From the Editor’s Desk: Healthy Living at 7300 Feet (Premium)

It’s been a while since my last health and fitness check-in, but after three months in Mexico, I do have some observations. And while this isn’t all that surprising to me, it’s clear that the lifestyle we adopt in Mexico City is healthier overall than our lifestyle in Pennsylvania. Which is interesting, given the smog and other issues that are common to big cities.

From a recap perspective, I guess I had lost track of when I started my current health push, but it’s been almost two years. In mid-2023, I went to my doctor with the goal of being proactive with my health, that included basic weight loss goals, controlling health metrics like blood pressure, cholesterol, and glucose, keeping track of my sleep apnea (I’ve been using a CPAP since 2013), and what was then a growing understanding that I almost certainly have ADHD as well. (I do.)

By the end of 2023, I had lost a significant amount of weight, somewhere over 50 pounds. And then I spent much of 2024 in what I’ll call a rough holding pattern. I came back from Mexico in March 2024 lighter than I’d been in decades, which was nice on some level, but I was also curiously gaunt and felt that maybe I’d lost too much weight too quickly. So I course corrected, gained some weight, and then realized I was heading in the wrong direction. By the end of 2024, I was still down dramatically from the weight I’d started at, but even with my weigh-in from one year earlier. So it was a bit of a wash, I guess.

Health isn’t just about weight, I know. When we get home in May, I’ll be heading back to the doctor and will be getting more blood work done to see where I’m at. But here’s what’s happened so far this year.

? Off to a bad start

In my last checkup with my doctor, in December, my weight was even with the year-ago check-in, as noted, and my blood pressure and glucose numbers were great. But she brought up cholesterol medication again, as my blood work had shown improvements in that regard, but not as much as she wanted to see. Having read up on this topic a lot, I feel like most doctors misunderstand cholesterol and overemphasize this metric, and my numbers aren’t all that bad, really. And I am not a fan of medication, in general, because it treats symptoms without fixing underlying problems.

But I also knew from my research, which she confirmed, that there is no downside to taking cholesterol medication, no negative effects or other worries. Plus, high cholesterol can be genetic. And so I agreed to take medication for cholesterol–a statin called atorvastatin that was previously marketed as Lipitor–in a 20 mg dose, once per day. I will see what impact that’s had when I get my blood work done in May, but my long-term goal is to not take this medication if/when my cholesterol goes down.

Everything seemed like it was going fine, but then 2024 got off to a bad start: My doctor informed me she was leaving to go to a different practice, so I had to pick a new doctor, and I have yet to meet this person. And this coincided with me flying to Mexico in mid-January, and knowing that I’d be gone at least three months. This length of absence is problematic for all kinds of reasons. But for me and my health, there’s one big problem: I take Adderall for ADHD, twice per day, and this drug is classified as a controlled substance. And that means it’s a pain in the ass. I can only get it in 30-day increments, I have to manually ask for the prescription to be filled each month, and there have been supply issues. I’ve had many problems with this.

In the past, I’ve gone on multi-week trips, and we were gone for two months in late 2024. So my doctor has worked with my pharmacy to make sure I could get a lot more Adderall than usual. But this would be for at least three months, an unprecedented time frame. So the Monday of the week we were flying (that Saturday), I messaged the doctor, reminding her of the trip schedule, and I request 3.5 months worth of Adderall, about 210 pills. (Compared to about 60 in a normal month.) This has always gone OK.

But I never heard back. Monday came and went. Tuesday. Wednesday. And then I started getting nervous. I messaged her again on Thursday. Called. Nothing.

Friday, I tried again. And by early afternoon, I called my wife from the gym and asked if I should just go over there. She said yes. And so I did.

I may recount this story in full someday. But the short version is that my doctor was gone, she had already left the practice. It was my new doctor who had never responded to my repeated requests. And so I asked to speak with her. She never came out, she was seeing someone at the time, but I got the start of a prissy lecture about them doing me “a courtesy” from some oddly young person who can’t possibly be a doctor before shutting that down. “There is nothing courteous about the way you’re treating me,” I told her, holding up my hand. “I’m a patient and a customer and the only courtesy I want is for you to respond in a timely fashion to my messages about a medication that I need.” I went home, upset and Adderall-less. And I was convinced I would head off to Mexico with about two weeks worth of the drug, since that was what I had left from the previous refill.

We went to dinner that night at our favorite local restaurant, sat at the bar, as usual, and hung out with friends there. I was freaking out, of course. I had contacted the folks at the pharmacy a few times that week as part of me trying to figure this all out, and though those guys had been horrible to me the previous year, they had turned things around nicely and were now firmly in the right space. One of them called me to tell me that they had gotten a massive Adderall refill request for me. It would be done soon, by 6:30 pm. But they closed at 7:00 pm. Would I be able to make it?

Yes. I got up, told my wife and friends I was leaving, but that I’d be back. The pharmacy was nearby, so I was just going to head over and wait for this. My wife got it, she probably needed me to get this more than I did. But no one else could believe I was leaving. But I did, and I got the medication somehow. I was positive that little wretch was going to quietly ensure that never happened. Instead, she made me sweat it out. (I did go back to the restaurant afterward, of course.)

I will be dealing with her–and my new doctor, soon to be my new ex-doctor–when I get home.

✈️ Life at 7300 feet

So we came to Mexico City, me with a bag full of pills like a drug mule. And since then, we’ve done what we always do here. We eat out for every meal, because it’s cheap and because the food is good, with none of the processed food options that are much more common in the U.S. Everything is shifted later, with lunch at 1 pm or so, since that’s when most places open, and dinner at 7 pm or so for the same reason. And we walk everywhere. So we walk to and from each meal, a short distance for lunch on most days, but up to 30 minutes for dinner.

The time change is interesting. Mexico City was 1 hour off from Pennsylvania originally, but now Mexico doesn’t observe Daylight Saving Time, and so we’ve been 2 hours off since March. That’s a problem for First Ring Daily, which we normally record at 9:00 am ET, but 7:00 am here is far too early, so Brad’s been nice to shift that back an hour so it’s more reasonable for me. When we head home again in May, we’re going to be a bit screwed up, especially when it comes to eating.

In any event, I don’t generally eat breakfast, though I’ve been getting a jugo verde mid-morning most days because my wife swings by a stand that makes them, and it’s mostly healthy. We eat lunch at an inexpensive cocina economic at lunch, a local place where we get good food at a cost of about $4 each. And then we have developed a curiously regular schedule for dinner, where we go to Café Tacobar on Tuesdays and Gin Chan (sushi) on Thursdays, and then shift between other favorites and the occasional new place on other nights. (In PA, we typically go to regular places on Wednesday and Friday nights.)

One side effect of this schedule is that we walk a lot, as noted. I’ve averaged over 6,000 steps per day while here, and the high altitude–Mexico City is about 7,300 feet above sea level–makes these walks a bit more of an exercise, which is nice. But another side effect is that we don’t watch that much TV. At home, we typically have salads at home for lunch, and we watch a 30-minute TV show while we eat. (Currently Brooklyn 99, which is spectacular, but currently on pause.) And at night, we usually watch a few hours of TV. Here, nothing. We eat out at lunch, and we eat dinner late. By the time we come home most nights, we just read and go to bed. We watch YouTube some nights for a short time, but we’ve not caught up on any shows or movies for the most part.

?A few numbers

My wife and I have come to understand that when we come to Mexico City, we invariably lose weight. And that’s been my experience on this trip, for sure. How much weight is unclear, I’ve not weighed myself. And it’s probably evened off at some point. But for the reasons noted above, we’re pretty active here and it seems to pay off. I can’t categorize this properly until I get home and see a doctor and do some blood work. But until last weekend, when I switched from my iPhone to my Pixel, I was using an Apple Watch. And so I do have some interesting data that supports my observations.

Resting heart rate. My heart rate goes up when we arrive in Mexico City because of the altitude. That’s normal, it happens to everyone, but it also takes longer than I’d like to go back down. Before we left, my resting heart rate was 71 bpm, and at its worst, it was about 77 bpm during the first two weeks we were here. It was 67 bpm during my last week with the Apple Watch.

Sleep. I sleep poorly, even with a CPAP, but I saw some interesting changes here, too. My average sleep time went up a bit over the three months, but the quality of that sleep went up more noticeably, with fewer times awake each night on average. The last night I used the Apple Watch, I slept for 7 hours and 10 minutes, which is great for me. I’ve had no notable sleep disturbances or respiratory rate changes, and I’ve seen my sleeping heart rate go down nicely over time. I’ve been getting into the low 50s bpm range since mid-February, something I’d not done since last year. This is all good because I had HAPE years ago and high altitude is a concern. But it’s always been fine here.

Steps. I was averaging about 3,000 steps per day in PA, but I also had days when I never left the house and didn’t move that much. Here, as noted, it’s over 6,000 steps per day and I leave the apartment every single day.

Standing. One of Apple Watch’s 3 rings is for standing, so it prompts me to stand up every hour. I do this here a lot more than I do at home, not sure why. (Pixel Watch is more about movement each hour.) In PA, I was average less than an hour standing each day, but here it’s usually over two hours (and sometimes close to three).

There’s more, but these things get progressively less important. For example, I spend a lot more time in the daylight here than in PA, though to be fair, it’s always Spring here, and it was Winter in PA when we left. There’s a lot of data.

Anyway, we head home in a little over two weeks. I’ll report back when I get my blood work done. And get a new doctor. That’s going to be a fun little conversation involving lack of professionalism and not doing the right thing for a patient. I can’t wait.