July 25, 2024
My mom is lying in critical condition in the ICU. A fully independent, cognitively sharp 89-year-old in January, she fell in the shower and fractured a bone in her lower leg. She entered the hospital mid January for an evaluation for surgery. Within days of being in the hospital, she got a urinary tract infection. Days later mild sepsis and antibiotics. The sepsis led to mental confusion causing her to aspirate some food resulting in a lung infection. Doing better after multiple rounds of antibiotics, in early April (3 months of hospitalization and rehab) takes the ride from Naples to Tampa General Hospital – a better hospital to finally get her surgery. Days later Another kidney infection and even more powerful antibiotics. The antibiotics are so strong that in a couple days her kidneys start not working well. Because of that, lungs fill with water. I get the call from the doctor…they are moving her to ICU, and I better come today…
Upon arrival I see a woman who has aged a decade in the 6 weeks since I saw her last. Cognitively still with it, but so hard for her to breathe, she can’t get out an audible word. It’s so hard to understand what she is trying to say. Is she still fighting for life, or is she resigned after 4 months of hospitalization, IVs, daily blood draws, tubes in her nose, and bedridden with a leg fracture.
I look up at the numbers on the screen above her bed in the ICU. Heart rate, oxygen saturation, respiratory rate. I find an uneasy comfort in the numbers. For over 20 years, 8 plus hours a day I stared at a similar screen as an anesthesiologist, treating healthy people, and people like mom, those near the end. The objective numbers dehumanize me a bit and make me react clinically. I guess this is the defense mechanism that anesthesiologists and critical care clinicians use so you able to treat without sorrow and fear clouding your clinical judgment. Her numbers aren’t great. Barely keeping her oxygen up while on 80% inhaled oxygen. A very bad sign. She is breathing 30 times a minute not the usual 15. She is working so hard just to get the air in.
My 95-year-old father who is sharp as the moment I can first remember him is at the bedside. He has been standing like a sentry, 12 hours a day for nearly 4 months. He is there when visiting hours starts and they ask him to leave every night. He isn’t medical and doesn’t understand why she is in ICU now when we came to this hospital because she was doing better and ready for surgery. He swabs her mouth with a wet swab. Kisses her forehead. Tells her when she is out and over this we are going to Dallas to visit me and Chrissy.
I fight back tears with each tender moment. I try and look brave for my mom. I look up the numbers on the monitor for strength. I know what’s coming. I have seen it hundreds of times in my career. Vibrant healthy 80+ year olds can take one hit and usually bounce back (leg fracture). It’s so much harder to bounce back after that second hit (infection). You are betting on a long shot if you get a 3rd and 4th hit (kidney insufficiency and pulmonary edema).
Healthspan and Lifespan: A Review
I wrote about this in my first blog 6 years ago. We preach longevity science at Formula Wellness but what most people want is not just a dramatic increase in lifespan but an increase in healthspan.
Lifespan is a simple concept: the number of years months and days you are alive on this planet. The average lifespan in America is 76 years. Despite spend more on healthcare in this country per capita then any other country and despite our medical advances, that number has not only had a slight increase (by 2 years over the last 4 decades) but has actually edged DOWN in recent years. There is some recent artifact in the recent decline, covid direct effects, covid indirect effects (people not going to doctor and missing cancer screenings or heart screenings), as well as the opioid crisis and overdoses striking over 100k a year of our young and prime, but the point is still valid, our human bodies are what they are, it’s hard to significantly move lifespan.
So, our medical advances aren’t moving the lifespan needle much, but can they move healthspan? Healthspan is how long you are active and healthy doing the daily activities you love. Most people experience a progressive decline of healthspan in their 60s. Those limited by heart attacks, bed ridden with dementia, too weak from poor muscle mass to walk more than a few feet may have years of lifespan, but such a poor decline that they have a low healthspan. The goal of both wellness and traditional medicine may one day be improving lifespan, but for now it’s improving healthspan (Increase the shaded grey area in the graph below).
The Prison of 2 Ideas: Wellness vs Medicine
8 years ago, when we opened formula wellness, I had a patient who was losing weight with us, off 3 medicines and feeling great from their hormones. This patient went to their internist and told them how great they felt from the vitamins and supplements and hormones. His doctor said that it sounds like those guys at Formula are quacks. That patient scoffed. He was getting well with a more natural approach. He was exercising, people he hadn’t seen in a while barely recognized him because he looked so good. His doctor was stuck in a paradigm that traditional medicine has all the answers and despite not bending the curve on healthspan or lifespan, his doctor was not open to new (well actually very old) ideas. He was trapped in a prison of certainty of the ideas that he learned in medical school were the only right ideas.
I saw an article on the now famous wellness influencer David Aspry about how he knows he is going to live to 120 (Side-bet: I will take the under). His blue light blocking glasses, infra red sauna, intermittent fasting, carnivore/keto/bulletproof diet, with MCT and butter in his coffee will be the breakthrough in lifespan that billions of dollars in medical research hasn’t been able to accomplish. He regularly has guests on that spout that cholesterol and blood lipids don’t matter and infers claims that his lifestyle alone unlocks the fountain of youth and longevity that has been searched for and has eluded us from the time of the Greeks to Ponce Deleon, to our modern age. He, and many of the modern “Bio-Hackers” are trapped in the mental prison that hacks are the true cure and have the answers to longevity that traditional medicine has failed to improve upon.
The truth is that you need both wellness and medicine in your life to maximize healthspan and lifespan. Wellness doctors / nutritionists /influencers hold an advantage over the standard medical establishment on prevention of illness. My opinion is that it’s not specifically the rucking or cold plunging or morning sun in your eyes that promotes this healthspan but how many of them you stack on a regular basis. I call this the healthy user effect. The more time you are walking your 10k steps, the less you are sedentary binging Netflix. There is no science behind a Stanley mug of water a day preventing ANY disease. But the more water you drink the less coke and Red Bulls you drink. Because we psychologically all need that next thing to reach for doesn’t make it snake oil. It’s a positive additive indirect effect of these healthy user behaviors.
Once you get a disease that’s past irreversibility- the narrower arteries or heart attack, the colon polyp, the blood sugar that pushes past pre-diabetes. You need medical intervention to prevent organ damage. Once our organs are damaged beyond that which our repair mechanisms can repair, we start a hard and fast decline in healthspan. Medicine can slow that descent into horrible loss – bending the area under the curve of less healthspan while there is still more lifespan left.
Then there is the even more significant medical injury. Infrared lights don’t lower mortality rates in the icu. Your Oura ring data doesn’t compare to a pulse oximeter when your lungs are compromised. Just as there are no atheists in a foxhole, no one should be calling for Ben Greenfield or Anthony Huberman when they (or a loved one) are in the hospital or ICU.
Wellness Doctor… Heal Thyself
I have told the story 1000x. Chrissy and I started formula wellness because I was 49 and she said I need to go see a doctor because in my life, I had never seen one. Instead, I drew my own blood, interpreted my not so good results and took functional medicine courses (and got board certified) and treated myself.
Lawyers say that a lawyer who represents himself has a fool for a client. Well despite my numbers being better 8 years later, Dr Rudman had a fool for a patient in Brian.
I drew my blood again a couple weeks ago. An experienced provider who was new to Formula was shadowing me and I told her to treat me like I was a new patient. She was blunt. I could be doing better. I was not a “great to excellent” patient and maybe not a “good to great. I was holding steady at good. I needed to increase my water intake instead of sipping coffee all morning. I needed to add more zone 2 cardio instead of mostly weights. I need kidney protection supplements. Her words stung. I realize I was a fool because what we do at Formula is not just hocking the latest wellness fad or technology that’s going to make you live to 120. We are an accountability partner and coach that keeps you doing the healthy user behaviors and adds medicines when needed. In looking at my own numbers I was as disassociated as a traditional doc is who spends only 5 minutes with a patient, or an anesthesiologist monitoring the unconscious patient in front of them. Or yes even the son looking at his moms failing vitals on the ICU screen.
The Longevity Journey
At formula we look at both our aesthetic and wellness services as part of a journey for our patients. We are experienced coaches and providers. We keep up with the best injectable filler techniques and the best way to stimulate your collagen naturally. We listen to Aspry, Greenfield and Huberman but we are trained at the other end of the spectrum and “coach” you up on the latest techniques to preserve health while also telling you when you need that blood pressure or cholesterol medicine. We won’t promise you will hit 120 years in longevity, but we will hold you accountable to your plan to keep getting better. We will use technology and show some improvements in your biomarkers during your journey.
Wil Rudman 95 – Longevity Guru
My first night in Tampa I went to the Airbnb where my dad and sister were holed up for 2 weeks while mom was at Tampa General. The only food in the fridge was hot dog buns and cheese. I looked at my sister who ordered Uber eats every night and she said, that’s all my dad eats since he has been here. Hotdog buns and cheese. Not exactly what our nutritionist would prescribe.
My dad is 95. Mows the grass every week with a push mower (although he now has to break it up into 3 sessions with breaks in between). He has a full head of salt and pepper hair and can growl at you when he is unhappy like a loud grizzly bear. He takes 5 medicines a day, has had prostrate surgery, and a stent in his heart.
I am convinced he has already outlived how old David Aspry will be when he passes. Did he do it through his use of EMF pads and a carnivore diet? No. He smoked a pack a day for 20 years in his youth.
So is it all good genetics and luck? I have done genetic testing on myself. There are known longevity genes that are passed down to you from your parents. I have NONE of them meaning they don’t have them as well. My dad though was a retail store manager for most of his career. He was walking 15k steps (activity) a day 6 days a week (consistency) managing a Target long before counting steps were cool. My mom and him, weren’t regulars at Barry’s Boot Camp but they took a walk every night (activity) and talked about their day (emotional connection). He ate a grapefruit every morning (antioxidants) and a salad with tomatoes and cucumbers (fiber and nutrients) every day. Him and my mom liked an occasional glass of wine but were always temperate in its use. They had challenges but I never saw them lose sleep due to stress. Despite not drawing a great genetic hand, few people have had more area under the healthspan curve then my parents. Except for the recent diet of hot dog buns and cheese, I think maybe mom and dad were the true “OG‘s” of Biohacking.
The End
It’s been days and mom is still on 80% oxygen and looking weaker. I look at the numbers but it’s harder to disassociate. She was so vibrant a few months ago. I see it in her eyes she is getting ready for the end. I feel sad for her. I worry about my dad. The lone sentry is being relieved from his post before he wants to. His nighttime walks will be lonely.
The palliative care nurse practitioner walks in with the ICU attending. I brace myself for the conversation. Dad does not understand. It’s time to make her comfortable. Let her go in peace. For mom, this is where her longevity journey ends.
Had my mom not bio hacked AND used traditional medicine she wouldn’t have made it this far. The cynical internist and the podcast guest who naysayers the other is bad are both wrong. All of it matters if you want more healthy days or just more days with the people you love.
As this longevity doctor faces his mom’s death it reinforces everything we coach in wellness. Invest in your health. Do the steps. The cold plunge. The sauna. The HIIT training and the weights. Eat your protein, drink your water take your Vitamin D and the supplements. Get your colonoscopy. Know your calcium score. Treat your blood pressure and your cholesterol. If it’s not us at Formula find your guide in your healthspan journey. Because in the end there is not a thing that matters more then the chance to create more memories while being healthy with the people you love.
Coda: Young Forever
It’s been days since she has left us. When I think of my mom now it’s not those final days in ICU I think of. It’s her smile and how young she looked picking me up from the carpool lane. It’s her smile on the sideline of my little league games. It’s how beautiful and her smiling at (both of) my weddings. That smile. My memories are all of her smile and how young and beautiful she was. I guess maybe that’s the secret to the fountain of youth that neither Ponce Deleon nor the Biohackers have figured out. It’s not living to 120 to keep you young. It’s having the healthspan to create and enjoy amazing experiences with those around you. Because when you do that, you create lasting memories, that to them, even when your lifespan ends, in their heart, you will be forever young.
Stay Well and Keep Getting Better!
Dr. Brian Rudman
Co-Founder & Chief Medical Officer | Formula Wellness