Part 8: Get Out and Get Walking!

Living life large with my Pop!

If you are anything like me in my 40's, than you know how hard it is to find the motivation to start exercising. What made me think that I was suddenly going to start working on my health from the perspective of better exercise? Here's what it took and what I finally did to change things.

BOB
Bob was a wonderful friend and dental patient of mine. I met Bob in Bible Study Fellowship and he was already in his 70's. He was a true gentleman. He was sharp, polite and always well put together. Bob was also in great shape for his age. I remember mentioning that to him at one of his dental appointments and he remarked how he had a real turn around in his 50's. 

Prior to that, he had been a smoker and a real Type-A personality who travelled the world for business. I forget what it was that motivated him, but at some point he decided to start running. On the first day, he put on some tennis shoes and tried to run around the block. He made it to the mail box about three houses away and walked back, but that did not dissuade him from going back out the next day. So, he threw out his cigarettes and quit smoking. By the end of the week, he was running down to the corner and walking back. By the end of the month, he was able to run around his block.

By the time I met Bob, he had run in the San Francisco, Los Angeles, New York and Boston Marathon races. Bob taught me that you are never too out of shape and you are never too old to do something big.

MID-AGE MANIACS
Speaking of doing something big, I joined a Facebook group called Mid-Age Maniacs that was started by a few friends. Here is the description from the page:

“Do you recognize the need and benefit for men and women to be pushing physical limits into and past middle age? From physical benefits, to mental and emotional health benefits, to setting an active example for our kids and grandkids, middle age guys and gals need to spend less time on the couch and more time out there crushing it.
It doesn’t matter what you’re into: 5k’s or marathons, MMA or tai chi, Crossfit or yoga, trail running, mountain biking, rock climbing, 100 mile craziness, calf roping, or whatever. Just be into SOMETHING! And CRUSH it.”

This group was full of stories of people in their 40's and beyond who were doing big and scary things. Some were taking on a marathon or a half-marathon, others running a 5K/10K, some walking, some hiking and others were just taking on a big task. I lurked, I read, and I got inspired by others stories.

LAURA'S STORY
One of those people who inspired me was a friend named Laura. She had started her transformation several years prior. Like Bob, Laura was also a dental patient. What makes the stories of my patients so interesting is the noticeable results based on the gaps of time between visits. When you only see someone every six months the changes are very evident.

At one point, Laura came in my office and the physical change in her body was clear. We asked her to share her story and she told us that she had lost 125 pounds using Weight Watchers. I was absolutely blown away. First, we calculated that she had technically lost the weight of my dental assistant. As if the physical changes were not dramatic enough, just recognizing that she had been lugging around another human being was incredible. Second, was the knowledge and understanding that Laura had been at it for several years. She was a picture of determination and her story was inspiring to me.

Laura's story and transformation pushed me over the edge. She was looking and more importantly feeling better. It was because of her that I was inspired to make small changes and wait for the results. She eventually joined the Mid-Age Maniacs and I still continue to be inspired by the things she knocks off her list of big scary things. She has gone from a non-walker to a bad-ass runner! Such an inspiration to me and I hope to you too!

ARTHUR'S STORY
One morning I was scanning Facebook and I came across a video. If you are on social media, I'm sure you have seen the same video about a guy named Arthur who discovered yoga. I will post it here. Watch it now!

Arthur's story continues to amaze me. He went from being injured to be an amazing practitioner of yoga. To say that his transformation encourage me was an understatement. I purchased the videos and began practicing DDP Yoga.

Did I see the same transformation? Not quite, but I did realize a few things. I was horribly out of shape and I did find small changes in my body. I was able to touch my toes and my flexibility improved.  It also proved to me that change was not going to happen over night. It took long term commitment and an element of sticking to it.

WALKING WALKING WALKING
All of these stories started fitting together at the same time that I was being hit by waves of depression and stress. I have posted about this before, but this is where my need to get out and walk took off. Taking the kids or the dogs on a walk really helped me battle my stress and depression. I would often drive to the local college and walk anywhere from 1 to 5 miles with my dogs or kids.  

Hitting the trail with my big sis!

One of the things that I began to notice was that walking causes you to slow down. You see more things, you smell more things and you experience all the things you miss when you speed by in a car. It was intoxicating. Suddenly, I wanted to walk more and more. I asked everyone I knew to join me. Cold, Rain, Heat or Fog. I found myself waking up at 5AM so I could get in a few miles before work. I planned long walks into my vacation time and kept pushing myself to get faster and walk farther.

You would think that life out in the country would make walking fun. Nope! There is something about roaming dogs in the country that takes all the fun out of a walk in the orchards. Instead, I got to know the neighborhoods around my office and found myself walking everyday at lunch too.

I also took up hiking and found myself driving out to the local river where I could hike for miles at a time. The kids came regularly and the dogs loved being free to run in and out of the river. Everytime someone came to visit I invited them out for a walk in the trails and rivers of eastern Stanislaus county.

I don't want to miss one other result of all this walking. I remember reading the biography of Steve Jobs where he mentioned taking walks to work through ideas and creative projects at Apple. When people came to visit him, he would ask them to take a walk.  Friends, co-workers, family members, ministry partners were asked to join me. It works! Don't believe me? Give it a go.

CH...CH...CH...CHANGES
I'm not sure what exactly changed in me, but I did begin to recognize that people were asking me if I had lost weight. Talk about motivation! That was like pure gasoline in my tank of motivation.

The patients were the first to notice. Again, 6 months makes a difference in the way someone looks. Eventually it was friends and then family members who noticed that my clothes looked and fit my body differently. It seemed that everyone wanted to know what I had done. Thanks to Bob, Arthur and Laura I was able to share the truth: Slow and Steady Wins the Race! There is no fast solution to reversing 45 years of bad habits.

I started a hashtag on Instagram and Twitter: #walkingawaymyType2 so I could go back and chronicle my efforts. Follow the links to see what I am talking about! 

There was only one problem with all of this: My blood sugars were still not dropping. There was one final change I needed to make. In my next post, I'll share the biggest component that helped me turn the corner in my transformation: an entire new way of eating!

Quietly making noise,
Fletch

READ THE WHOLE SERIES
Introduction
PART 1: Middle Age Status
PART 2: Fatty Liver Disease
PART 3: Ironman Is Here
PART 4: Hypertension
PART 5: Bloody Noses and a Tumor
PART 6: Stress and Depression
PART 7: Diagnosis: Diabetes!
PART 8: Get Out and Get Walking!
PART 9: Kicking Sugar to the Curb!

Part 7: Diagnosis: Diabetes!

Thanks for hanging in there with me. It has taken me a while to get to this post, but I'm finally to the place where I write about the culmination of my health issues and what led to my diagnosis of Type 2 Diabetes. My goal is to follow this post up with two final installments in this series where I share the details of changing my diet and exercise and how that finally beat diabetes and other health issues into submission. I encourage you to read along and get inspired.

FISHING AND DRINKING WITH MIGHTYJOE
In the summer of 2016, I thought I was starting to feel a little better. My blood pressure was under control with medication. The tumor in my sinuses had been removed. I was walking and hiking quite a bit. There were only two major things I was still dealing with daily. The first was the stress we experienced having the rug pulled out from under us every time we showed our unsold home to potential buyers. The second was the stress of parenting a large family, including two weddings and the daily management of a busy little brain-injured boy we like to call Mighty Joe.

People often ask us about Mighty Joe. I always say: "He's a busy little guy." Kendra follows up with: "There is no off-switch with Joe."  At the end of last summer, I surprised him with his first fishing trip to the the CA Sierras. We spent eight hours fishing together and at the end of the day I suddenly got super thirsty. We ran into a little general store in the mountain town near the river and I quickly finished a large bottle of gatorade and an additional liter of water. Both of those did not satisfy my thirst at all. So, I was back in for more water. On the drive back to town, I stopped two more times for drinks. My thirst was insatiable. 

I knew exactly what was going on. I had noticed and ignored a few other symptoms in prior months: The unquenchable thirst, the middle of the night trips to the bathroom to empty my bladder, and the multiple times I got shaky in the late afternoon. These are all the glowing neon signs of diabetes. On the way down the hill with Joe, I called my doctor and asked for a blood test. The next day I was sitting in the lab getting blood drawn. (At this point in the story, believe me when I say that I'm totally fine with needles and blood - it seems like every other week I'm getting poked for blood).

BLOOD LIKE SYRUP
This led to another time that I got a personal call from a doctor at home. He had the results from my blood tests. He said that my blood sugars were so high that if I cut myself I would see either caramel or maple syrup leaving my veins. Not only was it a great visual, but I was tempted to taste it and find out.

As I mentioned in the last post, I had begun to walk everywhere with my dogs and started to lose some weight. My blood test showed that the regular blood donations, exercise and weight loss had helped my liver numbers. All my high liver enzymes were well within normal levels again. My blood sugar was an entirely different story. Diabetes is diagnosed when your fasting blood glucose is above 100mg/dl and my blood test put me in the running for the president of the Undiagnosed Diabetes Club. (Note: The UCC is not a real club, but if there was one, I'd run the meetings and bang the gavel).

Blood Sugars Through The Roof!

The HbA1c is also listed and is another blood test that is used to determine how well you are controlling your blood sugars by taking a 3-month average. It is a better gauge than a single fasting blood glucose test. Once again, my high numbers indicated I was uncontrolled and I had been for a few months.

Look at the results, my levels were very high and out of control. In typical Fletch fashion, I was super nonchalant about my test results. Type 2 Diabetes? Psshaw! My parents had Type 2 diabetes. It seems like every other person I know has Type 2 diabetes. Afterall, I thought, it's not like I was diagnosed with Type 1. That's the bad diabetes. Type 2 was like Diabetes Jr. or Diabetes Lite. I compared Type 2 to Type 1 like I compared having the sniffles to lung cancer. All I had to do was eat a few less tacos, skip a soda now and then. If I could just make a few changes, I'd be back on the road to health in no time.

DIABETES 101
For those who don't really get it, I think this is a good place to pause and actually describe the differences between Type 1 and Type 2 diabetes. I'm going to make it simple

Again, diabetes is a disease of elevated and uncontrolled blood sugar. In a healthy body, every cell needs energy. Typically that energy comes when the food we eat is converted to sugar (glucose). The glucose then cruises around the blood stream and tries to get into every cell. But there is a problem! In order for the glucose in the blood to enter the cells of the body, it needs help. That help comes from a hormone called Insulin. Insulin is released by your pancreas and one of the things it does is to unlock the door to the cells, allowing glucose to go in and provide energy to the cell. 

That was easy, right?

Now, if you have more sugar in your body than what it needs for energy (read: Krispy Kreme, Coke in a Bottle), then the body says: "Let's save this fuel for later when we might need energy!" Insulin kicks in again by converting the excess sugar in your liver as fat. Now the energy is saved in nice little fat molecules and that fat storage can be used later to release glucose back into the body whenever it needs it. So, insulin helps balance out blood sugar levels and keeps them in a normal range. Basically, as blood sugar levels rise, the pancreas secretes more insulin.

Type 1 Diabetes occurs when the pancreas stops making insulin altogether. Type 1 diabetics have NO INSULIN and they must inject themselves with insulin to help maintain their blood sugar and help the glucose get into the cells of the body.

Type 2 Diabetes occurs when the insulin being made by the pancreas STOPS working. The pancreas keeps making insulin, but the receptors on your cells become resistant to the insulin. So, your pancreas makes more insulin. For a while that works, but eventually your pancreas says enough is enough and the insulin is ineffective.

To review: Type 1: NO INSULIN, Type 2: INEFFECTIVE INSULIN.

Now, when you have too much glucose in the blood, it starts to thicken up (like caramel). Thick blood does not do well in tight spaces or small blood vessels. FYI, the really small blood vessels are found in the kidneys, the eyes, and the peripheral fingers and toes. That's why uncontrolled diabetics end up having kidney disease, blindness and the loss of toes, fingers and feet.

My point with all of this? We need to realize that ALL DIABETES sucks! Type 1 and Type 2 are both a result of a broken system. They can both lead to a shortened life span and further complications if you don't pay attention.

LIFE WITH A LITTLE PRICK
Back to my doctor. He added a few new items to my health care strategy: First, I left his office with a new prescription (500mg Metformin 2x/day). I also was the proud owner of a brand new blood glucose monitor with enough test strips and tiny needles to test my blood twice a day. Metformin (or glucophage) has been used to control diabetes for many years. It seems like every other patient I meet is taking this medication. I willingly took the medication and just assumed this was my new normal.

Likewise, I learned to poke my finger 2x/day with a tiny needle device. It took me a week or so to get used to the snapping mechanism I used to prick myself. It's still a bit weird, but if you are reading this blog and wondering about this. It is NO BIG DEAL. 

Here's what I didn't know. Many times, Metformin is only the beginning. If blood sugars are not controlled, you are prescribed more and more medication and finally you begin taking insulin injections. It's a downward slope and if I wasn't careful I was ready to wax my skis and head straight down to the lodge.

HIGH NUMBERS AND A NEW ROUTINE
So, off I went popping pills and checking my blood daily. It was disappointing how erratic my numbers were and I could never really get them in the range of "normal." Each time I poked and checked I would get depressed as the numbers climbed. I began asking every type 2 diabetic dental patient about their numbers, I quizzed them about medication and testing. Everyone was all over the map. Either they were very concerned or they were horribly inconsistent. Some took oral meds, some took insulin, and a few were doing neither and just controlling it with diet and exercise.

It wasn't until a conversation with my friend Eric that I began to understand the whole blood sugar process much better. His son has Type 1 diabetes and he shared what he had learned from his son's diabetes education. His encouragement to get serious and his instructions on how and when to test my blood sugar were really the key to turning everything around for me.

Simultaneously, I received a gift from a patient named Judi. She is also a Type 1 and she gave me a book called, The Born Again Diabetic. It is a fantastic book written by a diabetes educator. It was this book where I learned to test my blood sugars multiple times/day and figure out how my body responded to the food I ate. So I began to test 6x/day and track the effect food had on my blood glucose. It became like a science experiment and I logged everything.

SHOCK AND STEROIDS
In regards to the stress I blogged about in an earlier post, one of the best things to happen last year was the sale of our home and our move over the holiday season. On the night before our big move, I paused to show Kendra my cool Corona Extra beer sign I had kept since college. As I plugged in the neon sign and grabbed the transformer, I discovered there was an electrical short. The electricity caused me to clamped down and I could not let go as the electric shock surged through my body. Kendra stood back and I prepared myself to meet Jesus as I shook violently. Thankfully, my screaming and shaking caused me to break my grasp and I ended up with a quarter sized hole burned in one hand and achy shoulders from the muscle clamping that occurred during the shock.

Eight weeks later I was still having shoulder pain and the orthopedic surgeon I visited recommended a cortisone injection in my shoulder. I agreed. The cortisone provided a small amount of pain relief, but it also sent my blood sugars through the roof. No matter what I did, I could barely get my glucose numbers below 175-180. Here's my point, I knew all of this because I had become so good at testing my numbers regularly. If nothing else, I had the gift of consistency and follow-through.

THE QUEST BEGINS
When people ask what happened, what clicked and how did I reverse my diabetes, I point to a few things.

First, I was motivated internally. I just wasn't satisfied with my ability to control my blood sugar and by the time I learned that there were +1500 feet amputated each week in the US, I decided that I liked my feet. So, I hit a wall and decided enough was enough.

Second, with the advice of a functional medical practitioner, I dove into a huge lifestyle change. I overhauled my diet and lifestyle. I understood it was not going to be exercise alone. In fact, I had learned that the ratio was really closer to 80% diet and 20% exercise.

Third, I had the help from others. Kendra was my dietary and relational support and she quickly got behind me. I also had other middle aged maniacs making huge life changes. Actually, there is an entire Facebook group of support friends. (Thanks Scott, Amie and Laura for the motivation!).

In the next post, I will put hands and feet to the theory and explain how diet and exercise helped to revers many disease markers in my body!

Quietly making noise,
Fletch

READ THE WHOLE SERIES
Introduction
PART 1: Middle Age Status
PART 2: Fatty Liver Disease
PART 3: Ironman Is Here
PART 4: Hypertension
PART 5: Bloody Noses and a Tumor
PART 6: Stress and Depression
PART 7: Diagnosis: Diabetes!
PART 8: Get Out and Get Walking!
PART 9: Kicking Sugar to the Curb!

Counting with Renée

Counting the years on your birthday is always way more fun when Renée Fleming is involved!

Happy Birthday Kenj! Hope your dreams are filled with miles of great knitting yarn, beautiful music, the smell and warmth of the beach, excellent match points with Federer, delicious food and gobs of good dark chocolate ice cream!

Quietly making noise,
Fletch

Part 6: Stress and Depression

I've chronicled how my poor choices led me down a path of unhealthy living. All of my previously discussed disease markers were taking a physical toll on my body. But in and around those diseases that had been diagnosed by blood tests and CT scans was another health issue which was more difficult to test and evaluate.

Can you measure stress with a blood test? Is there an x-ray for depression? I know this may come as a shock to folks who know me in real life, but both stress and depression have at different times overshadowed my life.  If you've been around theMangoTimes, you I know that I have alluded to this over the years. Throughout this series, I've found that my transparency has been helpful to me and my readers., so hang onto your hats and let's dive into these topics today.

Our family has gone through a number of big trials, but because of my personality it appeared as though I took each one of these trials in stride without showing any cracks in my exterior life. People often comment that "you and Kendra are so strong" or that they admire "how well we cope" in the midst of tragedy. I recognize this too. I believe that I have a high capacity for stress, but everyone needs an outlet for that stress. In other words, you can't keep it bottled up forever. The cork will pop and everything will eventually come pouring out. For those of you who are new readers, let me chronicle a few of the bigger issues I am referring to:

• 2008 - Mighty Joe - Coma, virus, brain injury which will affect his (and our) entire life.

• 2009 - Annesley - Car accident/Broken hip - Accident/False CPS investigation.

• 2010 - Caroline - Ruptured appendix. 21 days in the ICU.

• 2010 - Major paradigm shift/church change out of cultic legalism.

• 2013 - Hayden - Wedding upheaval and fallout

• 2015 - Hayden - Car fire survival

• 2015-2016 - Home/Property sale

I just listed the big things and each of them have their own story and their own ramifications that play out in my life to this very day. There continues to be broken bodies, damaged relationships, deception fallout,  loss of trust and heaps of long-term healing taking place.

As a Christian, I thought and communicated to everyone in the midst of these trials that my faith was secure. In the middle of life's biggest storms, I was able to articulate clearly that God was in control and would sustain us. I said it then, I believed it then and I still believe it now: God is sovereign and powerful. Nothing in life happens that He does not have ultimate control over. (Sorry for the theology in the midst of a story about diabetes, but stress, depression and spirituality are all integral parts of this story).

Get Real Fletch!
The only problem was that in the midst of saying these things and preaching to myself a solid message of hope, I had no outlet for the darker times. "God's got this!" or "This too shall pass!" are the things you are supposed to say in the midst of a trial. It is not cool to say out loud that you think life sucks! As a "good Christian boy" I could never say what I really felt: That life is really fucked up right now and it feels like everything is crumbling around me! 

It was simple. I just could not be real. I felt like I had too many onlookers and observers with super high expectations of me. Kids, friends, parents, employees, patients and the list goes on. Perceived or real, I felt like I was expected to have the right response at all times. Put your head down. Keep calm and carry on!

When it came to relationships, some of my closest friends had their own "major issues" going on, while others were physically and locationally just not present in my life. At the same time, I had other friends who had just abandoned our relationship all together. 

Kendra was there every step of the way, but she was processing through these trials in her own way. Besides, I didn't need to add my dark season to her equally dark season. Kendra processes on the inside and I didn't want to invade that space. It is what it is. Life is exploding right and left and the stress level keeps pushing up. Kids didn't know it. Friends didn't see it. Parents/Family didn't understand it. I just kept my head down and pushed forward. I wouldn't call this a mid-life crisis, just a stressful season with very dark days that I learned to walk alone. 

What do you do in this situation?
I remember not recognizing this as depression. You know why? Because, I'm not that guy! Depressed people are curled up in a ball sitting in a dark room, not busy running a business and a ministry and a family. That's not Fletch! Fletch is the life of the party. Fletch gets stuff done. He has capacity. His goal is to make others feel better. He reeks of optimism.

“I can remember when I first heard that Robin Williams had committed suicide and listened to all the rhetoric of the funniest man alive dealing with depression. Yeah. I get it. I totally get it. ”

But, the truth was that for the first time in my life, I found myself relationally alone and in a place of occasional darkness. I read a blog post where the author wrote about his battle with occasional depression. I related to everything he said. It was like I gave my self permission to embrace my melancholy.

I can remember when I first heard that Robin Williams had committed suicide and listened to all the rhetoric of the funniest man alive dealing with depression. Yeah. I get it. I totally get it. Life can be a stage sometimes. I have a job which requires me to "be on" 8 hours each day, but when the laughter and entertainment dies down, things can get lonely and dark. I've been there.

So that was my situation for several years. At the same time, my physical body seemed to be failing right and left. No matter where I turned, I was faced with a feeling of dread. I could physically feel my heart beating in my chest every day and with the least amount of added stress, my nose would explode into a river of blood. I was feeling it in my physical body and my mental body. Something had to change. 

Dogs, Dark Poetry and Loyal Friends
I forgot to mention that In the midst of these trials, I lost the best dog on the planet. My golden retriever, Salsa, died. She's didn't make the list of major life issues above, because she lived a great life and it was her time to go. Thanks to a friend over at Langley Labs, I had the space to add another few dogs in my life. The first was a yellow lab named Betty and then later I adopted a chocolate lab named Rasta. Little did I know this friend's encouragment to get one of her labs was way more than adding a dog to my world, but would actually be a large part of my therapy.

Because they were labrador retrievers, they required exercise, so I began walking with them wherever I could. Before long I was walking 3-5 miles at a time and looked forward to finding new trails together. The dogs required nothing, they were extremely loyal and at the end of the day they provided exercise and a place for me to think through life. I was quickly logging about a hundred miles each month. It's no joke. These dogs have become a part of my daily therapy.  As a bonus, I felt great and started losing weight. With their help, I could feel the dark cloud lift.

I also returned to my college habit of writing poetry. However, I found that my writing descended into an extremely dark form of poetry. The kind of poetry I would not want anyone to read or discover after I died. Yet, at the same time, it was very therapeutic for me to cry out to God and dialogue what I thought about life. They ended up as personal psalms for me and I shared them with very few people. Again, the cloud began to lift.

Lastly, I began to connect with a few old friends. Because I know that he occasionally reads what I write, I want to publicly thank my buddy James for being a steady friend through this dark time of my life. He was (and continues) to be a friend who takes whatever spills out of my mouth. The good. The bad. The ugly. 

As a reader of this post, if you have a friend struggling with a tough season in life, allow me to share a great piece of advice: Just Show Up. Just be there in the midst of the storm. Allow people to be real and to vent and even argue out loud. James and a larger group of guys (Byron, Jeff, Chris, Travis, and Don) let me do that and I am eternally grateful.

Before I wrap up this post, I want to be super clear. I know the answer. It's not dogs or friends or poetry. They were all ingredients in my recovery. Ultimately it was rediscovering the goodness of God. My faith was the main prescription and I was super rooted in the love of God for me. That is the answer. It still is.

I weathered the storm. I walked out of the darkness. The black dog of depression ran off. Will it come back? Probably. I'll be ready for it. But at this point, the fog lifted. I found ways to deal with the stress and the depression disappeared. Then, as if on cue, the next part of my body began to fail.

The Perfect Storm
If you follow the time line, you will see these storms came one at a time. There were a few times when I could barely catch my breath before the next storm rolled in, but thankfully they did not hit all at once. 

This all culminated last summer when the final shoe dropped. Yes I was walking and hiking every chance I got. I still had the stress of my dental practice. Business was going 100 miles per hour and it was continuing to grow. I still had the stress of unsold property which had been on the market for 18 months and there were no potential buyers on the horizon.

It was in the midst of this storm season that I began to notice a few more key issues in my health. I'm no dummy and I knew the signs of diabetes. In my next post, I'll tell you what happened and how I figured it all out.

Quietly making noise,
Fletch

READ THE WHOLE SERIES
Introduction
PART 1: Middle Age Status
PART 2: Fatty Liver Disease
PART 3: Ironman Is Here
PART 4: Hypertension
PART 5: Bloody Noses and a Tumor
PART 6: Stress and Depression
PART 7: Diagnosis: Diabetes!
PART 8: Get Out and Get Walking!
PART 9: Kicking Sugar to the Curb!

Part 5: Bloody Noses and a Tumor

There are a few things in life you don't want to need.

For example, you don't want to need an undertaker. You don't want to need a bail bondsman. You don't want to need your oxygen mask in the middle of a flight. Likewise, I didn't want to need a cardiologist, but as I shared in my previous post I had become one of those middle-aged men who was lucky enough to have a cardiologist on his speed dial. 

Even though I didn't want or need a cardiologist, I did leave my cardiologist's office with great news. My heart was functioning well as a strong pump in my body and after altering my blood pressure medication slightly, I quickly got the numbers down and closer to the normal range which allowed me to begin the monthly blood donations once again.

For those keeping score, the disease processes in my body had grown to include: fatty liver disease, hypertension, high iron levels and the beginning levels of obesity. As if that wasn't enough disease markers, a new area of my body began to feel neglected and began to show up on the scene.

Toilet Valves and Bloody Hell
I began to notice that whenever I caught a simple head cold, my sinuses would congest horribly. Once again, I didn't pay much attention to what my body was saying. I assumed my congestion was associated with the same allergies that many in the central valley of California struggle with. However, even when my cold symptoms disappeared, I noticed that the congestion remained and I felt like I could never really clear my airways. Two things began to grab my attention.

First, whenever I blew my nose, my airway would immediately clear. But, as soon as I sucked air back up through my nose, my nasal passages would slam shut. It almost felt like a flapper valve in a toilet. It was an odd feeling and I actually felt like something was moving inside of my sinuses.

Second, for the first time in my life I began to experience nose bleeds, but these were not regular trickling nose bleeds that you could pinch off to stop. These were uncontrollable bleeds that felt like I had ruptured an artery high inside my nose.

I began to avoid heavy sneezing and blowing my nose, because every time I did it was like I was standing in the middle of a murder scene. As things progressed, there was a point when I even considered asking Kendra to buy me tampons to shove up my nostril. When the bloody noses showed up at work it was time for me to address the issue with my family doctor.

Big Cameras and A New Doctor
With a quick scope up my nose, the toilet flap I felt in my nose had a new name. It was simply a nasal polyp and required a referral to the local ENT's office where I discovered a fun fact: Specialists have much LONGER cameras. With a few puffs of anesthetic to numb my nasal passages it felt like he wedged a McDonald's straw up between my eye balls. Delightful. Really. You should try it at home.

I thought it would be a simple removal. I actually expected him to remove the polyp while I was in his office at my consultation. But, my ENT requested I get a CT scan and an MRI so he could get a better sense of what we were dealing with. It seemed like overkill, but I'm glad he did. The results were astonishing.

Yellow outline of the polyp in my left nose/sinus

For those unfamiliar with the CT scan, pretend I am looking right at you. Those grey roundish oblong things are my eyeballs. All the white structures are bones. The dark spaces are the airspaces in my sinus cavity. So, my nasal polyp (highlighted in yellow) began high in my left sinus and extended down just above my nostril. The MRI confirmed this as a three dimensional worm-like mass that seemed to be attached to the bone at the base of my brain. As I sat down with the ENT to go over my results, he explained that based on the location of the polyp, it might be better to see a specialty surgeon at a university hospital and that meant either Stanford or UC San Francisco.

Yellow outline of the size and location of my tumor

Stanford Surprise
If you are keeping score, this little toilet flap growth that seemed to be the source of my horrific nose bleeds had now landed me in my third doctor's office in a few months. I chose Stanford University (because I love Palo Alto, CA) and was looking forward to scheduling surgery and by now had become very familiar with the routine for initial exams: Anesthetic spray deep up both nostrils and then a long camera tube up my nose. This time it was a little different. First, my new doctor gave me a pair of glasses connected to his scope. So, what he saw on his endoscope, I saw in my glasses. As he poked around, he was speaking with his attending students and mentioned two disconcerting things. First he mentioned wanting to get a biopsy. What did he say? A biopsy? Second, he mentioned the need to diagnose the tumor. Tumor? Did he just say tumor? What happened to polyp?

I interrupted the doctor and told him I thought I had been sent to Stanford based on "where this growth was located" and he was quick to explain that it was not only "where" this growth was in my sinus, but "what this tumor might be." Somehow I missed it, but his business card did list him as an ENT oncologist. Needless to say, I was surprised. My oncologist discussed a variety of things that each had their own list of questions: the possibility of cancer, submission to the Stanford tumor board for treatment planning and admission to the hospital for surgery and recovery. Before we really had a chance to process what he was saying, he was back in my nose with a pair of biopsy forceps and scissors. I watched it all with my fancy glasses. A quick snip and a chemical swab to burn the incision and we were on our way back home to wait for the results.

Diagnosis and Results
The good news is that the results came back favorable. "Just a nasal growth" is what he said when he called me personally on the phone. "We'll do the surgery in my office and you'll be back home that night recovering." What a relief. No pun intended, but I felt like I could breathe again.

Within a month we were back at Stanford and I was sitting in the same chair with several needles being injected into my nostril. Briefly let me pause and say that as a treating dentist, it was good to be a patient. It reminds you what it means to be gentle and communicate well. I know this, but it was great to experience it too!

They numbed this mass from every angle and then proceeded to cut and tug it out of my sinuses. I didn't get to watch this time and although I've seen a lot of traumatic oral surgery in my own dental practice, I am glad I did not get to see this. When it finally detached it felt like my doctor was pulling an oversized slug out of my nose. I looked down on the gauze and saw this nasal mass that was about the size of my pinky in length. It was way bigger and way uglier than I expected. My doctor commented on the color of the blob and suggested he might get a follow-up biopsy. He spent a few more minutes cleaning my sinus with a giant rooter blade and then sent me home. No bleeding. No packing. To this day, he is one of my favorite medical professionals I have ever had the pleasure to work with.

Having fun at Stanford

"This Changes Things"
As we left Stanford, I felt like I could smell things from across the county. The doctor assured me that the surgery was a success, but it was wonderful to take deep breaths out of both nostrils. He also said that he would contact me if there was any additional information. It did not take him very long.

One week later, Kendra and I were enjoying a Sunday night walk through the orchards around our home. My phone rang and I noticed it was a Palo Alto phone number. I was shocked to hear my doctor's voice, but I assumed it was a standard one week post-op phone call. I should have known better. When a doctor calls you personally on a Sunday night, there's probably a reason.

I quickly learned this was not an ordinary follow-up conversation, he explained that the new biopsy had revealed more information and a new diagnosis. My "toilet flap growth" that became a "nasal polyp" and then became a "nasal mass" had now become an actual tumor. It even had a name: Glomangiopericytoma. I've detailed this all here, but if you want the basics: It is a rare nasal sinus tumor. It is non-cancerous, but it can be aggressive in growth and localized destruction, which for me was the bone at the base of my brain and the nerves I use for smelling things.

"This changes things," he said. Instead of basic recovery from my in/out surgery, I was now on a 5-year evaluation plan. My doctor was going to need to look in my nose every 3 months and then every 6 months and eventually once/year. If there are no changes in growth, shape or color, I am in the clear. But if my tumor shows any rebound, we will need to go back in surgically (hospital visit) and find clean borders all around the tumor. The chances are good this will happen at some point, but as of now we have seen no changes. I still have great airway breathing and I have not had a nose bleed since surgery.

How Does This Relate To Diabetes?
During the time I discovered the growth in my sinuses and managed the horrible nose bleeds, I did not know I had diabetes. But, this was one more domino falling in my declining health. Circling above the blood pressure, the liver disease, the tumor and the weight gain were the thick black clouds of stress and depression. I'll talk about that more in the next part of this series.

Quietly Making Noise,
Fletch

READ THE WHOLE SERIES
Introduction
PART 1: Middle Age Status
PART 2: Fatty Liver Disease
PART 3: Ironman Is Here
PART 4: Hypertension
PART 5: Bloody Noses and a Tumor
PART 6: Stress and Depression
PART 7: Diagnosis: Diabetes!
PART 8: Get Out and Get Walking!
PART 9: Kicking Sugar to the Curb!