Chronic Disease Emotional Work

Day 168 and Red Queen Running

On a typical week I spend about 8 hours on health care appointments. This doesn’t include basic human maintenance like good nutrition, exercise and sleep. These are straight up hours I spend with health practitioners. It’s a lot.

I feel a little bad complaining about it as most people don’t have the opportunity to pursue some of the things that hold me together. The American medical system is built for those with spare money and time. But I’m envious of people who don’t spend all their spare time and money on healthcare. I cannot even imagine what I would get done if I was as healthy as the average person.

Regular people have the luxury of emotional dramas, personal hobbies and families. I on the other hand get to go to the doctor. I don’t get to stay up all night obsessing over men. I don’t have the capacity to raise children or parent. I don’t get to train for marathons. I’ve written before about the envy I feel for the lives of the fully able.

But mostly I resent that I have to spend so much time on my health just to maintain my progress. I feel like I’m trapped by the Red Queen in like Alice in Through the Looking Glass.

Now, here, you see, it takes all the running you can do, to keep in the same place.”

Lewis Carroll

Some might argue that having a disadvantage like this focuses you. I’ve become quite a charmer over the years to offset my physical disabilities. I do more in less time because I have to in order to compete. I’ve found ways to thrive in late stage capitalism. It’s entirely possible I’m not standing still.

There is a whole theory of evolutionary biology that these pressures just to maintain your place in the world are adaptive. In fact, it is called Red Queen theory. I guess just needing to work your ass off just to stand still is pretty normal.

Biohacking Chronic Disease

Day 162 and Reactivity

I’m sensitive to everything. Physically I mean. I’m surprisingly tolerant of emotional volatility, which means I’m well suited to entrepreneurial nonsense and financial chaos. Physically, on the other hand, I’m a hot house flower. Orchids have a wider band of tolerance than I do. If you don’t feed, water and rest me on a precise schedule I will cascade from blooming to dead in a few hours. Only a slight exaggeration.

I’ve got endless examples I can share. I can go from zero strain & a low heart rate when working out at 65 degrees to vascular distress and heart rate spikes at 75 degrees. When I was younger I would get drunk from one drink and now I can’t even have a sip of wine without turning beat red. If a drug has rare side effects I’m virtually guaranteed to get it. My doctors are pretty familiar with this now and like to make jokes about it. “Well .001 of patients experience thinning hair so you will probably go bald!”

On a day to day basis I hate this because it means I have a lot less flexibility to fuck around. I will find out. I need to keep strong rhythms and routines. And I can often spot when even a planned and positive therapy has negative consequences almost immediately.

For instance, I take an immune suppressing biologic every two weeks to keep my immune system from getting too worked up and causing inflammation. I’ve got ankylosing spondylitis which means the swelling shows up in my spine. It’s good to keep this suppressed. This drug lets me walk and live normally which is awesome! Yay! But on the day of my shot and about 24 hours after I feel like shit. I can literally feel my immune system getting shut down in real time. I’m sniffly, tired and slow today. While this is good in the long run, we want to keep my immune system down, I’m grumpy as fuck that I feel the effects of this drug.

The upside to this reactivity is even modest changes show up in my tracking tools. I can leverage many subtle therapies, diagnostics, treatments and supplements to significant effect. It’s probably a factor in my affection for biohacking. I can see results quickly. The feedback loops tend to be short and noticeable for me, which thanks to tracking many variables over a long time span, means I can isolate effects within relatively short order. So while I’m a pain in the ass patient I’m also a pretty emotionally satisfying one. If you make a correct diagnosis on me you will find out pretty fast. That’s so satisfying.

The irony of this short feedback loop reactivity is that I mostly work on longer term horizons and on extremely volatile things. Maybe it’s because I get the benefits of compounding because I have built up so many positive habits? I don’t get worked up by any individual data point because I’m used to seeing extreme reactions in myself. No big deal. I don’t mind chaos at all because I don’t have much chaos in my daily life because I’m constantly managing my own biology. Maybe I’m actually perfectly suited for my professional life now!

Chronic Disease Emotional Work

Day 158 and The Mondays

I feel like Garfield but I don’t like Mondays. After two glorious days of reprieve, on Monday I restart the constant parade of medical appointments, biohacking activities and other habits and routines I maintain to keep my body healthy. And even with all that effort, my health is still bottom decile. The routine I lay out below can feel overwhelming with the amount of time it takes and yet if I don’t care of my body…well it won’t take care of me.

Garfield the grumpy cat falling out of his bed as he realizes it’s Monday

I woke up at 730 and made myself a breakfast of berries and homemade yogurt from raw milk. I used to be an intermittent faster but now I have to take medications with food so breakfast is back.

At 830 I read the news headlines and top articles from Bloomberg, New York Times, and the WSJ as well as listen to NPR’s morning edition. Then I need to do my physical therapy and stretching.

At 9 I go for an hour long walk. In order to keep inflammatory conditions under control, it’s recommended that I do at least an hour of low impact walking to keep limber. During my walk I will listen to more financial news and podcasts. Today I treated myself to Exit Scam by Aaron Lammer. Normally I listen to Odd Lots or something more specific to my corners of finance like Flirting with Models. I decide to go with Exit Scam as Aaron Lammer impressed me so much in Odd Lots a few weeks ago with his episode on yield farming.

At 10am I organize my supplements for the morning. I take Ray Kurzweil levels of stuff that is monitored by not one but two functional medicine doctors. This doesn’t include the slurry of powders I drink in water, just the nice easy pills.

Then I am hooked into a EEG for an experimental “brain training” protocol called dynamic neurofeedback. The best metaphor I’ve got is to defrag your mind and reorganize your pathways. It’s basically CBT with an EEG. The session lasts for 33 minutes I also sneak in a meditation during this time.

Electrodes hocked up to my head for an EEG as I do dynamic neurofeedback

11am means it’s time to lift weights. I can’t do much and I need long rest intervals but I did a full squat cycle.

1130 has me showering and doing doing cold therapy. Yes I stand under a freezing shower for 5 minutes and do Wim Hoff breathing. Somehow I also manage to wash my hair.

At noon I have a banh mi (the pork and short rib from Daikon are quite good) and finish an episode of Mythic Quest. It’s wonderful and I recommend you get Apple TV just for this and Ted Lasso. I needed the break to just hang with Alex and do nothing for a minute.

Finally at 1pm I am able to get some work done. Getting emails out, checking on deals, reading some pitch materials and checking in on portfolio companies. I should have a straight shot through to 3pm to work before therapy but my mother and I ended up on the phone.

3pm is a full hour with my therapist. Arguably the most important hour of the week, especially for getting my mind right for Tuesday’s productivity.

4pm I have a brief break to take more supplements before I go back for two hours of group therapy.

Yes you read that correctly. On Monday I have 3 hours of back to back therapy. What else can I say? I’m committed to my emotional growth. We do family systems work and group work is particularly helpful for seeing your reactive patterns and how they are or are not mirrored back. As much as I sometimes resent how much time I sink into this work I do believe it’s the best ROI on time. We repeat the patterns of our childhood unless we clear them.

Finally at 6pm l have time to do things that are not explicitly for my mental or physical health. So yeah I’ve got mixed feelings on Monday. I want to live life beyond treatments and working on myself. I wish I could live without meds, supplements, physical therapy, walking, lifting weights, meditation, and therapy. But I guess that is what Tuesday’s are for. Monday is just Monday. And yes I repeat some of those activities every single day.

Chronic Disease

Day 156 and Social Accommodations

One-on-one synchronous communication requires energy and commitment. If you have plenty of energy and few health problems maybe this isn’t intuitively obvious to you why it’s tiring for me. To understand I highly recommend the Spoonie theory of living with chronic disease. A Lupus patient Christine Miserando explains to a friend using “spoons” as a prop/metaphor.

So, she laid out a handful of spoons on the table and explained that the spoons symbolize all of a patient’s daily energy reserves. Every activity, no matter how thoughtless and automatic, depletes from the energy supply. Getting out of bed, showering, getting dressed, eating, and any number of mundane tasks threaten to deplete energy at any given time. When you run out of spoons, you can choose to borrow against the spoons of a future date, but there are consequences. When you deplete your spoons, you are bedridden. Unable to manage the simple activities of life.

I work with a limited set of “spoons” each day. If I manage my energy budget well you would never guess I’m any different than you. But I optimize my day around accommodating my firm energy budget realities. I think of it as a wheelchair or a crutch. It’s a tool that helps me extend my capacity. I can do more with less energy and thus I need fewer spoons.

One area that makes a huge difference is digital asynchronous communication. Written documents or presentations, text messages, email, Slacks, heck even voice memos are all great ways to reach me as long as you don’t expect an immediate response. Asynchronous communication means respond when I have the energy. I rarely feel overwhelmed by those as there isn’t a need to respond right that moment. I don’t have to use a spoon to get you a response. If you need FaceTime or a phone conversation then I have to work around your preferences (which might not be strictly necessary for the information it’s just what you happen to link) and then you are also asking me to prioritize your preferences over my limited energy banks. Which can feel disrespectful if you don’t suffer from strict energy budgets. You are asking me to take a double hit. Accommodating me makes me more likely to budget more energy and time on you in the future if you respect my energy now.

This means you may need to reach out more. If you expect a synchronous back and forth you may end up waiting on me. Please don’t wait on me to reach out and have energy & free time at the same time as you. You will wait a long time! Reach out and we will work it out asynchronous style.

This is why I love social media. It is easy way to connect people to what I am doing on my own tike frame I have extremely limited energy and capacity to express that one on one. If I had to I’d end up limiting my entire world to like 3 people. My energy for one to one communication is limited. As someone who is disabled and chronically ill, I feel lucky that I have access to technology that allows me to expand my capacity to connect and communicate. If I didn’t have these tools my world would be severely limited as each conversation and interaction I have takes significant resources.

Like a myriad of writers who have been sick before me (Walker Percy, Virginia Wolf to name a few) I use this tool to extend my life and influence beyond the bed in which I spend 12 hours a day. So please understand I cannot always communicate in real time or in person for everyone. It’s the highest energy usage thing I do. Let me use technology to expand my world beyond my bed. We will both get a lot more out of it and you will find that thanks to technology I can can as much done as you.

Chronic Disease Emotional Work

Day 147 and Over My Skis

For a Colorado native (let’s ignore that I was born in Silicon Valley) a number of our most cherished pastimes are kinda “meh” for me. Skiing is a sport that I can take or leave. That apres ski life is much more appealing than cutting it up on the slopes. But one key metaphor from ski culture gets used lot. “I’m over my skis.”

To be over one’s skis is to risk crashing. Being over ones skis happens out of enthusiasm. An inexperienced or unfocused skier lets their center of gravity tilt forward over their knees. Best case scenario, you are simply going too fast and you better “pizza” your skis to slow down. It’s a endearing but slightly awkward experience which is what makes the metaphor so appealing. It’s never a bad faith metaphor merely a goofy oops.

I got over my skis this week. I’ve been so excited for my workload (new investments, new startups to advise) and some new structures forming in my life ( is coming into focus) that I’m leaning in and finding myself going too fast. A friend of mine, who is my favorite person to “over do it” with, was on the phone with me a lot. I was excited to talk to her. But all this added up.

I realized oh shit I need to slow down. I haven’t crashed yet but I’m french frying. There is still time for me to “pizza” or in the immortal words of South Park’s ski instructor Thumper

If you french fry when you should pizza, you’re gonna have a bad time

I love french frying, the food, the ski position and the metaphor for speed. I want get over my skis. But if I don’t pizza “I’m going to have a bad time.” So with true Colorado wisdom it is time to kick back, get some THC and pizza. May this edition of Rocky Mountain wisdom aid you in finding balance on the slopes and off.

Chronic Disease Politics

Day 142 and Optimism

The pandemic has done more to improve my life than to it has hurt it. I have a little survivors guilt as I am not far from family and friends that have suffered but I was lucky. Part of my luck has been tied to my privileged place in society. I was able to enjoy housing flexibility and leave behind an expensive city apartment for a townhouse in my hometown. I was always able to work from home with little fear my income would be impacted by disease or even negative secondary effects. Nevertheless I haven’t felt much optimism until recently.

Part of my lack of optimism has been tied to my health challenges. It’s been two years of working to get a diagnosis, stabilize my spine, and get the secondary symptoms controlled. There were low points when drug regimens didn’t work. Or when it seemed like the fatigue or pain would keep my life away even when primary concerns were improving. I was genuinely terrified going into the pandemic as it did cut off my access to typical doctors visits and more hospital setting delivered care.

But I’ve found significant improvement over the past six months thanks to excellent remote care I was able to receive from functional medicine doctors. It’s almost as if with the operational and physical logistics of care removed the actual outcome of my care improved. I was able to get to the heart of a diagnosis and hone in on effective treatment protocols more quickly. Thanks to this improvement I’ve come to find my optimism again.

Not that I think the world is getting better. If anything I’m far more worried about the many axis of American failure. Our politics has become authoritarian. Our economy increasingly serves only the entrenched and already wealthy. Our interest in mitigating climate change remains low. It’s so bad the best we can do is chuckle at why millennials don’t have kids. It’s because they are selfish right? Nothing to do with how hard it is to trust that the system will ever work for you so why bother investing in the future?

But I am intrigued by the opportunities afforded by the chaos. There is money to be made adjusting us to new realities. Maybe by dint of accidental or unexpected changes we find innovations that change our world. Maybe those will be for the better. And maybe I can help nudge along the better outcomes. And for the first time in a while o believe my body will be up for the challenge. It’s nice to be optimistic.

Biohacking Chronic Disease

Day 138 and Positive Reinforcement

All my health apps think I’m dying. Which like no duh guys I’m an avid biohacker because I’ve got some health challenges. This is a persistent issue across most tracker apps but a compelling example is the Gyroscope app which relies on a health score system. Because I have a high resting heart rate due to chronic pain from ankylosing spondylitis I get served persistent alerts like the one below. “Warning you are more likely to get sick right now”

Of course, the issue is if you are always getting flashing red lights your inclination to do anything goes down. It’s the “boy who cried Wolf” problem. If I’m always being told I’m more likely to be sick now why would I ever modify my behavior to try and improve things? It’s always “now” so there is no point in doing anything to make a better future.

We see this problem across so many areas where our future selves would benefit from our present selves being more responsible, from personal finance to weight loss. If everything sucks now and nothing we do seems like it will improve the situation by a meaningful margin why bother?

App designers need to take note of this tendency of despair based on the gap between short behavior loops and long term goals. Nudging us towards improvements required positive reinforcement that rewards us for who we are now even as it seeks to compound the positive effects for significant change over time for a future outcome. If you’ve got 50lbs to lose you need to be rewarded for each small decision that helps you lose your unwanted weight, not be told everyday by an app that you are at risk of disease.

Overwhelming human minds with the enormity of a goal or a gap between our current stare and our long term goals doesn’t lead to positive short term behavior. If it did we would have solved climate change and racism by now. If we think a problem is within our power to solve we will try but fuck it why bother if it’s a parade of impossible scenarios.

If you are designing systems for people that need to make changes keep in mind this gap. You will see better results and happier humans if you lay off the doom and gloom. Positive reinforcement works.


Day 131 and Doing Less with More

I’m a lot busier recently. Maybe it’s a function of the ebullience that is gripping a vaccinated America but I’m finding more obligations in my calendar than I can recall in years. It’s still not quite to the place I was when I was a full time founder but I’m noticing fewer long blocks of time to myself.

I benefit from unstructured unencumbered time at rest. It’s not that I need it to be alone time or quiet time as much I need full on rest. I thrive when I have no reason to get out of bed. I do best reading and synthesizing when my mind is free to wander without any obligation to anything but that space.

Even otherwise pleasurable but not explicitly rest activities like going for a hike or painting my toenails doesn’t register as rest to me I’ll feel a kind of indignation when I’ve had an otherwise amazing day (filled with leisure activities) but didn’t get enough rest. I’ll think “sure it was fun” but also “now I’m tired and that wasn’t restful at all” goes through my head. For me the most restorative thing is not to do anything at all.

In fact the further away my activity is from boundaries like being constructive the more constructive I am afterwards. I try not to set myself up with the expectation that I am rewarded by productivity when I am at rest. That would set in motion the same circle of doing activities and not feeling rested because it wasn’t explicitly rest. That would become a kind of self limiting belief that leads to workaholism which I’ve pledged to avoid.

I hope that as the enthusiasm of exciting work and better help take more of my time I don’t feel tempted to indulge in activities that don’t feel restorative to me. None of this year would have been worth it if I went back to old unfulfilling ways of living.

Chronic Disease Chronicle

Day 129 and Worried About Wellness

Last week I felt like I was struggling to hold together level emotions and coherent thought. I had a lot of “feels” posts where I spent more time inspecting my interior world than I did analyzing exterior events.

When I feel energetic I can take in more information and engage in synthesis but when I’m feeling tired or otherwise am flaring from autoimmune condition I requires more mindfulness. This mindfulness lends itself to more of an inner focus. Often this brings me a sense of peace and emotional well being. Lately my case has been well controlled to the point of recovery, yet I haven’t felt as emotionally joyful about the development as I thought I would.

Then around Thursday or Friday of this week I found myself turning a bend. I was excited to think about very abstract ideas like the aesthetics of finance and how critical theory and how great works culture is colliding with Gen Z vibes.

I struggle with wanting to lean into enthusiasm though. Too many days in a row of exertion or excitement and I fear I’ll set myself back. That’s a kind of self limiting behavior that I hope I can let go. I want to feel confident in my energy but I do not want to turn myself back into workaholic habits either. This is a fear so persistent I’ve tagged eight posts in the last five months with the topic. So great is the fear that I felt some relief that I felt physically unwell today as I could blame my body instead of making the choice for myself if I wanted to be driven by energy and not recovery.

I can’t put off the mixed emotions on wellness and how I feel about working in the world. My capacity is nearly there. I’m taking on more and more. I have even plotted some of my next moves. But I’m feeling Augustine about the whole affair. Oh make well God but not quite yet!


Day 124 and Taking a Pass

Most days I have at least some idea of a topic or an idea that grabs my attention. Even when I click open the WordPress app to write and don’t have something I want to explore I can generally find my way into something. Today I had a number of appointments for medical stuff that has just drained the life out of me. So I’m threading together sentences but a topic isn’t coming to me.

I mostly just want to sleep. My head hurts, my spine is throbbing, and I feel like the day just kicked my ass. But I swore everyday I would write something so here I am with nothing to say trying to fill a page.

It’s hard to know when a bad day will strike which is part of the challenge of a daily writing obligation. It’s somehow easier and harder all at once. It’s easier because with a daily exercise you know it will have some duds. But it’s also harder because you can’t just put it off. Still I think I’d rather know some days will have poor content. That’s easier than only ever publishing writing I’m proud to have made public. I’ll take the “pass” grade and move on. Perhaps tomorrow I’ll have something great.