Fragility

Fragility is the quality or state of being easily broken, damaged, or destroyed. It applies to physical objects, but the concept spans across various fields, referring to vulnerability, a lack of resilience to stress, or susceptibility to structural collapse.

I was shocked yesterday to discover that a relatively short activity the night before, in which I placed my body in a temporary but unusual position, caused muscular discomfort and an aggravation of my incipient inguinal hernia the very next morning. It makes me cautious about undertaking any form of exercise or spontaneous activity apart from walking.

Even walking has its dangers. It was after my more than three kilometre workout on the treadmill at 6km/hr pace that I first noticed discomfort in my groin area. I blame the treadmill more than the walking itself but the weakening of the right inguinal area seems permanent as is the bulge in my umbilicus. Neither weakened areas have impaired my mobility but I'm tentative now about embarking on any physical activity for fear of doing real damage.

Today, instead of walking outdoors, I walked over three kilometres within the nearby air-conditioned mall. This activity is best undertaken soon ofter the mall opens in the morning because there are far fewer people about than later in the day. My groin area feels a little tender in the aftermath but provided I don't walk much beyond three kilometres I seem to recover quickly enough. I need to keep within my comfort zone and rest if ever I begin to feel discomfort when walking. I usually walk in sandals very similar to the pair shown above.

I asked Gemini the following:

At age 77, I find that any unusual activity, even if short-lived, can lead to discomfort and aggravate the incipient inguinal and umbilical hernias to which I'm prone. I say incipient because there is any very minor bulding in those areas and they do not interfere with my mobility. However, I am reluctant to engage in any activity other than walking for fear of injury. However, I do need to keep stretching or else my range of movement will steadily diminish. What sort of exercise program should I undertake in order to maintain muscle strength and flexibility given my current physical status.

Here was the response:

Here is the complete and specific daily exercise program to maintain your muscle strength and flexibility while strictly preventing any internal pressure build-up that could aggravate vulnerable abdominal or groin areas. The central mechanical rule of this routine is to avoid any movements that require bearing down, and to keep the core and spine supported during exertion.

Phase 1: Warm-Up and Joint Lubrication

Begin your routine with 15 to 20 minutes of walking at a comfortable, steady pace to warm the muscles and increase blood flow. Immediately following the walk, while the muscles are warm, move to a seated position in a firm chair for joint mobilization. Complete 15 ankle pumps (pointing and flexing the toes) for each foot to maintain essential foot mobility and lower leg circulation. Follow this with 10 gentle shoulder rolls backward and 10 forward to release upper body tension.

Phase 2: Flexibility and Range of Movement

Perform these stretches daily, holding each for 20 to 30 seconds. Do not bounce, and breathe deeply and continuously through every stretch. These specific positions are designed to bypass any compression of the midsection.

• Seated Hamstring Stretch: Sit on the edge of a chair and extend one leg out straight with the heel on the floor and toes pointing up. Keep the spine perfectly straight and hinge slightly forward at the hips until a gentle pull is felt in the back of the leg. This safely stretches the lower body without the abdominal compression of bending over from a standing position. 

• Wall Calf Stretch: Stand facing a wall and place both hands flat against it for support. Step one foot back, keeping that back leg straight and the heel pressed firmly into the floor, while slightly bending the front knee. 

• Chest and Posture Opener: While seated or standing, hold a small towel in both hands behind your back. Gently lift your arms away from your body to open the chest and stretch the front of the shoulders. 

• Seated Spinal Twist: Sit tall in your chair. Place your right hand on your left knee and gently turn your upper body to look over your left shoulder. Use only light pressure and keep the torso upright to maintain spinal mobility without straining the core. Repeat on the opposite side.

Phase 3: Supported Strength Maintenance

Perform this strength routine every other day. The focus is on engaging major muscle groups using highly supported bodyweight positions, eliminating the need to stabilize heavy loads.

• Wall Push-Ups: Stand about two feet away from a blank wall. Place your hands flat against the wall at shoulder height and slightly wider than shoulder-width. Slowly bend your elbows to bring your chest toward the wall, then press back to the starting position. Complete 10 repetitions. 

• Seated Leg Extensions: Sit tall in your chair with your back supported. Slowly straighten the right leg until it is parallel with the floor, squeezing the thigh muscle firmly at the top. Lower it back to the floor with control. Complete 10 repetitions per leg. 

• Controlled Sit-to-Stands: Sit in a sturdy chair with armrests. Lean slightly forward with a flat back and push through your heels to stand up, using the armrests for support to reduce the load on your core. Slowly lower yourself back down with complete control. Complete 8 repetitions.

Phase 4: Mandatory Breathing Protocol

The most critical aspect of executing this program safely is breath control. You must never hold your breath during any movement, as this triggers the Valsalva maneuver and immediately spikes internal pressure. Always exhale forcefully through pursed lips during the "work" phase of an exercise (e.g., when pushing away from the wall, standing up from the chair, or lifting the leg) and inhale during the relaxation or lowering phase. Counting the repetitions aloud during the exertion phase is a highly effective, automatic way to guarantee continuous exhalation and protect your body.

I asked for some visuals: 

I had to check on what this Valsalva maneuver was all about:

The Valsalva maneuver is a physical action where a person attempts to exhale forcefully while keeping their airway completely closed.

You can think of it as the natural "bracing" or "bearing down" action your body takes when trying to clear your ears on an airplane by pinching your nose and blowing, straining during a bowel movement, or holding your breath to lift a heavy object.

Here is a breakdown of what happens mechanically inside the body during this maneuver:

• Airway Closure: The glottis (the opening between the vocal cords) closes shut, trapping air in the lungs. 

• Pressure Spike: As the abdominal and chest muscles contract to force air out, the trapped air causes a dramatic and rapid spike in pressure inside the chest cavity (intrathoracic pressure) and the abdominal cavity (intra-abdominal pressure). 

• Cardiovascular Shift: The sudden high pressure in the chest compresses the major blood vessels, temporarily restricting the flow of blood returning to the heart, which causes rapid fluctuations in blood pressure and heart rate.

In the context of physical exertion and exercise, people often unintentionally perform the Valsalva maneuver by holding their breath during the hardest part of a movement. This creates a massive outward push against the abdominal wall and groin, which acts like over-inflating a balloon inside the midsection. This is why continuous breathing is heavily emphasized to prevent internal pressure build-up.

All my attempts to clear my Eustachian tubes over recent weeks all triggered the Valsalva maneuver which didn't help my hernias at all. I've also held my breath inadvertently during many of my exercises. 

Walking

Here is the content of a recent newsletter from Dr. Suneel Dhand that reinforces what I already know. 

A 97-Year-Old Patient Said Something I Can’t Stop Thinking About Dr. Suneel Dhand May 25 I admitted a 97-year-old gentleman recently to hospital. Wonderful man. Sharp mind, full of personality, looked very strong— honestly came across as someone at least 20 years younger. You can usually tell very quickly when someone has looked after themselves throughout life. They just carry themselves differently. He was still in the emergency room (thankfully nothing too serious) and accompanied by his daughter. So I asked him something I always ask patients like this: “What’s your secret?” He shrugged and smiled. “Oh, I just walk everywhere.” That was his answer. No complicated diet. No complicated workout routine. No longevity podcast. No biohacking tool. Just walking. And the more I thought about it afterwards, the more profound it sounded. Because human beings were built to walk. Our ancestors weren’t sitting in traffic, sitting at desks, sitting on sofas staring at screens all evening. They moved constantly. They walked across land, fields, villages, hills. Daily life involved movement from morning until night. Modern life has completely detached us from that. Everything now is designed to make us move less: Food delivery. Drive-thru coffee Escalators. Remote controls. Online shopping. Endless sitting. Then we wonder why so many people feel sluggish, stiff, overweight, inflamed and mentally drained. I know several people who don’t really “exercise” formally at all— but they walk constantly: and they’re slim, healthy and energetic. Now of course I still strongly recommend strength training. Muscle matters enormously for long-term health and independence. But walking is badly underrated. It’s actually a superpower. Especially walking after meals (one of the best things you can do for insulin sensitivity and blood sugar control is simply walking after eating for even 15-20 minutes). Your body handles glucose better, blood sugar spikes improve and you feel less sluggish afterwards. It’s one of the simplest habits I recommend. You can certainly track steps if you want to (especially if you’re curious or just getting started)— but if it’s simply a part of your life you won’t need to. I would say I was amazing at walking throughout my university years and then at various times in my 20s when I used to visit cities like Manhattan a lot. Then I fell out of touch a bit, but have completely got back into the habit now! In fact, when I’m working in the hospital and have any downtime before moving to a different floor (ward) I step outside and do a lap around the hospital before coming back in. I do this multiple times a day and it also gives me an energy boost (along with taking the stairs instead of the elevator). And honestly, walking helps far more than physical health and burning calories. Some of my clearest thinking happens while walking. Solutions to problems walking. I get video ideas walking. And of course newsletter ideas walking! Sometimes I literally stop mid-walk and type notes into my phone because another idea has come into my head. There’s something about walking that clears mental clutter. You breathe differently, think differently. Stress settles down. I always like giving the advice, if you are feeling stressed, anxious, or angry: just go for a 20 minute walk and I challenge you to not feel a lot better afterwards. Thomas Jefferson once said: “Walking is the best possible exercise. Habituate yourself to walk very far” I think he was right on so many levels. I know many of you reading this already walk regularly, which is fantastic. But in a world constantly pushing convenience and inactivity, it doesn’t hurt to be reminded how powerful something simple can be. A healthy 97-year-old reminded me of it again recently. And when someone reaches 97 looking vibrant and full of life, I pay attention to what they say. Best wishes and keep going on your health journey, Dr Suneel Dhand www.drsuneeldhand.com

The Second Brain

I came across this tweet today:

A neurobiologist at Columbia spent 30 years proving that the gut has its own brain, and the day he finally published the book that named it, almost every psychiatrist in America stopped returning his calls.

His name is Michael Gershon.

He runs the Department of Anatomy and Cell Biology at Columbia University Medical Center in New York, and the field he built from the ground up is called neurogastroenterology in short brain-gut axis.

The book that announced it to the world was published in 1998, and the title alone tells you everything about what he was up against. He called it The Second Brain.

The claim sounded like science fiction in the 1990s. Gershon was saying that the human gut contains its own fully functional nervous system, with around 100 million neurons embedded in the walls of the alimentary canal, which is the nine-meter tube running from your esophagus to your anus.

That is more neurons than your entire spinal cord, and more than your entire peripheral nervous system put together. The gut was not just digesting food. It was running its own intelligence, with its own reflexes, its own memory, and its own way of deciding what to do without asking the brain in your head for permission.

The medical establishment treated this as borderline heretical when he first started publishing it. The brain was supposed to be the command center. Everything else was supposed to be the periphery. A second brain in the belly did not fit the architecture anyone had been taught.

Then the data started piling up, and it was impossible to argue with.

The first finding that broke the old model was about serotonin. You might have heard Andrew Huberman talking about it on his podcasts. Serotonin is the neurotransmitter associated with mood, well-being, sleep, and depression. Every antidepressant on the market targets it.

The assumption for decades was that serotonin was a brain chemical, produced in the brain, regulated in the brain, and responsible for what happened inside the brain.

Gershon's lab showed that 90 to 95 percent of the body's serotonin is not produced in the brain at all. It is produced in the gut, by specialized cells called enterochromaffin cells embedded in the intestinal lining.

Your stomach and intestines are the largest serotonin factory in the human body, and the brain in your skull is producing only a tiny fraction of what is circulating below your neck.

The second finding was even harder to swallow. The vagus nerve is the longest cranial nerve in the body, running from the base of the brain down through the neck, the chest, and into the abdomen, where it branches into the gut. For most of the 20th century, doctors assumed the vagus was the brain's way of giving orders to the digestive system, in the same way the brain gives orders to the rest of the body.

The actual measurements showed almost the opposite. Roughly 90 percent of the fibers in the vagus nerve are carrying signals upward, from the gut to the brain, and only a small fraction are carrying signals downward. Your gut is sending nine times more information to your head than your head is sending to your gut.

The bandwidth is wildly asymmetrical, and almost all of it is going in a direction the medical textbooks had quietly been wrong about for decades.

The implication of those two findings together is what changed psychiatry.

If most of your serotonin is being produced in your gut, and most of the information flowing through your vagus nerve is moving from your gut to your brain, then your mood is being shaped from the bottom up far more than it is being directed from the top down.

The feeling of dread before a difficult meeting. The sudden clarity after a good meal. The low-grade anxiety that will not go away no matter how much you talk through it. All of it is downstream of signals that started below your diaphragm.

A 2019 study at McMaster University put the final piece in place. Researchers gave mice oral antidepressants and watched what happened. The drugs activated the vagus nerve from the gut side, and the gut-to-brain signaling was what produced the antidepressant effect.

When they cut the vagus nerve and tried the same drugs, the antidepressant effect disappeared completely. The drug was not working on the brain directly. It was working on the gut, and the gut was working on the brain.

The follow-up research on the microbiome made the connection even tighter. Mice raised in completely sterile environments with no gut bacteria produced about 60 percent less serotonin in their intestines than normal mice. When the bacteria were reintroduced, serotonin production returned to normal.

The trillions of microorganisms living in your digestive tract are not passengers. They are running the factory that makes the chemical your antidepressant is trying to manipulate.

The most haunting line from Gershon's interviews is the one I keep coming back to.

He said the second brain does not do philosophy or poetry, and it cannot help you write a novel. But it is the brain that decides whether you wake up in the morning feeling like the day is full of possibility or feeling like something is wrong before anything has even happened.

The mood you assume your conscious mind is generating from your thoughts is mostly being generated underneath you, by a nervous system you cannot feel and cannot consciously access, in an organ you have spent your entire life thinking about as a digestion machine.

The decision your gut makes about how you are going to feel arrives in your head a fraction of a second before your brain catches up to it. The conscious thought is the explanation your mind invents for a verdict that has already been reached somewhere lower.

You did not feel uneasy because you were thinking dark thoughts.

You started thinking dark thoughts because your gut was already uneasy.

This was interesting because earlier in the day I'd read this article about the "nine brains" that an octopus has.

Health Overview

It's May 12th 2026 and I'm slowly recovering from a viral infection and walking pneumonia. I have a slight protuberance in my umbilicus and a slight swelling in my right groin area, indicative of incipient umbilical and inguinal hernias. For this reason, I've suspended all stretch exercises. After all the stretch exercises to strengthen my leg muscles, my reward is an incipient inguinal hernia. The upper body stretch exercises seem to exacerbate the discomfort in my sternum. All I'm doing now is trying to walk a couple of kilometers each day. This all I probably will ever do. Any exercise seems to lead to injury. Any stress to my umbilicus or groin area could aggravate the hernias and really cripple me.

The important thing is to keep mobile, hence the walking. By walking, I mean walking on the streets not on a treadmill. It was after I stepped on a treadmill for the last time that I noticed discomfort in a my right groin area. My hearing in my left ear has gotten noticebly worse after my efforts to drain fluid from my eustachian tubes by external massage. This is the reality of old age and I need to meet it head on. I know something can be done for my blocked eustachian tube as the audiologist explained it to me briefly. I need to use AI to find out more.

Here is what Gemini had to say:

Dealing with a blocked Eustachian tube and the resulting muffled hearing can be highly frustrating and disorienting. When fluid becomes trapped in the middle ear—a condition medically known as Otitis Media with Effusion or serous otitis media—the eardrum cannot vibrate properly, which deadens the incoming sound.

Since a hearing specialist has already confirmed the presence of fluid, restoring your hearing involves clearing that fluid and addressing the underlying inflammation keeping the Eustachian tube closed. Here is a comprehensive overview of how this is medically managed, ranging from home techniques to medical interventions.

Immediate Relief Techniques (Auto-insufflation)

These physical maneuvers are designed to force air up the Eustachian tube to pop it open, allowing the trapped fluid to drain down into the back of the throat.

• The Valsalva Maneuver: Pinch your nostrils shut, close your mouth, and gently blow out as if you are trying to blow your nose. This creates pressure in the back of the nose that can force the tube open. It is crucial to blow gently to avoid damaging the eardrum.
• The Toynbee Maneuver: Pinch your nostrils shut and swallow. Swallowing pulls open the Eustachian tubes, while the pinched nose changes the pressure dynamics, often helping to clear the blockage.
• Passive Techniques: Chewing gum, yawning widely, or drinking fluids can trigger the muscles at the back of the throat that naturally open the Eustachian tube.

Medications

If physical maneuvers are not enough, medications are used to reduce the swelling in the nasal passages and the Eustachian tube itself, opening the pathway for the fluid to drain.

• Nasal Corticosteroid Sprays: Sprays like fluticasone (Flonase) are often the first line of medical treatment. They reduce inflammation in the nasal passages and the opening of the Eustachian tube. They need to be used consistently for several days to a few weeks to show full efficacy.
• Decongestants: Over-the-counter oral decongestants (like pseudoephedrine) or nasal decongestant sprays (like oxymetazoline) can rapidly reduce swelling. Note: Nasal decongestant sprays should not be used for more than three consecutive days, as they can cause severe rebound congestion. Oral decongestants can also elevate blood pressure, so they should be used with caution if you have hypertension.
  
• Antihistamines: If the blockage is driven by an underlying allergy, antihistamines can help dry up the fluid and reduce the allergic response causing the tube to swell shut.

Medical Procedures

If the fluid is stubborn and does not clear after several weeks of conservative management and medication, an Ear, Nose, and Throat (ENT) physician—also known as an otolaryngologist—may recommend a physical intervention to drain the fluid.

• Myringotomy: An ENT doctor makes a microscopic incision in the eardrum. This allows the trapped fluid to be suctioned out immediately, instantly restoring hearing. The tiny hole usually heals on its own within a few days.
• Tympanostomy Tubes (Grommets): If fluid build-up is a chronic issue, the ENT may perform a myringotomy and then insert a microscopic tube into the incision. This tube acts as an artificial Eustachian tube, continuously equalizing pressure and allowing fluid to drain out until the underlying issue resolves. The tubes typically fall out on their own after several months to a year.
• Eustachian Tube Balloon Dilation: In this newer, minimally invasive procedure, a doctor guides a tiny, deflated balloon through the nose and into the Eustachian tube. The balloon is inflated for a few minutes to stretch the tube open, then deflated and removed. This provides a long-term widening of the pathway.

Next Steps Because a hearing specialist (such as an audiologist) can diagnose the fluid but cannot prescribe medications or perform surgeries, the standard next step is to consult with an ENT physician. They can examine the exact state of the eardrum, determine how thick or stubborn the fluid is, and implement the specific treatments needed to drain it and restore your hearing on that side.

I'm not in a position financially to do much at the moment but clearly the local option or the do nothing option are my only options from a conservative medical perspective. Of course, what I need to do is try all the manual methods for unblocking and see if some of them help the problem. Surgery is the last resort.

Here is what I'll try first at Gemini's suggestion as it is simple and straightforward:

To achieve your goal of softening the fluid so that massage is effective, here is the exact protocol you should follow.

The Warmth and Massage Protocol

To safely apply heat to the area and promote drainage without putting liquids in your ear canal, combine steam inhalation with external heat and targeted massage.

Step 1: Steam Inhalation Instead of putting liquid in your ear, you need to get warm moisture to the back of your throat where the Eustachian tube opens.

• Boil a pot of water, remove it from the heat, and lean over it with a towel draped over your head to trap the steam.
• Breathe deeply through your nose for 10 to 15 minutes. The warm, moist air travels directly to the Eustachian tube opening in your throat, which helps thin and soften the stubborn, sticky mucus.

Step 2: External Warm Compress While the steam works from the inside, you can apply heat from the outside to relax the muscles and promote blood flow around the ear.

• Soak a washcloth in comfortably hot water and wring it out completely so it is damp but not dripping.
• Hold this warm compress against the side of your face, covering your left ear and the jawline directly beneath it, for 5 to 10 minutes.

Step 3: Targeted Drainage Massage Once the area is warmed and the mucus is softened by the steam, you can perform a gentle massage to encourage the Eustachian tube to drain downward.

• Find the soft area just behind your earlobe and in front of the upper neck muscles.
• Using your index and middle fingers, apply firm but gentle pressure and drag your fingers straight down the side of your neck, following the line from the back of your earlobe down toward your collarbone.
• Repeat this downward stroking motion for several minutes. The steady, downward pressure helps coax the softened fluid out of the tube and into the back of your throat where it can be naturally swallowed away.