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BP rechecks without office visits?
Glucose readings sent daily to a doctor's EHR?
Multiple data points for adjusting patient care, instead of one or 2 points per year?
Is it really a question, whether mobile health technology will reduce costs, improve the quality of care, and magnify patient satisfaction?
Courtesy of Mashable, a CES snapshot of current and future directions in personal health, aka quantified self, aka self-monitoring, as seen by FitBit.
Lots of moving parts in this field -- FitBit, iHealth, and Withings all now make a digital scale that can upload weights and bodyfat % to the Internet and social media sites -- a very powerful motivating tool -- and FitBit, BodyMedia, and Nike now make personal devices to track activity and exertion with similar uploading capacity.
The deciding factor for the winner(s) in this space may be the utility of the smartphone or web interface, the reliability of the product (Jawbone stumbled here), or the basic slickness of the marketing campaign (Nike).
Any way this plays out, we as consumers should benefit.
The one on the left is my all beef patty-sized hematoma, or blood bruise. Only moderately tender to the gentle ministrations of my main PT, Chris, and his trusty PT aide, Becca "the Hammer," aka "Man Hands."
This is squarely in the upper middle of my gastrocnemius muscle, the calf muscle that actually crosses the knee joint as it attaches to the lower thigh bone. Hence, the difficulty walking without keeping the knee bent, with a definite gimpy limp -- gimpy, that is, unless you wear a rocker-bottom boot like this:
Started with an ACE wrap, graduated to the sleeve once I could pull it on without manipulating my ankle and passing out.
Today's routine: ultrasound to start, then expert hematoma mobilization and softening plus scar fiber molding parallel to the muscle grain, then active and passive stretching to get the foot past 90 degrees (finally!). From there, some new exercises and homework for basic quad, VMO, and hip adductor strengthening. Then 10 minutes on the recumbent bike, finishing with about 10 minutes of icing while getting e-stim:
After running becomes possible, the real calf work begins, to re-prep for beyond basic daily activity stuff. Am working now to build other bases (bodyweight pushes, pulls, core work, and squat prep).
It's going to be a long road. Long, but very educational.
Common denominator: going explosively all-out, like my hindbrain remembered from Muay Thai class, but with my body unprepared thanks to a 10-15 year hiatus.
In retrospect, this was more idiotic than "weekend warrior" syndrome; it was more like "high school reunion" syndrome. Joint mobility and flexibility work, deadlifts, plus kettlebell ballistics and grinds aren't the same as percussive strikes. Particularly with the highly plyometric takeoff of the Thai knee stutter step, I basically made my body tear a piece of itself off.
Major take home: don't drive faster than your guardian angel can fly. If you're older than 40 and it's been a while since you've done something, reaquaint your connective tissue (muscles, tendons, ligaments, etc) over 3-6 months and get technique down cold before going all Kill Bill.
If you're not a fan of Doctor Who, hold that thought.
A just-as-good question would be, "If you ever get the chance, should you make every effort to see Seth Godin speak in person?" Like I did last night at the Linked OC event at the Segerstrom Center in Orange County, CA.
Answer -- Only if the following matter to you:
Any of these would be worth the price of admission.
Special thanks to Bryan Elliott, the organizer behind Linked OC who made the evening possible.
It boggles the mind that this is the second year in a row he's gotten Seth to speak to the OC business community, until you see some other A-listers he's had over -- including Chris Brogan of Trust Agents, and Gary Vaynerchuck this coming May (author of Crush It!). Clearly this was no lucky fluke.
I understand that Seth is based in New York, and doesn't bounce coast to coast a lot. I now envy folks in the Upper Right Corner just a wee bit more.
I'm happy I got this nice pic with my old iPhone, plus a chance to chat briefly while he graciously signed my copy of Poke The Box. Who knew that pastrami causes ulcers on the East Coast? And I thought getting healthcare providers engaged and connected was hard.
I resisted any temptation to pitch a book idea, a product or service endorsement, or any other thing to impress him while he signed "Peter -- go, go, go." Even if I'd had one, I wouldn't have, I'm pretty sure.
So how is Seth Godin like a Stetson?
Because as any good fans of the Doctor know, Stetsons are cool:
It's available free from the Posterous blog engine that this blog is hosted on...feel free to sing out if you find the older one more readable.
If you look really closely, you can see the BodPod reading on % fat has dropped a mere 0.2% units, from 23.8% to 23.6%, after 4 weeks on the 4HB Slow-Carb Diet. I was expecting a drop into the teens at least, as well as a weight drop of around 15 lbs. Time to roll up the sleeves and see what da heck happened.
By any stretch of the imagination, these are pretty poor #s for a month on Slow-Carb -- from a weight and fat loss standpoint. I was thrilled to be under 200 lbs for the first time since college, and most thrilled with the 30 point BP drop that prompted this endeavor in the first place. But I'd expected double the drop, and losing nearly 5 lbs of muscle surprised me ("You're getting lighter," my wife kept saying, "and not in a good way").
Should it have been a shocker?
Previous exercise regimen:
Exercise during these last 4 weeks:
With that drop in exercise volume, it's a wonder I didn't lose more muscle mass.
I'll be re-measuring and reporting the change in TI -- total inches -- on my cheat day this Saturday; I have lost inches, but noticed that the waist slimming, while ongoing, had slowed in the last 2 weeks, and that I'd also lost fractional inches from my arms, legs, and already flat butt.
Clearly, am hitting an equilibrium point between three forces:
This raises some interesting questions about my primary focus, which was and still is blood pressure reduction. Losing "just" 2 pounds of fat is chump change on paper, but is a surprising real-world volume -- about four and a half cups, or a little over a quart. Was the fat loss itself responsible for the BP drop? [Research topic: check with Plastic Surgeons who do lipo on hypertensive patients, and compare pre-op BPs to daily post-op readings for a week in folks with a small amount of removed fat (around 2 lbs)]. Did the decreased exercise volume help the BP by reducing overtraining stress? Or was it more the sodium reduction plus potassium rich food intake (green smoothies)?
Next direction queries:
Can the 23.6% body fat -- 24% -- be lowered into the teens, while pursuing total weaning off BP medication? Probably; there's no intrinsic reason why lowering body fat percentage should raise blood pressure.
Has the muscle mass loss plateaued? Also, probably; the weight has been stable within 2 lbs for the last 1-2 weeks. Ergo, the current dietary habits, including a cheat day per week, equate to daily activities plus 2 brief kettebell swing sessions per week.
So which way to go, reduce calories, increase metabolic burn rate, or both?
Easiest would be to reduce calories a tidge, by one of the intermittent fasting protocols. Skip lunch a couple days a week, or for longevity and protein restriction purposes, turn the cheat day breakfast into a protein-free green smoothie, and ditto for one other dinner during the week.
Increasing metabolic burn rate would mean ramping up the exercise burn and/or building muscle, and or invoking other aides: the thermogenic cold therapy protocol from 4HB, or the PAGG stack. For efficiency and the minimizing of pills, I'm leaning towards the cold showers and ice packs on the traps, and adding one KB grind day a week: more frequent and drawn out exercise may not be needed, and might raise the BP, which I've seen before. Isometric gymnastics and total body bodyweight programs are also candidates, just less standardizable than KB lifting.
So, here's to Round Two!
Never gets old:
For breakfast, had a quick 3 egg in-skillet scramble, after sauteeing 2 clawfuls of organic spinach in a glop of olive oil with a little Dairygold butter. No added salt, lots of ground pepper, and some leftover black beans heated up with some sprinkled cayenne pepper on top. Protein, potassium, magnesium, fiber, and testosterone enahncement all in one.
Hibiscus tea through the morning.
Still exploring the exercise options...will be studying Tracy Reifkind's DVD, Programming The Kettlebell Swing, this weekend. Have a line out to a local kinesiologist for an exercise physiology update. Both should help direct the next phase of personal testing: which exercise types are either blood pressure neutral, or hypertension reducing.
One senior RKC gave a shout out to Gumby: get flexible like Gumby before focusing on any other moves, if you've got elevated BP. I was more flexible than most, though no pal to Pokey, when my BP was 30 points higher a month ago, but I see his point. Hard to lower your pump pressure if you're tight and clenched all the time.
Love the KB swings, but miss the adeptness of moving up, down, and around. Even if they don't lower the BP, it's time to re-introduce the joint mobility and movement training.
No rice, chips, sour cream, cheese. And by accident, no lettuce, instead of extra lettuce.
Still, very filling. Apparently the appetite killing effect of the SCD is in no small part because of the beans, not the protein: missed beans at lunch yesterday, steak and veggies, and was hungry enough to break through dinner with some almonds and dark chocolate. Beans with each meal keep those cravings non-existent.
AM body weight: 199 lbs -- for midweek, encouraging. If the few pound drop before cheat day pattern resumes, should be in the 196-197 range by Saturday, which would be pretty close to the 2nd stage goal of 195 (1st stage was under 200).
Next week: the post 4 week BodPod bodyfat % recheck. Even if the scale weight doesn't budge, should be interesting if the fat/muscle proportions have changed significantly.
At work, I'm a medical director, Family Medicine Dept Chair, primary care physician, and a healthcare IT consultant for an EHR.
Twitter handle: @doccottle
Main blog: http://www.MedicalRecordShow.com
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