Losing a friend to COVID-19

About a month ago, one of my long time tai chi students sent me a text message. He had been exposed to COVID-19 and tested positive himself, so he would be missing classes for a while. Knowing that he is single and living alone, I tried to keep in touch with him every few days by text, but within about a week, he stopped responding. I was able to contact a close friend of his, and found that he was in the hospital. He was treated for low oxygen, then pneumonia, then blood clots. Finally, he was placed on a ventilator because his condition had gotten so bad, and he died a few hours later.

It was not a pleasant way to die. Gasping for air. Unbelievably thirsty. Confused from lack of oxygen. Scared. Alone.

He had not been vaccinated. I brought it up many times at tai chi class ever since he was eligible back in February, and every time, his response was the same. “I haven’t had a vaccine since I was a kid, and I never get sick.” His feathers were plainly ruffled by my questions. He wanted me to mind my own business. As his illness progressed, he changed his mind about vaccines, and was asking to see if there was still any chance of getting the shot. It was too late for prevention.

The person who infected him HAD been vaccinated. I did not hear anything about that COVID-19 patient, but being vaccinated, he presumably had a mild case and recovered. However, with the Delta variant, that did not prevent him from passing on a 100% virulent pathogen on to my friend, which proved lethal to him.

I suppose I have been fortunate, that this is the first time I have lost a friend to COVID-19. There have been deaths: friends of friends, or barely remembered family friends from long ago, but this is the first death amongst any of the people I am used to seeing routinely. It hurts. It makes me sad. It makes me think of the many years of good healthy life that my friend lost. He had his life all figured out. He was going to live the dream and die of old age on a beach in Thailand.

Please be careful. Please get the vaccine. Please wear masks, especially around people who might not be vaccinated, or who might have a weak immune system.

Even if you have been vaccinated, please continue to be careful. Things are different now – the virus is now more dangerous and more transmissible. You may be safe, but the Delta variant could still pass through you and go on to someone who is vulnerable.

Janssen single-shot COVID vaccine

The Janssen vaccine for COVID-19 (manufactured by Johnson and Johnson, and approved for emergency use) only requires a single dose to offer good protection, and is much easier to transport and administer because it can be stored long term at normal refrigerator temperatures.  Those differences will greatly reduce the logistical overhead of mass vaccination.  As production of the vaccine ramps up, it will become especially important in reaching smaller, more distant communities.

Similar to the Moderna and Pfizer vaccines, it doesn’t actually contain the material that your body is getting trained to recognize, the coronavirus spike protein.  All three vaccines are designed to transport an RNA sequence into a small number of cells in your body.  Those cells then produce and secrete a portion of the spike protein.  The sudden presence of the foreign spike protein is what triggers your immune system to action, and teaches it what kind of antibody or T-cell response to use when confronted with actual coronavirus in the future.  The Pfizer and Moderna vaccines contain bare mRNA, encapsulated in small globules of fat, which are designed so that they have a tendency to fuse with your cells and inject the mRNA into them.  The Janssen vaccine uses a different vector to carry the RNA, an adenovirus which normally causes the common cold, but which has been modified so that it cannot replicate or cause illness.

Side effects will vary from person to person. I received the single dose vaccine on March 4, and experienced only mild symptoms. There was some injection site soreness, extending to the neck and shoulder muscles.  I felt a little muzzy-headed for a few hours that evening, but after having a good night’s sleep, I felt much clearer.  I had a very slightly elevated body temperature, about half a degree higher than normal, which made me a little bit uncomfortable for about a day.

This vaccine provides moderate protection after about two weeks, and better protection after about four weeks.  That means that even if confronted with new variants, the chances of illness are reduced, and the chances of serious illness or hospitalization are greatly reduced.

I will be continuing to wear medical grade masks in the clinic, and ask that patients continue to wear masks during treatment whenever possible.  

Covid-19 Policy, Updated August 15, 2021

If you are feeling unwell (fever, cough, shortness of breath, runny nose, sore throat, etc.) on the day of your acupuncture appointment, please call, text or e-mail to cancel without penalty.

I will be screening myself and every patient with a non-contact thermometer to be on the lookout for any possible signs of fever.  Furthermore, in addition to my normal practice of disinfecting the treatment bed between patients, I will also be disinfecting other surfaces in the treatment room (doorknobs, chairs, etc). I will also be wearing a face mask to reduce the likelihood of virus transmission.

If you have been fully vaccinated, then wearing a mask is recommended.  It is also a good idea to wear a mask in other parts of the building, especially in enclosed spaces such as the elevators and restrooms.

If you are not fully vaccinated, please wear a mask, and consider getting vaccinated as soon as possible.  The current COVID-19 variant in our area is quite contagious, and more dangerous for patients of all ages.

Unfortunately, the only access to the third floor is via elevator.  However, you can take the stairs down to the first floor if you would like to avoid the elevator when you are leaving. Bear in mind that because there is a mezzanine level, you would have to actually walk down four sets of stairs.

Metabolic syndrome in Asians

A few years ago, I started having trouble with high blood pressure and cholesterol.  The good cholesterol was low, the bad cholesterol was bad, and the triglycerides were going up.  My blood sugar was also a little bit worryingly high.  At the time, my doctor said I was doing everything right; diet, exercise and weight (I was obviously skinny – by American standards), and that my metabolism going all wrong was “just genetics.”  He said that at some point soon, I would have to start taking medication to control it.  Because my father has the same sort of problems, I figured that he was right.

That sort of statement – “Just genetics” is a tough thing to hear, because it suggests that there’s nothing you can do about it.  However, a few months later, I happened to read a scientific article [1] that said that some Asians start having trouble with their metabolism with a Body Mass Index (BMI) as low as 22.  At the time, my BMI was exactly 22, and it got me thinking.  What would happen if I lost a few pounds?  I recalled an uncle who suddenly lost 20 pounds after being hospitalized for a stroke, and among other surprises, his diabetes went away.  Was that just a fluke, or could it be a clue to something that might work for me?

I decided to lose three pounds to see what would happen.  I chose the number three because my weight varies about that much over the course of a given day.  I would normally weigh about 147 lbs in the morning, and about 150 lbs at the end of the day before going to bed.  If I lowered those limits to 144 lbs in the morning, and 147 lbs at night, then it would be about the smallest measurable weight loss I could accomplish, but it would put my BMI at 21.7.

It took about a month to lose the weight, and I was pretty unhappy about it the whole time. I held the same weight range for the rest of the year, and then I went and got all of the same tests done at my next annual checkup.  While there was no meaningful change in my blood sugar, the blood pressure and cholesterol were all great.  They were as good as they had ever been when I was younger and ridiculously athletic.

I had thought that maybe it was age.  Maybe it was not being physically able to tolerate the amount of cardiovascular exercise I used to do.  Then there’s the genetics.  But losing a little weight was a relatively simple, non-pharmaceutical and not-so-stressful way of achieving the same healthy blood pressure and cholesterol levels.

Subsequently, I decided to lose an additional 3 lbs. That’s just because it’s too easy to gain 3 lbs over the course of a vacation, and I wanted a little bit of wiggle room before having to worry about my blood pressure and cholesterol.

I suspect it would work well for the blood sugar if I were willing to put the weight loss in combination with a low carbohydrate diet, but as an Asian, I really like my rice and noodles.  It’s also possible that an even lower weight threshold might take care of the blood sugar.  It may be in the cards for me in the near future, and I will update if I decide to go low-carb or lose another three pounds.

I think the take home lesson is that if you are an Asian experiencing any sort of metabolic control problem, such as cholesterol, blood pressure or high blood sugar, one of the first things you should consider is getting your BMI under 22.  It seems that some of us might be genetically wired to be healthy at a lower weight than comparable non-Asians.  Also, it’s possible that 22 might not be a magic number, as more recent research suggests that Asians can get in trouble at an even lower BMI [2].

Maybe my doctor was right about it being genetics.  However, maybe it’s genetics and there’s still something you can do about it.

Shoulder and neck pain? Check these muscles

For many patients who are experiencing chronic shoulder pain at the top of the shoulders, leading into the neck, there are three main sets of muscles that are likely to be tense.  These muscles tend to be tight as a result of stress or poor posture (frequently due to poor ergonomics when working at a computer).  Learning to stretch these muscles and to periodically check they are in a healthy position, especially when working under stressful conditions, can be very helpful in minimizing this type of shoulder and neck pain.  An acupuncture treatment can help relax these muscles to alleviate much of the pain, but learning good posture is critical for preventing the problem from recurring.

The first and most obvious muscle is the upper portion of the trapezius, which extends from the base of the skull to the outer edge of the shoulder.  Flexing this muscle causes the outer portion of the shoulder to rise.  Second is the levator scapula, which extends from the upper vertebrae of the neck down to the inside top corner of the shoulder blade.  Flexing this muscle causes the inside part of the shoulder blade to rise.  The third set of muscles are the scalene muscles, which connect the neck bones to the upper ribs, and assist in respiration by lifting the ribs a little bit.  Most people don’t have a lot of conscious control of the scalene muscles.

If all three of these muscle groups are tight, then your entire shoulder is elevated (which makes your neck look shorter than it really is, and makes your shoulders look square), and it may be a little bit hard to take a deep breath.  If all of these muscles are chronically tight and knotted, severe neck and shoulder pain are not far behind.  Unfortunately, stretching these muscles to alleviate the tension and pain is difficult.  If you attempt to stretch the muscles on one shoulder by tilting your head, it’s difficult to avoid aggravating tension in the same muscles on the opposite side.

Now consider the Venus de Milo.  Like many ancient Greek statues, her neck appears very long and elegant.  This posture comes from elevating the head while lowering the shoulders.  To get into this position, the woman who modeled for the sculptor must have had relaxed muscles throughout her upper shoulders and neck, and we can presume that at least at that point in her life, she didn’t have any pain in that part of her body.

The stretch I recommend is to imitate the appearance of the Venus de Milo’s neck in several steps.

  1. Hold a light weight such as a one pint water bottle or small barbell in each hand, and let your arms hang at your sides
  2. Elevate your head up as high as you can
  3. Allow the weight of the water bottle to pull your shoulders down.

Hold this position for perhaps 30 seconds, until the neck appears longer (indicating that the levator scapula and scalene muscles are elongating) and until the shoulders angle downward on the outside (indicating that the trapezius muscle is elongating).

I would suggest doing this stretch preventatively if you have a profession that requires a lot of sitting at a computer desk, or if you have any sort of job which requires holding your arms up for prolonged periods, e.g. driving.

One other hint is to be careful of the types of bags you hang on your shoulders.  If you carry a satchel or purse on one side, using a single strap on that same-side shoulder, you may be unconsciously elevating your shoulder to prevent the bag from sliding off.  People who have shoulder and neck pain should avoid using this kind of bag.  Instead, use a double strap backpack (which can also help you do the Venus de Milo stretch), or use a courier type strap which extends over the neck to the opposite shoulder, switching sides periodically to avoid lopsidedness.

Eating more fresh fruit to lose weight

I would guess that the typical American isn’t getting enough fruit in his or her diet, and this is a big contributor to the obesity epidemic in our country.

Current dietary guidelines recommend that at adult get about two cups of fruit per day (on a 2000 Calorie diet).  Most fruits also have a low glycemic index, which makes them a good healthy food choice for diabetics, even though fruits do contain sugar.  This is because they also tend to be high in fiber, which helps slow absorption of sugar and moderates how fast blood sugar rises.  (Also, fiber is good for you and the fruits are loaded with vitamins.)

So what exactly does two cups of fruit mean?  A typical medium-sized apple or orange is about one cup of fruit.  Are you eating an entire apple and orange every day?  I do on some days, and it feels like a lot.

One of the most important qualities of fruits is that they have a very low calorie density.  What this means is that for the amount of calories (or sugar) that is in a piece of fruit, it tends to take up a large amount of space in your stomach.  Since fruit is also high in fiber, it tends to stay in your stomach for a long time, because your stomach has to grind it up before it can pass on to your intestines.  This means that fruit can be used as an important substitute for unhealthy foods.  You eat the fruit, and it makes you feel full.  That keeps you from eating too much of something regrettable.

Recommended approach: Substitute some of your usual food with fruit

Here’s how this might work.  Suppose I normally eat two slices of pizza at dinner and follow it up with two scoops of ice cream.  What I could do is instead eat one apple before dinner, and then limit myself to one slice of pizza and one scoop of ice cream (if I still have room for it).  By making a substitution like this, I can reduce my calorie intake by almost half, and still feel full after dinner.

I would say that any trick which can help you cut your calorie intake by half, but not result in you feeling hungry, could be the difference between losing weight and gaining weight very quickly.

To maintain my weight at my typical level of exercise, I need to have about one quarter of my food to be fruit.  If I’m trying to lose a few pounds, I need to increase my fruit intake to about half of my diet.  If I get lazy and stop eating fruit for a few days, I start to gain weight.

One important suggestion is that eating slower can really help increase the impact of this technique.  If you eat the fruit and then follow it with the “healthy” portion of your meal, you should consider waiting a little while before you think about dessert.  A delay of maybe only 20 minutes can allow your brain to catch up to your stomach, so you realize how full you are, and you can eat less dessert or skip it altogether.

The “Crazy” approach: Add a weight cap

People have been asking me how I’m still skinny at the age of 43, even though many of the elders in my family are struggling with their weight. (In other words, me being skinny is not genetic.)  Because I’ve seen loved ones struck down by diseases that are compounded by poor diet, high blood sugar and obesity, I am kind of crazy serious when it comes to not gaining weight.

I have a hard upper limit on my weight.  I don’t recommend this approach to everyone, because it requires kung fu discipline (which basically means you consistently do something difficult despite suffering, because it’s important).

I weigh myself several times each day.  If my weight is over 148 pounds (chosen because it’s a safe BMI for Asians to avoid diabetes), then I stop eating.  After that point, I am only allowed water or fruit.  If I am craving protein, I may allow myself an ounce or so of pecans or other nuts.  The fruit contains very few calories.  The water contains no calories, and if I eat nuts, it’s not very much of them. The fruit makes me feel full, and the nuts add a level of satisfaction.  I suffer a little bit, but barring a major metabolic problem like liver or thyroid disease, it’s more or less impossible for me to gain weight with this approach.

Given that I’m eating fruit for the remainder of the day, and only consuming fluids, the extra weight that is keeping me over 148 pounds is always gone the next morning, digested away and excreted as urine.  (I normally start the day at about 146 pounds.)

Obviously, I don’t do this on special occasions, like holidays or vacations.  If I’m out on a dinner date, I can’t run home and weigh myself before dinner, so I just eat like a normal person.  However, on your typical week, I am restricting myself on about six of the seven days of the week.  Do I feel deprived sometimes?  Yes, I do.  But I also don’t worry about diabetes, which to me is worth it.

Herb tincture


One of the more interesting ways of taking an herb in Chinese medicine is the topical tincture.  Herbs are soaked in liquor for a period of several months. The liquid is filtered and applied to the skin for a variety of conditions.  The advantage of applying a medicine topically to an affected area is that compared to drinking an herbal concoction, there is less risk of adverse systemic affects, such as allergies or interactions with other medicines.  This particular mixture is modified from a traditional formula used by martial artists to help them recover from the constant injuries they suffered as a result of their strenuous physical conditioning.

How to weigh yourself

One of the biggest health problems that people face in this country is weight loss.  To be able to control your weight, the first thing you must be able to do is measure it correctly, and the vast majority of people don’t.  This leaves them unable to tell what effect their lifestyle changes are having on their weight, and leaves them often mystified as to what is going on with their weight.  From the point of view of a former engineer, I would say there are two major problems with the way that people tend to weigh themselves.  First, they don’t do it often enough.  Second, they don’t consider how variable a person’s weight is during the course of the day.

One of the main things that prevents people from weighing themselves is that they don’t want to see the number on the scale.  Of course, it is frustrating to see the numbers on the scale stubbornly refuse to budge, or worse, go the wrong way, despite all of the hard work you are putting in to diet and exercise.  However, the more you can weigh yourself, the better you will be able to understand what’s going on.

Let’s consider the speedometer of your car.  Imagine if your speedometer had to calculate speed the old fashioned way by timing out a minute and seeing how far you got in that time.  If your car only told you the speed every 60 seconds, you would get pulled over for speeding all of the time.  Accelerating from a stop sign to the speed limit takes less than 60 seconds.  If you hold down the accelerator too long or too hard, you could be easily 10 mph over the speed limit and not realize it.  That’s why our speedometers are designed to give us continuous feedback about the speed of the car, so you can keep an eye on the needle and not wind up going 35 mph in a 20 mph school zone.

Suppose you only weigh yourself once per week.  In the same way that a car could go from zero to 60 mph or 70, or 80 mph in a minute without you realizing it, you can gain or lose several pounds during a week.  That means you could get in trouble while you are between weight measurements, and as we all know, it’s way easier to put weight on than it is to take it off.  Similar to a speeding ticket, it’s a costly mistake to make.  This is why it’s important to measure more often than your weight tends to change.  I would say for most people, they should consider weighing themselves once or twice a day, if their weight has a tendency to go out of control.  That way if you see that you’re suddenly eating way too much during the course of a day, you can consider whether you really need to have that bedtime snack.

The second problem is the variability of a typical person’s body weight.  I’ve seen people celebrate or mourn a change one pound on the scale reading, but consider how fast my weight changed yesterday at different times, and under different conditions.

Weight (lbs) Change (lbs)
Before breakfast


After breakfast



With clothes



After workout



Walk and lunch



Bathroom and shower



Before dinner



After dinner



After workout



Bedtime snack



Next morning




As you can see, a meal can be as much as 1.6 pounds (cereal and milk with fruit for breakfast, or a noodle or rice soup for dinner or bedtime snack), but it can also be as little as 0.2 pounds (a spinach salad and some bread for lunch).  Similarly, a mild workout during which I was able to properly hydrate results in a drop of 0.2 pounds, but a more intense workout during which I didn’t drink enough water causes me to drop 1.6 pounds.  (That’s why I had a noodle soup before bed – partially to rehydrate.)

The presence or absence of clothing can result in significant changes to your weight measurement.  If I’m wearing sweat pants and a T-shirt, it causes my weight to change by 0.8 pounds, and it’s possible for heavier clothing to affect the reading even more.  Blue jeans, for example are very heavy.  One pair of my blue jeans weighs 1.8 pounds.

So how do you tell if you’re gaining or losing weight?

I would recommend that the typical person watching their weight should weigh themselves twice each day.

First, every morning on rising, most people go to the bathroom.  I would suggest immediately after doing so, but before eating breakfast, you should measure your weight with no (or almost no) clothing on.  This measurement tells you if you are gaining or losing weight, because it will be the most stable measurement from day to day.  You should watch for trends in this measurement.  I.e., is this week’s average morning weight different from last week’s?

Second, I would suggest weighing yourself prior to the last meal of every day.  If you find that you weight has skyrocketed over the course of the day, it’s a sign that you may have eaten too much that day, and you should seriously consider how much to eat for the rest of the day.