Medications

I was diagnosed with type 2 diabetes on September 2, 2009. By then, I was already being treated for hypertension, high cholesterol and depression. Shortly after my diagnosis, I started tracking my blood glucose levels, initially in the little book you see below and later on my phone. I also began a regimen of medications that would evolve through the years. Here’s where it started:

Sept 17, 2009

There were many changes over the years, including supplements, prescriptions and over-the-counter medications. In July 2010, I started an injectable medication called Byetta, which treated my diabetes and was supposed to reduce my appetite. A few years later that was replaced by another injectable called Bydureon. Eventually, Bydureon was replaced by Ozempic. I credit these GLP-1 medications with helping me keep my weight under 400 lb.

My regimen is a bit more complicated now because the timing is important.

Omeprazole, on the left, must be taken 30-60 minutes before food. When I wake up in the morning, I open one of those capsules over my mouth and swallow the granules. I am taking this medication for six months following surgery. It reduces the amount of acid my stomach produces, which helps protect my stomach while it heals.

An hour later I take a daily DS/SADI multivitamin, 150mg (2 x 75) bupropion and Culturelle. The multivitamin is formulated specifically for duodenal switch patients. My digestive system now absorbs less of some nutrients from food, so the multivitamin helps make up for that.

At noon, I take the first of three doses of Citracal, which contains calcium and vitamin D3. The body can absorb only a limited amount of calcium at a time so it has to be spread throughout the day. Calcium can interfere with iron absorption, so the first dose is at least two hours after the multivitamin, which contains iron.

At 5 pm I take second doses of Citracal and bupropion. Bupropion is an antidepressant I’ve been taking for many years. Prior to surgery, I took a 300mg extended-release dose once a day in the morning. Because extended-release medications may not be fully absorbed after a duodenal switch, I take the immediate-release version in two doses. I take the second dose at five because bupropion can be stimulating and could interfere with sleep if taken later.

At bedtime, I take the final dose of Citracal along with simvastatin for high cholesterol. Because the body produces most of its cholesterol overnight, simvastatin is most effective when taken in the evening.

I’m fewer medications than I was taking before surgery but managing when I take them has become much more important.

Weight

Weight has been a dominant fact of my life for as long as I can remember. I first began tracking my weight around 1990 but lost the earliest data. This graph uses logs I entered in a spreadsheet for about 20 years and then, after a gap of not keeping track, picks up again with data from Apple Health.

The chart is interactive. Hover over a point—or tap it on a touch device—to see the date, weight, and any note associated with it. You can zoom and pan through the timeline, use the slider at the bottom to focus on a particular period, or use the 1y, 5y, 10y, and All buttons to change the view.

The graph contains a lot of my life. There are diets in there, bike commutes, periods when I walked everywhere, stressful stretches, successes that lasted months or years, and many occasions when I lost a substantial amount of weight only to gain it back.

Some of the notes are full of hope and determination, but many are riddled with defeat and despair. There is much self-loathing. Sometimes it became too much and I didn’t want to step on the scale for a long time, and so there are gaps.

Today I stepped on the scale and it read 299.0 pounds. That is a number I thought I would never see again.

Duodenal Switch Bariatric Surgery

In the simplest terms, this surgery makes the stomach smaller and reduces the amount of food and calories the body can absorb.

This before-and-after diagram above is a little technical but the procedure essentially does this:

About 70-80% of the stomach is removed, leaving a smaller stomach (labeled “pouch” in the diagram)
The duodenum, the passage between the stomach and small intestine,is divided just beyond the stomach.
A cut is made about halfway down the small intestine, essentially dividing it into two parts. We’ll call the top part Intestine 1 and bottom part Intestine 2.
The upper end of Intestine 2 is connected to the portion of the duodenum that is still attached to the pouch.
Intestine 1 remains connected to the liver and pancreas, allowing bile and pancreatic enzymes to continue flowing through it.
The bottom end of Intestine 1 is connected at the bottom of Intestine 2 near where it meets the large intestine.

The consequences of the surgery are:

The stomach is much smaller and can hold far less food than it could before surgery.
Food travels through a shorter digestive pathway (Intestine 2), so fewer calories and nutrients are absorbed.
Digestive enzymes from the liver and pancreas still mix with the food, but this happens much later in the digestive process, shortly before the contents enter the large intestine.

All of this leads to rapid weight loss.

I had this surgery on July 14.

Credit Cards

How to use a credit card
What happens when you use a credit card
Best Practices
Basic Glossary
Extended Glossary
Notes on Interest
Advantages
Disadvantages
Benefits (in progress)

How to use a credit card

Pay for things using the credit card
Set aside money to pay the credit card each time you use it
Pay the statement balance by due date

What happens when you use a credit card

Pay for items (charge)
Cost of items are added to the current balance
The current balance can never exceed the credit limit
On the statement date, the current balance becomes the statement balance
The statement balance must be paid by the payment due date
Any portion of the unpaid statement balance is subject to interest after the due date

Best Practices

Pay statement balance when due every month, preferably on auto-pay
Know your statement and payment due dates
Using your credit card does not build credit. Paying without incurring fees builds credit.

Basic Glossary

Statement: a detailed summary of the charges, payments and credits to your account that have occurred since the last statement date
Statement date: the cut-off date for transactions that are included on the statement, usually comes a few days after payment due date
Statement balance: amount you owe the day of statement date
Minimum payment: amount that must be paid by the due date. Failure to pay this amount can result in late fees and negative marks on your credit file.
Payment due date: date that minimum payment is due (see late payment fee). Pay the full statement balance by this date to avoid interest charges.
Remaining statement balance: statement balance minus any payments that have been made since the statement date

Extended Glossary

Credit limit: Maximum amount of money that can be charged to your account at any given time.
Minimum payment: the amount that must be paid by statement date to avoid late fees and negative marks on your credit report. If interest is charged, the minimum payment will include those charges.
Late payment fee: a fee charged on the next statement if the minimum payment is not paid by the due date
APR: annual percentage rate used to determine how much interest is charged
Cash advance: a cash withdrawal from your account. There is usually a per-transaction fee, either a small percentage or a flat fee. Interest accumulation begins immediately until the cash advance amount is paid.
Balance transfer: a cash advance that goes directly to pay off a balance on your account with another creditor.
Annual fee: Yearly cost of having a premium credit card. Cards that have annual fees usually offer services, benefits, coupons, etc. that will offset the cost.
Auto-payment: payment is made automatically each month before the due date from your bank account. Payment options are usually:
- minimum payment
- statement balance
- amount you specify
Grace period: the time between statement date and payment due date when no interest is charged for charges made during that time. The grace period often is only valid after the statement balance is paid on the due date.

Notes on Interest

You will never have to pay interest if you always pay your statement balance by the due date.
Monthly interest can be roughly calculated by multiplying the current balance by your APR and dividing by 12. Example: a $1200 balance with 20% interest would cost $20 every month.
There are separate APR’s for cash advances and purchases. Cash advances usually have a higher APR than purchases and often incur interest immediately with no grace period.
Sometimes credit cards will have an introductory APR of 0% that will be in effect for a specific amount of time, usually measured in months. If the balance is not paid by the end of the introductory period, the entire balance can be subject to interest including interest charged retrospectively.
Cash advances and balance transfers are sometimes offered with a 0% introductory APR but a one-time fee is charged. Your credit card company may send you checks in the mail that can be used for this purpose. You should shred them immediately.

Advantages

Cash back/rewards
Can spend during low cash flow
Fraud protection
Travel benefits

Disadvantages

Misuse leads to excessive interest
The Float: a false sense of security based on bank balances

Benefits (in progress)

Some benefits are common across cards. Premium benefits are usually available on cards with a membership fee.

Statement Credits

You charge a thing and receive reimbursement for it on your next statement.

Travel: reimbursement for common travel expenses like hotel stays, ride sharing, airline incidentals (baggage, seat assignments, etc), and expedited airport security (TSA pre-check).
Category credits: utilities, streaming, restaurants
Service credits: delivery services
Vendors: Saks, Dell
Services: Lyft, Uber, Walmart+, DoorDash, Instacart

Travel

Access to member travel booking portals
Enhanced status for hotels and airlines
Foreign transaction fees waived
Insurance: car rental, trip delay, trip cancellation, trip interruption, luggage
Free night certificates: offered by co-branded hotel cards like Marriott, Hilton, Wyndham
Free checked bag: offered by co-branded airline cards
Airport lounge access

Non-travel Protections

Purchase protection
Return protection
Extended warranty
Cell phone protection

Rewards

Rewards are complicated.

Gratitude

The Crickets, led by Buddy Holly, had their first hit with “That’ll Be The Day” in 1957. Many more hits would follow for Buddy Holly and the Crickets until his tragic death on February 3, 1959. He had just left a gig at the Surf Ballroom in Clear Lake, Iowa, when his plane crashed in the middle of a frozen cornfield. All three passengers – Holly, Richie Valens and J.P. “The Big Bopper” Richardson – and the pilot were killed instantly.

Last summer I visited the site of the crash which is only 45 minutes from where I grew up. There are no signs on the gravel roads leading to the cornfield and there is no dedicated parking. Once you get near, though, the presence of other visitors is soon evident.

The site lies at the end of a half mile walk along a dirt road with weeds and grass growing in the center. There is a small entrance at the start of the road that is festooned with horn rimmed glasses, flowers and other mementos.

As I walked past the entrance and down the half mile path to the crash site, I couldn’t help but notice something remarkable – crickets! Every person I encountered on the path I asked, “Can you believe it? Crickets!” The younger ones looked puzzled but the people my age nodded politely and kept walking back towards their car. Eventually, I stopped telling people about the crickets.

As I walked out of the cornfield and approached the entrance, a man about my age walked towards me in the opposite direction. I said to him, “I can’t believe the crickets!” He looked at me puzzled at first and then realized what I meant. He pointed at his ears and said, “I can’t hear high frequencies any more.”

As he walked by me, I stopped for a moment, pulled the hearing aids out of my ears and I could no longer hear the crickets. I put them back in and the crickets were audible again.

On that day, I was extra grateful for my hearing aids because they helped me hear the crickets singing for Buddy Holly.

Category: Explanation