Column 7: Health

“Health is not valued until sickness comes.” - Thomas Fuller

Wine: ONEHOPE Sonoma Coast Rosé

Recipe: @cookingforone1 Watermelon Balsamic Salad

BODY

May 3, 2023

“Hi Dan. 

Your ultrasound was normal.

You may have autoimmune hepatitis with negative autoimmune markers.  A liver biopsy would be the way to figure that out. 

For now, I think we can just repeat your labs. Let me know if you have any questions. Take care.”

That was the first of the handful of diseases that doctors told me I may have had in the past year. Among the others were sarcoidosis and celiac disease. A few months prior, routine blood work revealed that I had elevated ALT liver enzymes, which indicates some type of damage has been inflicted upon that organ. Since then, they have skyrocketed to double and even triple the normal range, and also dropped down to nearly normal. I’ve lost count of the times I’ve gone into the lab to give blood samples. I’ve had an ultrasound, chest x-ray and underwent a liver biopsy. 

Ironically, a year ago I started to write a column centered around health. While I was drafting it, I received that email above from my doctor telling me he thought I may have autoimmune hepatitis. That caused my writing to come to a screeching halt. Up until then I had felt like I had learned alot about health, but the news took the wind out of my sails. I didn’t want to write and share the column until I better understood the situation. I figured it would be a matter of weeks until I got more clarity around the condition I had, but weeks turned to months and now it's been over a year later and I still haven’t gotten a concrete diagnosis.

MIND

I woke from a nap and immediately knew something was off. I had felt a cold coming on that day, but there was something else wrong. My heart rate quickened and sat up on the edge of my bed. I had the single thought in my mind that I couldn’t breathe. It felt like it was playing on repeat at what seemed like an alarmingly fast rate and I couldn’t get it to stop. And I couldn’t think about anything else. I would look at the room around me, and my vision of the surrounding objects seemed to ebb and flow in a way that seemed like they were pulsing slowly.

A minute or so passed where I sat completely panicked, thinking I was suffocating, and that I was about to die. I picked up my phone, and called my parents who lived just 10 minutes away at the time. They picked up and I immediately told them what was happening and that I was going to call an ambulance. Looking back, I’m surprised at how calm they were. They said they understood, and would come over right then. I called 911, told them the same thing, and they said an ambulance would be on its way. 

My parents arrived before the paramedics, and at some point before then I realized that I was still breathing and alive. They checked me out, and we came to the conclusion that I had experienced a panic attack. I was shocked, and couldn’t believe it. It was alarming that my body had experienced such a physical manifestation of stress. It was eye opening, and one of those things you think would never happen to you…until it does. Without going into too much detail of the specifics of what was causing my stress, I know now that the main cause was that I was running myself ragged in more ways than one to try to prove that I was good enough. And I was tired.

The circumstances around my next panic attack were similar. Again, the onset came when I woke up from sleeping. The main difference between the first and the second was that I now knew what was happening. I had the same thought in my mind telling me that I couldn’t breathe, but this time I knew that it wasn’t true. I was able to “weather the storm”, knowing that there would be an end in sight. I sat in a chair in my apartment, told myself what it was, took deep breaths and waited for it to pass. Again, it was a wake up call that I needed to take better care of myself, in many ways. The first experience was like an alarm going off, telling me that something was wrong. And the second was as if the universe had both of its hands on my shoulders, shaking me, telling me that I needed to wake up and make a change. I’ve experienced a few more since then.

SPIRIT 

In my last column, I told the story of a December evening a few years back where I broke down crying in my car. The evenings were becoming a dark time of the day for me. I saw them as a lonely time where I wanted things that I didn’t have, and I was sinking into a state of depression when they came around. 

I wasn’t taking the best care of myself and my mind was in a place of scarcity. I wasn’t taking advantage of the freedom my life had or investing in my health as much as I should have. I was living in “the space between” where I was and where I wanted to be, and not enjoying the present moment. Looking back, it was a time when my spirit was broken. 

*******************

LIVER

Over the past year, I’ve been trying to figure out what has been causing my liver enzymes to be so high. For months my parents urged me to take a more eastern medicine approach, so over the summer I met with an acupuncturist. I sat down and talked with him, he took my pulses, and then he performed acupuncture on me. He asked me a long list of questions about myself and how I spent my time day to day. At the end of it he told me that he felt like I was in a constant state of irritation. 

From what I told him and what he observed when he took my pulses, his opinion was that my body was constantly in a state of stress. He explained how stress causes the body to release cortisol, which then goes directly into the liver and causes damage. I showed him the lab work from the past 6 months, and he commented on how up and down my levels were. The ALT levels were often double and triple the normal range, but then would go down to just above the normal range. Aside from the high enzyme levels, I didn’t have any of the symptoms of the conditions that my doctors speculated I had. And in parallel, the test results for autoimmune hepatitis, celiac disease and sarcoidosis all came back negative. 

He told me that I needed to take better care of myself. While on the outside I appeared to be a healthy young adult, these results were saying otherwise. He described how health is an overall system, and how each part of the system needs nurturing. He told me to take more time to do things that simply made me happy. He gave me a long list of ideas - among my favorites were taking walks just for the sake of taking walks, and eating dessert every once in a while and not feeling bad about it. 

He explained how on the outside I probably appeared to be someone who handled stress well, but I likely internalized my stress too much. When he said that, it was a lightbulb moment that I knew to be true. There were many reasons for this, but I immediately thought back to the first 20 years of suppressing a major area of who I was, by hiding that I was gay. That set off a bad pattern of me internalizing and suppressing many of my other feelings. The time surrounding that visit was eye opening and alarming. It was scary to learn about how stress and depression could be manifesting in such a physical way in my body.

It dawned on me how good writing was for me. Although I still have trouble expressing my feelings sometimes, writing has been a cathartic way for me to work through, process and release them in a healthy way. I had naturally gravitated to writing throughout my 20’s, but it was then that I realized how vital it was to my overall health. I’ve never been more grateful for it.

My dad came with me to the appointment and when I met him back in the waiting room, I told him I just felt like I spent an hour with Yoda. 

ALCOHOL & COFFEE

After a certain amount of testing by my doctors, they asked me to stop drinking alcohol for 3 months to see if that made a difference on my elevated ALT enzymes. I generally don’t drink very much or often, but liked the idea of taking a break from it to see how it made me feel. There were so many interesting things I learned about myself after this experience.

My first observation was how much alcohol is tied to social gatherings, and how you’re the odd man out if you aren’t consuming it. I quickly realized it was one of the few things that when you tell someone you don’t do, they often assume you must have an addiction to it. Rather than people quickly accepting the “not drinking” claim, I quickly found myself defending that decision. There aren’t many other substances that, when you tell someone you don’t use, they question if you have an addiction to it. 

The above observation aside, I did notice many people close to me also beginning to reexamine their relationship with alcohol. I suspect part of it is due to the novelty of drinking in our early 20’s wearing off, and health becoming a bigger priority as we get older. I don’t know too many people that have taken as big of a step back as I had, but many of my friends were reducing their consumption and trying to be more mindful when it comes to the frequency and amount they drink. 

In the past year, I’ve embraced the challenge of taking better care of myself. I’ve been eating better, working out more, and getting more sleep. Sleep was one of the biggest game changer for me around general wellness, and it was highly tied to my relationship with caffeine. I am a coffee lover and have been drinking it ever since I was 18. Historically I have 1 - 3 cups a day, and at times have felt like it has had diminishing returns for me and didn’t boost my energy levels like it once did. On some level I knew that I was reliant and addicted to it, and I didn’t like that my day to day energy was so tied to it. So I stopped drinking it. 

The first few days were rough. It was then that I fully realized just how addicted I was to it. I had headaches and was tired for the better part of the morning for the first week. But over time this faded and my energy levels improved beyond what they were before I gave it up. I began to have a more steady and consistent stream of energy throughout the day, and less highs and lows. 

I began to feel calmer and less anxious. Looking back over the past decade, I realized I spent most of my days in a frenzied state, going from one activity to the next. I am a very task oriented person, and I get a thrill from checking things off of my to do list. That said, I fight the feeling that I am consistently never doing enough. I was realizing that I was borderline high strung and I didn’t want to be that way. Anxiety is something I struggle with, but I started to notice myself to be calmer and more clear headed. I think the lingering effects of alcohol can cause me to feel emotions in a more extended, drawn out way. Me not drinking caused me to feel those same emotions, but be able work through them and move on from them quicker. I felt a new level of mental clarity that was changing my mindset.

I learned how heavily my coffee drinking was tied to sleep. I have historically been a huge night owl. I can find a million random things to do between the hours of 9 PM and midnight, and I always went to sleep pretty late. When I stopped drinking coffee, I began to notice how tired I was around 8 - 9 PM, and I started to go to bed then. Soon I began getting around 8-9 hours of sleep every night. And believe me when I tell you how much of a game changer that was for my energy levels, general mood and likely many other things in my body. It was big…huge (anyone get that Pretty Woman reference?). Until recently, rest and recovery was something I never spent enough time giving myself…in all 3 areas of mind, body and spirit. 

When I decided to not drink anymore, it was important to me that this didn’t affect how often or the quality of time I spent with my family and friends. I made the commitment to myself that not drinking wouldn’t affect how social I was. Being a somewhat introverted person, I’m a pretty big homebody, but I do like to get out and about and spend time with my close friends and family. The funny thing was that I was more social during this time of not drinking. Back when I did drink, I would often say no to going to a social gathering because I didn’t feel like drinking. But when drinking was removed from the equation, it made it easier for me to say yes. 

I saw this time as an opportunity to get my health back. I needed to figure out what was going on with my liver. Beyond that, I wanted to get in the best shape as I could, and use the break from drinking as a catalyst to do better things for my body. Signing up for a half marathon that summer was one of the first things I did. I wanted to make the best of this time and take advantage of the compounding effects of making decisions to better my health.

By the time summer came around and being a month out from the half marathon, it didn’t make sense for me to start drinking again. And by the time the run was over, I thought to myself “why not make it a year?”. And I would have made it a whole year, but then around month 11, the Chiefs (aka Taylor Swift) won the Super Bowl and I felt like I had a divine calling to celebrate. And that we did. Before I knew it I was at the diviest dive bar in Napa throwing a few back with my friends. And boy, did I miss drinking, haaaaa. We had A TIME that night. There really is nothing like letting loose with your friends and just getting a lil silly. 

With everything above said, I’ve created a new relationship with alcohol. For me, I don’t want or need alcohol to be part of my day to life. These days I generally only drink now when there is something to celebrate. That way, it makes it more special. It's a new balance that works for me. Now more than ever I appreciate how a glass of wine can help us let our guard down, connect and have better conversations. I love how food and wine bring people together and build community. The last year has helped me create a better and more balanced long term relationship with both.

The biggest lesson I learned in the past year is the importance of fun. I spent over a decade living heavily in the space between where I was and where I wanted to go. I didn’t carve out enough time to enjoy myself and appreciate all that was right in front of me. Having a health scare put into perspective how fragile life is, and how quickly something like our health can be taken away. While my condition is far from life threatening, it was a wake up call for many things for me. The first is that I know now that taking care of my health (mind, body and spirit equally) should be at the top of my priority list. The second, is to simply enjoy my life more, and to stress and worry less about the things that don’t matter. I know that it's okay to want big things for my life, but my grip on wanting them was just a little too tight. I’m learning how to strike the balance between working towards things, but also detaching from the outcome. While time is something that is outside of our control, we can choose to use it wisely, and I’m thinking now more than ever of how I want to spend it, and who I want to spend it with. 

LIVER BIOPSY

Throughout and after my time of not drinking alcohol, the test results from the blood work revealed that my liver enzymes were still all over the place, and at times, higher than before when I was still drinking. The next step that the doctors recommended was a liver biopsy. They’d insert a needle into the abdomen to pull out a piece of liver tissue. That way they could do testing on the tissue to learn more about what was going on with it. While it's a somewhat routine procedure, I didn’t want to do it. And while the test results weren’t good, I still felt fine and didn’t have any of the symptoms of the conditions that they speculated I had. The procedure is done with the patient awake, however heavily sedated. In my mind, the only thing worse than having a needle stuck into your abdomen is doing so while you are awake. The gastroenterologist I was seeing kept pushing me towards doing the biopsy, and wouldn’t explore any other methods of treatment without doing the biopsy first. It seemed like a narrow minded approach, and I felt like I was being backed into a corner. That said, I pushed it off for almost 9 months.

One of the things “Dr. Yoda” was adamant about was that he felt like a liver biopsy was unnecessary and way too invasive for what my symptoms were. He didn’t think the risks (albeit small) were worth the benefits of the procedure. That was another reason that I pushed it off for as long as I did.

After more and more bloodwork coming back with poor results, I finally decided to move forward with the biopsy. The uncertainty was starting to eat away at my peace of mind, and I grew more and more anxious about all of the “what ifs” that came with not doing all that I could to know more. 

A big part of me putting it off was also the fear of what was on the other side of it. And while I was still feeling healthy day to day, ignorance was (sort of) bliss. Beyond that, I live alone and am single, and even figuring out who would pick me up from the hospital after the procedure was a question that gave me anxiety. I’m an independent person who (inconveniently) is uncomfortable asking for help when I need it. If I ended up needing care day to day, I didn’t know who in Napa I could call on for that. Throughout this process, many people close to me offered to help me in any way they could, but I still felt too uncomfortable to take them up on it. Many of them have full lives, and it was hard for me to imagine asking them to take time out of their lives for me. For a long time, my “lone wolf syndrome” had gotten the better of me. I was in a strange place mentally where I felt lonely and unsure of who to ask for help, but secretly wishing I had just one person by my side throughout it all. I felt a confusing mixture of conflicting thoughts and emotions that is hard to put into words. The scarcity of still being single at 31 was getting the best of me. It was a lonely time.

There is a quote in the intro to the Goop Podcast that resonated with me during this time. “When people stop believing that somebody’s got your back or superman’s coming, we turn to ourselves. And that's where you become empowered.” It was then that I realized that I had to stop waiting around for someone to come in and save me, and just move forward doing the best I could with as much courage as I could muster.

The morning of the procedure I was nervous and scared. I took an uber to the hospital and regretted not taking the offers of a few people to drive me. It would have been nice to just have the company.

The best part of the experience was the nurses - they were angels. They did so many things to ensure I was comfortable and had the best bedside manner. The procedure was smooth and relatively painless. 

I had mustered up the courage to ask a good friend to pick me up from the hospital. To him, it wasn’t that big of a deal at all. But to me, asking someone to take time out of their day for me is something that I was uncomfortable with.

A few days after the procedure I got the results. The good news was that they were able to rule out autoimmune hepatitis, but the not so good news was that they found granulomas growing on my liver. Granulomas are small clusters of white blood cells and other tissue that form in response to chronic inflammation. They are often found on other organs, including the lungs. So the week following the biopsy I went in for a chest x-ray. Fortunately, the x-ray revealed no granulomas growing on my lungs, which is when we were able to rule out sarcoidosis. 

I was advised to not workout for a week after the procedure, which I abided by. But when I began exercising again, I started to have pain in my abdomen where the incision for the biopsy was. I had to wait another 3 weeks before I was able to exercise again. I was frustrated that doing a procedure in an effort to better my health was keeping me from exercising, which I did to stay healthy. But again, I was reminded of the importance of rest & recovery. For someone who was used to working out 4-6 days a week, I found myself with some extra time on my hands. And that is what caused me to “pick up the pen” again, and get writing. I had wanted to wait until I had a proper diagnosis to wait to write about it, but that never came. And while I still don’t know with certainty what is causing the high ALT enzymes, I decided it was important to me to share the story for what it was, despite how inconclusive it is. Talk about “detaching from the outcome”...

I am still going into the lab once a month to do bloodwork to monitor the enzyme levels, and doing my best to eat right, get exercise, and keep my stress levels down.

BODY IMAGE

For so long I always felt like my body needed to look a certain way. There is so much messaging in our society that tells us what we need to look like to be considered attractive. I’ve found that some gay men can be pretty critical of each other's bodies. I of course don’t mean that to be a broad generalization about the whole community, but I’ve definitely felt more scrutiny about my body from gay men than any other segment of people I know and am exposed to. 

I have some theories around why that is. For many gay men I know, we’ve spent a significant part of our lives in the closet and feeling like we aren’t good enough. Before, during and far after we come out of the closet, I still sense a strong need to prove to the world that we are indeed good enough. Overperformance in one or many areas of our lives is common. Whether it's professionally, or personally…the size of our pecs or our paychecks…there is a desire to show that we are not only equal to, but better than the rest. I think it's a sad outcome of years of society telling any community that they are less than. What's even sadder, is that the victims of this are often the ones that continue the cycle. Self improvement is a good thing. But it becomes harmful when it's fueled more from a place of inadequacy, and less from a place of inspiration. 

I don’t have a full answer here just yet, but what I do know for sure is that if we don’t think we are good enough, then other people won’t either. These days I’m trying to step out into the world in a more confident state of mind. I’m starting by doing my best, and telling myself that that will always be enough. Writing about it, and pulling the topic out from the shadows is where I’m going next.

PUTTING IT ALL TOGETHER

It's been said many times before, but true health goes back to taking care of the body, mind and spirit. The three stories at the beginning of this column were three experiences where my care for each was broken.

When I graduated college, I made it my priority to work as hard as I could so that I could advance myself as far into my career as I could while I was young, energetic and had the time to make it my #1 priority. Beyond that, I feel that I’ve had a certain sense of privilege in my life, and quite frankly, had a good amount of support. I have a college degree, a great job, supportive family and incredible friends. I really do count myself lucky. A lot has been given to me, and I felt that I owed it to the world to make the most of it and to work hard. All of that being said, throughout my 20’s I constantly felt like there was this tremendous gap between where I was, and what I saw for myself in my future. 

Now for my thoughts on taking care of the body… I have been a pretty active individual for most of my life. I was overweight as a teen, so ever since then I have been relatively health conscious. That being said, my biggest learning around sustainable fitness & eating habits has been having the correct intention. For most of my teen & early 20’s years, my focus was always weight loss. It was driven in large part by vanity and the way my body looked. At one point, I read something by a trainer that resonated with me. He said that the better motivator is your overall health and how you feel day to day, both physically and mentally. He added that “a little bit of vanity is good too”, and helps get you over the hump on days you just don’t want to do it. Since then, I have found that working out to feel good, both mentally and physically, has been a better motivator and has allowed me to maintain a more sustainable routine. 

I recently found another quote that was an important piece in solving my health & happiness puzzle. It’s by Mignon McLaughlin and reads: “For the happiest life, days should be rigorously planned, nights left open to chance.” I’ve done just that. These days, I start my day at 6 AM. I wake up and first enjoy 30 minutes of quiet where I sit in silence, drink my mushroom coffee and write down 5 things in my journal that I am grateful for. From there, I cook myself a balanced breakfast and get ready for the day. I’ve learned to find workouts and physical activity that I enjoy, and to make it part of my day to day lifestyle. These include running, crossfit, swimming, yoga, hiking, and now simply walking. I try to view exercise as a privilege and to be grateful that I get to take care of my body in that way. That helps me get over the hump on days when I don’t feel like doing it. 

Working out at the end of my workday has consistently been the best time for me. I find it to be the best “buffer” between work and my free time in the evenings. It is a good reason for me to leave work at a reasonable hour, and is the best way for me to de-stress. If there is anything from the workday still lingering in my mind, or things I need to just shake off, I’m able to do just that during my workouts. By the time I get home, I have an endorphin high, feel proud of myself that I got a workout in, am in a more relaxed state, and am ready to enjoy the rest of my night.

From there it's all about spending as much time as I can with the people I love, and having a little fun. Some nights fun looks like cooking dinner and listening to a podcast…or listening to nothing at all. Other nights, it's time with friends and family. Without going down the nutrition rabbit hole, what I do know for sure is that the act of cooking and sitting down to share a meal with your loved ones is good for your health. Cooking with a diverse assortment of fresh produce, meats and whole grains is a game changer. It’s certainly an investment of time and money, but it is a good one. Setting those practices early in your life, and having them trickle down our children will have long lasting affects on their health as well. 

While I definitely need quiet time to myself to recharge, I’ve never had more fun getting together to cook and eat dinner with friends. It's one of my favorite ways to spend my free time. It's one of the ways I feel most connected to my friends and family. To me, a celebration of life, and feels like it is nurturing my mind, body and spirit all at once. And these days, it doesn’t get much better than that. I think it's important to work hard and have a sense of rigor to our days, but it is also equally important to let ourselves have some time to feel free, rest & recover.

So that's my formula. And do I stick to it 365 days out of the year? Of course not. But I try my best. And on the days when I can stick to that routine, that is when I feel the most healthy, happy and whole.

I love letting my mind wander into the possibility of what the future may hold. I have so many ideas of where I want my life to go, predominantly in romance and work. That said, I often get lost in that space between where I am and where I want to go. So these days I am trying my best to be mindful about my daydreaming, and to not let those dreams get in my way of day to day contentment.

Creating Writing For Hope has been a powerful way for me to nurture my spirit. The process of writing down many of the tumultuous events of my 20’s has been an incredibly cathartic experience. It has allowed me to process different events I’ve experienced, and fully realize their significance and effects on me. I was very hesitant to write this specific column until I had a more clear diagnosis. The condition with my liver is still undiagnosed. I am going in for bloodwork at least once a month, and keeping a close eye on the ALT enzyme levels. I’ve been slowly writing it for over a year, and simply just didn’t want to hold onto it any more. While it still feels messy and unclear to me, I wanted to stay true to sharing my story and remind myself that sometimes you don’t have to have all the answers. My intent with this column is to put the story out there to share my learnings, and see what comes of it. 

There have been times when I didn’t feel like I deserved to take time for myself. I still struggle with shaking the feeling that I’m never doing enough. Never working hard enough at my job, never in shape enough, never having enough money, etc. Just simply falling short in many areas. It took a few “rock bottom” moments to wake me up. And at the end of the day, we can choose to have a mentality of scarcity or abundance. No one has a perfect life or “has it all”. It just doesn’t exist. So right now I’m doing the best I can to be happy with the cards I’ve been dealt, and not let the uncertainty in my challenges consume me. 

This journey with my health has opened my eyes wide to how interconnected all the areas of our lives are. In the age of never ending to do lists, it sometimes feels impossible to carve out that time for yourself. Beyoncé once profoundly stated that “people will push you as far as you allow them”. That has stuck with me ever since I heard it, and now know for sure that the only person that will create the proper boundaries for yourself is you. Catching a glimpse of what my life could turn into if I didn’t care for myself better was a huge wake up call. It has never felt more essential and important. Tomorrow isn’t guaranteed for any of us, so we need to make the most of the present moment. Giving myself permission to pause, rest and take care of myself has never felt better.