Jacob J. Walker's Blog

Scholarly Thoughts, Research, and Journalism for Informal Peer Review

My Month of Daily Medical Appointments for Chronic Conditions: A Good Start, but More Work to Be Done

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I wrote the following informal report to send to my supervisor and payroll department at Twin Rivers:

Introduction & Justification

I have several chronic cardiovascular health conditions that could ultimately lead to cardiac arrest, stroke, dementia, or other acute condition that could end my life.  I take these seriously, as at least one of my past coworkers had a son who died in his thirties of heart disease, and my family has a history of heart disease.  I truly don’t want to die of something that I could have prevented, or slowly lose my mind.  And, while my health is not terrible now, being in my mid-thirties, I can see that if I don’t make changes now that are long lasting, there is a probability that I might not make it to retirement.

Specifically, I have been medically diagnosed as being obese (with a Body Mass Index of being 30 or greater), I have high low-density lipoprotein (LDL) cholesterol, and my blood pressure is high at a pre-hypertension level, and has been at a hypertension level in the past.  From the classes I took with Kaiser, I learned that because my obese fat  is around my gut (I’m “apple” shaped), that it is likely that I have fat around my internal organs that can cause issues with my health.  Further, my blood pressure can be a “silent killer”, as it may lead to greater amounts of inflammation in my blood vessels, which can lead to cholesterol filling those blood vessels, which can later lead to heart disease.  Research is also starting to link high blood pressure to dementia. Thus, any actions I can take to reduce my blood pressure, reduce my fat, and reduce my LDL cholesterol, in a manner that does not rely on pharmaceuticals that often cause other negative health effects, is the best therapy for my conditions, and for my long-term health.

So, for four weeks I worked actively to improve my health, through education, measurement, and therapeutic activities that have been recommended by my doctor and by Kaiser Permanente for the chronic health conditions I have.  I feel I did this in an ethical manner, as at the time, I was on the layoff list for Twin Rivers Adult School, and I had finished teaching all the courses I was scheduled to instruct.  Thus, I started this treatment plan instead of “twiddling my thumbs” at work at the tax payer’s expense. Especially, because by using my medical leave to do this treatment plan reduced my CalSTRS retirement benefits, thus reducing Twin Rivers and California’s long-term liability (expense).

I believe that my actions were completely legal.  The Twin Rivers Teacher’s Contract states that “Sick leave may be used as follows:” and then states “Dental or medical appointments of the employee.”  Clearly every time I went to Kaiser during normal work hours and had a medical test of my blood pressure being checked during work hours was a medical appointment.  Further, I often attended Kaiser medical education courses, and attended Kaiser medical exercise courses. Further, I had previously asserted in an email to my principal that medical leave could be used for small medical appointments, and she agreed.  And when I told her openly about my planned activities to improve my health, she didn’t make any statements against what I was doing or suggesting I couldn’t use medical leave for this medical activity.

Methodology & Initial Results

First, I must be clear, that I recognize that a single month of work on my health is not sufficient to change my long-term health, nor even likely to dramatically affect my current chronic conditions.  But, it takes at least 21 days of practice to change a habit (and research is starting to suggest it generally takes longer).  Thus, the four weeks is an investment into a continuing change of lifestyle.

Education & Research

I took several courses about health with Kaiser Permanente, with the PHASE (Prevent Heart Attacks and Strokes Everyday) course being the most relevant to my cardiovascular issues.  From this class I learned the role that cholesterol plays in filling up arteries, and how research is suggesting that cholesterol does this because of inflammation of the blood vessels, which may be caused partially by high blood pressure.

In addition to courses with Kaiser, I have been taking the audio course of Scientific Secrets for Self-Control by Professor C. Nathan DeWall, and reading The Power of Habit by Charles Duhigg.  These two works are especially important to my health, as there is a clear difference between knowing what is healthy and doing what is healthy.

I learned from these that intelligence doesn’t correlate to self-control, hence why intelligent and educated people can get pulled into addictions.  (I thankfully do not have any addictions, except possibly to food and sugar)  Further, I have learned that in general, to change my habits, I will need to replace the habit with a new one, but that the old habit will likely stay partly wired in my brain forever.  (Again, this gives credence to why an addict may never fully recover, and why it is so critical for good habits to form in the first place.)  Further, I have learned that self-control (like taking actions against a habit) appears to draw upon metabolic energy, and thus the more self-control we exert, the more challenging it can be to continue using it.

Blood Pressure Screening

Blood pressure is notorious for fluctuating. In the PHASE course, I learned that “white coat syndrome” may artificially inflate blood pressure readings, because people are stressed at doctor’s appointments.  I made a commitment during my month of health focus that I would check my blood pressure daily, with the precision that could be done at the Kaiser medical centers.   By being regimented in gaining daily data, I could get a more accurate understanding of where my blood pressure is, and without being so regimented, my doctor and I would not have as good of understanding.

From the daily blood pressure readings, two things were learned:

  1. My cardiovascular exercise, diet, and loss of weight may be having some effect upon my blood pressure, as a trend line based upon the data shows a downward slope.  Although, the data is not yet sufficient to state whether this is likely to be a long term trend.
  2. My blood pressure varies widely, especially my systolic blood pressure (the pressure on my arteries as my heart is beating).  According to the American Heart Association the systolic reading the one that should be paid most attention to as a major risk factor of cardiovascular disease.

The following chart shows my systolic blood pressure readings over the period of time that I actively had it measured at Kaiser; nearly all of these readings were within the prehypertension range (being greater than 120), but at the end of the month I was able to have a reading as low as 116 (although the next day it went back up to 138, but the day it was 138 was a rather stressful day on me.)

Diet Logging

My doctor has said that losing weight is about 20% exercise, and 80% diet.  This is because exercise does not burn a lot of calories, in general, thus if a person “rewards” themself with a soda after a workout, they may have undone all the work that they did.   To improve my diet, I know I need to understand what I’m eating.  To facilitate the logging, I used the MyFitnessPal application on my Android phone.  I chose this as it was ranked high in Consumer Reports, and has a thorough database of food items, and also can scan UPC codes, making data entry convenient, thus improving the probability that logging will occur whenever I ate something.

I did an excellent job of logging what I ate, although I am not good at necessarily knowing what proportion sizes are, so in general I tried to err on the side of saying I ate more than I likely really did.
I must admit that diet was the hardest part to control and improve upon.  As can be seen from the following graph, starting from when I first started tracking my diet, until today, that there is a great deal of variation of my caloric intake, and only the slightest of current downward trend:

Although, past sporadic informal checks of my diet suggested that it may have been more common for me before to eat at the 3,000 calorie level, so while I did not generally meet my 2,000 calorie goal (thus far), I may still be eating less than before.  Further, my increase in cardiovascular exercise has likely also

Cardiovascular Exercise

As part of my month long focus on my health, I would generally attend Kaiser’s Move to Thrive medical exercise program 2 to 3 times per week, and also go the gym and do cardiovascular workouts 1 to 2 times per week.  While I attempted to measure these workouts using the Scosche IPTM myTREK  Wireless Pulse Monitor, along with the Digifit iCardio app for Android, I unfortunately found the myTREK to be inconsistent in its measurements, and until I can get it to work properly through placement and calibration, I do not feel that I have sufficiently valid data to share.

But it does appear that my diet and exercise has had some effect.  According to my official Kaiser measurement of my weight I went from 224 pounds (BMI of 30.1) in January to being 217 pounds in June (BMI of 30.2).  This has brought me down to the borderline of being considered medically obese (a BMI score of 30), and I believe that continued work will likely be able to attain my current goal of a weight of 190 pounds (BMI of 26.5).

My personal tracking of my weight using a Wii Balance Board also suggests that I have improved, although my weight has fluctuated along similar lines as my caloric intake.  As of the time of this writing, I have not been able to export my weight data from the Wii Balance Board, to do a full analysis.

Further Work

My month of proactive medical focus, and daily medical appointments is only a start.  If I do not continue to improve and have this month being a foundation for future improvement, then it was a waste of my time, and a waste of reducing my future retirement (by reducing the sick days that will contribute to my retirement.)

But, if this month of work is the start to improved habits, and further proactive therapeutic work by reducing my caloric intake more consistently, and doing appropriate cardiovascular exercises more, then using the medical leave, and thus reducing my retirement benefits will be truly worthwhile.  This is especially true because the possibility of dying before retirement does exist, given that one’s health tends to get worse over time, not better. For example, my current prehypertension based upon my systolic blood pressure is very likely to “rise steadily with age, due to increasing stiffness of large arteries, long-term build-up of plaque, and increased incidence of cardiac and vascular disease”, according to the American Heart Association.  Thus, I MUST improve this now if I want to have the longest life span that I can have.

Longitudal Study and Sharing

As I have just discussed, one month of work is not enough.  Further, I cannot see the results of the one month of work, because it is so easy to slip out of good habits back into bad ones.  So the data in this report can only be seen as being preliminary.  I must improve my accuracy of data collection, and continue to measure my results for at least a year to see what the results are of what I have started.  And even from there I will not know, without doing at least a yearly analysis, and continuing to log and measure as best as I can, so I can see if I’m actually improving. I want my data collection and analysis to be rigorous enough to be able to be published as Personal Science, to show an example of how self-quantification and scientific methods can contribute to improvements in our lives.

While my month of proactive medical focus has first and foremost been about improving my chronic medical conditions, it has also been important to my Professional Development, and future curricula creation.  While I will no longer be teaching Medical Math and Microsoft Excel with Twin Rivers, I hope to continue to improve this curriculum and be able to share it with other teachers within Twin Rivers and elsewhere.   My research and continual data collection can be data that I can release to others to be able to analyze, and I can further develop lesson plans around helping others to learn to analyze and improve their own health, by using my data as an example.

Thus, if this month of work can lead to not only my own improvement from chronic health conditions but help others to improve their health, and increase their lifespans, then this month investment of time and energy will truly be worthwhile, and may be the most important medical appointments I had.

Post Revisions:

This post has not been revised since publication.

Written by Jacob Walker

June 13th, 2013 at 8:55 pm

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