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 Post subject: Re: The score so far (Health & Fitness)
PostPosted: Thu Jun 28, 2018 9:54 am 
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Jersey Girl,

Thanks so much for typing all that info (twice)! They had me try an albuterol inhaler back at the beginning of this saga with no effect. Tried several other things, including Montelukast, an oral steroid, a couple other things. What really set it off was smoke from forest fires last summer. I'd had a low-grade, occasional cough for a while, but the smoke sent it into overdrive. And it never ramped back down after the air cleared.

The doc says they see this in adults who had sinus and ear infections in younger days. I had the sinus infections.

Good news is I think the cough has lessened and no sign of bad side effects. Thanks for the bone density advice. I'll talk with my doc at my next visit.

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 Post subject: Re: The score so far (Health & Fitness)
PostPosted: Thu Jun 28, 2018 12:39 pm 
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Res Ipsa wrote:
Jersey Girl,

Thanks so much for typing all that info (twice)! They had me try an albuterol inhaler back at the beginning of this saga with no effect. Tried several other things, including Montelukast, an oral steroid, a couple other things. What really set it off was smoke from forest fires last summer. I'd had a low-grade, occasional cough for a while, but the smoke sent it into overdrive. And it never ramped back down after the air cleared.

The doc says they see this in adults who had sinus and ear infections in younger days. I had the sinus infections.

Good news is I think the cough has lessened and no sign of bad side effects. Thanks for the bone density advice. I'll talk with my doc at my next visit.


Bone loss is listed as a possible side effect of the inhaler you have been prescribed. It's a feature of corticosteroid use. If I were you, I'd push for a baseline DXA just so you have a starting place and know, that if/when you do have a baseline scan done, you will likely be measured against females in the normative data base in the scanner software, if the data base is NHANES--I know I'm speaking Greek right now but I do know what I'm talking about. It's a far more complicated process than what docs would lead you to believe. Thus my 4 years of stress and hell, with thank God, light at the end of the tunnel and no reason for concern.

So what you do with the scan, is do a follow on 2 years later, and that is what helps you to track your bone density. Should you discover that you are losing bone on account of your meds, there is a series of blood labs you can do to pinpoint what is happening inside your bones. I have that list and that's mostly what resolved the question about my own bones in addition to the fact that the DXA scanner cannot accurately read my bone density. That's another issue altogether and probably doesn't apply to you if you are of average height. If you are very tall or small, it applies.

And by the way, if you are located IRL where I think you are, you have a world class expert in bone loss in your area. If you'd like that information tell me where you want me to put it. You could just do a baseline with her and know you are in good hands should the need to address bone loss arise. If I put the contact info here, the location will go up with it.

Her work (and that of another world class expert) was pivotal in locating the light at the end of my own tunnel. In other words, she knows her subject.

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 Post subject: Re: The score so far (Health & Fitness)
PostPosted: Thu Jun 28, 2018 1:00 pm 
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Thanks for checking, but I’m fine with you posting the doc’s info. I’m in the Seattle area. I saw the bone loss info in the package info, but it sounds like I need to be more pro active than I thought. Thanks for all the info and advice.

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 Post subject: Re: The score so far (Health & Fitness)
PostPosted: Thu Jun 28, 2018 1:42 pm 
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Res Ipsa wrote:
Thanks for checking, but I’m fine with you posting the doc’s info. I’m in the Seattle area. I saw the bone loss info in the package info, but it sounds like I need to be more pro active than I thought. Thanks for all the info and advice.


See? This is one of the things I do when I say I work online for support groups. I've been doing this one for 5 years. I don't like giving details publicly but I'll do it to help someone else. I do it nearly every day of my life.

Never let your GP, NP, or PA to evaluate you for bone density issues. What they actually do is allow the scanner report to diagnose you. They don't know what they are doing. They don't know the history of the DXA scanners and how medications evolved over time along with the scanners, they don't know how the WHO determined what constitutes bone thinning vs bone density loss. They don't understand the values they are reading so they go with a particular score found on the report and advise meds. They do not understand the inner workings of the scanners, margins for error (LSC tests), calibration issues and software updates, or any other damn thing. Trust me, they do not.

I could tell you case after case, and even my own case is proof positive that this is true. You do NOT want that.

You want a good baseline scan with a doc who knows precisely what they are doing regarding your individual health history and scans results, and then a good follow on scan by the same facility on the same machine two years later.

Docs who eval and treat patients for bone loss are endocrinologists, rheumatologists, and nephrologists.

I'm giving you a well known and highly regarded expert here:

Dr. Susan M. Ott
Internal medicine - nephrology
4245 Roosevelt Way NE Fl 2, Seattle, WA 98105
(206) 598 - 4288

Her work regarding densitometry and short stature adults, and the work of the world class expert that I see saved my sanity.

I will drive my point home so you get a referral to her and keep her on your medical team.

Had I listened to the so-called diagnosis and medical advice of my then (now fired) healthcare professional 5 years ago, by the time I had finally learned my stuff via Dr. Ott's study, my online participation, personal research, and saw the expert that I do see now...I would have shown up at his office on year 4 of a medication that carries with it a window of 3-5 years when one can take it safely because somewhere inside that window, the medication itself can cause the very fractures that you are trying to prevent---and with no way to test when you've reached that threshold. That is to say, I could have been in a hospital by that time suffering from debilitating spontaneous femur fractures instead of out and about, enjoying my life, and working out like I do now.

As it stood at the time, I walked into his office 4 years later knowing what I was talking about and he said so. ;-)

And get this, the 2 sets of scans that I had originally done 2 years apart? They both contained errors, not the least of which was that one of them was measuring and comparing the WRONG vertebrae (it matters!), and my healthcare professional (now fired) at the time (who got paid for reviewing them) didn't even notice it. Nor did she understand that my results (the scores she based her diagnosis on) can never be accurate on account of my height and would be the same issue were I a very tall person.

Don't mess around with this. You need to take your new inhaler as prescribed. You also need to just shoot over to Dr. Ott and get a baseline and just discuss with her, so you don't get caught up in a giant medical ____ some years down the road. If you need to use regularly your inhaler, she can help you avoid the ____.

I'm not trying to scare you. I'm trying head you off at the pass and save you from going through the miserable ____ that I've seen hundreds upon hundreds of patients go through because their docs didn't pay sufficient attention to--corticosteroids, steroids (pred) eating disorders, hyperparathyroidism, cancer meds, malabsorption issues, pregnancy/lactation, kidney problems--all of these and other things-- that can cause humans to lose bone mass.

I regularly recommend Dr. Ott to patients in the area. Go see her, get it done, and get it out of the way. And let her run these baseline labs on you if she will:

PTH Intact
Bone Specific Alkaline Phosphatase
Vitamin D25 Hydroxy
C-Telopeptide (CTX)
Osteocalcin
Celiac Disease Panel
Immunofixation IFE/PE
Sed Rate Westergren
Phosphorous
Total Calcium
Preopetide Type 1 Collagen (P1NP)

Greek right?
:lol:

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 Post subject: Re: The score so far (Health & Fitness)
PostPosted: Thu Jun 28, 2018 1:56 pm 
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Thanks for letting me post her info publicly. I always have in the back of my mind that someone "out there" might be reading and could use the information that we post about. This is another issue that I've become a strong and vocal advocate for (driven by a combination of gratitude, compassion, and outrage about the ____ inferior practices I've seen happen to myself and others) so it matters to me to get it "out there" because it might matter to someone else. I'm well versed in medication options as well, if anyone needs to know about that at some point, jump into my PM's or the thread and I'll give you a hand with it.

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 Post subject: Re: The score so far (Health & Fitness)
PostPosted: Thu Jun 28, 2018 2:03 pm 
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You’re very welcome. I was also thinking it might be of help to someone else. UW Medicine is my provider, and I’ve spent more time at the Roosevelt Clinic than I care to think about. :lol:

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 Post subject: Re: The score so far (Health & Fitness)
PostPosted: Thu Jun 28, 2018 2:21 pm 
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Res Ipsa wrote:
You’re very welcome. I was also thinking it might be of help to someone else. UW Medicine is my provider, and I’ve spent more time at the Roosevelt Clinic than I care to think about. :lol:


Now you’ve got me reading. https://www.ncbi.nlm.nih.gov/pmc/articl ... po=39.2308 was pretty eye opening.

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 Post subject: Re: The score so far (Health & Fitness)
PostPosted: Thu Jun 28, 2018 2:32 pm 
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Res Ipsa wrote:
You’re very welcome. I was also thinking it might be of help to someone else. UW Medicine is my provider, and I’ve spent more time at the Roosevelt Clinic than I care to think about. :lol:


Holy crap are you ever in luck!

I know for a fact she's done phone consults to sort people out at the very start. You might want to try that first. Look up her CV, you'll see she's first rate and then some. Just have your health history in front of you and leave her a message to see if she suggests a baseline.

Indicate things such as:

Lifelong serious athelete (think: long distance runner)
Long term use of steroids and corticosteroids
Cancer medications
Eating disorders
Alcohol or substance abuse
Malabsorption issues--celiac disease and the like.
History of fractures (not trauma fractures that involve forceful impact)
Thyroid issues (Hypo/Hyper-medications)
Hyperparathyroidism (different issue)

Those are among the things that you'd want to mention along with your new RX. She'll know if a baseline scan and labs are advisable.



PSA for the readers/lurkers: There are a variety of medications used to treat bone loss. They work in specific and different ways, for particular issues, and have different methods of delivery. If anyone mentions an "annual infusion" to you--jam on the breaks like you mean it, and avoid it entirely. Sounds good on paper, in actual fact, if you experience serious side effects you're stuck with them for at least 9 months (some forever) and there is no antidote for that particular medication. In other words, you're screwed.

I'm medications free and in good shape, however, I've spent the past 5 years of my life learning, researching, and discussing. I'm available if anyone has a question and can point you in the right direction in terms of doctors, accredited DXA techs, studies, articles, etc. Pay attention to the list of labs that I posted. Some of those are to rule out underlying causes for bone loss and others indicate the activity within your bones. An example: If you have undiagnosed hyperparathyroidism, all the meds in the world won't cure your bone loss until that disease is corrected via surgery.

If you've got bone loss and are put on meds, you want some of those labs done as a baseline before beginning your treatment.

Happy to share what I know and remember that your doctor works for you, folks. :-)

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 Post subject: Re: The score so far (Health & Fitness)
PostPosted: Thu Jun 28, 2018 2:43 pm 
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Res Ipsa wrote:
Res Ipsa wrote:
You’re very welcome. I was also thinking it might be of help to someone else. UW Medicine is my provider, and I’ve spent more time at the Roosevelt Clinic than I care to think about. :lol:


Now you’ve got me reading. https://www.ncbi.nlm.nih.gov/pmc/articl ... po=39.2308 was pretty eye opening.



There are TONS of research studies just like that on PubMed. Look to the right for additional studies/articles. Keep going. It's a vortex in there.

Any question you have, I can point you in the right direction.

You need Dr. Ott because she'll know what is best and right to do given your particular health history and medications history. She will know if your inhaler (or other meds) warrants looking into. Like I said, better to have her as part of your team right now than encounter a gigantic medical ____ 10 years down the road that happened because no one paid attention to your meds and their influence on your bones.

I have seen this happen over and over and over and over again.

You may have no problems whatsoever. You also don't want to become the patient who has multiple concerns and issues, one on top of the other, not knowing which way to turn, so it only makes sense to get with an expert right from the beginning and let her take it from there.

Readers: I have a good list of experts in various areas of the country if you need them.

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 Post subject: Re: The score so far (Health & Fitness)
PostPosted: Fri Jun 29, 2018 10:41 am 
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Checking in... We'll be at Cheshire, MA today. I'm definitely reaching burn out with the trail. My wife, bless her beautiful self, is down with slowing things down for me. She's 100% the better hiker between us. I discussed taking our miles down to a place where I can get more rest and enjoy the town's we're passing through. I kind of had an epiphany today in that it's not a personal failing to always be balls to the wall, but to know your limits and enjoy a happy medium. We're very lucky to be in the place in life where we can be out here doing this sort of thing and there's no reason to turn this into a personal crucible I must pass in order to prove some intangible aspect of my character to myself.

Maybe health and fitness is as much mental as it's physical, and given RI's other post today I'm seeing the importance of cutting one's self some slack. My wife picked up this nice quip a couple of days ago that dovetails nicely with RI's post:

"Don't quit. Just learn how to rest."

Red lining your engine is just going to burn you out, no? Funny how I need to learn how to idle the engine once in a while. It seems my whole life I've been told that not pushing yourself is in of itself accepting failure. I'm not sure that's the case. We'll find out!

- Doc

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 Post subject: Re: The score so far (Health & Fitness)
PostPosted: Fri Jun 29, 2018 11:25 am 
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Doctor CamNC4Me wrote:
Checking in... We'll be at Cheshire, MA today. I'm definitely reaching burn out with the trail. My wife, bless her beautiful self, is down with slowing things down for me. She's 100% the better hiker between us. I discussed taking our miles down to a place where I can get more rest and enjoy the town's we're passing through. I kind of had an epiphany today in that it's not a personal failing to always be balls to the wall, but to know your limits and enjoy a happy medium. We're very lucky to be in the place in life where we can be out here doing this sort of thing and there's no reason to turn this into a personal crucible I must pass in order to prove some intangible aspect of my character to myself.

Maybe health and fitness is as much mental as it's physical, and given RI's other post today I'm seeing the importance of cutting one's self some slack. My wife picked up this nice quip a couple of days ago that dovetails nicely with RI's post:

"Don't quit. Just learn how to rest."

Red lining your engine is just going to burn you out, no? Funny how I need to learn how to idle the engine once in a while. It seems my whole life I've been told that not pushing yourself is in of itself accepting failure. I'm not sure that's the case. We'll find out!

- Doc


Wow, Doc, that business with pushing yourself so resonates with me. I've been told the same thing for most of my life, mostly by the critic that lives inside my head. When I hike, I tend to pick something ridiculous that will challenge me to the point of sheer exhaustion and will see not making it to the goal as a failure. What the hell? I'm lucky to live in an area of the country where I can experience amazing beauty without pushing myself to the limit -- so why not take advantage of that?

You've accomplished something pretty special already. There's nothing wrong with throttling back and just enjoying the beauty and the experience.

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 Post subject: Re: The score so far (Health & Fitness)
PostPosted: Fri Jun 29, 2018 11:50 am 
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Doctor CamNC4Me wrote:
Checking in... We'll be at Cheshire, MA today. I'm definitely reaching burn out with the trail. My wife, bless her beautiful self, is down with slowing things down for me. She's 100% the better hiker between us. I discussed taking our miles down to a place where I can get more rest and enjoy the town's we're passing through. I kind of had an epiphany today in that it's not a personal failing to always be balls to the wall, but to know your limits and enjoy a happy medium. We're very lucky to be in the place in life where we can be out here doing this sort of thing and there's no reason to turn this into a personal crucible I must pass in order to prove some intangible aspect of my character to myself.

Maybe health and fitness is as much mental as it's physical, and given RI's other post today I'm seeing the importance of cutting one's self some slack. My wife picked up this nice quip a couple of days ago that dovetails nicely with RI's post:

"Don't quit. Just learn how to rest."

Red lining your engine is just going to burn you out, no? Funny how I need to learn how to idle the engine once in a while. It seems my whole life I've been told that not pushing yourself is in of itself accepting failure. I'm not sure that's the case. We'll find out!

- Doc


Maybe you did this but, I would have taken a journal with me to write these thoughts down. And save page space for a photo of where I wrote from on any given day--because I can't draw to save my life. I think I said at the beginning of your journey that I've never spent time in the natural world where I didn't learn something about myself.

I think you are doing that right now. I think you are on a life changing journey that is giving you unexpected insight.

No, it's not a personal failing to not jam the gas pedal and push yourself like the through hikers do. It's wisdom in practice to slow down, and give yourself a chance to interact with and appreciate the places, people, and food, that bring themselves to you on your path.

Why chug the whole case without ever tasting the beer?

You're in a beautiful part of the country. Drink it in and drink it in slowly so you don't forget how it tasted.

I brought up a map with Cheshire Mass on it. I noticed you are right there on the same general route we took up to Canada. Ft. Ticonderoga is right there across the New York border. I've been there. It's kind of fun for me to follow where you guys are going and notice the places I've been to myself.

How I wish you could see New England in fall! And how I wish I could see it myself! That's on my list of things to do and see! About 3 years ago, I went to Jersey in fall for the first time in 40 years. Didn't notice the trees changing color until I got up into North Jersey to see my relative in a nursing home. When I caught sight of the woods, I cried, it was so beautiful. But that's me.

I cry over beautiful trees.

:-)

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 Post subject: Re: The score so far (Health & Fitness)
PostPosted: Fri Jun 29, 2018 2:47 pm 
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Res Ipsa wrote:
Wow, Doc, that business with pushing yourself so resonates with me. I've been told the same thing for most of my life, mostly by the critic that lives inside my head. When I hike, I tend to pick something ridiculous that will challenge me to the point of sheer exhaustion and will see not making it to the goal as a failure.


That is exactly my issue, too. I can 't tell if feeling that anything less than excellence or perfection is a Mormon thing, an Army thing, or a growing up as a male in the 70's & 80's raised by a hard man thing... Regardless, you know all too well what kind of fun it is to live in your own brain with that background. I guess the upside to always punching above your weight class is a bit of success here and there...

On a funny note, my wife and I will be staying at a church tonight. There's a gas station nearby with air conditioning, Dunkin Donuts coffee, and free WiFi. Only on the trail does one think this is an amazeballs miracle...

- Doc

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 Post subject: Re: The score so far (Health & Fitness)
PostPosted: Fri Jun 29, 2018 6:16 pm 
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Doctor CamNC4Me wrote:
Res Ipsa wrote:
Wow, Doc, that business with pushing yourself so resonates with me. I've been told the same thing for most of my life, mostly by the critic that lives inside my head. When I hike, I tend to pick something ridiculous that will challenge me to the point of sheer exhaustion and will see not making it to the goal as a failure.


That is exactly my issue, too. I can 't tell if feeling that anything less than excellence or perfection is a Mormon thing, an Army thing, or a growing up as a male in the 70's & 80's raised by a hard man thing... Regardless, you know all too well what kind of fun it is to live in your own brain with that background. I guess the upside to always punching above your weight class is a bit of success here and there...

On a funny note, my wife and I will be staying at a church tonight. There's a gas station nearby with air conditioning, Dunkin Donuts coffee, and free WiFi. Only on the trail does one think this is an amazeballs miracle...

- Doc


I suspect it's an all of the above thing. Enjoy the A/C!

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 Post subject: Re: The score so far (Health & Fitness)
PostPosted: Fri Jun 29, 2018 6:18 pm 
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Jersey Girl wrote:

How I wish you could see New England in fall! And how I wish I could see it myself! That's on my list of things to do and see! About 3 years ago, I went to Jersey in fall for the first time in 40 years. Didn't notice the trees changing color until I got up into North Jersey to see my relative in a nursing home. When I caught sight of the woods, I cried, it was so beautiful. But that's me.

I cry over beautiful trees.

:-)


Just do it. Yeah, you'll cry. Totally worth it, though.

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 Post subject: Re: The score so far (Health & Fitness)
PostPosted: Fri Jun 29, 2018 6:47 pm 
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Oh, and Doc, just got a look at the forecast for early next week. Heat's gonna be a ____. Stay hydrated.

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 Post subject: Re: The score so far (Health & Fitness)
PostPosted: Sat Jun 30, 2018 6:53 am 
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Res Ipsa wrote:
Oh, and Doc, just got a look at the forecast for early next week. Heat's gonna be a ____. Stay hydrated.


Thanks! We can't avoid it, sadly. However, my hiking partner talked me into taking today off to rest and watch the World Cup. NO ARGUMENT FROM ME.

Also, because we changed our approach to hiking we stayed at Our Lady of the Assumption. The paritioners insisted we come in and listen to a concert they we're putting on. It was really, really cool. It was like a Catholic version of Saturday's Warrior (they we're paying homage to various aspects of nature). There was also a barbershop type group there that sang love songs which was endearing because the dudes were like 80 years old and whatnot.

Image

Image

Image

Image

They even had us help put out refreshments and feed us as well. Salt of the earth, man. Such a difference from what I grew up with...

- Doc

Aaaaand we were invited to attend the ceremony designating Cheshire an official Appalachian Trail community! Live music, too! People here are wonderful.

Image

Image

Image
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 Post subject: Re: The score so far (Health & Fitness)
PostPosted: Sat Jun 30, 2018 1:46 pm 
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They let you tent camp right on church grounds? That's so cool. Sounds like the whole experience was cool. Love the wood ceiling in the sanctuary. Reminds me of a local church out here.

See? If you had rushed through the area you wouldn't have had those experiences. You slowed up, and had a great time and made new memories!

:-)

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 Post subject: Re: The score so far (Health & Fitness)
PostPosted: Sun Jul 01, 2018 2:35 pm 
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Yeah, slowing it down has been great. We were hiking an 11.7 today, but I was fussy as ____. My wife called ahead to Bascom lodge which is atop Greylock mountain. So we did 8.5 (a pure unadulterated bull ____ ascent today) instead and are now chilling out at a cool lodge. We got to know a new hiker who is transitioning from teaching school to social work. Really cool dude, and that wouldn't have happened had we not stopped here. The views, of course, are beautiful. Tonight we enjoy live jazz music with dinner. Beats bull ____ trail food.

Anyway. I keep sharing because what motivated me to challenge myself is others sharing their adventures. I'm hoping to read other forum members' adventures, too. On a side note, my wife's lifelong friend just posted pics of her hiking.

She's never hiked an inch in her life.

I like to think we're maybe planting some seeds with friends and family...

- Doc

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Mormonism is a group of people claiming to know all the answers, when they really don't even know the questions. - /u/jiff-bifton, /r/exmormon


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 Post subject: Re: The score so far (Health & Fitness)
PostPosted: Sun Jul 01, 2018 3:55 pm 
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Joined: Tue Oct 24, 2006 7:16 pm
Posts: 29128
Location: Off the Deep End
Just popping in between "shows", as it were after, seeing your post on my phone while eating my blasted greek yogurt and apple. Back down to 125 so I shouldn't complain. So I searched up Mt. Greylock on wiki and here's a couple of things that were of interest to me.

The elevation. I'm obsessed with elevations and the interactive topo map of the trail. I have no idea why except that I live at very high altitude (7600ft) and never once did I ever think about the elevations back home so I check them.

Mount Greylock is the highest natural point in Massachusetts at 3,489 feet (1,063 m).


The views of 5 states from the summit and nature of the forest biome:

The mountain is known for its expansive views encompassing five states and the only taiga-boreal forest in the state.

And this little tidbit right here caught my interest:

Thoreau:

By the mid-19th century, improved transportation into the region attracted many visitors to Greylock. Among them were writers and artists inspired by the mountain scene: Nathaniel Hawthorne, William Cullen Bryant, Oliver Wendell Holmes, Herman Melville, and Henry David Thoreau.[23]

And material regarding the logging industry clear cutting trees and stripping the land, I won't post that here it's too lengthy.

And this:

Mount Greylock State Reservation was created in 1898 as Massachusetts' first public land for the purpose of forest preservation.

And the wiki talks about the AT, Bascom Lodge and the war memorial tower which I assume you're right there by it.

So yeah, that's what I do when you post about a location that is unfamiliar to me.

Here we have had (put up the list) hail storms that took out parts of my garden and new deck chairs, grasshoppers are now eating what's left of the flowers, the praying mantis I bought (to slaughter the grasshoppers) haven't hatched out yet, the deer are also mooching flowers off us, I've been mostly stuck inside for a three day stretch due to the air quality--ash in the air from wildfires all over the state (I'm allergic to that stuff), so I just want you to know how much I enjoy following your journey here on the thread because of the escapism it provides on a negative attitude day.

And I didn't mention this on the board, but I will say that one of our beloved Pugs (belonged to one of our kids, had her for 16 years, raised our Pug) passed away in May. Broken hearts everywhere! Then a Border Collie Mix puppy came into the picture that died before she was ready to go to our daughter. But she has now rescued a new puppy and she's precious.

So the last few months while you all are on the trail, have had some low points for us and it's been wonderful to read your stories at times when things weren't going so well, and I really appreciate your sharing here.

I'm hoping that Xeno might take off on a journey to share. My only journey will be to the UK (via Jersey) in fall. Maybe I'll write about that since this thread could easily be re-titled-- I feel great/I feel like ____ this is why.

It remains my favorite thread on the board.

:-)

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Stay close to the people who feel like sunlight ~ Arsu Shaikh


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 Post subject: Re: The score so far (Health & Fitness)
PostPosted: Sun Jul 01, 2018 4:09 pm 
God
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Joined: Fri Oct 05, 2012 5:37 pm
Posts: 7039
Location: On walkabout
Congrats on the 125!!! And I'm very sorry to hear about your Pug. :cry: I'm looking forward to reading about your trip!

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​“The ideal subject of totalitarian rule is not the convinced Nazi or the dedicated communist, but people for whom the distinction between fact and fiction, true and false, no longer exists.”

― Hannah Arendt, The Origins of Totalitarianism, 1951


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