Body Energy Usage

I ponder macro-nutrition needs a whole bunch. Here’s what I have handy, though my technical references are scattered and omitted.

There’s always a need for roughage, vitamins, and minerals, which come from foods with very low calories/kilojoules. Aside from that, the three main macros have specific needs.

A body needs 125 grams of carbs for your brain/nerves; just under 1 gram of protein per kilo of lean body mass to maintain tissues/muscles; and around 30g of fat for cellular and neurological structures. This is usually around 1200 kcal per day, but varies by person 10-20 percent.

Anything else you eat is either poop, or gets converted to sugar. Sugar is burned if it’s needed immediately for exercise (growing, standing, walking, cardio, whatever, anything other than sleeping). Any sugar that is not immediately needed is stored in muscles as glycogen, up to around 4% of your muscle mass. All sugar past that is turned into fat and stored in our fat cells.

This is where “whole grains” comes into play. If it’s not ground up, it takes longer to break it down. However, if you take grains, and mill them into a powder, IT IS NOT WHOLE GRAINS. Just because there is fiber in the food does not mean it’s slow to absorb. The less processed the food, the longer time period over which it trickles energy into your body. If it’s super processed, it all absorbs very quickly, and your body may have trouble figuring out what to do with it unless you’re depleted already.

This is also where some insulin resistance comes from, and why diabetics have normal sugar metabolism in their muscles during exercise, even if they are short on insulin, or are resistant to it. Resistance is GLUT4 which causes glucose receptors to move to the cell membrane, but exercise does the same thing – muscle is hungry, it asks for more. Muscle is not hungry, it asks for less, even if you try to overfeed it. Where would it put this excess sugar? It can only store so much.

During exercise, your fat cells can liberate about 90% of your weight in pounds as usable calories per hour. For me, it’s about 260 calories. The gap is made up from glycogen in the muscles, which is good for just about 90 minutes. If you exercise hard, and stop at 60, and rest for 30, those 30 mins still use up that glycogen for delayed processes, cleanup, etc.

Eating carbs cannot provide as much energy as glycogen, but it’s the next best thing. Also, if you’re fasting, your glycogen reserves get burned up pretty quickly. Glycogen is 3:1 water to sugar, so this is why the first week of dieting is so awesome. No, that’s not fat. It’s muscle energy.

Any energy deficiency not covered by food will be covered by muscle damage. About the same number of calories can be broken down out of injured muscle cells. For me, this is a total of muscle and fat sourced calories of about 520 calories per hour. If I exercise for 3 hours with no food, then my power output drops to 130 watts, which is about 520 calories per hour.

The best option to limit muscle damage, limit recovery time, and optimize exercise benefits when going for more than your glycoge, is to eat as much every hour as you burn, minus the calories that can come from fat. Staying carb focussed can give more energy, and can be easier to absorb, though for some people, this slows the breakdown of body fat.

Staying fat focussed keeps the fat burn mechanisms running, but it takes twice as much oxygen, which means you’re hear-rate limited. It’s less about muscle conditioning then, and more about cardiovascular improvement.

Staying protein focussed is tougher on the kidneys. The aminos have to be converted for use as fuel, and that’s a lot of extra ammonia to pee out. That can be an issue when dehydration might already be at play.


Gym Workout Routines

I was talking with a friend about my Gym routine, I thought I’d share some of that here. It’s kind of a wall of text, soI tried to organize it for easy skimming.

I keep a notepad on my phone to track what I did and what’s next. End of workout, I add the updated list to MyFitnessPal in the exercise notes. This keeps me from twiddling my thumbs during rests.

#### Warmup is cardio:
* About 10 mins or 200 calories warmup on the recumbent bike. I’ll start at about 50%, and crank it up to 100% a couple of times. I try to vary my RPM, but tend to hang out around 70. I have long legs, so momentum is a factor. I make sure I clear 160bpm, but I never get to max HR. Sometimes I try to draw pictures with the hill profile.

#### Safety warmup for exercises I’m not sure about:
* 10-20 reps at 50-60% just to make sure everything moves right, especially for heavier weight exercises.

#### I usually go for strength
* Target is 2-4 sets of 6-10 reps per exercise.
* If I make it to 16 reps, I bump up the weight on the next set.
* Sometimes I’ll do 8 reps, then drop 40% and do another 8.
* If anything pinches or doesn’t feel right, I’ll back off the weight.
* Not so worried about cardio since I average 75 miles per week on a road bike.

#### I do circuits for time efficiency:
* Whole Body Days: alternate upper/lower, front/back, with 30 second rests between circuits.
* Upper OR Lower Only: I’ll do 2-3 exercises with a 60-90 second rests.
* I average almost one working set for every 2 minutes. That includes the set, equipment setup, walking between machines, updating my notes, and any rest/cooldown time. That excludes the warmup time at the start. (eg, a 2 hour workout has 20 mins of warmup, and 40-45 working sets. A 1-hour workout will have 10 mins warmup, and 18-24 sets.)

#### With a workout buddy:
We could alternate on the same machine with 60-90 second rests. This is less overall workouts, but more social. We could also do the circuits, and just be one machine off from each other. Less social, but more efficient.

#### Workout Duration:
I prefer a longer, whole body workout every 4 days. I get better results, and less wasted time. My goal is to grow muscle mass, and I’m missing the sprinter gene, so recovery time is usually 3-5 days instead of 2-3 days for most people.

If I have only 1 hour, it’s best if I stick to only upper or only lower, because exercises always pull in a other muscles a little. I don’t feel I get quite as good of a workout this way.

#### Upper Body Exercises:
* Freeweight bench row (Low-Back sparing vs seated)
* Chest Press (like a bench press)
* Lat Pulldowns
* Seated dips (because I’m too heavy to do real dips yet)
* Chest fly & rear deltoid fly (same machine, diff settings)
* Biceps curls (cable or dumbell)
* Triceps extension (Slow to improve)
* Sometimes I do a shoulder press or a vertical row, but those are not so great on my shoulder sockets.
* Lateral dumbell arm raises.

#### Lower Body Exercises
* Freeweight seated calf extension (Soleus Muscle)
* Rotary Calf Extension (Gastroc Muscle)
* Inner/Outer thigh (adductor/abductor)
* Leg Curls (Hamstrings)
* Leg Extension (outer and inner quads, nearer the knee)
* Leg Press (because it doesn’t load my low-spine like squats & deadlifts do.)

###### Back Pain avoidance (Chronic and Acute)
* Nothing with a torso twist (wood choppers, obliques) – always causes days of increased pain.
* No abdominal crunches – Still hurting from 2 weeks ago when I let my form get sloppy.
* No back extensions – Same as with crunches, though a 45 degree bodyweight back extension bench would be fine if I could find that at my gym.
* Backed off of seated rows, just to be safe. I’ve moved to bench rows, though bent-over single-arm dumbell rows are okay too (off-arm is on the bench, so no low-back load).
* I should be doing planks and leg lifts at home, but I keep forgetting. This gets core without abusing low-spine.
* I should do more stretching on non-workout days, but I keep forgetting. This helps keep from putting too much strain on low-back when moving around.

#### Preferred Machines
I like the Hoist machines my Gym has best, but I’ve maxed out the leg press. Not sure I want to use the freeweight leg press without a big spotter. I like most of the Precor machines, and use them for things missing from the Hoist line-up. Last are the Life Fitness for a couple things, but they use bigger weight stacks for the same effort, and just seem to be on a different scale from all of the others.


Calories

This is what SEEMS to make the most sense for me. No *way* is easy, but this seems the least hard.

Energy Plans:

  • Defer first meal until actually hungry (9:30a-12:30p for me)
  • Keep each meal before 3:30pm around 12% of my daily intake.
  • Eat before I get ravenous (around every 2 hours).
  • Try to keep a reserve of about 25% of my calories for the evening.
  • Don’t be TOO aggressive (20% deficit is okay, but 40% is not).

Procedures:

  • Keep extra servings away from my plate/bowl.
  • Split up snack/mini-meals when I’m not hungry.
  • Stay busy (yay computer!)
  • You have to exercise, because your body will reduce your BMR to keep from losing fat reserves.
  • Hungries are worse the day AFTER exercise, so save your calories for tomorrow.

Foods:

  • Lots of broths, leaves, fresh veggies to add bulk, and fill in when I’m STILL HUNGRY!
  • Make sure I get the food groups and vitamins daily / weekly rather than every meal.
  • UMAMI: Your tongue creates Peptide YY it detects meat, glutamate, etc. Reduces hunger by 30% in the lab.
  • VITAMIN A: Hunger hormones are produced by fat cells. Empty fat cells do not get recycled without Vitamin A.
  • VITAMIN D: Vitamin D is blocked by Vitamin A, and is deficient for many indorsy people.
  • CALCIUM: Requires Vitamin D to be absorbed. Prevents brittle bones.

Some days will be better than others. Don’t give up. Keep tinkering.


Spinal Health

My critical stretches are:

  • Calf stretch just because it reduces referred pain on hamstring stretches, and because I tore a gastroc once.
  • Hammies get a hurdler stretch or similar. Tight hammies are big, bad back things, and a major problem for me.
  • IT bands get a figure-four, or a leg over stretch to help reduce piriformis syndrome.

Others I enjoy when remembered:

  • Pidgeon pose gets adductors AND IT bands a little, because I cannot really do the splits. This is mostly for 2 days after a long bike ride.
  • Quad stretch, usually just grab my foot behind me and get as much stretch as I can. This is more for my knees than anything.

Core strength I need more of:

  • Planks in all 4 directions also help core. Front plank can be replaced with pushups if form is good. Modified planks/pushups as necessary to prevent strain.
  • Rows, whether off a doorframe, or a table, or with proper equipment, are important. However, a year post-op, and I’m still not really comfortable with twisting under load. I do one arm at a time, and keep my shoulders square. YMMV.
  • Walking / hiking are great for core if it’s more than a few minutes, and more than just on a track or treadmill.

Aerobic/Calorie Burn

  • Road bikes are low impact, but the bending is not always best.
  • Spin bikes are easy to sit upright and get comfy, while burning calories, but the class matters a bunch.
  • Some people run, but if your heel hits the ground, it just hammers your spine.
  • Swimming, if that’s your thing. More of an upper-body thing.
  • NOTE: Stretching after a good warm-up will be much more effective. Also, a good warm-up will break down some of the tight strands the same as stretching, just smaller amounts per step/stroke/whatever. Also, if I don’t stretch after a long bike ride, everything goes bad faster.

Other Stuff

  • There are other body stretches I should do, but I don’t suffer when I don’t do them. The /r/bodyweightfiness has good enough reference that I mostly ditched all of the other lists, charts, and PT printouts for it. http://www.reddit.com/r/bodyweightfitness/wiki/kb/recommended_routine.compact
  • Aspirin for NSAID since my family has a history of clots, and Ibuprofen/Naproxen increase clot risks when used long-term.
  • Hot Tubs/showers are awesome for relaxing muscles, preventing cramps, etc.
  • Extra salt when I exercise, because I’m a salty guy. Seriously. I cramp up if I don’t get enough, and this could be 1-2 grams of salt per liter of water consumed, depending on the temperature outside.

General health

I just saw a picture of myself from today’s bike ride, and while I’m still wanting to drop pounds AND fat, I’m about as happy with how I look as I can ever recall being.

In the mirror this morning, I noticed SAGGY BELLY SKIN. This is a good sign, and I’m young enough that skin-shrink is just barely lagging behind fat loss.

Health-wise, my right knee, low back, stamina, and self image all are massively improved. Circulation is better. My BP and cholesterol were good before, so no real change. My resting pulse is down a little bit. I’m having fun exploring and spending time with people. I’m enjoying measuring my progress technically, and seeing myself exceed goals. Also, endorphins.

Also, the rates at which I can convert fat to muscle show me that I don’t have any metabolic issues. “Weight loss is all in my head.” So, picking the right foods will be key. I’ve found I really like Greek style yogurt, and it’s low fat, high calcium, high protein, and only has moderate carbs if I have the mix-up jelly kind (I do).

It seems calorie dense, but it also seems satiating. One day I had 500 calories of it to finish off evening hungers. Then next day I had 2 in the evening. The next morning, I had 2 for breakfast, and had no real hunger for most of the day. I had another before riding my bike, and a snack bar, and some carby elecrolyte drink. I blew through 4000 kcal today and have eaten under 1100 without hunger.

I did have a bunch of caffeine today, so I need to test further. If I could eat 120-240 kcal and be satiated for 6 hours, that’s just famazing and would be a big win for me.

As to wanting to drop pounds and fat:

  • I’m 29.6% body fat based on bioelectric impedence, and the increased risk limit is 28%. I’d like to get down to 25%.
  • My Waist to Height ratio is 56.7%, and the increased risk limit is 53.6%. I’d like to get down to 50%.
  • My Waist to Hip ratio, which is an accurate predictor of morbidity risks, is 95.76%, and the risk limit is 90% for men. I don’t have a target for this other than the risk limit or below.
  • I’d like to drop to a size 36 pants due to availability of tall clothes. Also, I found out / confirmed that even men’s clothing is vanity sized by 7-10%, so tape measures differ vs pant sizes.

I just had a life insurance medical exam. It’ll be interesting to see what the CBC comes back with.

Photos, with me on the far right:
https://www.facebook.com/photo.php?fbid=10202777493151050
or direct: https://scontent-b-atl.xx.fbcdn.net/hphotos-prn1/t1/q71/s720x720/1619156_10203080001591592_2096155125_n.jpg

https://www.facebook.com/photo.php?fbid=10203080001591592
or direct: https://fbcdn-sphotos-f-a.akamaihd.net/hphotos-ak-ash3/t1/1947922_10202777493151050_1370307925_n.jpg


Sugar is not bad for you

Be sure to know what a “Complex Carbohydrate” really is. It doesn’t mean long-chain starches. Those are still sugar. A baked potato, bowl of white rice, a slice of bread, and even corn on the cob are just fast-acting sugars to the body. In fact, they all have a higher glycemic index than table sugar (except some low-carb breads such as Ezekiel bread).

“Complex” means trapped inside of other things. So, an apple is complex. Broccoli is complex. Kale is complex. Peppers, asparagus, etc. You have to chew it, and it has fiber that hasn’t been milled in a factory.

Not apple juice, or any type of juice. As soon as you juice or puree something, even if you “leave the pulp in”, it’s no longer complex. The body no longer has to wait to absorb the calories out of it.

Sitting at a desk, you need about 0.4 kcalories per pound per hour. There is no need to eat anything starchy or sugary. It is turned into glucose before it enters the blood stream, and it only has a half-life of 15 minutes. Anything you didn’t burn in an hour will be turned to fat. Most sugars other than glucose, including half of table sugar, is sent to the liver, converted to glucose, and only about 10% of it makes it into the blood before being turned into fat.

If you’re exercising for 2 hours, you should be able to fuel that with reserves, even at maximum effort. The key is to keep your water and mineral levels happy (20-30oz per hour, with a gram of salt mixed in, and whatever else you want to flavor it). If you want to eat, eat whatever you can stomach.

However, if you’re exercising hard for 5 hours, there is no reason to eat fresh vegetables during your workout. You should have done so before, and will do so after, because of the vitamins and minerals. Those are just too slow to provide your energy needs during cardio.

Exercising at maximum effort, you need about 4 kcalories per pound per hour, plus water and extra minerals. At sustainable effort, you need 3kcal/pound. A tablespoon of corn syrup (not HFCS) washed down with water is almost exactly what you want. (2mg magnesium, 4mg calcium, 9mg potassium, 31mg sodium, 16g glucose, 57 kcal).

Even if you stop for an hour in the middle, you’re still running 30% over idle. If you don’t supplement during the exercise, even with a meal break in the middle, you’ll run out of energy. This will feel like you’re too tired to go on, and if you’re measuring, you’ll lose 30% or more of your peak effort. The refill rate is 3x longer than the burn rate, so once this happens, it’s too late to come back.

Ultra-athletes can double this reserve, and improve their ability to burn fat to extend their peak efforts. Also, their peak efforts move further up, so they can operate at a lower percentage of peak, meaning they can refuel a higher percentage of their reserve consumption during the workout.

Even so, even the best athlete will eventually run out of glycogen reserves. They just have learned how to keep going at this point. They’ve killed off the muscle cells that can’t handle it, and walled off the parts of the brain that tell them they are too tired to continue (fatigue is mostly in the mind if your hydration and electrolytes are okay).

Proof? Look up ultracycling mph ranges. 7hour riders might be in the 17mph range, 12 hour rides in the 16mph range, and 2.5 day rides in the 13.5mph range. Many of these riders can easily average 20mph for 2-3 hour rides, and push 22mph averages for hard workout days. These stats do not subtract rest stops.

Comparatively, my non-athlete speeds, and I did 40mi at 14.8mph, 23mi at 16.3mph, and I can easily hit 18-20mph on flats, even 34mph on a downhill if I don’t have far to go. I *do* subtract out rest stops.


Weight Goals – WARNING

I realized yesterday at Dinner, or rather, Erica reminded me, that I let my goal slip. The goal is to be 250 LBS or less by spring break so I can do the indoor skydiving out at Stonebriar. I haven’t been doing ANYTHING about this. Actually, that’s a lie. I’ve been compensating for any calorie burn with cake, cookies, candy, and huge portions of food.

Technically, I have too much to lose safely by then (6-7 weeks for 19-20 pounds). A pound a week is good. I’ll be happy with that. 2 pounds a week is tough. I’d be ecstatic for that. 3 pounds per week is not recommended for the average person.

I was 245LBS before, so I should be able to get there, even if I don’t get there in time for spring break.

I know it will be beyond hard. The habits are hard, as is the hunger in general. We’ll see what I can do. I burned a pound today, or rather, tomorrow, since it’s always on the recovery that it changes. It will be important to keep up the calorie burn, because calorie restriction causes the body to reduce metabolism.

I believe if I stay on top of vitamins, proper portions, avoiding starches and fat additions, and cycle my butt off, I might get close. However, as long as the trend is downward again, I’ll be happy.


2014-01-01 New China Wed Lunch Ride

Group ride to New China for lunch. First ride out in a few weeks. Found a new Max Heartreat of 191, which is higher than age-estimates.

Distance: 7.25 mi
Calories: 432 C

Time: 42:29
Moving Time: 41:05
Elapsed Time: 1:59:44

Avg Speed: 10.2 mph
Avg Moving Speed: 10.6 mph
Max Speed: 28.8 mph

Elevation Gain: 325 ft
Elevation Loss: 279 ft
Min Elevation: 554 ft
Max Elevation: 663 ft

Avg HR: 121 bpm
Max HR: 191 bpm

Avg Power: 87 W
Max Power: 1,102 W
Max Avg Power (20 min): 112 W

Avg Bike Cadence: 55 rpm
Max Bike Cadence: 175 rpm

Avg Temperature: 69.6 °F
Min Temperature: 66.2 °F
Max Temperature: 84.2 °F

NOTE: Temp is high by 10 degrees

http://connect.garmin.com/activity/422942535
http://www.strava.com/activities/103258914
http://www.mapmyride.com/workout/454347709
http://runkeeper.com/user/xaminmo/activity/286093664


2013-09-07 Moose Ride

Ride was great. Met up with Sharon Haney’s group at the AMC HV. From there, we rode up to Lake Dallas to meet with Mark Solow’s group. From there, we rode up to the Smiling Moose Deli in Denton (Hickory St.). Ride was about 22.5 miles for me from home, and about 15-17 in, I started feeling a hump in my ride. I thought it was a spoke, but Kathy pointed out that it looked pretty wonky. I checked it out, and the bead was separating from the tire. Maybe sand got in there. Not sure. Either way, I needed a new tire. Charlie Haney was pulling SAG support, and he gave me a lift over to Bullseye Bike Shop. Picked up a Vittoria Randonneur for MSRP, about 30% over Amazon price which is good for an LBS. Plus, they let me use tire levers and a floor pump. Then, back to the moose because I left my helmet. Oops! By that time, the fast group was already pretty far down the trail, so Charlie took me back down to the the Lake Dallas meet where he was picking up another bike. I rode out to Corinth St to meet the group and test the tire, and then finished the ride back. I lost about 7 miles off of what I was hoping, but it was still a great ride. My average moving speed was 15mph, and average overall was 14.3 I’m really proud of that, and excited by how much group dynamics push me to ride faster. I’m modelling much of my push and coast on Sharon, who’s a couple of levels beyond me in ability, but everyone out there has something I can learn from.

ps, On the first half, I still had some juice, though the heat of the second half really started slowing me down. I didn’t get enough ice in my hydro pack during the food stop. Even so, I stayed in the front of the pack the whole time.

Distance: 35.18 mi
Calories: 2,862 C

Time: 2:27:20
Moving Time: 2:21:09
Elapsed Time: 5:11:55

Avg Speed: 14.3 mph
Avg Moving Speed: 15.0 mph
Max Speed: 30.2 mph

Elevation Gain: 1,184 ft
Elevation Loss: 1,325 ft
Min Elevation: 494 ft
Max Elevation: 720 ft

Avg Power: 130 W
Max Power: 675 W
Max Avg Power (20 min): 170 W

Avg Temperature: 85.0 °F
Min Temperature: 76.0 °F
Max Temperature: 94.0 °F

http://connect.garmin.com/activity/372037618
http://runkeeper.com/user/xaminmo/activity/238266495
http://www.strava.com/activities/80769041
http://www.mapmyride.com/workout/377409469


Bike, Spine, etc

My bike still isn’t in service, and neither is my spine.
I’m not taking alieve or valerian today, but there’s no way I could do hills or a hard trail.

Final tally of damage on my bike:

  • 3 sprockets on my freewheel – DNP is replacing this. Probably will be okay, but I realized I got the 11-32 and wanted the 11-34.
  • Busted links on my chain – Amazon replaced this for me, but I think the new chain will fail too. I did pick up some missing link spares so I could reassemble any broken links on the ride. I may have to pick up an SRAM 951 chain. It’s build/design is what I’d expect. KMC and Shimano in the 9-speed sizes are dimpled and when the pin pulls, it just fails permanently. Still, $25 for a chain. ouch.
  • Bent axle – second time I’ve noticed this, but the only time it was major. I had to use my brass, machinist hammer to bend it back down before I could remove the freewheel.
  • Freewheel thread shoulder – It’s not a flush/flat fit, so the freewheel overtightened to the point of actually rolling back part of the hub shoulder. This could lead to the entire freewheel thread shearing loose from the hub. Though there are enough locknuts to keep the wheel from falling off, I’d have to walk the bike back if that happened. The alternative is to switch to a freehub, which has a better bearing placement, so I wouldn’t be as likely to break things. There are limited options for a 28″ or larger tire, but still using rim brakes. It looks like I can get a replacement wheel for about $60, or both as a set for about $100. The alternative would be upgrading to disc brakes too, which would be more cost still. Also, changing to a freehub means buying a sprocket cassette. My freewheel wouldn’t fit on it.
  • My spine… it’s still only about 60%. I may be able to ride Thursday morning, or I may wait until the weekend.

When I visited the local bike shop, they could order the wheel for me for $100, just for the one. I did let them order replacement axles for me… it’s the same price as I can get online, or within a dollar or so. I test-rode a decent 20″ bike with 29″ wheels, front suspension, disc brakes, 3×8 transmission, and it was very smooth, very comfy. The brakes were wire pull, and didn’t grip as tightly as I’d hope. Overall though, the bike was good stuff, and seemed like it, or a 22″ version would be what I would want in an upgrade. BUT, this low-cost version was $600, and I’m still not sure what all I break on bikes. Still, the 3-speed front is nice, because it would keep my chain from jumping. I might basically end up with close to that much in my existing bike. *sigh*


gps and cucling

Try two of recording with my iphone 4 vs ipad mini fails. try 1 failed because my manual sync between devices broke permissions. try two failed necause the GPS decoder in the iphone4 sucks.

It says i flew hundreds of feet into the air, which i did not do this time. also, saving takes way longer (slower, single cor processor).

I need to buy a jailbroken 32g 4S from someone, preferrably unlocked, for not a huge amount of dollars.


Cycling and health

I am 258.2 pounds now, and 28.5% body fat. Not my lowest weight, but is lowest fat pct. I am dropping a pound and one percent fat per week from cycling. It’s relatively fun. We’ll see if every other day is maintainable, and if body metrics continue to improve.


More dad stuff

: is your dad okay?
: Welp… they expanded his diagnosis, and he’s going to be there for a while, and will need and I to pull his stuff from Tremont, including his financial info. He’ll go back there, but not for a couple of weeks.
: He has air in his bladder and a kidney. they believe it’s an intestinal fissure
: he has a mass in one kidney, and they may have to take that kidney, which would mean definitely dialysis every couple of days for life
: Because of all this, his gall-bladder surgery will not be laparoscopic… they’ll just do one open surgery
: so he’ll be in the hosp for 7-10 days after that, and it’ll be a month or two before he’s really recovered.
: is concerned about his difficulty in recovering from this large of a surgery what with his general health.