Saturday, September 21, 2019

Pigs knuckle in Vienna.

Best thing I ever ate.




Back to NYC #3 McSorley's Old Ale house






The dark is better than the light.  Less bitter



See the turkey wish bones hanging from the rod.

These were left behind Irish soldiers in WW I who never made it back alive from the war.

There was dust accumulation on them that was almost 1/2 inch tall.
Finally the dust fell into someone's stew and the bar had to clean the dust off. 

Back to NYC #2 Looking for Dum Sim as good as Shanghai city

You may not find this on google but the best Dim Sum is in Shanghai.

I tried to find someplace in America that was almost as good.

It was second best but it was close.









This is how to eat Dim Sum.
Take a small bite out of the noodle.
Don't let the fluid spill out as I did in this photo. 
Suck all the fluid out from this aperture. 



Crispy beef strips were excellent.






Back to NYC #1 Surprised to see these barriers in action.

Success story with maintaining weight loss with good documentation

By my calculation @50fitty maintained at least 
15% body weight for 18 years. 
Great job!
















 Posted Sept. 2019

Monday, September 16, 2019

Gellert Thermal Bath in Budapest

Highlight of 14 day Eastern European Tour

Getting ready in closet size cabin.

 Front entrance to hotel.  Entrance to bath around the corner.

Indoor Swimming pool.

Outdoor swimming pool.

Spa cafe.

BBQ ribs for lunch.  Very good. 

Big hamburger

Aperol spritzer and Long Island Ice Teas

I built up an appetite after dunking in 
18 degree Celsius (64.4 F) pool 5 times alternating with 
80 C  degree (176 F) Sauna
43 C degree (109.4 F) Bath
and Steam room.

Friday, September 13, 2019

My advice is to get NON-fasting triglycerides to less than 150 or 100 in anyone with positive CAC.

I started Atkins or Low Carbohydrate High Fat diet in 2011
Here are my lab since 2013. Routine Lipid Panel. Not expensive, usually covered by insurance.






Routine Lipid panel  10-28-19  on very low dose Lipitor (atorvastatin)
I break the generic 10 in half.  I started  Lipitor 5 mg  on 10-20-2019


I have BMI 30 and take Lovastatin 5 mg, Zetia 10 mg and Enduracin (nicotinic acid 1,000 mg)
All low doses and inexpensive.  At low doses rare to have side effects.





New National Lipid guidelines came out to lower triglycerides in high risk patients.



In 2010 I published The Tubby Theory from Topeka



In patients with a positive CAC and one risk factor 
I advised aggressive treatment to prevent further plaque 
and even regression of plaque. 


Goals: 
non-HDLc less than 80
LDLp less than 1,000 or 750
Triglycerides less than 150.
(I now advise getting Triglyceride level less than 100 Non-fasting)

Over the ensuing 10 years the guidelines have caught up with my advice.
The idea of treating earlier to prevent complex plaques which are resistant to the therapy later caught on.
I called this the  Multiplier Effect link
1- use multiple medications in low doses to avoid side effects
2-use them early at the first sign of positive CAC or high LDLp


In recent years two great medical advances have been made:
1-PCSK9 inhibitor drugs
From wiki


2-Ethyl eicosapentaenoic acid

From Wiki



These are great drugs and apparently very safe. 

However in 2009 I proposed Topeka Triple Therapy to achieve very low levels of LDLc or nonHDLc or LDLp or apoB with very low cost and safety as low doses are used synergistically.

1-Lowest dose statin (many generic now)
One month later,
2-Endur-acin (nicotinic acid 1,000 mg) OTC
One month later,
3-Zetia (now generic)

Goals to get non-HDLc less than 80 (don't need expensive advanced lipid testing for this)


My goal was to give the public an inexpensive way with less side effects to get very low non-HDLc.
It was generally believed if at an early age LDLc was kept below 100 it would help prevent progression of plaque.
It was also believed if LDLc was kept below 75 it might reverse plaque accumulation.

I liked low dose nicotinic acid as it was shown to lower LDLc as well as triglycerides and raise HDLc.

Endur-acin was a wax matrix preparation that did not cause significant flushing.
In my patients I follow glucose levels carefully and never had to stop the niacin because of increased glucose.


Finally, I would give 1,000 to 4,000 mg of Lovaza (now generic) to lower triglycerides.

The new drugs are great.
They have the trials behind them.

Please try the less expensive Topeka Therapy first.











Thursday, September 12, 2019

The Absinthe experience in Cesky Krumlov


My two sons drank Absinthe when they visited Czech Republic ten years ago.

I wanted to share the experience.

The Zapa Bar was the perfect place in Cesky Krumlov.








The potential danger

Everything went well yesterday on my lone odyssey to the Prague Castle.
My wife allowed me to go out on my own as I had done very well with the group on the first day in Berlin.
 She needed to do laundry.
She said I seemed determined to do it and why should she try to stop me.
 She said I was so hyper that day that she knew she couldn't talk me out of it.
 She also thought I was having a good day.
 I told her I had the address of the Adler hotel in my wallet and I could always hail a cab to take me back if I became lost.
I had no fear of getting lost.

The potential danger is if I get stressed out trying to figure out the metro.
 I might get confused and take the wrong train.

Most people did not speak English but at the restaurant in the Old Town Square a waitress knew English and spent the time sending me in the right direction to my hotel.
 She showed me on the map how to get there.
It was fun following the map in such a picturesque setting.
I made a mistake bypassing one turn.  It was a long block and I didn't want to retrace my steps so I made a new route to the hotel.
When I reached the point to make the circle back it was difficult to determine whether to take a left or a right.
I took my time and believed I needed to take a right.
Fortunately five minutes later I saw a Mall that was a landmark and I knew exactly where I was.
I did not stress out despite being tired after walking 10,000 steps that day.
It was nice weather, not hot at all.
A bottle of water had greatly refreshed me going over Charles Bridge.
Another potential danger is getting dehydrated which adds to the difficulty of dealing with stress and making good judgements.
The sauerkraut soup seemed to have all the essential nutrients to help me carry on.

Another potential danger in traveling with Alzheimers is to not have the benefit of the iPhone in Europe.
Ginger and I can't contact each other to see how we are doing.
Ginger worried a great deal about me yesterday which is in her nature.

We both know that to make a place where there would be no risk would probably be worse for the progress of my disease.

We must be brave and bold and enjoy the challenges of travel and the unexpected set backs that will be unavoidable.

This is why I am writing this book, Traveling with Alzheimers Year Two.
I want people who receive the diagnosis early to know there is time for a great many good times and experiences ahead.

I am amazed and gratified that I was able to make this journey on my own one year and ten months after my diagnosis of Alzheimers was made.  Back in Dec 2017 I had no knowledge of what to expect in my particular case.  It was terrifying.
We made the decision to plan for the best and make the most of our time left together with great travel experiences.

When the diagnosis of Alzheimers is first made there will be initial shock and despair.
There will be depression from the apparent loss of a future.

These will pass with attitude correction, exercise, socialization,  and medication.

















Wednesday, September 11, 2019

Why worry about short term memory if I can still explore Prague on my own

I was diagnosed with Alzheimers in Dec 2017.
I only had mild cognitive impairment but a great deal of myeloid brain plaque.
I had one gene positive for AZ.

Today I was able to find my way to the Prague Castle by myself.
I asked the front desk at the hotel how to get by metro to Prague palace.
I had been. here for two days so I was already somewhat oriented.

I got off the metro and followed the signs to the palace.
I had the some hints from other travelers to bear right, not left.
That hint helped a lot.

I had a private car tour the day before and that helped me with reverse engineering.


I found the entrance to metro

 I took escalator down
 I validated my day transport ticket

 After going through some tunnels  I found the correct platform




I knew I wanted the green line

 On the surface I crossed this bridge



 The signs were a great help.
 View from the palace

 How I looked after my odyssey.  5,000 steps
 On the Charles Bridge
 Liter of beer and sauerkraut soup at Old Square.   Perfect replenishment.

 Later that evening after walking 20,000 steps for the day.  A new record.


update trials of Alzheimers

 The best part of the day is when I have a bowel movement.   Recently started Miralax. I found MOM too harsh. Pacing helps but I get exhaust...