The Second Cup Is Decaf

In the be-careful-what-you-wish-for category here's a little story from some years ago.  I'm doing an appointment with my regular optometrist (who has since retired) and there's something wrong with my eyes, part of a general deterioration due to acute myopia.  So I tell him, my goal is for all my parts to wear out pretty much at the same time.  That got a good chuckle out of him.  I wish the joke were still fresh with me. 

I'm going to do a brief inventory of what ails me at present coupled with an equally brief status report.  For some of these, change in diet might be helpful.  The post is really about producing such a change via a nudge, a term from behavioral economics which means taking some action in advance to influence a subsequent choice.  It's my particular nudges that I want to elucidate.

Starting with my eyes, this has been a lifelong issue, but I notice the consequence only once in a while.  This happens when reading and the font is small - my current example of that is the bridge column in the local paper (in print) where I can't distinguish the symbol for clubs from the symbol for spades. (I do figure out that information from the context.) Much of the rest of my reading is done on the computer screen, where the font is large, and it becomes a non-issue for me.  The other issue is driving at night, where I struggle when the lighting is dim.  Since these days I'm driving exclusively near to home and am already familiar with the area, it's not that big a deal.  But I would be wary of nighttime driving if in an unfamiliar location, even when armed with that delightful voice from Google Maps. 

As to treatment, I take prescription eye drops twice a day, and likewise an eye vitamin twice a day.  It's hard to tell cause and effect with treatment like this, but my general sense is that it slows down eye deterioration greatly, particularly if I'm a good boy with regards to the rest of my health.  (In particular, that means keeping my blood pressure in check.)  

Let's turn to the next ailment, chronic osteoarthritis, particularly in my lower back but also in my neck and in my feet.  This was originally diagnosed in 2009, when I first found walking painful.  At the time the doctor recommended exercise as the treatment.  Until about 9/11, I relied on jogging as a form of exercise.  I would do about 4 or 5 miles at between 9 and 10 minutes per mile.  It was a good workout for me and helped to keep my weight in check.  Plus, it was a good stress relief.  (Until the kids were born, I also played golf fairly regularly.  If you walk the course and carry your own bag, that is something of a workout, though it is not aerobic exercise.)  But then my knees started to bother me while jogging.  One of the bigger mistakes I made in life was not to take up an alternative form of exercise then and there, which most likely would have been walking.  Instead, I became very sedentary and my weight ballooned. I did take up walking after that arthritis doc made the recommendation.  For a while it was reasonably good for me and a pleasant diversion.  But then the lower back pain became more acute.

Eventually, I discovered two things.  First, I was a candidate for having my right hip replaced.  After consulting with the doctor, I opted to defer doing this.  I feared that an infection would develop after the operation.  Back in 2012 I developed such an infection after a rotator cuff repair (itself an outpatient procedure) and spent 5 days in the hospital after the infection was discovered, which was incredibly gruesome, plus perhaps 6 weeks of further infection treatment after I was released.  I really don't want to go through that again if I can avoid it.  The doctor and I agreed that my weight was a significant factor to consider in whether the operation would be safe.  I needed to take off quite a few pounds to make it a good bet.  (More about my weight below.)  Second, I learned that if I supported some of my weight with my hands, for example by wheeling a shopping cart around in the grocery store, then that took pressure off my lower back, and I could tolerate walking for a much longer period of time. So now I do my exercise on the treadmill, where by holding onto the guardrails I give myself such support. 

The third ailment is perhaps mislabeled with the term ailment.  I was diagnosed with prostate cancer in winter/spring 2018 and received radiation treatment thereafter.  Prostate cancer doesn't show much in the way of symptoms.  In my mind there are two.  The first is excessive fatigue.  In fall 2017, I taught one class and would come home exhausted, needing a nap immediately.  That hadn't happened before with my teaching.  After the fact it made sense.  The second is an excessive need to go number 1.  This includes during the night and hence interrupts sleep.  But maybe this second issue happens to men as they age whether they have prostate cancer or not, of that I'm not sure.  (And maybe all men will get prostate cancer, if they live long enough.)  I want to note that post treatment the first issue is largely gone.  I do like to take naps during the day now, but I attribute this to sleeping in fits and bursts rather than sleeping through the night.  The second issue remains. C'est la vie.

During the time post radiation treatment, there is a monitoring stage to see if the cancer has been held at bay or if it returns.  This monitoring is ongoing.  A relatively modest blood test, checking the PSA level, gives the indicator of how things are going.  On this front, while my scores have not been perfect, they are reasonably good and for the time being appear stable.  Let me turn to why that might be the case.  Early on after treatment concluded I had an appointment with the urologist.  He suggested certain dietary changes: giving up eating beef, having a soy bar from Revival Soy on a daily basis, and eating/drinking some processed tomato product every other day.  I did this pretty religiously for the first year or two.  I found that a turkey burger or a veggie burger is a reasonable substitute for a hamburger.  Indeed, the beef restriction wasn't as big a deal for me as I thought it would be.  I found the soy bars on Amazon, so ordering them wasn't a big deal.  The company has since stopped producing the type of bar I favored, but what is still available is okay.  And now I order directly from the company, as Amazon seems to be out of the soy bars most of the time.  I'm more erratic about the tomato thing now.  Part of this is the oncologist telling me there is no proven benefit from the regimen.  The other part is an inability to consistently find good real estate in the refrigerator for the bottle of tomato juice, while not having the inclination to cook up some dish with tomato sauce sufficiently frequently.  (I do make a tomato-based turkey chili once in a while.)

The fourth ailment is kidney disease.  I have had mild indications of this for quite a while and got to learn new words from the blood test results, in particular, Creatinine and BUN. With the recent blood test, I had in preparation for my annual physical, it seems I've regressed to the next lower level, though it is possible that my kidneys are performing about as well as before and I was dehydrated when taking the test, which can make the results seem more severe.  So, I hope I can repeat the test in the near future to make sure of the conclusion.  In the meantime, I've done a little reading online about diet and kidney disease.  There are certain foods that the kidneys find difficult to process.  Eliminating them from the diet helps the kidneys function better.  I was pleased to note that red meat was one of those foods.  But there is quite a list of such foods, including caffeine.

With this as backdrop, let me describe my goal from here on out.  I take as my role model, Buzz Lightyear, after he has learned that he couldn't fly. The goal then becomes falling with grace.  That is my goal, as well.  This includes reducing my weight enough so I can have the hip replacement with minimal risk of infection, keeping my blood pressure down as a consequence of the weight reduction, perhaps to the point where I no longer need to take blood pressure medicine, eliminate or at least dramatically reduce the various foods in my diet that make the kidneys strain to function, and doing all of this while keeping my mental outlook on a relatively even keel. 

* * * * * 

I've had lifelong issues keeping my weight in check.  My mother called me a fresser, a German word, someone who is always thinking about eating and often acting on those thoughts.  It wasn't only my mother with this view. One of my math team classmates wrote in my high school yearbook that I was the hungriest kid he knew.  Not too many people get an entry like that.   In college, I eventually became more overweight than I was in high school, and it definitely impacted my social life.  For that reason, I went on an extreme diet, one meal a day only, it was dinner with no seconds, which I did for about 8 weeks.  I lost nearly 50 pounds in that time and got down to 210 pounds, which I view to be my normal weight.  I don't recall exactly what I did during the day and how I dealt with the feelings of hunger and the consequences of low blood sugar, but I think mainly I just stayed in my bedroom at home and watched TV.  In retrospect, it is somewhat amazing that I did this, as I've tried for brief times to do this more recently, and I could soon feel myself falling into depression.  So, I know it is not the answer for me now.  But maybe some partial step in that direction would be sustainable as a weight loss approach. 

I started graduate school in fall 1976 at that normal weight and more or less maintained that weight for the next 16 years or so, after which my older son was born. During those 16 years, the weight would drift up in the winter to about 220 pounds, mainly because I exercised less then, and it would come back down in the spring.   The year I met my wife, 1989, I briefly got under 200 pounds as I was jogging quite a lot then and keeping reasonably fit.  But I returned to my normal weight for when we got married, a year later.

Thereafter, the weight began to drift up.  I would attribute this to lack of sleep, at first.  With a newborn baby there is a world of joy but also a reality of responsibility.  Lack of sleep was part of the latter.  I coped by reducing the set of activities I used to do regularly.  But I also compensated for the lack of sleep by eating more starchy food than I previously had been eating.  And I learned that it was very difficult to do economic theory research when sleep deprived, which was one of the main reasons why I had a career change in the mid 1990s, into online learning, soon becoming the main ed tech guy for the university.  This produced its own stresses, some of it quite severe.  Both my eating and drinking got out of hand as a consequence.  And, as I mentioned above, I stopped jogging a little after 9/11, which until that time served as something of a countermeasure.  The results were not good for my health.   

There is no reason to belabor the full history of my weight here.  I will only mention a few general lessons.  First, there have been dramatic increases in weight, with a high of about 315 pounds in September 2006, and significant periods of weight loss as well.  When I was 58 or so, I got down to about 242 pounds and even at my 60th birthday I weighed 250 pounds, quite reasonable given the recent history.  But the weight ballooned upward after that.  I'm now in another of those significant weight loss periods.  This morning I weighed 238 pounds.  I need to lose about 30 more pounds to get to that normal weight ideal and then I need a strategy for keeping my weight relatively level thereafter.  

Second, the nudges I would do if I were single to manage my weight, for example not keeping ice cream in the house, are simply not feasible now.  My wife is entitled to have the food and drink she wants in the household.  Maybe we can agree on a few items to refrain from, but largely it is my responsibility not to indulge in unnecessary starch eating of stuff that is laying around the house.  This makes it especially difficult from about Thanksgiving through Christmas.  If I'm conscious of the issue, I can limit my indulgence, if not avoid it entirely. 

Third, and this one may be unique to me or at least a less common issue, I can't lose weight unless I stop drinking entirely. My self-control regarding food consumption vanishes when I drink.  Further, the notion of fresser applies to my drinking as well.  If one drink is good, then another drink is better.  There is the related issue of whether one drinks purely for the taste or for the buzz.  Regarding the latter, since I am a big guy, it takes more drink to get me to feel its consequences. So, between food and drink there is the possibility of a self-enforcing downward spiral, which in itself can explain those upward drifts in weight that I've experience as an adult. 

Fourth, and this is related to the previous one, there are time of day effects regarding my self-control.  I'm best in the morning - after breakfast and at least one cup of coffee.  I'm worst in the evening.  The desire to have a drink is present then.  It's not present earlier in the day (even when we tailgate). 

The nudges I've come up with are based on the recognition of these lessons learned.  Plus, I'm retired and am somewhat time abundant. Somebody else struggling to manage their own eating and drinking might come up with quite a different approach, because their situation is different.

Then there are ideas I've taken from behavioral economics.  It is much better to focus on establishing routines (or making new habits) than to leave choices about food and drink to decision making in the moment.  I have consciously done this for other aspect of my life.  I post a quote of the day in Facebook available to my friends.  With it, there is a quip from me, so I make a little contribution each day.  This is done early in the morning, while I'm on that first cup of coffee.  Following that I write a rhyme each morning and post to Twitter (so it is less than 280 characters in length).  I repost that rhyme to Facebook.  I've developed this little motto - a rhyme a day keeps the Alzheimer's away. The rhymes seem to get a positive reaction from a few friends, which helps to keep the process going.  In any event, I'm looking for something similar with most of my nudges for regulating eating and drinking. Here are a few of these.

• Go to bed very early, around 7 PM. 
  
  The pandemic makes this easier.  That plus my wife and I like to watch different things on TV or do other individualized activities much of the time means there is little social consequence from doing it.  The goal here, of course, is to avoid the treacherous time of day when I'm most likely to stray from the plan.  If I could get to sleep almost immediately and sleep straight through till morning, this would be perfect. Neither of those happen.  But for some reason, I don't go back for something to eat or drink (other than a glass of water) after I've gone to bed.  I'm not sure what prevents me from doing that but so far this has been an effective nudge for me that way.
  
  
• Keep my favorite beers out of the house.
  
  This is the one nudge I would also do if I were single.  I'm rather partial to imperial stout from craft breweries and Dragon's Milk from New Holland brewery.  My wife won't drink the imperial stout even when it's in the outside fridge.  She might drink a bottle of Dragon's Milk, but won't complain if it isn't there.  I would break down and drink it if it was there, so this one is a must.
  
  
• Start the day's exercise in midafternoon, around 3 PM and work out for somewhere between 60 and 90 minutes. 
  
  Since I break up the walking on the treadmill with some light weightlifting and there is some transition time between the two, with the occasional bio break also part of the routine, the time here is just meant to be enough for me to work up a sweat.  The real key is that with the need for a shower afterwards and then a need to re-hydrate some, there is only a very limited time for the happy hour and dinner period. 
  
  
• Find a non-alcoholic drink, I use decaf coffee for this purpose, to segue between re-hydrating and the dinner/happy hour period.
  
  I want to note here that decaf coffee for me is tolerable but definitely not a treat. I don't need a treat here.  I just need to do it regularly.  This helps to lessen the time where temptation is present.
  
  

It would be nice if the nudges were sufficient to always keep me on the straight and narrow. Let me focus on a few factors that cut in the other direction.  One is that the exercise, especially if I do it intensively, tends to increase the pain in my hip and lower back.  I take extra strength Tylenol as part of my regular regimen to deal with the arthritis pain.  But at times it is not enough.  When the pain is severe I either grin and bear it or I have a drink, which serves as a more effective pain reliever in the moment.  Another factor is that between the pandemic and our national politics, sometimes I get extremely angry for an extended period of time.  I need something to blow off some steam.  I could do the Howard Beal thing and yell out of my window - I'm madder than hell and I'm not going to take it anymore.  Having a drink seems a safer alternative to that. The third factor is that we have a regularly scheduled happy hour in Zoom on Fridays with some good friends.  When everyone else is having a drink, having one yourself seems like the social thing to do.  Sometimes I have a V8 instead and nobody says a word about that.  But I have guilty feelings when doing so.  This points to a possible conclusion - the ideal is not perfect never drinking but mainly non-drinking and once in a while straying from that, but not for very long. 

Let me also note that the first two factors pertain equally as well with binge eating, though then the goal is some form of compensation for the unfortunate stimulus rather than something that negates its effect. 

I now want to talk about experimenting with potential nudges and the need to do that, if for no other reason than that we don't live in a static world and there is a need to made adjustments.  This first one I've only tried a few times and the jury is still out. 

• Have plenty of romaine lettuce around (or your preferred alternative green leaf) and eat it on demand the way others eat popcorn or peanuts.
  
  The idea here is that there may be a need to munch, which should be fulfilled rather than thwarted, but do that in a way the doesn't consume a lot of calories.  Indeed, use this to ward off other "cheats" at going to the refrigerator.  (And to be clear, this is just the lettuce, no salad dressing, or other ingredients.)
  
  

Now a couple of nudges I've been trying recently to ward off specific food consumption.  This is in preparation of making diet changes if my kidney disease has indeed gotten worse.  One of the recommendations is to stop eating dairy products.  For me, that's a big deal, especially around breakfast.  A mainstay for me is blueberries or strawberries on bran buds, then topped off with yogurt or cottage cheese.  I prefer the non-fat varieties if I can get them.  This is reasonably healthful and also filling enough that it can be a breakfast in itself. 

• Experiment with soy, almond, or other alternatives to dairy products, to see if they can be a reasonable replacement for your prior dairy usage.  You may have several different criteria for making a comparison, e.g., taste, consistency, and calories. 
  
  I've only just started on this with two versions of soy yogurt from Silk.  On the taste they were okay, though sweeter than I'd prefer.  They were also more soupy than I'd like. I have not yet checked whether they are high in sugar or using some artificial sweetener.  Also, these containers were rather small.  I'd rather purchase in quart containers, if those are available. The first experiment sets the height of the bar.  The next experiment can be made in reference to that, and the choice of that experiment is informed by the prior choice.  (In this case, my wife bought those as a favor to me when she went to the store to buy something else.  I need to do this shopping by myself to learn what is available.)
  
  

Some might not consider the above a nudge, but in my view there is a rather constant need to experiment to make adequate adjustments to the current needs and something is required to become willing to engage in such experimentation rather than to become frustrated at the outset.  Put this way, the diet restrictions that the need to preserve good health may place on us are an invitation to try new things to eat.  Some of that experimentation can be enjoyable for its own sake.  This has been my attitude about teaching since I embraced online learning back in the 1990s.  The same idea applies here. 

This last nudge is based on the need for me to reduce my caffeine consumption.  Caffeine is another thing that the kidneys struggle to process.  My typical pre-nudge coffee consumption was 3 cups of regular coffee before noon and then that one cup of decaf later in the afternoon after exercise.  Here the idea is not to go cold turkey on regular coffee, which I would find extremely difficult to do now, but rather to reduce the regular coffee consumption on an ongoing basis in a way that is sustainable for me. In case you were wondering, the title of the post refers to this nudge.  But the title only gives a partial picture of the nudge, because the nudge is also an attempt for me to stay hydrated during the day. 

• With each cup of coffee, drink a glass of water of equal volume. Then alternate the coffee cups between regular and decaf, starting with regular, and expecting to drink two cups of regular per day, preferably having the second cup before noon.
  
  I like to sip coffee.  It's a preference developed over a very long time.  I tried the water thing recently, but didn't follow through on it, because while I don't mind drinking the water, if I'm not thirsty I have no craving to do so.  I also like the oomph that coffee gives me, especially when I'm writing, which I try to do in the morning. The oomph aids in the thinking, or at least seems to do that. But recently my being dehydrated has been brought to my attention, so I've been doing the above for about a week.  This is not a controlled experiment.  I haven't been drinking during that time and on more than one night I had only a light dinner, so may have had low blood sugar when starting out in the morning.
  
  I don't like the feeling of low blood sugar and I'm expecting the coffee to counteract it - the oomph I referred to above.  But it may be that the coffee actually exacerbates the situation.  Perhaps I should have some citrus fruit and other breakfast in this case before the first cup of coffee. But that would really upset the routine I've developed.  I take the morning pills and other medications with the water that accompanies the first cup of coffee. And I do that while I'm working on the quote of the day and the daily rhyme.  Adjusting the timing of coffee and breakfast would be a large trick to learn for this old dog.  Alternatively, I could eat a larger dinner the night before to avoid the low blood sugar in the morning.  But then, confronting the scale in the morning, I'd have made even less progress on the dieting than I had been making the other way.  As you can see, my own impatience with wanting success on the dieting front interferes in coming up with a sensible solution.
  
  

Let's wrap this up.  I've tried with this post to show how I plan to address my current health issues, much of that revolves around getting my eating and (alcoholic) drinking under control.  In elaborating on this in such detail, it may be evident that I'm fixated on these matters.  I can't be fixated for an extended period of time and still be mentally balanced.  So, the hope is that the fixation leads to new routines that can be sustained without fixation, after which I can turn my attention to other things.  The other hope is that I learn to forgive myself when I stumble, which I surely will, and then get back to these routines soon thereafter.  Achieving normalcy and then maintaining it is the ultimate goal.  It was far easier to do that when I was 21, no doubt.  I hope it isn't impossible to do now, at 67.