My photo after excision of some dysplastic cells on cheek.

This photo was taken on Sept 16, 2019

Not much to see. But I knew it was there. 

It is visible on the right side of check just under my sunglasses. 

I circle the lesion below

The lesion (a cluster of dark spots) is just under my right sunglass. 

My plastic surgeon was young but good. 

She injected my skin with pain killer before the excision. 

It hurt.

I said if you let the alcohol dry first it doesn't hurt as much when you put the needle in. 

 I told her I learned that from doing phlebotomy.

I learned from my dentist it is also important to inject the fluid slowly. 

I was nice and said kindly, "but I know surgeons are in a hurry."

She replied that they are in a hurry but she would try my tip.

At the end she said she took off my 'dog tails'

I asked what that was that?

She told me it is the end stitches. 

I was surprised I didn't know about it. 

She said why should you know about it?

I said I have been around but

 I don't know what I don't know. 

Stay tuned for stitches out in 2 days and pathology report. 

If I can still twitter do I still have sense of self with Alzheimer's diagnosis

I love to twitter and blog.

I am publishing YEAR TW0 and writing YEAR THREE series of having Alzheimers.

If I can tweet I don't have loss of self from Alzheimers.

This is an amazing discovery in the study of Alzheimers.

It is similar to "I think therefore I am"

If I tweet I am link

I think this is a bold discovery 

Review of article: What I wish I knew before my My Mother's Alzheimer's death

What I Wish I Knew Before My Mother’s Alzheimer’s Death

“They say the disease takes a big downward step and then stabilizes, but that those periods of stability get shorter and shorter.”

 “she had lost the ability to walk”

“we finally encountered the real killer with Alzheimer’s—forgetting how to swallow.” 

 “She hated those—even in her advanced state, she refused those pastel, toddler sippy cups. I could get her to take one or two sips of water from a normal glass, but her eyes would go dark when I tried with a sippy cup. I clung to that.” 

“She may have been in the grips of the last stages, but by gosh, she wasn’t going to lose what shred of dignity she still had by drinking from a plastic pink sippy cup!”

 “Why is Alzheimer’s so cruel to steal memories and awareness, but leave the emotions?”

“she had forgotten how to cough, forgotten that coughing would clear the airways, that it was important to spit or swallow the phlegm. Instead, she sputtered. It was distressing to see her like this, and we asked, like we always did, “Are you in pain?” For the first time in the eight years that she battled the disease, she nodded yes, yes.”

 “I didn’t understand that when she still did a slow tap-tap-tap on her head, it would be the last time she would move. Either I misunderstood the doctor, or I didn’t want to understand the doctor—I thought she would be comfortable, without pain, but still awake.” 

“I learned that there is a silver lining to the disease. By the end, the patient is unaware of their condition, unaware that they will die from it. Not like a cancer patient, that is fully aware of the terminal nature of their disease until the end. An Alzheimer’s patient isn’t aware and that is a blessing”

“And that is the one good thing about Alzheimer’s, it makes saying goodbye at the end easier for the family and for the patient.”

Plateau success over Holidays with Intermittent Fasting

I finally decided to try Intermittent Fasting on November 9, 2019

I was never against IF except for concern of nitrogen balance. 

The main reason I didn't advise it in my book 

THE CHRONIC DISEASE OF OBESITY

was because I thought IF was too restrictive for long term dieting. 

Also the usual belief was that breakfast was essential. 

I thought for myself when I skipped breakfast I overate at lunch.

I skipped  breakfast through High School. 

With coffee I find I can do IF and cope with the hunger. 

I am motivated to stick with it because IF has improved my glucose levels

Today I am impressed that IF broke through my plateau to 208 pounds

I achieved this with only walking 4,000 to 7,000 steps a day

I do have the advantage of taking 

Belviq for hunger

Victoza for hunger

Invokana to urinate glucose 

Metformin for DM

I want to control my glucose better as I have Alzheimer's.

I hope to slow the progression of my disease. 

I also keep my LDLp down to extreme low of 333.

This is a unique approach to Alzheimers. 

I have done well with my CIMT's due to my low numbers despite 

poor control of Hemoglobin A1c.

Lab, CIMT, CAC results over a decade link

I have obtained much better glucose levels with intermittent fasting

I have obtained much better glucose levels with intermittent fasting as determined by multiple glucose checks with Continuous Glucose Monitoring. 

I have coffee in AM and again at Noon to put off food as long as possible. 

Today after 2 coffees at 12:25 PM
I had CGM 90.
Glucose stick was 99.
Ketones went from 3.2 in AM to 5.3

This improvement in my glucose has motivated me to stay with intermittent fasting.

I have Alzheimers and want to have better glucose control.

If I can do that with skipping breakfast and putting off lunch as long as I can, I will do it. 

I always was taught to not skip breakfast.

I thought when I did skip breakfast I became hyperphagic and overate. 

I am on Victoza and Belviq which helps me with my appetite. 

I also take Invokana which causes me to urinate about 200 calories of glucose/day 

Lost 30 pounds with Invokana link

TEN quotes from Jasja De Smedt Kotterman March 16th, 2018

What I Wish I Knew Before My Mother’s Alzheimer’s Death

“They say the disease takes a big downward step and then stabilizes, but that those periods of stability get shorter and shorter.”

 “she had lost the ability to walk”

“we finally encountered the real killer with Alzheimer’s—forgetting how to swallow.” 

 “She hated those—even in her advanced state, she refused those pastel, toddler sippy cups. I could get her to take one or two sips of water from a normal glass, but her eyes would go dark when I tried with a sippy cup. I clung to that.” 

“She may have been in the grips of the last stages, but by gosh, she wasn’t going to lose what shred of dignity she still had by drinking from a plastic pink sippy cup!”

 “Why is Alzheimer’s so cruel to steal memories and awareness, but leave the emotions?”

“she had forgotten how to cough, forgotten that coughing would clear the airways, that it was important to spit or swallow the phlegm. Instead, she sputtered. It was distressing to see her like this, and we asked, like we always did, “Are you in pain?” For the first time in the eight years that she battled the disease, she nodded yes, yes.”

 “I didn’t understand that when she still did a slow tap-tap-tap on her head, it would be the last time she would move. Either I misunderstood the doctor, or I didn’t want to understand the doctor—I thought she would be comfortable, without pain, but still awake.” 

“I learned that there is a silver lining to the disease. By the end, the patient is unaware of their condition, unaware that they will die from it. Not like a cancer patient, that is fully aware of the terminal nature of their disease until the end. An Alzheimer’s patient isn’t aware and that is a blessing”

“And that is the one good thing about Alzheimer’s, it makes saying goodbye at the end easier for the family and for the patient.”

Fish Oil

I am trying to take more DHA for my brain as I have Alzheimer's

I have been taking Lovaza 4g/d for a long time with great non-fasting triglyceride levels.

My Cognoscopy done at the Atma Holistic clinic shows my levels are good on Lovaza 4,000 mg a day.

In the End of Alzheimer's Program by Dr Dale Bredensen on page 154.  "The brain is unable to manufacture DHA locally."

Omega Quant I ordered this test today.

Testing for fish oil levels is easy now? link

Fish oil by Maki link

My lab with history of DM2 since 1999 and obesity

People asked me to stop Lipitor 10 mg to see if it helped my memory. 

 April 10, 2019.
I stopped the Lipitor before my trip to Europe and Mediterranean cruise around

May 7, 2017
I started Zetia 10 mg 

August 3, 2019
I stopped Endur-acin


Stopping Lipitor on Zetia alone. LDLp went up to
LDLp 1033 on 6/12/2019

Non Fasting Routine Lipid Panel Oct 2019

October 2019

BIA weight 12-17-2019

More advanced testing

My first 1993

How I survived 5 days of Holiday eating in New Orleans

I flew into New Orleans on Nov. 19, 2019 Tues 
Red Dog Diner  link
I had Old Fashion
Sphagetti Bolonese



Weds 11-20-19
Cooked shrimp scampi in Timeshare
Wine

Thurs 11-21-19
Compere Lapin link
Spiced Pig Ears
Great small oysters from Alabama
Curry Goat
Collards and coconut cream
Sazerac cocktail
Wine
 Amazing restaurant.  Everything we ate was unique and wonderful.

Fri. 11-22- 19
Luke restaurant link
Oyster Happy Hour
75 cents per oyster.
I had cocktails and wine.
I always try to hit this on my trips to NOLA

Sat. 11-23-19
Cooked Lamb and Salmon in Timeshare
Wine
Salad


Sunday 11-24-19
Ruby Slipper  link
I had two vodka bloody mary's.  Excellent with more pepper than spice as do it in NOLA
Migas plate
Only breakfast I ate in NOLA


I survived the Holidays in New Orleans with my new diet approach
 INTERMITTENT FASTING ON LOW CARB HIGH FAT.

I went on stricter IF here link 

Earlier I was able to do below:

 IF with help of Continuous Glucose Monitor link



Notice on the BIA scale below, lower weight had more fat. 

How to get your NON-fasting triglyceride less than 100

I wrote advice to get NON-fasting triglycerides less than 100 link

Now, I want to point out the 3 items to get to that goal:

1- Low carbohydrate high fat #ketosis diet

2- Enduracin (nicotinic acid) 1,000 mg/d

3- Lovaza (omega-3-acid ethyl esters) 1,000 to 4,000 mg a day

I will start with discussing the brand name: Lovaza.

I go to my pharmacy and ask for the generic version of Lovaza. 

It is very easy to do.  

You do need a Doctors prescription.

I like Lovaza because positive trials were done with it in Italy.

GISSI trial 1986

I like buying this drug (nutrient) because it has been much cheaper, especially on my medicare with the supplemental drug coverage. 

If no coverage you can find the cheapest SAM's or COSTCO version.  

Just do the math. 

1,000 mg Lovaza = EPA 465 mg + DHA 375 mg

Concerns have been expressed that DHA raises LDLc.

It is a fluffier, larger LDLp.

Thus the LDLp increase was never an issue for me in my practice. 

New great trials with only the EPA component suggest they may be better. 

1-statin

2-Enduracin

3-Zetia. 

All 3 are now generic (inexpensive) and at low doses have few sides effects.

I continue that model with generic Lovaza. 

Now that high triglycerides are receiving much more attention, I give the 3 steps (items) above. 

Try it out, then:

Add Zetia and then statin to get the 

MULTIPLIER EFFECT (link) 

that I write about.

This approach will achieve superlative target values as good as the 

expensive intravenous PCSK9 drug

Best Breakfasts in the World : New Orleans

Best Breakfasts in the World :  New Orleans

Many great breakfast spots such as Mothers on Canal.

Ruby Slipper very popular. 

Lines outside restaurant form early.

All excellent and unique specials. 

I had Migas below. 

 I would have it again.

Maybe the best Tortilla chips ever.

Spanish Omelete 

The roasted potatoes were the best.

French Toast 

Alcohol with breakfast?  Dat true in New Orleans