If someone asked me how I define how I am doing at any point in time, I would tend to focus on many of the same things everyone thinks about with regard to their wellbeing. People usually weigh their wellbeing across several overlapping areas starting with physical health, gauged by sleep, exercise, nutrition, energy, managing illness or pain, and preventive care. They then move to mental and emotional health like stress, mood, resilience, and a sense of calm or control. Relationships and social connection tend to come next with issues surrounding close family and friends, community, and the things that stave off feeling isolated (research consistently ranks this among the strongest predictors of happiness and longevity). Then there’s purpose and meaning, where work, volunteering, creative projects, faith, or anything that makes our days feel worthwhile reside. We can’t ignore financial security, even if it’s less about wealth than about feeling secure and having enough to cover needs and some choices. Then there are a list of broader categories like autonomy or control over our time and decisions, growth and engagement (learning, curiosity, challenge), overall environment like a safe and pleasant home and neighborhood, time in nature, etc., and general life satisfaction (whether life is going well). These are all well-established elements established in one framework or another by social psychologists over the years. I would argue that there is also a new category that is particularly relevant to our times which might be best characterized as global security, which is where our concerns about things like democracy in America and other regions, global demographic trends, climate change, global conflict and violence levels, etc. have now risen to the whole DEFCON 2 level.
The question I find myself asking myself is how much of my bandwidth should be spent thinking about these issues and “worrying” about them versus just living out my days in as much peace and harmony as possible. There is certainly a part of me that thinks that life is short and there is only so much one can do about any of these factors, so we should just “Don’t worry, be happy”. But that seems both somewhat irresponsible and a bit denialist and I’m not convinced that one maximizes happiness by ignoring these things in favor of the hedonism of the moment. I regularly mention the Socratic warning that an unexamined life is not worth living. How can I be happy ignoring all of these issues which clearly affect me and the world around me, however I choose to define it? I can’t, but clearly there needs to be balance. How can I embrace Socrates and eschew Aristotle’s view of the “golden mean” where virtue sits between extremes? Aristotle is backed up by both Buddha (the “Middle Way”) and Confucius (Doctrine of the Mean), so I try to seek balance.
Since being O.K. starts with physical health, I feel that my last 18 months have finally found me getting to a good place on changing the things I can change like my weight loss and my fitness. I am down to a BMI of just over 30 and am perhaps 20-30 pounds from my ideal weight (the toughest 20-30 to be sure). I am on minimal meds (one ACE inhibitor and one diuretic, which Claude tells me may both be due to be eliminated). I just had a stress test which gave me a fitness rating of 10.5 METS (Metabolic equivalents), which puts me at 154% of average for a man of 72…in other words my fitness level is rated as excellent…which was a pleasant surprise. But at age 72 there’s literally always something. For men over about 65, the biggest health risks are, in this order: heart disease (blood pressure, cholesterol, diabetes, smoking, and inactivity drive most of the risk), cancer (for men, the most common are prostate, lung, and colorectal cancer, and skin cancer is very common too), stroke (high blood pressure and atrial fibrillation are the key drivers), falls (the top cause of injury death in older adults, often from weakening balance, strength, or medications), diabetes (accelerates heart, kidney, and eye problems), chronic lung disease (COPD – mostly tied to smoking history), dementia and cognitive decline, infections like flu, pneumonia, COVID, and shingles), depression and isolation (older men have the highest suicide rate of any group), and muscle loss (sarcopenia, which weakens mobility and independence, and increases fall risk). The most protective habits are the familiar ones: regular aerobic exercise plus strength and balance work, keeping blood pressure and blood sugar in check, staying socially connected, and keeping up with screenings and vaccines.
Those health risks have been ticked off my list one after the other (though they always need to be rechecked). I have no cancer or diabetes (and no family history of either), COPD, depression or dementia (my mother was good until well past 95). Falls can never be assumed away, but I have worked hard over the past year to minimize muscle loss and improve aerobic and strength fitness and it seems to show in the stress test results. My left hand/thumb weakness earlier in the year gave me reason to do a full stroke testing with ECG and CT scans that showed no blockages or weaknesses that would likely give rise to stroke or ATI’s…and my regular LifeLine Screenings show no peripheral artery narrowing…all good to know. And then there’s heart disease. I’ve been medicated for high blood pressure for over a decade, but the weight loss has dramatically reduced that and I track it regularly. The stress test showed good BP prone, sitting, standing (115/70) and at exercise with good recovery. However, for years, doctors have found my heart to be tricky and non-symptomatic to evaluate. They always suspect an issue and put me through extra testing only to find little or nothing troubling or actionable. Just this year I went through EKG’s, echocardiograms, venal and arterial sufficiency imaging and even a halter event monitor looking for arrhythmia signs…all without positive indications, despite an abundance of suspicions. I have a Swiss cardiologist now and he was the one who ordered the echo stress test. The results showed some risk of ischemia (arterial blockage) due to stressed movement reduction in the anterior and posterior heart walls. But the results were mixed because the existence of irregular PVCs (something the halter monitor test ruled out as concerning, even though I seem to have them irregularly) can cause that heart wall movement differential. My genetically low cholesterol levels (143 with LDL of 87), good resting echo, strong fitness levels in the stress test, low resting heart rate (low 50s), good halter and EKG results all suggest that that may be a false positive, but since when are doctors not inclined to be safe rather than sorry? So I’m now scheduled for a cardiac CT scan to image my coronary arteries. My cardiologist ordered it with routine timing rather than “stat” so obviously there is minimal urgency and immediate concern. I’m doing it the day before Thanksgiving, which seems oddly appropriate. I have asked Claude everything there is to ask and downloaded all of the various test results and it turns out AI is about where the medical community is, which is that it seems of minimal concern, but better safe than sorry. So now I have to decide if I want to bother thinking any more about whether I’m O.K. even if I feel healthier than I have in forty years.
I’ve decided that instead of worrying about my health, which I have done all I can do to improve of late, I need to focus on that new category of global security risk so that it can absorb all the worry that my cognitive awareness can allocate. I am searching for O.K. status in the midterms, the global unrest, Elon Musk and Ukraine, Iran, MBS and Houthis and the Trumpster fire that is American democracy, all of which deserve all my capacity for worry and that makes my heat risks seem to pale in comparison…