant who arrives in Europe or North America experience some painful realities, so do the expat retirees. But we are driven by similar, and somewhat eternal forces. Humans are migrants. Why this is still a mystery and a controversy defies logic.  Now is a new era of migration, and retirees are now being recognized as being part of the new diaspora.

 

 

 

 

Emergency Room Bogota: Health Care in Columbia

Nothing makes you long for “home” like getting ill while traveling. I’ve been sick in many countries, almost to a one with food borne illnesses. It is a miserable time, exacerbated by needing to encounter an unknown medical system in a developing country. Last night I got an immersion course in Colombia’s health care system.

The last time I needed urgent care I was in Bangkok, and for me it was about like being home. I knew the health care system, and I had a hospital that I had been using for many years for my basic medical needs. When I got food poisoning there and was doubled-up with pain, at 2 in the morning, I got myself a taxi and was to the emergency room in 20 minutes.

This time was different. Being in Colombia for about a month, I knew nothing about the healthcare system except what I had read and heard. It is essentially a socialized system, but one that is fragile and inefficient. Delivering adequate healthcare to a large, and largely poor, clientele, would be a challenge anywhere, but here there is an inadequate tax base and too much corruption. The system covers everyone. I don’t think it is intended to cover foreigners, but effectively, it does.

This was research I didn’t intend to do. On Friday afternoon I had a large meal at a fairly well known restaurant. It is in fact the nicest restaurant I’ve been to in Colombia. The meal was mediocre, maybe because it was at the end of the afternoon meal time. By 8:30 I was good and sick. I got worse through the evening, and by the middle of the night I asked the owner of the hostel for help. He made some phone calls, and then said I needed to go by ambulance to a clinic. This seemed a bit extreme on one hand, on the other, taking a taxi in my condition in the middle of the night is a bit risky.

The ambulance arrived about 50 minutes later. The hostel owner helped me to the ambulance and the driver asked him for money. There is a sign in the ambulance that says that you do not pay for an ambulance, and he didn’t. My vitals were taken, and then we sat in the ambulance for about 1/2 hour for some unknown reason. Finally we took off, me weakly on a gurney in the back, not strapped in at all.

45 minutes later we arrived at a very modern clinic. I was wheeled in and planted next to a wall across from the admitting desk. The attendant from the ambulance stayed with me and was my only contact. The rest of the people of the clinic aggressively ignored me. After over an hour, the ambulance attendant said he was taking me to the hospital. They loaded me up again in the ambulance and drove for 45 minutes to the public hospital. Wheeled in, and planted again next to a wall, I went through the same experience. Other patients walked in to the emergency room or were brought in by ambulance, and seemed to be in excruciating pain, falling on the floor and crying for help. They also got little attention. I clearly wasn’t being discriminated against, or for, as a foreigner. We were in this together, and suffered the same indignities and level of service.

A couple of hours later, by now 8 AM, things started moving a bit. I was told I would get an IV. I said I wanted to see a doctor first. A crowded under-served old emergency room is not a place to be unmindful about things like needles. Around 9 AM I saw a doctor. I think all of us were waiting all night for the morning doctor to come on shift. Wisely they had treated the worst patients first, so I was about 4th in line. The doctor was young and competent, and spoke a modicum of English. With my less than a modicum of Spanish, we managed. I got examined, diagnosed and got prescriptions in about 20 minutes. All smartly and efficiently. When it was my time with the doctor, I had all the time I needed and did not feel pressured or rushed.

I had meanwhile called my friend/former hostel host from Villa de Leyva and he advised me a bit. He offered to have a friend come and help me and take me back to my hostel after I was done at the hospital. He said I was in a very bad neighborhood and I should not go on the streets. Instead of putting his friends out, I had the hospital call a taxi for me. 45 minutes later I was on the road home.

I’m feeling better today. The meds are doing their job and I’ve been making up for lost sleep and the stress of the illness.

Conclusion about my healthcare in Colombia:

I was treated as well as anyone else here, which is marginally adequate but I was treated. If I were to show up at a hospital in the US as a foreigner, getting treated at all would require a ton of paperwork and a lot of money upfront. I could easily be turned away.

My out of pocket expenses?

  • $12 to the hospital (the hostel owner was outraged-he said I should not have been charged at all)
  • Nothing for the ambulance. Remember, the attendant stayed with me for hours, in addition to the total at least 2 hours ride
  • $3 for 3 prescriptions
  • $6 for the return taxi, only because we had to drive around to find and ATM and drugstore

Yes, in a developing country, socialized medicine is a struggle, but one based on the principle that health care is a human right. The drunkest, most belligerent, ancient toothless old man got respectful care, and poor mothers with small children were able to walk in and get care, after waiting a long time.

Yesterday morning I would have given anything for a nice bright efficient US clinic. But even with insurance it would have cost me a lot of money, money that the drunk and the poor mother don’t have. Even with Obamacare there are still “deductibles” and out of pocket expenses. Now in retrospect, even just a day later, I am grateful for the care I got and for the experience of the system. It was a sobering experience, but a useful one.