Healthy Living Can Be Deadly

A Guide to Not Dying

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This is very much a behind-the-scenes post. As I mentioned recently, I had to undergo life-saving surgery last week, and the problems leading up to that had caused my fall-off in productivity. I’m now ramping back up.

First, I know I missed a bunch of comments while I was sick. I don’t yet have the strength to go back and reply to them, and I might just give them all a miss. If you commented on anything of mine in the last two weeks and are itching for me to reply, do let me know.

Now, since prurient interest is the defining virtue of the Internet, and since I’m enough of an exhibitionist to write this column, I figured I’d indulge the mutual voyeurism for fun and profit..and, maybe, save someone else’s life in the bargain (seems only fair as I almost died for one of the stupidest reasons I’ve ever heard of). So buckle up for a journey of guile and bile and the most ridiculous medical misadventure I’ve ever experienced (which is saying a lot). If you’re offended by irreverent metaphors and disgusting imagery involving life threatening bodily conditions...well, how have you ever read anything I’ve ever written to this point?

On with the show!

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Life Is Pain, Highness

I’ve never made a secret of the fact that I’ve always lived with pain. I was one of those kids you couldn’t keep down. No adult, no proscription, no law of physics could keep me from following every stream, climbing every tree, and mounting every Ford.

But gravity would occasionally glance sharply in my direction and bitch-slap me. As a result, on no fewer than four occasions, I fell from a high place to a low place and landed on my neck, head, or shoulders, and suffered a sprained neck and concussion. If you think I’m insufferable now, you can thank these injuries for reducing both my IQ and my sense of unaccountable invulnerability from truly catastrophic levels to their current state of mere insufferability.

By the time I entered elementary school, I was always in pain. I had permanently damaged my neck muscles, making my genetic predisposition to cluster headaches much worse (the injuries added a series of triggers for those headaches that cued off of muscle pain and tension loops). For the next twenty-five years, I lost at least a week out of every month to dark-room isolation because a cluster broke through and made me hurt too much to keep my eyes open.

So yeah, pain’s a thing. You can learn to live with anything.

I was always active. I wasn’t about to let the pain get me down. Weirdly, though no matter how active I was—and at my most active I was hiking 10-20 miles a day at quite a brisk pace—I never could avoid weight gain. No matter what I did with my diet, or how much I lifted, or anything else, the pounds kept piling on at the rate of 2-10 per year. It drove me insane. Feeling like a freak of nature has its perks, but there are definite downsides.

Unbeknownst to me, there was something else at work in my body that would eventually put me in mortal peril just as I hit my stride on the project I’ve been working towards my whole life...and this one didn’t come from an injury.

But we’ll get to that.

By the way, if you want to skip all the ridiculous medical fuckery to the takeaways, click here.

A Life Less Urbanary

By my mid-thirties, I figured out that being a writer in the city is a bonehead maneuver, financially-speaking. I loved my city, but the call of the wild has always tugged at my heart, so I moved to a little shack on the beach in the middle of nowhere, got a high-drive dog, and spent most of every day walking and running on that beach.

My stress was lower, my headaches were better, and I was insanely productive (fully half of my currently-published fiction catalog was written in those two years). Country living, fresh air, garden food, it all agreed with me. I kept looking for ways to take the weight off—Type-2 Diabetes runs in my family, and I really wanted to avoid that fate.

After several more years of experimenting and research, I happened upon Intermittent Fasting. What intrigued me most about this weight-loss method was its apparent ability to de-escalate metabolic syndrome [link] (which is pre-pre-diabetes, and which I assumed I had because of the perpetual weight gain). I gave it a try and...

...it worked.

Over the next four years, I lost around a hundred pounds.

I had conquered my Everest. I felt great. I got to the point where I was comfortably wearing clothes that I owned in Jr. High—they weren’t particularly fashionable, but they were great for grubbies around-the-farm.

The Stress Demons Strike Again

Unfortunately, for various personal reasons, life was insanely stressful, so of course my back was acting up. Stress always made it do that. But life has stressful seasons and better seasons, and I was in the middle of moving to my dream home—a place in the wilderness where I could hand-build an artist's retreat (a childhood dream) and write my novels. There was a lot of hard work ahead, but hard work is, I have found, good for stress levels. I had no reason to expect that things wouldn’t move onward-and-upward.

Then I got here. The first winter my brother lived next door, and he said I looked like I’d aged ten years in the last three. He was also worried that I was “always” sick now—between back pain and garden-variety rhinoviruses, I seemed to be down more than I was up.

I figured I was just recovering from a few stressful years. I was still feeling grand most of the time, and I was doing what I loved, so I kept getting my exercise, and sticking to my fast schedule, and building my homestead.

But the stress wasn’t getting better, and my health wasn’t either.

By the time we hit this winter, I was in bed more than out. I was barely eating. My muscle mass was waning, and yet I was gaining weight, probably because the only thing I could eat without pronounced discomfort were simple carbs.

I’d had a sour stomach from stress before. I knew what it felt like, and it felt exactly like this...

...except, this was worse than before. And the incredible stressors of the past few years, which I’d blamed for my sour stomachs, were mostly gone.

Well, I figured, it has to be because I’m not a spring chicken anymore. It takes longer to recover from bad stress hits when you’re in your 40s than it does in your 20s, doesn’t it?

Lacey, a spring chicken

The Seizures

The worst thing for me about all of this was the back pain.

No, not pain, massive muscular seizures.

Without any major injuries I could identify, my back would just seize up. A few too many hours at the desk, and my back straps were so tight you could use them in a suspension bridge. A minor argument with a friend, and the next day I might be flat in bed feeling as if I were being constricted by a python (yes, I actually know how this feels, as I used to keep large pythons and there were some entertaining accidents). I knew something wasn’t healing right, but I couldn’t figure out what.

Then, in January, shortly after I published [The Parable of the Shuffle Plow], I took a minor slip-n-fall on some ice and strained my lat muscle. No big deal. That kind of thing makes me a little sore for a couple of days. True to form, the next day I only had a dull ache. Walked it off, easy peasy.

But the day after that, I was all seized up.

And it didn’t go away.

Four hours of massage per day, hot packs, muscle relaxants, nothing seemed to help for three weeks.

Then, one day, I woke up, and it was all better. I got back in the groove, took on a new client, and got myself back on track with the various projects I had going. Life was back to great.

For eight days.

Then, fifteen minutes after a minor argument with a business associate, the pain was back. I laid down, popped the pills, went to sleep, and woke up feeling okay.

The Moving Baseline of Gross-Outs

When I read all of that, it seems insane to me that I didn’t cotton that there was something else going on. Some part of me obviously knew—my fiction and affect have gotten significantly darker over the last few years, and that’s saying something (both have always been quite dark)—and I’d occasionally openly speculate on whether I was going to discover I had some weird form of almost-undetectable cancer someday, despite no family history and no behavioral or environmental risk factors. I’ve literally never even been drunk—not because I disapprove, but because I’ve never particularly enjoyed the sensation of being high. It feels too much like being woozy from pain.

But when you’re living in the same body day-to-day, you can decay quite quickly and not consciously notice it. Your baseline of “normal” moves much quicker than you might expect.

The morning I woke up feeling okay, something happened that jogged me out of the moving baseline:

My urine was brown.

Not “I’m a bit dehydrated and should drink more” dark, but “I’ve decided to open a coffee shop with my penis” brown.

fancy a cup?

A quick glance through the layman-available medical literature will show you a half dozen conditions that can cause this problem. Fortunately for yours truly, each and every one of them can kill you pretty damn quick.

But one of them can be cured without major surgery or chemotherapy:

Myoglobin poisoning caused by muscle death, what doctors call “rhabdomyolosis.”

Treatment?

Fluids. You’ve got muscles that are dying and releasing toxins into your body, you have to keep fluids going through you to flush those toxins out. If you don’t, they’ll box your kidneys, ruin your liver, and eventually stop you heart. But if you get enough fluids, you’ll be okay.

Overdoing it on massage can cause this condition.

Brilliant! Hydration, here I come!

So, for the next few days, I paid the annual salary of at least 4 full time employees of the Gatorade corporation. I have never drunk so much in my life, and I managed to keep my urine slightly-lighter-than-coffee. It was working!

And then, suddenly, it wasn’t. I couldn’t keep up. I was going to need to go to the hospital for IV fluids.

No sooner had I made up my mind to do that, than the jaundice set in.

Half an hour later, in the ER, I looked like I was trying to infiltrate a mustard factory.

Some quick tests revealed that I didn’t have rhabdomyolosis. I had something worse:

A blocked bile duct.

What is bile?

Bile is secreted by the liver, collected in the gallbladder, and squirted down into the small intestine where it helps break down complex fats and alkaloids (cocaine, caffeine, nicotine, capcasin, several other kinds of drugs, etc.). Without it, you can’t properly process fats, and you become malnourished and get a lot of diarrhea.

Illustration of gall bladder and bile ducts, Gray's Anatomy, Plate 1095

The bile had backed up into my pancreas, causing severe pancreatitis (inflammation of the pancreas), which was causing all the back pain.

It had backed up into my circulatory system, causing the jaundice.

And it was about to kill me.

There was no non-surgical solution: either I had bile-duct cancer, or I had big gallstones. Either way I was going under the knife in the next forty-eight hours, or my pancreas was going to shut down and I was going to die.

A Few More Surprises

This was the point when I posted the Quick Update.

Things happened fast after that. I rushed to the big city to snag the only open hospital bed for 800 miles in any direction. I had an MRI to determine gallstones vs. bile duct cancer.

To my relief—and surprise—it was gallstones. I didn’t have a gallbladder so much as I had a gravel pit. The surgeries corrected both the blockage and removed the source of the blockage, so my prognosis was good. The surgeon told me to expect to feel better as soon as the sutures healed.

But that wasn’t what happened.

The morning after the second surgery I woke up, no drugs in my system, and I felt something very strange indeed.

I felt no pain.

I don’t mean “my pancreatitis was gone” or “my back didn’t hurt” or anything like that.

I mean that nothing hurt anywhere.

Not a twinge in my neck.

Not an itch in my ankle.

Not a stiffness in any joint.

Not any discomfort in my guts.

No.

Pain.

At.

All.

I sat there in the morning sunlight, looking out the window, and sobbed.

I sobbed because I hadn’t felt “no pain” since I was in elementary school, if not earlier.

Oh, I’d thought I had. I’d had great days—a lot of them—when I wasn’t aware of any pain.

But the pain was always there.

A lot of it.

My mind was limber. I felt as if I’d gained a standard deviation in IQ (there is a long story about how I know what that feels like, but I do). I dreamed up four new novels that afternoon, and got notes down for them, and in doing so I realized I haven’t completed a fiction project in three years...because I was in too much pain to drop my emotional walls low enough to close character loops.

Which left a hell of a puzzle:

What was actually going on all this time?

The Foundations of Misery

Since this is the kind of question that can re-write your entire understanding of your life, I was not about to let the puzzle go. I had a couple days in the hospital and I had four specialists doing rounds on me, so I decided to deputize them.

How the hell was it possible that removing your gallbladder in your 40s could possibly take away pain you’d been having when you were ten years old? Ten year-olds don’t get gallstones, right?

Well...actually, they might. And, in the case of my medical support staff, they were pretty sure I did.

How?

Well, what causes gallstones?

The big risk factors are the four Fs: Fat, Fair-skinned, Forty-or-over, and Female.

I’ll cop to the fair skin, but the others were not a problem when I was ten years old.

So, dig a layer deeper. What are gallstones?

Gallstones are congealed lumps of bile. They happen when the body can’t correctly synthesize bile from its nutrients. This can happen because excess systemic cortisol (the stress hormone) screws up the hormones your liver needs to make bile. Or it can happen because you have a nutritional deficiency that throws off the balance of cholesterols, enzymes, and carrier fluids that make up the bile.

I had an unusually high stress childhood. Part of that stress came from poverty, and a side effect of having impoverished Boomer parents was malnutrition.

Specifically, in an era where “received wisdom” (i.e. nutritional dogma which has long since been exposed as pseudo-scientific marketing scams) held that “unsaturated” fats and “vegetable” fats were much healthier than horrible things like butter, lard, bacon, fatty fish, etc., the health-conscious budget-conscious Boomer parent did everything they could to keep their kids away from those things and keep them well-supplied with treats that would take the edge off: cookies made with shortening, candies, fruit-sweetened foods, granola, etc.

tasty snack, but a not-so-balanced breakfast

In my case, I grew up in a family that was—for both budgetary and health reasons—vegan for about six years. And at the end of those six years, I came down with appendicitis.

Appendicitis?

This deadly inflammation of the appendix happens when something gets caught in the sphincter that opens and closes the appendix. Among the more common “somethings” that can do this are—you guessed it—gallstones.

So, in pursuit of “good health,” I developed a diseased gallbladder as a child, which nearly killed me from appendicitis. This same underlying condition then riddled me with all kinds of pain my whole life, which was a huge factor in my long-term weight gain.

Oh, yeah, the weight gain. That’s a fun one. Here’s how it works:

When your bile chemistry is off, you don’t do a good job digesting the very fats that your body needs to manufacture healthy bile. However, simple sugars induce the synthesis and release of opiates, which kill pain. So your body is always pushing you to eat the wrong balance of fats and sugars, and what your body is driving you to do you will eventually do no matter how much you try not to.

Too much sugar can cause pancreatitis just like the bile-backup can, which can cause (among other things) Type-2 Diabetes.

What else causes the release of these kinds of opiates?

Exercise. I didn’t appreciate how big a factor this was in my staying highly active my whole life. I literally did film stunt work and acrobatics for a while, despite looking more-or-less like Jabba the Hutt dancing Swan Lake.

Fasting, it turns out, also stimulates opiate release. Which is why Intermittent Fasting is the only weight loss program that ever worked for me.

And that led to another interesting complication.

“There’s a problem with the literature on intermittent fasting,” my gastroenterologist told me...

The Last Sting in the “Healthy Living” Tail

“If you don’t increase the percentage of animal fats in your diet while you’re fasting, you’ll get gallstones sooner or later, especially if you’re European or East Asian.”

So, having gallstones made me fat. Getting skinny made the gallstones try to kill me. Great. “Trying to be healthy pretty well fucked me all around, didn’t it, Doc?”

“Well, not exactly. All your blood work and cardio tests we’ve given you while you’ve been here,” and there were a lot of them, “show your metabolic response, oxygen update, and cardio function are where we’d want them to be for a twenty-year-old. Your activity and the intermittent fasting have really made you healthy. You’ll be fine now that you don’t have a gallbladder or an appendix to worry about.”

So, word to the wise, if you want to shed some pounds, make sure you don’t just restrict your food intake, you’ve gotta change the ratios of animal fats-to-protein-to-carbs.

Anyway, ladies and germs, that’s what I’ve been up to the last few weeks. I’m still on the mend, but am approaching fighting shape (I mean, I could write this essay, couldn’t I?). So I’ll leave you with a few fun thoughts:

• Nietzsche was right: what hasn’t killed me made me stronger. Huzzah!

• Hospital people seem to be divided into two groups, both of whom are vastly entertaining in their own way. The first is used to dealing with folks who have room-temperature IQs, and have optimized their patter around that. If you run into this sort and ask an informed question, their brain skips. You’ve disrupted the patter, they try to code switch, and they have a small aneurysm while forgetting how to speak English. The other sort, upon encountering an informed question, blink. Their face blossoms with delight. They look at you as if you’ve just restored their faith in humanity. There IS intelligent life on this planet, they want to shout. At last my time of trial is over! I can now return to the mother ship and report this joyous news!

• Every time I go to the hospital, they take an organ away, and my life gets better. It makes me wonder what heights of health I might achieve if I were to have my whole body surgically removed.
  Then again, having known some prominent transhumanists, perhaps this would be “too much of a good thing.”

Thanks so much for all the messages of support and goodwill. I shall return to attempting to mangle your brain on the regular very soon!

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Next week should see the return of my Reconnecting With History series, where I bring to bear my four decades as a history and geopolitics geek on the strange world-historical moment unfolding around us.

Catch up here with the inaugural post: The Myth of the Myth of the 1950s

While you’re at it, you may also want to check out my Unfolding the World series, a history of the current geopolitical storm rocking our world, its roots, and its possible outcomes.

When not haunting your Substack client, I write novels, literary studies, and how-to books. You can find everything currently in print here, and if you’re feeling adventurous click here to find a ridiculous number of fiction and nonfiction podcasts for which I will eventually have to accept responsibility.

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