Two Thirds Done

Thoughts and experiences of an eighty one year old Wild Duck.

Avram Miller by the sea
EN | IT

587 posts since 2006

Category: Health and Fitness

  • I am getting tired of being me

    An older man dressed as a superhero with a blue suit and red cape, flying in front of a city skyline, with a ‘Daily Planet’ sign visible.

    I always had a lot of drive. I used to joke that I would wake up standing because I jumped out of bed. It was not really a joke. It was the truth. For such a long part of my life, I woke up with tremendous energy. That energy would keep up pretty much during the day but would start to fade in the evening. But even that was relative. My low point was probably equal to most people’s high point.

    Now that energy is fading. It probably has something to do with being 81 years old, but there may be other factors. I am really speaking about my physical energy. The opposite seems to be happening with respect to my mind. It seems to be on fire, lit by a match called AI.

    Unfortunately there’s sort of a mismatch between my mind and my body. It’s not the first time I’ve experienced this. I used to joke that my body was just a socket for my brain because I had a pretty big disconnect between my mental self and my physical self. Then when I was 40 I was able to integrate the two parts of who I am. That happened when I started working out regularly at the gym, doing yoga, and then later doing Pilates.

    I still am physically active, but I’m starting to feel a decline in my energy level. I don’t have the same drive, but I have the same desire to do things. In fact, while my body may be declining some, my brain seems to be going the other way, particularly as it has been stimulated by AI. There are so many things I want to do every day, so many things I want to write, so many things I want to learn. I want to play piano more. I want to study Italian more. I am still helping to start companies and continuing my work in medical science. I have all these desires but I can’t keep up with it. At a certain point I just don’t have the energy, and this is really a new experience. I’m grappling with it and I worry that the schism will increase. What’s worse, perhaps I will want to do more and more and I will be able to do less and less.

    Thinking about this takes me back to my childhood, a time when severe asthma ruled my life. It was a curse and a blessing. Without it, I doubt that I would have developed the creative abilities that have played such an important role in my life. Back then, we did not have “devices,” so my device was my mind. I am in no way comparing myself to the great physicist Stephen Hawking, who suffered from ALS from the age of 21. By the time he was in his 30s he could no longer write by hand. He lost the ability to speak with his own voice at the age of 43, 33 years before his death. I have been interested in how he handled this transition, including the tools he used and in particular the skills he developed to work on complex problems just in his head.

    Perhaps my decline in energy is related to taking a small dose of GLP-1 every week or two to maintain my weight at a very healthy level and derive additional and significant health benefits (my labs are amazing). Another possibility is it’s my diet. I have been on an intermittent fasting diet for more than 6 years. I eat between 12 pm and 8 pm, although sometimes I eat a little bit later than that. I’m wondering if taking GLP-1 and intermittent fasting have reduced my energy level. It could be. This is something I could experiment with and get some more information. Another possibility is just really changing my diet. Also, for the longest time I was on a very low-carb diet, but that’s virtually impossible here in Italy. Everything is carbs and you just end up in situations where you’re eating a lot more carbohydrates than you used to, which also means I’m eating less protein.

    Many of the hours of my day are spent standing in front of my computer (I don’t have a chair), writing or reading or watching. I’ve been using a standing desk for probably 15 years. I don’t know if that contributes to the lack of energy, but I don’t like to sit and I actually think sitting is not a good thing. I either stand or lie down and read.

    I am starting to use tools like Wispr to help me dictate. This blog post was dictated using Wispr, for instance. I love that I can now write just using my voice. This has freed me up to work on my writing while I am also taking a walk. I also do a lot of work with ChatGPT or Claude just using voice. So my dependency on being in front of a screen and some kind of keyboard is declining.

    It has also occurred to me that I might actually be working harder than I have been in the last several years, and that’s one of the causes of the sense of losing energy.

    What do you think?

  • AI, longevity, and the End of Growing Old as we Know It

    I have been thinking about the impact of AI on health and what that will do to the concept of age.  Usually when we talk about longevity, we think about how much longer people will live.  Those of us who are more sophisticated about this topic break it down into health span and sick span, hoping we will have not only more days but better days.

    We may wonder if we will reach 100 or 120 or perhaps live even longer. This may be the least interesting question.  It assumes that we will just slow down our aging, but otherwise things will remain the same.  I don’t think it will be that simple, and the results might redefine who we actually are.

    Today we define aging as a simple process. I am 81. Next year I will be 82. If I am fortunate enough to be around ten years from now, I will be 91. That is chronological age, and there is nothing to be done about it. Time marches on. As the joke goes, “aging is better than the alternative.”

    But there is another concept: biological age.  This is an estimate of how old your body is functionally and physiologically, rather than how many years have passed since you were born.  There are a number of ways it is estimated. I will not go into that here.  Frankly, the various methods are still very primitive.  Most provide a single age.  I had my biological age measured by TruDiagnostic about three years ago. I was delighted that my biological age was computed as 15 years younger than my chronological age.  But I do not give this test or the other commercial tests much validity. They do not deal with the complexity of our bodies, and giving  age one number is where the biggest mistake starts.

    An essential issue of age is that not every part of us has the same life expectancy.  This has great implications. Imagine an 80-year-old whose body functions like that of the average 70-year-old. Now suppose medicine becomes increasingly effective at slowing aging. Ten years later that person is chronologically 90 but biologically 75. That would be quite an accomplishment.  At some point his life expectancy would increase by a year every year.  This is what is referred to as longevity escape velocity.  But as I said, just living longer does not really communicate what is likely to happen.

    So far the focus has been on slowing down the aging process.  But it is likely that we can actually reverse aging at some point. Now take it one step further. What if we become capable not merely of slowing biological aging but of reversing some of it? Our 80-year-old who was biologically 70 reaches 90 chronologically and has become biologically 60.

    Chronological age went up ten years. Biological age went down ten years.I imagine a graph showing this, but the more I thought about it, the more I realized it was the wrong graph.  It was one-dimensional because we are not a uniform age already.  Some of us have hearts five years younger than our chronological age but knees that are ten years older.

    We Have Never Been One Age

    There probably isn’t any such thing as one biological age. My liver could function like that of an average 60-year-old while my kidneys function like a 70-year-old’s. My cardiovascular system might be another age, my muscles another, my immune system another, my brain another.

    This isn’t science fiction. Human aging has always been heterogeneous. Different organs and systems age at different rates, and researchers are now developing ways to measure those differences. So perhaps we shouldn’t talk about our biological age. We should talk about our biological ages. We have always been mosaics of age.

    What AI and biotechnology will do is make those differences much greater. Suppose we become very good at rejuvenating muscle but nowhere near as good at rejuvenating skin. I might look 70 and have the strength of a 40-year-old. Suppose we also become extraordinarily good at maintaining cognition. I could have an 80-year-old face, 70-year-old kidneys, a 50-year-old cardiovascular system and a brain performing like a 40-year-old’s.

    So how old am I really?

    The question itself begins to lose its meaning. Knowing one’s chronological age is a recent development.  But it has become a big factor. It has been remarkably useful shorthand. It is important data with respect to understanding someone’s personal history and the things they may have experienced, but it does not tell you their biological age. Tell me someone is 20, 50 or 80 and I immediately have some idea of what that person looks like, how strong they are, what they are physically capable of and, to some extent, what their health risks are. Those things have always travelled together. Perhaps they won’t anymore.

    We May Be as Old as Our Weakest Part

    There is another way I think about aging, particularly when I think about myself. I sometimes say that we are as old as our oldest critical part. More precisely, we are as old as our most vulnerable critical part.

    I can be in excellent shape. My muscles can be strong, my brain can function beautifully, and my heart can be doing its job. But my kidneys are giving out. If one essential system is deteriorating rapidly, that system may determine how long I live. The average doesn’t help when a single critical component fails.

    This is one reason I spend so much time trying to understand what is happening inside my own body. I look at blood tests, MRIs, heart data, sleep data and anything else I can measure. I am particularly interested in trends. I don’t simply want to know whether today’s measurement falls within some population’s definition of “normal.” I want to know whether something is changing. I stay alert.

    In a real sense, I am hunting. I am trying to identify, as early as possible, what is going to try to kill me. I don’t think of that as morbid. I think of it as sensible. If something is going to become a serious problem, I would much rather discover it five years too early than six months too late.

    Cancer is a good example. I have already dealt with it three times: prostate cancer, melanoma and bladder cancer. I don’t think that means I have won my war with cancer. I have won three battles, and I assume there could be others.

    Surveillance is part of staying alive.

    This is one of the areas where AI will make an enormous difference. Today medical information is fragmented. One specialist looks at one system. Another physician looks at something else. Blood tests are taken occasionally, imaging is done occasionally, and wearables produce still another stream. Each provides a piece of the picture. But who is continuously looking at the whole?  I have now integrated all my medical information into an AI agent—an agent that has access to 30 years of my medical data and knows my blood chemistry, imaging, medications, genetics, exercise, sleep, heart rhythms, blood pressure, cognitive performance and hundreds of other measurements, as well as my genetic information. More importantly, it knows me. It can see patterns most, if not all, doctors would miss. Instead of asking whether today’s kidney measurement is normal for an 81-year-old man, it asks whether something has changed from what has been normal for Avram over the last fifteen years. Perhaps no individual change is alarming. But the agent sees five subtle changes occurring together and says: something is happening here. Let’s find out what it is. It can also make suggestions about the things that I can do to improve my longevity.

    This will transform medicine. We would move from waiting for disease to reveal itself toward continually searching for the next weak link. Fix the cardiovascular problem and perhaps the kidneys become the limiting factor. Fix the kidneys and perhaps it is cancer. Control cancer and perhaps neurodegeneration becomes the problem. Then we go after that. Longevity becomes an ongoing process of finding and repairing the next weakest link as well as strengthening the others.

    What if we don’t grow old together?

    There is another consequence I hadn’t thought about until recently. We assume that people grow old together at the same rate.

    Imagine a couple who are five years apart when they marry. Fifty years later they are still five years apart. Chronologically, that will always be true. Biologically, perhaps it won’t. Suppose a new rejuvenation treatment becomes available. One partner responds extraordinarily well because of some combination of genetics, immune function and biological circumstance. The other doesn’t. Ten years later they might be chronologically 85 and 90, but one functions like someone who is 50 while the other functions like someone who is 85. A five-year difference has effectively become a 35-year difference.

    What does that do to a marriage? One person may want to travel, work, ski, start a company or begin another entire chapter of life. The other may increasingly need care. We have always talked about growing old together. Perhaps some couples won’t.

    And then it gets stranger. Suppose their children are in their sixties. The rejuvenated 90-year-old parent could be biologically and functionally younger than their 65-year-old child. Who is the old person? Who takes care of whom?

    We are accustomed to generations moving through life in a predictable order. Parents get old. Children become middle-aged. Eventually the children may care for the parents. But what happens when biological age no longer respects generations? Two people born on the same day might eventually be biologically separated by decades.

    If we want to have children at a later age, we will be able to.  So it will not be so uncommon to have parents with children younger than their grandchildren.  Yes, another breakdown in what we have considered to be normal.

    Human relationships are based partly on the fact that we move through life together. Changing the rate at which individuals age could therefore change marriage, friendship, caregiving and the relationship between parents and children. One of the strangest consequences of defeating aging may be discovering that we no longer age together.

    What happens to the stages of life?

    That raises an even larger question. Our entire civilization is organized around the assumption that a human life follows a predictable curve. We grow up. We go to school. We work. We raise families. We retire. We grow old. Eventually we die. We can divide life into three ages: the first is where we learn, the second is where we apply, and the third is where we retire.

    Why should education be concentrated in the first twenty or twenty-five years of life if you might remain cognitively vigorous for a century? Why have one career? Perhaps people will have five. Why retire at 65 if you are biologically 45? Why accumulate money for a retirement that may last longer than your entire working life once did? Why inherit your parents’ money at 60 if your parents are biologically younger than you?

    Longevity could require us to redesign institutions we don’t normally think of as having anything to do with biology: education, careers, retirement, marriage, inheritance, pensions, politics. The stages of life themselves may begin to disappear.

    Youth may become a luxury good

    There is also an uncomfortable economic dimension to all of this. The first really effective rejuvenation technologies are unlikely to be cheap, and wealthy people will probably get them first. That could create an entirely new way of displaying wealth.

    Today we recognize wealth through houses, cars, clothes and travel. In the future we may recognize it by looking at the person. You meet someone who is chronologically 85 but looks 60, moves like someone who is 45 and has the energy and cognitive ability of someone decades younger. You immediately know something about them: they can afford it.

    But there is another possibility. People may change what they choose to spend their money on. Suppose you aren’t extraordinarily wealthy, but you have accumulated some savings. You can buy a bigger house. You can buy an expensive car. Or you can buy another ten healthy years. What do you choose?

    I suspect a lot of people will choose the years. The ultimate luxury may turn out not to be something you own. It may be time. Or, more precisely, the ability to remain capable while time passes.

    Politics Without a Single Age

    Politics could get particularly strange. Today an aging politician inevitably faces questions about age. But imagine an 82-year-old candidate saying: “Yes, I am chronologically 82. But my cardiovascular age is 58, my cognitive age is 52 and my physical performance is equivalent to the average 55-year-old.”

    Candidates might release biological-age reports alongside their medical records. Of course, we would immediately begin arguing about the measurements. Which test counts? Who administers it? Can campaigns choose whichever biological clock makes their candidate look youngest?

    But the fundamental political question could change. Instead of asking whether this person is too old to be president, we might ask which parts of this person are actually old.

    And there is a more uncomfortable possibility. If rejuvenation is expensive, wealthy politicians might be biologically younger precisely because they can afford treatments unavailable to many of the people voting for them.

    The geopolitics of youth

    The same paradox exists between countries. Many of today’s richest countries are also among the oldest. Birth rates are low and populations are aging. Meanwhile, many poorer countries possess something rich countries increasingly lack: young people.

    But what happens if wealthy countries learn how to make old people young? Not chronologically young; an 80-year-old remains 80. But suppose that 80-year-old has the cardiovascular system of someone who is 50, the muscles of someone who is 45 and the cognitive capabilities of someone considerably younger. Suddenly an aging population doesn’t necessarily mean a declining population.

    We could have two kinds of young countries. One is young because its people were recently born. The other is young because its people can afford not to become biologically old. Which has the greater advantage? I don’t know.

    A young African country might have millions of energetic people entering the workforce. A wealthy European or Asian country might have scientists, physicians, engineers and entrepreneurs remaining highly productive into their eighties and nineties. Imagine a scientist with sixty years of experience and the cognitive capabilities we currently associate with middle age. Experience itself begins to compound.

    And eventually rejuvenation technologies may become inexpensive. Then the balance changes again, as countries with large populations of naturally young people acquire the same technologies. Perhaps someday we won’t simply ask how many people live in a country or what their median age is. We will ask how old those people are biologically, and who can afford to keep them young.

    Why stop at just younger?

    But there is an assumption buried in everything I have written so far that I increasingly question. Why is youth the objective? Why should I be satisfied if, at 90, I have the cognitive capabilities I had at 40? Why shouldn’t I be smarter than I was at 40?

    I think of myself as a cognitive athlete.  I believe cognitive training has played an important role in my own cognitive development. I have never been interested simply in holding on. I want to get better: to learn faster, recognize patterns better, improve memory and attention, understand complicated things more easily. I don’t merely want to avoid becoming less capable as I get older. I want to become more capable.

    AI could make that idea enormously more powerful. Imagine an AI that understands precisely how I learn, that knows my strengths and weaknesses and continually develops experiences and exercises designed to improve my cognition. Combine that eventually with advances in neuroscience, pharmacology, neurostimulation, brain-computer interfaces and things we haven’t yet imagined. Then perhaps the objective isn’t maintaining intelligence. It is increasing it.

    Could we turn ordinary people into what we would today call geniuses? Why not at least ask the question? We accept that years of training can transform an ordinary human body into that of an extraordinary athlete. Why assume the brain must remain permanently limited to whatever nature happened to give us?

    And why stop with the brain?

    I have never thought of myself as a physical athlete. It simply hasn’t interested me very much. But it interests lots of other people.

    Imagine someone who has spent a lifetime running. Today, success at 80 means running remarkably well for an 80-year-old. Perhaps someday that qualifier disappears. Suppose regenerative medicine restores muscles, joints and tendons. Cardiovascular treatments improve oxygen delivery. AI continually optimizes training, nutrition and recovery for that particular individual. At 85, that runner might not merely run as well as she did at 60. She might run faster than she did at 35. A swimmer might set a personal record at 90. Someone might become stronger at 75 than they ever were at 30. Then the familiar human life curve of growth, peak and decline no longer describes us. Perhaps your best memory occurs at 75. Your greatest intellectual achievement at 90. Your fastest running time at 80. Your most creative period at 100.

    “Longevity” seems an inadequate word for that. This isn’t simply living longer. It is continuing to develop.

    How old would you feel?

    There may also be an age that has nothing to do with biology.

    Suppose I am chronologically 110. My body functions like that of someone who is 50. My cognitive abilities are better than they were when I was 40. But I still have 110 years of memories. I have watched people be born and die. I have experienced relationships, successes, failures, grief, love and perhaps several completely different careers.

    Would I feel 50? I doubt it.

    We might create people who are physically young and cognitively extraordinary but psychologically unlike any humans who have ever existed. Imagine possessing the physical vitality of middle age with a century of lived experience. We have no idea what that person would be like.

    Just speculation

    Almost everything I have described may prove wrong in timing or degree. Measuring aging is not the same as reversing it. AI may give us increasingly sophisticated maps of how our organs are aging long before medicine gives us reliable ways of making those organs young again. Some forms of aging may prove extraordinarily difficult to reverse. Some interventions may work only for certain people. Some may have consequences we didn’t anticipate. There is no guarantee that an 80-year-old will ever be able to become biologically 50.

    But I don’t think we need to know that these things will happen to think seriously about what would follow if even some of them do. The direction of travel is already interesting. We are getting better at measuring biology. We are getting better at manipulating biology. And AI is getting better at finding patterns in complexity that human beings could never hope to understand unaided.

    Put those three things together and it seems reasonable to ask some very unreasonable-sounding questions.

    We created AI. Will AI create us?

    And that brings me to the strangest thought of all.

    Humans created AI. But perhaps AI will create the humans of the future.

    We created artificial intelligence with the brains evolution gave us. Now AI may help us understand those brains well enough to improve them. Those improved brains may then become better at creating AI. That more powerful AI becomes better at improving us. And around we go.

    Smarter humans create smarter AI. Smarter AI creates smarter humans.

    For hundreds of thousands of years, evolution determined the basic capabilities of Homo sapiens. We didn’t choose our memory capacity. We didn’t choose how quickly we learn. We didn’t choose how long our muscles remain strong or how our brains age. We inherited all of that.

    Perhaps that is about to change. For the first time, intelligence itself may participate in designing its successor. And that successor may be us.

    Which means that perhaps I started this essay with the wrong question. The question isn’t how long humans will live. It isn’t even how young we can remain. The question is: what will a human being be?

    I have no idea. But I increasingly suspect that the humans living at the end of this century will not simply be longer-lived versions of us. They may be something we have never seen before.  And at 81 there is even a small possibility that some form of me will be around to observe it.

    Humans created AI. The great irony may be that AI’s most important creation turns out to be the next version of humans.

  • The Decline and Ascension of Avram Miller

    My body is slowing down as my brain speeds up. It is quite a dilemma. It is understandable that my body would be slowing down. After all, I am 81 years old. But why is my brain speeding up? That is not to be expected. Now, I feel like I felt when I was an eight-year-old, reading a book a day as I consumed a library. Then I only had two things to stimulate my mind: books and, most importantly, my imagination. I learned by creating and by doing. I was destined to find my own way because I was incapable of following anyone else’s.

    Now, at this advanced age, I am still driven to learn and to create. Perhaps the advent of AI has set my brain once again on fire. But like my childhood when I was so ill that most of my days were spent in a bathrobe, my body cannot keep up with my brain.

    I have begun to feel tired. Not sleepy tired, but weary. While I am still strong, doing pilates and gym training four days a week, walking miles every day, and doing push-ups and planks at home, the physical energy that sustained me over all these years is dissipating. I am beginning to be at war with myself. My body wants to lie on the sofa passively, but my mind demands that I stand up and go to my computer. I still put in about 10 hours a day of what others might think of as work, but it is the struggle to do this that I am expressing, as well as the concern about how this situation will evolve.

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  • Healthcare in Italy-My Positive Experence

    We moved to Italy in February 2025, first living in Genoa and then moving to Lecce in October 2025. In Lecce we bought a palazzo built in 1731 in the historic center, which we are now renovating. The renovation will ultimately cost more than what we originally paid for the property and will take about a year to complete.

    Living in Italy, and particularly in southern Italy, is an intense experience with many positives and many negatives. For us, however, the positives greatly outweigh the negatives.

    When we were considering moving to Italy, the quality of the healthcare system was a major factor in our decision. I am 81 years old and in excellent health, but I also recognize that as I age, healthcare will inevitably become a larger part of my life.

    We are financially comfortable and can afford excellent healthcare. While the United States and the Netherlands provide extraordinary healthcare for people who can pay for it, quality alone is not the only factor that matters.

    Healthcare System Comparison

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  • Turning Silver into Gold-The Inversion of the Population Pyramid


    I was recently interviewed by a newspaper in Genoa about an idea I’ve been developing—“Turning Silver into Gold.”

    Almost every developed nation in the world, with the notable exception of Israel, now has a birth rate below replacement level. Italy’s fertility rate is about 1.18 children per woman, far below the 2.1 needed to sustain population size over time. In Genoa, home to the Italian Institute of Technology (IIT), the demographic shift is even more pronounced. It is the oldest major city in Italy.

    The median age in Italy is 49. In the United States it is 39. In Israel it is 29. In Genoa, nearly 30% of the population is over 65. By 2050, projections suggest that Italy could have roughly one retired person for every working-age adult. An inverted population pyramid is not just a statistic—it is a structural challenge to economic growth, healthcare systems, innovation capacity, and social cohesion.

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  • Brain Tech 60 years later


    There is a growing interest in coupling technology with the human brain, from devices that monitor brain activity and help relax or stimulate the mind, to the more ambitious goal of creating high‑speed connections between brains and computers.

    This year, CES in Las Vegas made it clear that brain technology is becoming one of the next major frontiers in health tech. Several companies demonstrated devices aimed at measuring, training, and enhancing mental states. CES is a show I used to attend regularly in my years as a corporate vice president at Intel, back when residential broadband was just beginning to reshape the world. Seeing this new wave of brain technology brought back memories .  

    While I helped drive the creation of today’s residential broadband, few people know that I was also a pioneer in EEG biofeedback. In 1966 I joined Professor Joe Kamiya at the University of California, San Francisco. I was twenty‑one, a hippie and jazz pianist with an unusual talent for designing electronics, and I was making ends meet as the night manager of a pizza parlor. Through a friend, Mel, who was a medical resident working with Joe, I was introduced to this scientist who had a radical idea: if people could see and hear their own brainwaves in real time, they could learn to change them.

    Joe believed that with feedback, people could learn to control their own brain states. He was right. Mel told Joe I might be able to build the equipment he needed to test this theory. Joe explained his vision and asked if I could make it work. I told him I didn’t know, but I would try and that if I succeeded, I wanted a job. He agreed.

    For the next two weeks I worked in Joe’s lab during the day and made pizzas at night. In less than a week I completed the first task, and Joe kept his promise and changed my life.  I quit the pizza parlor and joined the lab, first as a technician and later as a research assistant. Joe became my mentor, teacher, and friend. He turned a wandering musician into a scientist. Why he took that chance on me is something I still don’t fully understand.

    The equipment I built would look crude today. Brainwaves are extraordinarily faint electrical signal, only about 10 to 100 microvolts when measured at the scalp, roughly 100,000 times weaker than a AAA battery. We used around twenty electrodes attached to the head, which was messy and uncomfortable, especially with hair. I designed ultra‑low‑noise analog amplifiers using the first generation of operational amplifiers, filtered the signals to isolate different frequencies, and then digitized them with a custom‑built computer i designed and built, all in real time.

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  • Now for a surprise-you may live to be a 120 year old

    Life expectancy has been increasing worldwide by about 0.2 years every year — roughly two extra years per decade. Even more importantly, health span — the number of years we live in good health — has been rising as well, which is critical.

    If you’re 40 today, actuarial tables suggest you’ll live to about 85 on average. With steady medical progress, 95 is realistic for many. Already, the healthiest 20% have good odds of crossing 100. But that does not account for breakthroughs that are likely in the coming decades. Already, drugs like the GLP-1s are transforming metabolic health, and that’s just the beginning. Advances in gene editing, regenerative medicine, and AI-driven drug discovery could push the boundaries even further. I’ll go out on a limb: I believe some of you will live not just to 100 or 110, but to 120.

    That is 80 years from now. The world in 2105 will be very different from the world of today — perhaps beyond our imagination.

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  • Avram Miller Rebuilt — The Wrap Up

    Here is a recap and wrap-up of my attempt to replace some of my aging parts.

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  • Avram Miller 2.0 – The Rebuilding

    As I wrote earlier, I am in the process of replacing some of the older parts used for eating, hearing, and vision.

    First: A Bit of Extraction and a Lot of Pain

    The extraction of three molars was not easy—it took three hours. I’ve been in pain for about ten days, but it’s getting better. I won’t be able to have the implants placed for six months, and then it will take another three months for the crowns. After that, however, my mouth will be very strong.

    Hearing Like a Baby

    The hearing aids have been a very interesting and positive experience. I can definitely hear well in noisy environments, and I understand Italian (which I am studying) much better. My inability to hear consonants clearly had been making it very difficult to learn Italian and was probably also a handicap in learning Hebrew.

    My AirPods Pro are much better at streaming than the hearing aids, and—crazy as it sounds—I can actually wear both at the same time. This is important because soon Apple will provide translation capabilities using AirPods.

    What’s strange is that when I’m streaming a podcast, no one knows. The AirPods Pro have a feature called Conversation Awareness: if someone starts speaking to me (or if I start speaking), the sound of the stream lowers automatically, letting me hear the environment. Hearing aids don’t offer anything like this. Normally, if I had my AirPods in, my wife would realize I was listening to something. I’m thinking of creating an accessory like a little “recording light.”

    I can adjust the mix between outside sound and streaming. This works well inside the house, though less so in noisy environments. My Phonak hearing aids have an app that lets me set up different configurations and switch between them easily—I’ve been experimenting with this.

    I’m happy to say my hearing aids are practically invisible, which for a vain person like me is important.

    Advances are coming, driven by AI. Soon, hearing aids will not only separate voices from background noise but will also target the voices you want to hear while reducing those you don’t.

    A new feature called Auracast is being rolled out. It’s essentially a Bluetooth LE Audio stream you can tune into, much like selecting a radio station. You can mix it with the ambient sound around you. It’s a one-to-many capability: in a theater, you could tune into the actors’ speech or singing—or even a live translation. In an airport, you could hear announcements clearly, and on an airplane, instead of asking what the pilot said, others may be asking you.

    The feature I’m most looking forward to is simultaneous translation. Apple will soon bring this out for the AirPods Pro. While this won’t work the same way with hearing aids, the good news is that you can use AirPods Pro at the same time as your hearing aids. I’ve already tested this.

    I put on my hearing aids after I shave in the morning and take them off just before bed. They charge during the night, giving me about 18 hours of use per day.

    New Eyes

    After much consideration, I decided to get cataract surgery. I had my first eye done three days ago. The process was amazing. Many eye surgeons use the same operating facility—mine was in Beverly Hills, close to where I’m staying. It’s like a factory with seven operating rooms. They do about 60 operations a day. The whole process takes about two hours from check-in to check-out.

    The first hour is paperwork and preparation. Then comes the operation, done in two parts. First, a laser performs the incision and separates your lens. Then the laser breaks up the cataract. (This can also be done by hand, but the laser is more precise and results in fewer complications.) You’re fully awake during this part. Your eye is dilated and numbed—you feel nothing. A device holds your eyelid open. You communicate with the surgeon while watching a big “light show.” It isn’t unpleasant.

    Next comes the implant of the new lens. You’re given a very light sedative (I just felt relaxed). Once my natural lens was removed but before the new one was placed, I could see—though not focused. As soon as the new lens was in, I started to see again, though very blurry at first. Because of dilation, the light was intense, so I was given dark glasses.

    Recovery took about 30 minutes, and then I was free to go. By the end of the day, I was already seeing better with that eye than I ever remember. Colors and contrast were amazing—everything vivid. However, I could only see well at a distance. Intermediate and near vision were poor. The kind of lens I received, an Extended Depth of Focus (EDOF) intraocular lens, is designed for distance and intermediate vision. But it can take weeks for the brain to adapt, so for now I’m using drugstore reading glasses.

    The hardest part so far is having one corrected eye and one bad eye. I tried using glasses with a clear lens for the corrected eye and my old prescription for the uncorrected eye, but it made me dizzy. So for now I’m using no glasses at all. I can see and get around, but my depth perception is a bit off. In five days, I’ll have the second eye done. I can’t tell you how happy I am with my new vision.

    But old habits remain: I keep reaching for my glasses when I wake up—only to realize I hadn’t worn them to bed, so they aren’t on the nightstand.

    Yesterday, I got a haircut. It was the first time I could actually watch the barber cut my hair.

    GLP-1 (Mounjaro)

    I should also mention that I’ve been taking a GLP-1 drug called Mounjaro for about a year, initially to lose about 15 pounds. I’ve continued because I think it’s a miracle drug. All my labs improved. My glucose levels were about 30% lower on average, and I had no spikes.

    However, I stopped taking it two weeks ago in preparation for surgery. Now I can see my glucose rising again, with spikes after meals. The first thing I’ll do after my next surgery on Friday is give myself a jab.

  • I Realize I Am Guilty of Self-Ageism

    I realize that I am guilty of ageism—and in particular, what I would call self-ageism. Ageism is a form of prejudice. It means thinking poorly of someone not because of their behavior or character, but simply because of their age.

    This realization came to me the other day while I was considering the possibility of joining the board of a company doing work I believe is very important. I said to myself, “You can’t join the board because you’re too old.” This wasn’t because I doubted my ability to contribute, but because of how I thought others would perceive me.

    Chronological age is not the same as biological age. Chronological age is useful in understanding the kinds of experiences a person may have had. For instance, I can remember when televisions were circular, the images were in black and white, and there were only three channels. But this says nothing about my biological age.

    Biological age is complex. It’s an estimate of how you compare to others, physiologically. It’s often thought to follow a bell curve around chronological age, but I don’t believe that’s accurate anymore. Advances in healthcare have extended both health-span and life-span. Importantly, different parts of our bodies age at different rates, making it hard to define anyone by a single number. For a board member, cognitive function is far more important than the ability to lift weights.

    Yet the world still runs on chronological age. For example, I can’t get a mortgage in Italy, where I now live, because of my age. No test of ability will change that. It’s understandable that things like life insurance or driver’s licenses must rely on averages, but I don’t think that should apply to things like board positions.

    Intel, where I served as a corporate officer, had a policy that management board members had to retire at 65, and corporate officers could not be older than that. That included people like Gordon Moore, Andy Grove, and Les Vadasz. Outside independent directors could not be older than 72. This meant losing those with the greatest experience and wisdom. It didn’t seem to work out so well for Intel.

    I believe I still have much to offer. I shouldn’t let my perception of how others might view me affect how I view myself. While ageism is real, I at least have control over how one person sees me—me!