From the Editor’s Desk: Good Results, Same Old Worries (Premium)

As I write this, we’ve been in Pennsylvania for about a month and a half, after spending four months in Mexico City. We weren’t sure about how the rest of the year would unfold, but we just booked our return trip to Mexico for July 8, and we’ll be there through the end of August. And then we’ll be back in Pennsylvania for most of September, I guess, and then back to Mexico City for October and most of November. We’ll figure that out later.

Stephanie and I planned to use our time here to get caught up with appointments, see friends and family here and in Boston, take a couple of small local trips, and do some things that are difficult or impossible in Mexico. I also went on a major work trip, to Seattle for Build, and had a few in-person meetings locally. Basic life stuff, in other words. And we’ve done pretty well on that note.

I have all kinds of goals and what I will call a mixed success rate. But the most important, perhaps, was to get caught up on all the health-related stuff in the form of blood work and a series of appointments with various doctors. I saw my optometrist and have no changes to my prescription, which is good, but still need to order new glasses. I can’t see my dentist until we’re away, so that was pushed back to September, which isn’t ideal. And I’ve met my new primary care doctor, which was interesting.

A month ago, I provided an overdue but also incomplete health and fitness update. Long story short, I had seen my previous doctor in December and she convinced me, after two years of trying, to take the statin formerly known as Lipitor to lower my cholesterol. So I was looking forward to getting my blood work done when we came back to Pennsylvania to see how that went.

My doctor had also informed me she was moving to a new practice, so I was assigned a new doctor who I’d meet later. This transition was supposed to take place in March, but since we were heading to Mexico City in early January, I wouldn’t have to deal with the new doctor until I got home. Or so I thought. In that article linked above, I described the horrific experience I had the week before our flight and the difficulty I had getting my prescriptions filled and then just getting anyone to respond to my increasingly frantic requests for help.

I later learned that my previous doctor had had to move to her new practice months earlier than expected, and the week she made that transition is when I got lost in the shuffle with regard to communications and prescriptions. But I was treated unprofessionally and, I think, unethically. And I went to Mexico looking forward to when I could set that right, in person, when we returned.

Well, we returned. My pre-scheduled first appointment with the new doctor was set for a day in early May that ended up being too early: We didn’t originally have a return flight booked, and when we finally did book that, I had to move the appointment back by a week or so. And a few days after we got home, I headed over to the lab to get the blood work done so that I could discuss the results with my new doctor at the appointment that was scheduled for later that week.

? Lab tests

The lab results were overwhelmingly positive, and that’s not something I’ve seen in longer than I can remember. They were so good, in fact, that my previous doctor actually texted me. “Great job!” she wrote. “Your cholesterol numbers are much improved and are normal now.”

In some ways, that had been all I really cared about, as I figured my other results would be OK as well. But I did of course look at all of it.

On the cholesterol front, you’re looking for a number under 200 mg/dL. I had been slowly lowering my total cholesterol number over time, most recently from 234 mg/dL in 2023 to 221 mg/dL in 2024, both of which are in the “at risk” range. And so my doctor had put me on a low dose of Lipitor back in December. And my number in early May was 150 mg/dL.

Then there are numbers for triglycerides, HDL (high-density or “good” cholesterol), and LDL (low-density or “bad” cholesterol).

For triglycerides, you’re looking for a number under 150 mg/dL. Here, things weren’t so bad: I had gone from 93 mg/dL in 2023 to 79 mg/dL in 2024. And now the number is 57 mg/dL.

My HDL numbers had likewise been in the normal range before. Here, you’re looking for a number in the range of 23 to 92 mg/dL, and I had posted almost identical 52 mg/dL and 53 mg/dL scores over the past two years. But this fell, too, to 48 mg/dL.

LDL is considered normal if it’s under 130 mg/dL. I had gone from 160 mg/dL in 2023 to 149 mg/dL in 2024. But it’s now at 93 mg/dL.

Finally, there’s something called non-HDL cholesterol, which is ideally under 160 mg/dL, and I’m at 104 mg/dL. And a cholesterol to HDL ratio, which doesn’t seem to have a normal range per se, but this has gone down from 4.5 and 4.2 over the previous two years, respectively, to 3.2.

Beyond that, my hemoglobin A1C, a measure of blood sugar, remains in the normal range, meaning I’m non-diabetic. It also hasn’t moved at all, which is curious, since I’d done a good job of lowering it over the previous two years.

? More hiccups

Armed with this data, I was feeling pretty good about myself. But on the day of my appointment, I tried to check in and the receptionist couldn’t find it in the system. Finally, he looked me up and told me that my appointment wasn’t that day, it was two weeks from then. So I asked him if I could just see a psychiatrist instead, we laughed, and I left, confused. I guess I had screwed up the date change when I rescheduled the appointment in the app.

But this also meant I wouldn’t see my new doctor for two weeks. And I needed a refill for my Adderall, which I take for ADHD. This was the source of my early January freak-out, when no one was responding to my requests to get that filled for the Mexico City trip. And so I texted my new doctor through the app. And waited.

It was a Wednesday, and that day came and went without a peep. So I texted her again on Thursday morning, a bit more earnestly, explaining that I was literally out of pills and had already requested a refill, but had heard nothing. I was getting ready to text my previous doctor when my phone rang. I looked at the screen and saw my new doctor’s name. We had never spoken.

That call didn’t alleviate all my worries about this doctor transition, nor did my eventual first appointment two weeks later. But as I wrote last fall in Only What You Take with You, it’s astonishing how a person can impact the outcome of an encounter, positively or not, through their behavior. And in this instance, as with the story of that bar in Berlin I discuss via the above link, my new doctor said and did the right things. That is, she was apologetic and not dismissive.

Long story short, she wanted to set this right. She is off on Wednesday, she told me when I explained how this had happened in January and it had happened again that week. And she told me the story about my previous doctor having to leave much earlier than expected, which screwed up all kinds of things. And that she was sorry, again. And that there was no excuse for this. And I kind of appreciated the bluntness. Not so much because it was what I needed to hear–arguably, deserved to hear–but because it felt like the way a credible person would handle what was clearly a bad situation. She renewed my prescription and the pharmacy texted soon thereafter.

?‍⚕️ Same nurse, new doctor

When I did finally have my appointment, I was greeted by a nurse my wife and I have known and loved for years. She’s personable, not clinical and cold, and as per This is What Matters Most, she is one of those people out there who has made a positive difference in our lives. And I’m happy to say that, like Ali, I’ve told her this. But on this day, I had to tell her again, because as soon as I saw her, I launched into the story of my horrible experience from January, when I had to eventually go into the doctor’s office in person to get my prescription filled. And encountered these two terrible little urchins who treated me so poorly.

She thought she knew who I was referring to, and she told me what I could do about it. There is, of course, a formal way to complain. And I wanted to do that. But I also wanted to do right by this person, this nurse who makes something horrible, a doctor’s appointment, more bearable just by being who she is. And so I asked if there was also a formal way I could report her, but for being wonderful. She laughed and told me that I could do that, though the last time someone did, she only found out later and coincidentally. And that me just telling her how much I appreciated her was more than enough. Of course it was. But I took the forms regardless. I have a lot of feedback about this place.

Anyway. I finally met my new doctor.

And that was interesting. I started off by thanking her for the phone call. She could have just silently responded to my request by refilling the prescription, or whatever. But calling me must have been difficult and she handled it well. In speaking with her, I learned that she also has ADHD. And she was so blunt throughout, I finally told her that I assumed she wasn’t from this area, since everyone in this part of Pennsylvania was so passive-aggressive. She seemed more like someone from Boston or maybe New York. On that count, I was wrong, she actually grew up here, but she knew what I meant, of course. And being from Boston myself–like Mary Jo, I’ll always be a Masshole–I appreciate straight talking.

Or I thought I did.

“You have terrific numbers across the board for blood pressure and cholesterol,” she began, looking at my chart. At that moment, and it was only a moment, I allowed myself some sense of accomplishment. I thought they were great too. But then she continued.

… On medication.”

That kind of hung in the air. A criticism. What?

She then proceeded to see where I was at when it came to my health care. Did I want to address the problems, like really fix them? Or did I just want to take medication?

This was unexpected. As I’ve written in the past, I am not a fan of medication. I don’t want to cover up symptoms, I want to solve problems. When I started down this path–was it two years ago?–my goal was to improve my overall health through diet and behavior. I lost a lot of weight, I kept my blood sugar below pre-diabetes levels, and I was making slow but steady progress on cholesterol. But at the urging of my doctor, and after years of me putting it off, I had accepted the Lipitor. I already take something for high blood pressure. And I take Adderall, a controlled substance, for ADHD. That’s a lot of medication for someone who doesn’t like taking medication.

My blood pressure that day was 110 over 70, low. My cholesterol was down big-time. My ADHD … well, that can be a mess. But overall, I was doing well. On medication.

Fair enough.

She told me that her goal for me, like any patient, was to get to the point where medication is not required. That I agree with, though I also wonder whether there are certain genetic causes for some things that may prevent that. And so this is something we’re going to work on. Between the tough talk express routine and being on the same page when it comes to medication, I was starting to warm to this person. While also seeing that others–especially the passive-aggressive types in this area–might be put off by this. That almost made me like her more.

She also pointed out an interesting data point related to health that I’d never heard about explicitly. I later asked my wife about this, since she writes about health and nutrition, but this was news to her as well. My doctor told me that there were three primary components to overall health, but that only two of them were commonly understood: Heart health, which is both blood pressure and cholesterol, and blood sugar. Did I know what the third one was?

I did not. She told me that it was kidney health, which is measured by something called eGFRcr, or estimated Glomerular Filtration Rate using creatinine. It basically determines how well your kidneys are functioning. I have never considered my kidneys. I’ve thought about my liver for obvious reasons. But not my kidneys.

As it turns out, eGFRcr is one of dozens of tests that were performed on my blood. The way she had brought it up, I was expecting a “but” moment. As in, “you’re doing pretty well, but …”

Fortunately, there was no but. My eGFRcr is 99, and any number north of 59 is considered normal. Two years ago, it was 88, so I guess it’s heading in the right direction too. We left things on a good note. I will see her again in September.

?‍♂️New year, same old problem

But here’s the thing.

When I discussed the results I had seen from my smartwatch’s health monitoring functionality after three-plus months in Mexico City back in April, I noted that my lifestyle there is healthier than it is when we’re in Pennsylvania. We walk every single day, and I always seem to lose weight when I’m there. But when I’m in Pennsylvania, I don’t walk, almost at all. I sit more, I eat more, and I exercise less. It’s difficult to make the time, and I find myself gaining weight. This happened last year–up in PA, down in Mexico–and it’s happened this year, too.

On the one hand, I am looking forward to getting back to Mexico, if only to resume the daily walking. But on the other, I have not solved a problem I’ve known about for a long time and have done nothing to circumvent. It’s too easy to just stay in the condo and work, and when I leave, I have to take the car to get anywhere.

This, I have not fixed. And this needs to be fixed.