Meditations for Mortals – by Oliver Burkeman
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We previously reviewed this author’s “Four Thousand Weeks”, but for those who might have used a lot of those four thousand weeks already, and would like to consider things within a smaller timeframe for now, this work is a 28-day daily reader.
Now, daily readers are usually 366 days, but the chapters here are not the single page chapters that 366-page daily readers usually have. So, expect to invest a little more time per day (say, about 6 pages for each daily chapter).
Burkeman does not start the way we might expect, by telling us to take the time to smell the roses. Instead, he starts by examining the mistakes that most of us make most of the time, often due to unexamined assumptions about the world and how it works. Simply put, we’ve often received bad lessons in life (usually not explicitly, but rather, from our environments), and it takes some unpacking first to deal with that.
Nor is the book systems-based, as many books that get filed under “time management” may be, but rather, is simply principles-based. This is a strength, because principles are a lot easier to keep to than systems.
The writing style is direct and conversational, and neither overly familiar nor overly academic. It strikes a very comfortably readable balance.
Bottom line: if you’d like to get the most out of your days, this book can definitely help improve things a lot.
Click here to check out Meditations For Mortals, and live fulfilling days!
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Elon Musk says ‘disc replacement’ worked for him. But evidence this surgery helps chronic pain is lacking
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Last week in a post on X, owner of the platform Elon Musk recommended people look into disc replacement if they’re experiencing severe neck or back pain.
According to a biography of the billionaire, he’s had chronic back and neck pain since he tried to “judo throw” a 350-pound sumo wrestler in 2013 at a Japanese-themed party for his 42nd birthday, and blew out a disc at the base of his neck.
In comments following the post, Musk said the surgery was a “gamechanger” and reduced his pain significantly.
Musk’s original post has so far had more than 50 million views and generated controversy. So what is disc replacement surgery and what does the evidence tells us about its benefits and harms?
What’s involved in a disc replacement?
Disc replacement is a type of surgery in which one or more spinal discs (a cushion between the spine bones, also known as vertebrae) are removed and replaced with an artificial disc to retain movement between the vertebrae. Artificial discs are made of metal or a combination of metal and plastic.
Disc replacement may be performed for a number of reasons, including slipped discs in the neck, as appears to be the case for Musk.
Disc replacement is major surgery. It requires general anaesthesia and the operation usually takes 2–4 hours. Most people stay in hospital for 2–7 days. After surgery patients can walk but need to avoid things like strenuous exercise and driving for 3–6 weeks. People may be required to wear a neck collar (following neck surgery) or a back brace (following back surgery) for about 6 weeks.
Costs vary depending on whether you have surgery in the public or private health system, if you have private health insurance, and your level of coverage if you do. In Australia, even if you have health insurance, a disc replacement surgery may leave you more than A$12,000 out of pocket.
Disc replacement surgery is not performed as much as other spinal surgeries (for example, spinal fusion) but its use is increasing.
In New South Wales for example, rates of privately-funded disc replacement increased six-fold from 6.2 per million people in 2010–11 to 38.4 per million in 2019–20.
What are the benefits and harms?
People considering surgery will typically weigh that option against not having surgery. But there has been very little research comparing disc replacement surgery with non-surgical treatments.
Clinical trials are the best way to determine if a treatment is effective. You first want to show that a new treatment is better than doing nothing before you start comparisons with other treatments. For surgical procedures, the next step might be to compare the procedure to non-surgical alternatives.
Unfortunately, these crucial first research steps have largely been skipped for disc replacement surgery for both neck and back pain. As a result, there’s a great deal of uncertainty about the treatment.
There are no clinical trials we know of investigating whether disc replacement is effective for neck pain compared to nothing or compared to non-surgical treatments.
For low back pain, the only clinical trial that has been conducted to our knowledge comparing disc replacement to a non-surgical alternative found disc replacement surgery was slightly more effective than an intensive rehabilitation program after two years and eight years.
Many people experience chronic pain. Yan Krukau/Pexels Complications are not uncommon, and can include disclocation of the artificial disc, fracture (break) of the artificial disc, and infection.
In the clinical trial mentioned above, 26 of the 77 surgical patients had a complication within two years of follow up, including one person who underwent revision surgery that damaged an artery leading to a leg needing to be amputated. Revision surgery means a re-do to the primary surgery if something needs fixing.
Are there effective alternatives?
The first thing to consider is whether you need surgery. Seeking a second opinion may help you feel more informed about your options.
Many surgeons see disc replacement as an alternative to spinal fusion, and this choice is often presented to patients. Indeed, the research evidence used to support disc replacement mainly comes from studies that compare disc replacement to spinal fusion. These studies show people with neck pain may recover and return to work faster after disc replacement compared to spinal fusion and that people with back pain may get slightly better pain relief with disc replacement than with spinal fusion.
However, spinal fusion is similarly not well supported by evidence comparing it to non-surgical alternatives and, like disc replacement, it’s also expensive and associated with considerable risks of harm.
Fortunately for patients, there are new, non-surgical treatments for neck and back pain that evidence is showing are effective – and are far cheaper than surgery. These include treatments that address both physical and psychological factors that contribute to a person’s pain, such as cognitive functional therapy.
While Musk reported a good immediate outcome with disc replacement surgery, given the evidence – or lack thereof – we advise caution when considering this surgery. And if you’re presented with the choice between disc replacement and spinal fusion, you might want to consider a third alternative: not having surgery at all.
Giovanni E Ferreira, NHMRC Emerging Leader Research Fellow, Institute of Musculoskeletal Health, University of Sydney; Christine Lin, Professor, Institute for Musculoskeletal Health, University of Sydney; Christopher Maher, Professor, Sydney School of Public Health, University of Sydney; Ian Harris, Professor of Orthopaedic Surgery, UNSW Sydney, and Joshua Zadro, NHMRC Emerging Leader Research Fellow, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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What Actually Causes High Cholesterol?
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In 1968, the American Heart Association advised limiting egg consumption to three per week due to cholesterol concerns linked to cardiovascular disease. Which was reasonable based on the evidence available back then, but it didn’t stand the test of time.
Eggs are indeed high in cholesterol, but that doesn’t mean that those who eat them will also be high in cholesterol, because…
It’s not quite what many people think
Some quite dietary pointers to start with:
- Egg yolks are high in cholesterol but have a minimal impact on blood cholesterol.
- Saturated and trans fats (as found in fatty meats or dairy, and some processed foods) have a greater influence on LDL levels than dietary cholesterol.
And on the other hand:
- Unsaturated fats (e.g. from fish, nuts, seeds) have anti-inflammatory benefits
- Fiber-rich foods help lower LDL by affecting fat absorption in the digestive tract
A quick primer on LDL and other kinds of cholesterol:
- VLDL (Very Low-Density Lipoprotein):
- delivers triglycerides and cholesterol to muscle and fat cells for energy
- is converted into LDL after delivery
- LDL (Low-Density Lipoprotein):
- is called “bad cholesterol”, which we call that due to its role in arterial plaque formation
- in excess leads to inflammation, overworked macrophage activity, and artery narrowing
- HDL (High-Density Lipoprotein):
- known as “good cholesterol,” picks up excess LDL and returns it to the liver for excretion
- is anti-inflammatory, in addition to regulating LDL levels
There are other factors too, for example:
- Smoking and drinking increase LDL buildup and cause oxidative damage to lipids in general and the blood vessels through which they travel
- Regular exercise, meanwhile, can lower LDL and raise HDL
- Statins and other medications can help lower LDL and manage cholesterol when lifestyle changes and genetics require additional support—but they often come with serious side effects, and the usefulness varies from person to person.
For more on all of this, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
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What Happens To Your Body When You Do Squats Every Day-Not Just For Legs!
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Squat Every Day? Yes, Please!
It’s back to basics with this video (below). Passion for Health’s video, “What Happens To Your Body When You Do Squats Every Day-Not Just For Legs!” really brings home how squats aren’t just a one-trick pony for your legs.
The humble bodyweight squat is shown to contribute to everything from bolstering all-around lower body strength to bettering bone density and increasing metabolism.
Indeed, squats are so powerful that we reviewed a whole book that focuses just on the topic of squatting. Other, broader books on exercise also focus on the positive impacts that squatting can make.
A proper squat goes beyond your legs, engaging your core, enhancing joint health, and, some argue, can lead to improved balance and circulation.
(Plus, they’re easy to execute, given they can be done anywhere, without any equipment).
This is probably why Luigi Fontana and Dr Rangan Chatterjee have spoken about the benefits of squatting.
How Should We Start?
The video goes beyond the ‘why’ and delves into the ‘how’, offering step-by-step squatting techniques.
It answers the burning question: should you really be doing squats every day?
(Hint: the answer is most likely “yes”).
Of course, some of us may not be able to squat, and for those, we’ll feature alternatives in a future article.
For beginners, the advice is to start slow, aiming for 10 repetitions. You can gradually increase that count as you feel your muscles strengthen. Experienced gym-goers might push for 20 or more reps, adding variations like jump squats for an extra challenge.
The key takeaway is to listen to your body and ensure rest days for muscle recovery.
At the end of the day, Passion for Health’s video is a treasure trove for squat lovers, from novices to the seasoned, and insists on the importance of form, frequency, and listening to one’s body.
How did you find that video? If you’ve discovered any great videos yourself that you’d like to share with fellow 10almonds readers, then please do email them to us!
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Managing Jealousy
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Jealousy is often thought of as a young people’s affliction, but it can affect us at any age—whether we are the one being jealous, or perhaps a partner.
And, the “green-eyed monster” can really ruin a lot of things; relationships, friendships, general happiness, physical health even (per stress and anxiety and bad sleep), and more.
The thing is, jealousy looks like one thing, but is actually mostly another.
Jealousy is a Scooby-Doo villain
That is to say: we can unmask it and see what much less threatening thing is underneath. Which is usually nothing more nor less than: insecurities
- Insecurity about losing one’s partner
- Insecurity about not being good enough
- Insecurity about looking bad socially
…etc. The latter, by the way, is usually the case when one’s partner is socially considered to be giving cause for jealousy, but the primary concern is not actually relational loss or any kind of infidelity, but rather, looking like one cannot keep one’s partner’s full attention romantically/sexually. This drives a lot of people to act on jealousy for the sake of appearances, in situations where they might otherwise, if they didn’t feel like they’d be adversely judged for it, be considerably more chill.
Thus, while monogamy certainly has its fine merits, there can also be a kind of “toxic monogamy” at hand, where a relationship becomes unhealthy because one partner is just trying to live up to social expectations of keeping the other partner in check.
This, by the way, is something that people in polyamorous and/or open relationships typically handle quite neatly, even if a lot of the following still applies. But today, we’re making the statistically safe assumption of a monogamous relationship, and talking about that!
How to deal with the social aspect
If you sit down with your partner and work out in advance the acceptable parameters of your relationship, you’ll be ahead of most people already. For example…
- What counts as cheating? Is it all and any sex acts with all and any people? If not, where’s the line?
- What about kissing? What about touching other body parts? If there are boundaries that are important to you, talk about them. Nothing is “too obvious” because it’s astonishing how many times it will happen that later someone says (in good faith or not), “but I thought…”
- What about being seen in various states of undress? Or seeing other people in various states of undress?
- Is meaningless flirting between friends ok, and if so, how do we draw the line with regard to what is meaningless? And how are we defining flirting, for that matter? Talk about it and ensure you are both on the same page.
- If a third party is possibly making moves on one of us under the guise of “just being friendly”, where and how do we draw the line between friendliness and romantic/sexual advances? What’s the difference between a lunch date with a friend and a romantic meal out for two, and how can we define the difference in a way that doesn’t rely on subjective “well I didn’t think it was romantic”?
If all this seems like a lot of work, please bear in mind, it’s a lot more fun to cover this cheerfully as a fun couple exercise in advance, than it is to argue about it after the fact!
See also: Boundary-Setting Beyond “No”
How to deal with the more intrinsic insecurities
For example, when jealousy is a sign of a partner fearing not being good enough, not measuring up, or perhaps even losing their partner.
The key here might not shock you: communication
Specifically, reassurance. But critically, the correct reassurance!
A partner who is jealous will often seek the wrong reassurance, for example wanting to read their partner’s messages on their phone, or things like that. And while a natural desire when experiencing jealousy, it’s not actually helpful. Because while incriminating messages could confirm infidelity, it’s impossible to prove a negative, and if nothing incriminating is found, the jealous partner can just go on fearing the worst regardless. After all, their partner could have a burner phone somewhere, or a hidden app for cheating, or something else like that. So, no reassurance can ever be given/gained by such requests (which can also become unpleasantly controlling, which hopefully nobody wants).
A quick note on “if you have nothing to fear, you have nothing to hide”: rhetorically that works, but practically it doesn’t.
Writer’s example: when my late partner and I formalized our relationship, we discussed boundaries, and I expressed “so far as I am concerned, I have no secrets from you, except secrets that are not mine to share. For example, if someone has confided in me and asked that I not share it, I won’t. Aside from that, you have access-all-areas in my life; me being yours has its privileges” and this policy itself would already pre-empt any desire to read my messages.
Now indeed, I had nothing to hide. I am by character devoted to a fault. But my friends may well sometimes have things they don’t want me to share, which made that a necessary boundary to highlight (which my partner, an absolute angel by the way and not prone to unhealthy manifestations of jealousy in any case, understood completely).
So, it is best if the partner of a jealous person can explain the above principles as necessary, and offer the correct reassurance instead. Which could be any number of things, but for example:
- I am yours, and nobody else has a chance
- I fully intend to stay with you for life
- You are the best partner I have ever had
- Being with you makes my life so much better
…etc. Note that none of these are “you don’t have to worry about so-and-so”, or “I am not cheating on you”, etc, because it’s about yours and your partner’s relationship. If they ask for reassurances with regard to other people or activities, by all means state them as appropriate, but try to keep the focus on you two.
And if your partner (or you, if it’s you who’s jealous) can express the insecurity in the format…
“I’m afraid of _____ because _____”
…then the “because” will allow for much more specific reassurance. We all have insecurities, we all have reasons we might fear not being good enough for our partner, or losing their affection, and the best thing we can do is choose to trust our partners at least enough to discuss those fears openly with each other.
See also: Save Time With Better Communication ← this can avoid a lot of time-consuming arguments
What about if the insecurity is based in something demonstrably correct?
By this we mean, something like a prior history of cheating, or other reasons for trust issues. In such a case, the jealous partner may well have a reason for their jealousy that isn’t based on a personal insecurity.
In our previous article about boundaries, we talked about relationships (romantic or otherwise) having a “price of entry”. In this case, you each have a “price of entry”:
- The “price of entry” to being with the person who has previously cheated (or similar), is being able to accept that.
- And for the person who cheated (or similar), very likely their partner will have the “price of entry” of “don’t do that again, and also meanwhile accept in good grace that I might be jittery about it”.
And, if the betrayal of trust was something that happened between the current partners in the current relationship, most likely that was also traumatic for the person whose trust was betrayed. Many people in that situation find that trust can indeed be rebuilt, but slowly, and the pain itself may also need treatment (such as therapy and/or couples therapy specifically).
See also: Relationships: When To Stick It Out & When To Call It Quits ← this covers both sides
And finally, to finish on a happy note:
Only One Kind Of Relationship Promotes Longevity This Much!
Take care!
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Low-Dose Aspirin & Anemia
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We recently wrote about…
How To Survive A Heart Attack When You’re Alone
…and one of the items was “if you have aspirin readily available, then after calling an ambulance is the time to take it—but don’t exert yourself trying to find some”.
But what of aspirin as a preventative?
Many people take low-dose aspirin daily as a way to reduce the risk of atherothrombosis specifically (and thus, indirectly, they hope to reduce the risk of heart attacks).
The science of how helpful this is both clear and complicated—that is to say, the stats are not ambiguous*, but there are complicating factors of which many people are unaware.
*it will reduce the overall risk of cardiovascular events, but will not affect CVD mortality; in other words, it may improve your recovery from minor cardiac events, but is not likely to save you from major ones.
And also, it has unwanted side effects that can constitute a more relevant threat for many people. We’ll share more on that at the end of today’s article, but first…
A newly identified threat from daily aspirin use
A large (n=313,508) study of older adults (median age 73) were sorted into those who used low-dose aspirin as a preventative, and those who did not.
The primary outcome was incidence of anemia sufficient to require treatment, and the secondary outcome was major bleeding. And, at least 1 in 5 of those who experienced anemia also experienced bleeding.
The bleeding issue was not “newly identified” and will not surprise many people; after all, the very reason that aspirin is taken as a CVD preventative is for its anti-clotting property of allowing blood to flow more freely.
The anemia, however, has been getting increasing scientific scrutiny lately, after long going unnoticed in the wild. Given that anemia also gives the symptom “dizziness”, this is also a significant threat for increasing the incidence of falls in the older population, too, which can of course lead to serious complications and ultimately death.
Here’s the paper itself:
Want to know more?
As promised, here’s what we wrote previously about some of aspirin’s other risks:
Aspirin, CVD Risk, & Potential Counter-Risks
Take care!
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When A Period Is Very Late (Post-Menopause)
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Knowledge Is
PowerSafety, Post-Menopause TooNote: this article will be most relevant for a subset of our subscribership, but it’s a very large subset, so we’re going to go ahead and address the reader as “you”.
If, for example, you are a man and this doesn’t apply to you, we hope it will interest you anyway (we imagine there are women in your life).
PS: the appendicitis check near the end, works for anyone with an appendix
We’ve talked before about things that come with (and continue after) menopause:
- What You Should Have Been Told About The Menopause Beforehand
- What Menopause Does To The Heart
- Alzheimer’s Sex Differences May Not Be What They Appear
But what’s going on if certain menstrual symptoms reappear post-menopause (e.g. after more than a year with no menstruation)?
Bleeding
You should not, of course, be experiencing vaginal bleeding post-menopause. You may have seen “PSA” style posts floating around social media warning that this is a sign of cancer. And, it can be!
But it’s probably not.
Endometrial cancer (the kind that causes such bleeding) affects 2–3% of women, and of those reporting post-menopausal bleeding, the cause is endometrial cancer only 9% of those times.
So in other words, it’s not to be ignored, but for 9 people out of 10 it won’t be cancer:
Read more: Harvard Health | Postmenopausal bleeding: Don’t worry—but do call your doctor
Other more likely causes are uterine fibroids or polyps. These are unpleasant but benign, and can be corrected with surgery if necessary.
The most common cause, however is endometrial and/or vaginal atrophy resulting in tears and bleeding.
Tip: Menopausal HRT will often correct this.
Read more: The significance of “atrophic endometrium” in women with postmenopausal bleeding
(“atrophic endometrium” and “endometrial atrophy” are the same thing)
In summary: no need to panic, but do get it checked out at your earliest convenience. This is not one where we should go “oh that’s weird” and ignore.
Cramps
If you are on menopausal HRT, there is a good chance that these are just period cramps. They may feel different than they did before, because you didn’t ovulate and thus you’re not shedding a uterine lining now, but your body is going to do its best to follow the instructions given by the hormones anyway (hormones are just chemical messengers, after all).
If it is just this, then they will probably settle down to a monthly cycle and become quite predictable.
Tip: if it’s the above, then normal advice for period cramps will go here. We recommend ginger! It’s been found to be as effective as Novafen (a combination drug of acetaminophen (Tylenol), caffeine, and ibuprofen), in the task of relieving menstrual pain:
See: Effect of Ginger and Novafen on menstrual pain: A cross-over trial
It could also be endometriosis. Normally this affects those of childbearing age, but once again, exogenous hormones (as in menopausal HRT) can fool the body into doing it.
If you are not on menopausal HRT (or sometimes even if you are), uterine fibroids (as discussed previously) are once again a fair candidate, and endometriosis is also still possible, though less likely.
Special last note
Important self-check: if you are experiencing a sharp pain in that general area and are worrying if it is appendicitis (also a possibility), then pressing on the appropriately named McBurney’s point is a first-line test for appendicitis. If, after pressing, it hurts a lot more upon removal of pressure (rather than upon application of pressure), this is considered a likely sign of appendicitis. Get thee to a hospital, quickly.
And if it doesn’t? Still get it checked out at your earliest convenience, of course (better safe than sorry), but you might make an appointment instead of calling an ambulance.
Take care!
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