'Retiring' at Christmas 2016

Ben and Theresa are thriving in Cherry Creek. Ben is surviving the second of four years juggling up to 16-20 emergency patients at once. Sleepless in Denver, he rotates days, evenings and nights 2 days at a time, then starts over. Theresa is working from home full time through the sum of two parts, Glow (women’s fertility App based in Shanghai) where she used to work and a new analytics start-up based in SF. She is a real foodie and Ben and I were the Thanksgivingful beneficiaries. I was there twice in the last 3 weeks with their two black spot on white rescue dogs, Newton who has warmed to me after nipping me several times last year and Bo who has not. I’ve learned that Denver has more sunny days than San Diego and is a hot destination mecca, the driven up cost of real estate is unreal. Besides the many long dog walks, Ben took me for a spectacular mountain rim walk. We also went to see Moonlight, insightful, intense, tender which we highly recommend.

Rachel and John and Naomi age 4 and Jack age 6 (Ms. full of vim and Mr. lego vigor respectively) are settling into Mendham, especially into their young kids-plentiful 17 house cul de sac. Jack is in kindergarten, just started Tae Kwon Do working on his yellow belt and otherwise walks on legos and talks on Star Wars. Naomi is loving Montessori (3rd generation), tries to keep up with big brother, using both her tough (packs and punch) and soft (empathetic) sides. Rachel returned to shorter triathlons while recruiting neighbor and friend, and completed her first marathon (discounting the 4 as part of the Ironwomen) just 10 sec over qualifying for the Boston. John strategized (through 4 major acquisitions) so well that in the WSJ last week it was announced that his company was purchased by a Swiss health conglomerate. So change is afoot or longer.

So retirement is in my ether. Despite being planned a year, it arrived suddenly, almost unexpectedly. I walked through Day Surgery always abuzz with post-anesthetized children where I had performed so many endoscopies … for the last time. Mostly, the scent for me was nostalgia. The reception was held last Friday under winter storm warnings where the hospital closed early. Going out in a blizzard. My chief recalled how Teri held his hand during the last week of her life and asked him to take care of me … she was always trying to look out for others … even to the very end. My GI fellow (in training) mentees who are now on pediatric faculty and the gastroenterologist who I helped start an adult Cyclic Vomiting Program graciously captured my evidently self-less yet successful mentoring approach. Nothing is better than seeing the next gen mentees succeed and carry on. Such warm feelings. Most of the thoughts about my disheartening fight with the medical school about their refusal to cover her bone marrow transplant and rescue chemotherapy receded into my recesses. I chose to make a point about hope despite more than half of my time here being spent in end of life care for Teri and my father and its aftermath. I had self healed and in so doing become a better person, largely as a result of Teri’s life example, her strong core values supporting women’s rights, diversity, disadvantaged and family, and her ever in the present mindfulness. She was there.

Mentees Dr. Lerner, Chris my nurse and Dr. Kovacic

Because everyone would ask what I was going to do which would not allow me time to find what they were up to, I made a personal poster for the reception. I share it with you below. A fellow faculty commented that I would eventually have to retire from all those full-time retirement activities.

What am I going to DOOOOO?

Imm gun you (Cantonese)

Fasting intermittently is doable, interesting. and healthy

Not sure if my knees will take it this year, we'll see

National teleconsultation may work out!  But where to land? 

Several amusing and memorable anecdotes percolated up. After returning from a speaking trip in Shanghai, severely time lagged, I overslept deeply, didn’t answer my cell, land phone or pager, and missed the start of my clinic. My assistant Nadine distressed that something medically serious might have befallen me … well imagine awakening to two fully armed policemen standing over my bed trying to arouse me! “I’m Ok, I’m OK, I’m OK, just jet lagged.” During my year-long intermittent fast diet – my anniversary was Dec 8 still down 10% in body weight and 2¼” in waist – my nurse Chris detecting a note of impatience in clinic would nicely ask, “Is this a fasting day?” and embarrassingly always be spot on. Lastly, Lisa my former nurse referred to me as the ‘Wizard’ (of cyclic vomiting syndrome) as these patients and their families traveled from 42 states and 5 continents. Lest, my head become swelled, she would also add that in fact I was only the little man behind the curtain cranking up the smokescreen with a larger than life aura. I guess I have to get back to Kansas, now.

Merry Christmas, Happy Channukah 2016, Happy New Year and Happy Chinese New Year (Jan 28 – Rooster) 2017 to your families ... especially your grand kids, born and yet unborn.

Canada, anyone?

Friends last night:  "How much room do you have in Vancouver?"

Me:  "It's a small condo, but I'll put bunk beds in.  Come on up!"

Teri Li Education Awards 2016

The Teri Li Awards in educational excellence for early pediatric gastroenterology faculty across the US & Canada continue in their 5th year with double outstanding awardees.  

The official presentation took place at the 5th World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition held in Montreal in early October. 

Thanks to many of you, we have raised over $50,000 for this endowment.  And as a result, we will be able to offer educational grants for the first time next year.

Teri continues to support education in 'youngsters'.

Aliza Solomon and her chief Robyn Sokolow, Cornell

Bram Raphael, Harvard

Travellin' Man ... the last 2 months

Round and round I went mid August to mid October, 2016

Vancouver, Canada - Chen's Tai Chi training 35 days straight, Rachel and grandkids visit

Beijing, China (Talk @ Beijing Children's Hospital) - Forbidden City, Great Wall, National Museum

Dunhuang, China - Mogao Caves @ on Silk Road on edge of Gobi Desert

Guazhou, China - Yulin Caves several hours away

Xian, China - Terra Cotta army, Beilin Temple

Shanghai, China - heights. Shanghai Museum, Yu Garden, M50 Gallery enclave

San Francisco (ANMS Talk) - SFMOMA

Chicago (APAMSA Welcome, Panel)

Montreal, Canada (WCPGHAN Moderating, Teri Li Awards – 2) - bicycling on the waterfront

Mendham - Jack & Naomi’s bouncy house birthday 

Philadelphia (Talk @ Children's Hospital of Philadelphia)

New York City - Noguchi Museum, Whitney Museum, walk Highline

I completed a full circle, and a highlight of my life, reaching Dunhuang in the far west of China. 

From 400 - 1400 AD, Dunhuang stood as the important oasis outpost on the Silk Road before it crossed into the desert to reach the Middle East.  After a 1000 years of continuous occupancy into the Yuan (mongol) Dynasty, Dunhuang was lost to civilization until 1902 when it was rediscovered by the West and raided.  Some30,000 documents were purchased for a few hundred dollars and removed to London (British Museum), Paris (Guimet) and Boston (Harvard Museum).  Art history can be deceitful and thrilling.  

It was personal.  My part time job as a Princeton undergraduate was to mount thousands of black and white picture of these Dunhuang caves taken by James and Lucy Lo in 1943-44 - for 30 years the best photographs outside of China.  As an 18 year old, although I recognized their beauty, I didn't appreciate how important and unique they were.  To view them in person now was a completion of a 50 year cycle.

It was familial.  My father always wanted to go and made it there in 1979 (but didn't get to see the caves that year when they first opened) and did see them in 1987.  It was the highlight of his travels. The curators there remembered my father visiting 30 years ago.

It was 'professional'.  All Chinese art historians desire to visit Dunhuang, the equivalent of mecca, Florence and indeed each cave is painted in Buddhist themes - Sistine-like universes with a plethora of flying apsaras, merciful Boddhisatvas and stately Buddhas in two and three dimensions covering every wall and ceiling. Revealed by flashlight alone, each dazzled.

Our professor/docent from Princeton Dora provided numerous insights that revealed the complex interweaving of folk, Chinese, Tibetan, Indian and Middle Eastern iconography over 1000 years of continuous development.  Because of her unique relationship (she is publishing a 7 volume work on the Dunhuang photographs I mounted) to the Dunhuang Academy, Dora was able to gain entry for us into special caves not seen by other groups! 

Remarkable journey, on so many levels.

I wish I could show you pictures of the insides ... you'll have to google.  Especially the blue water-moon Boddhisattva from Yulin Cave 003.

Forbidden City ... despite thousands of tourists

Throne for the Emperor (of Emesis of course)

Temple of Heaven - a direct line to the above

Ascending and sweating on the Great Wall

The Grrrrrrrrreat Wall - marathon anyone (for real)?

Dunhuang (Mogao) astonishing Buddhist cave paintings 400-1400 AD

Nine story Buddha - imagine - no pictures allowed

The desert (Gobi) Sphinx

The western end of the Great Wall

Yulin Caves - magnificent Buddhist cave paintings and sculptures

Terra Cotta army (8,000) for 1st emperor's tomb in Xian - all unique faces

720,000 conscripts worked on the tomb for 40 years

Exquisite horse

The General

The archer

Muslim night market in Xian - grilling goat, juicy dumplings

Xian Bell Tower ... Las Vegas style

Tallest building in China - Pudong, Shanghai

Shanghai proper from the 100th floor after a rainstorm

Old town (modern fascimile)

Yu Garden - the dragon serpentine wall

Discovery and detritus by Jack and Naomi

The two dervishes whirled and went. 

Moving ...

In their wake, I still discover sticky notes left over from their made up games, hidden behind furniture, on the back of the toilet seat, in the shower. 

Obviously ... in code

Tangible reminders of turbocharging my Canadian pied-à-terre.

At YVR, it begins with a hug from Jack and a punch from Naomi and ends much the same. 

And then … it is all fast forward.

Unadulterated verve … go, Go, GO with max audio (squealing)!  No walking, only running, hopping, skipping, jumping between cracks or carpet squares (‘break your mother’s back’).  Continuous climbing, jumping (couch trampoline), spinning, sliding, swinging, zipping.  Exuberant exploration.  Punctuated by truncated jet lagged sleep.

Watermania (indoor water park), Fraser River/Waterfront/David Lam Parks (climbing structures), Terra Nova (outdoor adventure playground with zip line), Lonsdale Quay (shops/indoor climbing structure), Fun4kids (Indoor climbing/slide/maze structure), Kidstropolis (indoor kids town and climbing/slide/maze structure) by public transportation.

Steering in Kidstropolis

Piloting in Kidstropolis

Gastown, Granville Island (Kids mall), Daiso $2 store, feeding giant coi at friend’s pond ...

Discovering.  Electronic fobs – take turns.  ‘Compass’ (electronic transit cards) – take turns.  Escalators – jump step.  Buses – pull stop cord.  Sky Train (driverless elevated train) – hold on.  Ferry – go to the front.  Sea taxi.  Sea planes. 

Creative playing.  Let’s put gong gong (maternal granddad) in prison (Kidstropolis).  Escape, chase, capture, imprison, escape, chase, capture, imprison, escape chase, capture, imprison ...  ‘Gong gong catch us’ in the climbing structure (note: 4’ high passage ways, full of obstacles, and steep skin scraping slides) – attempted but impossible.  Gong gong, find the hidden (on stickies) numbers and letters ...

Rediscovering Vancouver through 3 and 5 year old eyes. 

Reinvigorated AND exhausted. 

I just find the ‘M’ or 'W'. 

Mmmm.

Happy

It is as an ordinary day in March.  So unremarkable, that it is difficult for me to recall details, only feelings.  Yes, it is sunny, a slight swirling wind, still crisp bite of air in the 40’s.  Definitely no rain.  I am walking to the athletic club to undergo spinning to exhaustion.  Definitely unprepared for the unexpected.

There is a lightness to my step, more athletic than feathery.  Not just less poundage and less pounding.  But an undeniable spring, hang time and softness to each advance.  I check it so as not to skip, trip or appear inebriated.  A rhythm in motion.  Kohala plays in my ear.

And then something happens.  A visceral sensation begins to well up.  Not with a rumble or roar.  Not as a gush or geyser.  But gently, like a fresh cold spring bubbling from deep within earth’s cisterns.  It first fills, then flushes and then overflows, wave laps over wave.  These vital fluids long lost, now cleanse and invigorate me … I’m alive! I’m happy!

So why?  I reflect. 

It has been six years of Teri’s unrelenting illness, unceasing circadian father care, unending end of life challenges, and still incomplete estate resolution.  I am not yet free to move on.  Though I work and exercise, I have regained my ability to laugh, feel, engage ... 

Is it the light at the end of work tunnel … Not there yet, and so much to do before I take that next step. 

Is it the hard effort of shedding my burdensome lifelong maternal and paternal baggage.  Partly.  The EMDR finally, finally, finally has calmed my inner turmoil. 

Is it coming to accept my fate as conscripted caretaker while watching my peaking career fall into ‘suspended academiation’?  Partly. And it forced an appropriate reappraisal of my (paternally acquired) achievement-only focus. 

Is it is the increasing closeness with the kids, their significant others, and the grand kids?  Oh yea. 

Is it the woman?  Still too early to tell.

Am I healed?  Am I at peace?  I don’t know, it’s a process, it’s ongoing.  But I’m better, much better. I've learned a lot from processing Teri's subtle example on mindful living.  I've become more balanced, calmer.  And I reached a place where those tortuous flames within have finally been quenched, and now the water that flows is potable. I can taste its delicate freshness, drink it, bathe in it, frolic in it, and live ...

Today happens to be our wedding anniversary.

Waist loss on the cheap, by fasting

Dear friends

Introduced by Kari (Ben & Rachel's violin teacher) to Michael Mosley's (British physician-journalist) Fast Life, I just completed the 12 week induction plus 5 weeks of maintenance program of fasting twice a week (600 kcal/day - men, 500 kcal/day - women).

It's based on rigorous animal research that demonstrates that intermittent fasting not only induces weight loss, more more importantly targets the central belly fat (that leads to hypertension, diabetes 2, metabolic syndrome and obesity).  Although it has been known for 70 years that cutting calories prolongs life in animals and humans, the reasons were not known until recently.  Fasting enhances insulin sensitivity (reverses diabetic tendencies), stimulates cell cleanup and renewal (autophagy and increased stem cell production), and promotes anti-cancer immunity. 

In one illuminating  experiment, reducing calories in a rats diet not surprisingly led to weight loss.  In the paired group, restricting eating to only 6 hours per day and fasting the other 18, led to significantly greater weight loss.  Therefore, it's not just about reduced calories but when you eat them ... a long period of fasting allows the tummy fat to be burned off because it serves as your belly backup fuel tank when not eating.  Conversely, snacking every 2-3 hours, floors the insulin (storage) pedal and deposits those carbs right into the belly fat - look around you, and down, can you see your toes?  Constant snacking was my issue.  Note: this is counter to the 'conventional wisdom' of 6 small meals per day.

So how am I?

Lighter and fitter than I've been in 20 years, with a spring in my step, pants loose, almost needing s'penders ...  I could not have done this without this low cost diet (except for the new pants) as I was already exercising 7 days a week (run, road bike, spin, tennis, Tai Chi, yoga).

And ... it is absolutely empowering to be able to reshape oneself at my age. 

OK, OK I hear you ... you want to see proof (da numbers)

Lost 13.8 lbs = 9.3% of body weight (12 weeks of induction fasting 2X/week and 5 weeks of maintenance fasting 1X/week) - within striking distance of my high school weight

Reduced waistline by 2 1/4" (most important given my familial hyperlipidemia 2b and type 2 diabetes) - but sadly only a 2 pack abs (mostly lumpy excess skin)               

Test name             Before*           After fast**    (Normals or desirable)

Total cholesterol (C)      218                         171                  (< 200) I have run > 300
Triglycerides                     222                         101                  (< 150) I have run > 400
good HDL C                        64                           65                  (40-60) higher the better
bad LDL C                          110                           85                   (< 100) I run > 100     
glucose                                  96                           96                   (65-99) I usually run > 100
HgbA1C                                   5.8                         5.8                (3.9-6.1)

*On medications but no statins due to intolerance (muscle breakdown with CK elevation)
Partial Portfolio diet (soy, oatmeal, almonds)

**On medications and diet above PLUS fasting 2X/week for 12 weeks

Yaoza, have never had lab numbers like these!

More em-power-ment to you and your new bod!  Call for Qs.

Note:  This has recently been featured in NY Times, Time Mag and WSJ.