Always a wrestler….

I was out running with my dog today and I couldn’t help but think “The human body is amazing.”  I ran roughly 7.2 miles today with my dog which was twice as far as her previous long run with me (we’ve had the dog for less than two weeks).  While she was significantly stronger this go round then our 3.5 mile run (it was a lot cooler today) she was still definitely dragging a little by the end.  I look at my stocky, wrestler-pretending-to-be-an-endurance-athlete body and then my dog and think, how’s it even possible that I can out run her?  Our physiology is amazing and I got to remembering about how humans can outrun horses in distance races.  Say What!?!?  No really, take a minute (after my blog) to go read this:

All Men Can’t Jump

But I was also thinking this week (thanks to a question by Tim Sinnett) about my habitus.  I was a pretty scrawny, short kid with a reasonable amount of innate talent in running, but where I grew up outside Chicago during the peak of the Jordan years there was only one sport- basketball. That wasn’t the best for me given that only one girl was shorter than me in my 8th grade class.  When I moved to Washington I joined cross country.  I ran too much too fast, suffered through shin splints, didn’t know how to suffer athletically and really didn’t like the coach. I never went back which was probably a mistake in the grand scheme of things, by the end of high school I posted a few *almost* collegiate level running times in local races and ran a marathon a few days before my 18th birthday.  BUT I never did really run again for a team other than my wrestling team. Wrestling was fundamental to my development as me.  I’ve discuss this before, but it also probably changed the way I looked.  I wrestled 101 pounds my freshman year, really weighed 99 and didn’t need to worry about making weight ever.  By my senior year I was about 150-155 pounds (wrestled at 135) and could bench over double my body weight 315lb one rep max on bench, I did 405lb x 3 in back squats AND ran a marathon a few months after my senior wrestling season.  I was a machine.  I was a terrible wrestler but great at training for wrestling.     My sophomore year at 115 varsity I was 5-15 and my senior year I was something like 13-13 for the season.  I was probably at to low of a weight class but I would have been JV behind our very good 141 wrestler but that’s a different story.

The summer after high school (before heading off to college) I basically worked out all day.  I rode my bike to Godfather’s Pizza (my only fast food job ever) and on break had all-you-can-eat pizza buffet every day.  After work I rode my bike to Gold’s gym and worked out hard (including long runs).  I did this until around the start of August when I got sick.  In retrospect I realize it was mono, but all I knew then was I was to sick, tired to workout.  In-fact I think I couldn’t even ride my bike to work for that next month.  I remember being all but couch bound from exercise.  Then I went off to college, lifted weights, ate to much, partied to much and shortly after college I was 205 pounds (at 5’6″).  I certainly didn’t look super fat or anything, I have some unflattering pictures of me with a bit of a gut but I still basically looked like a muscly wrestler.  I got into medical school (accepted spring 2001) and knew that I needed to return to cardiovascular fitness. That led me to a several year path of pursuing greater and greater levels of fitness and eventually hitting ~155 pounds again during winter of 2006 while training for bike racing. That next year I had my early season crash, hurt my AC joint and never really had a great season (though I did race all year) and the next year we moved to Jerome and I basically stayed around 168-170 average until early this year.

During all of that though I’ve always looked more like a wrestler faking it in endurance sports.  During medical school my VO2 max was tested somewhere around the mid to high 50’s ml/kg/min, which is pretty good by today’s standards though certainly not elite athlete levels.  Average males today are under 40.  They have detailed information from ancient Rome on soldier’s gear, height, weight and march times, etc and have calculated that the average Roman legionaire was over 40  (here’s the article I remember though they don’t mention what the average must have been in that) and I recall reading in one place that the average was probably closer to 55 for the legionarres. So I wouldn’t have made the height cut off, but I maybe could have hung in a forced march with them.  Even at my skinniest post-college fitness my back and legs in particular looked like a scrapper not a bike racer.  It’s pretty clear in my post crash photos (here) what I mean (especially my back).  I was right at my current weight (~160) in that picture though from several years of bike racing my habitus was a little different in that today I have bigger arms by a long shot, so it’s a little unclear where all that extra weight was in that crash picture, legs maybe?

So to sort-of go somewhere with all this discussion about my body habitus: do I look like a wrestler because I was a wrestler or if I had run all along would I have eventually looked like this?  I have no idea.  I certainly have a significant tendency toward muscle development, I’ve never been worried about my testosterone levels, but I really prefer endurance sports.  Right now I really don’t care very much because I really do enjoy lifting weights also.  I’m not really willing to only run and shrink down that muscle mass that I continue to carry.    I’ve also become convinced that muscle is super important for long term health.  There’s several controversial population studies that suggest being in the overweight range of BMI (25-29.9) is associated with lower mortality then normal (even when corrected for smoking).  This could be from it being bad for your health to be “frail” as an elderly person?   Mortality rate after a hip fracture is 25% that first year.

Either way what I can say is that “you can take the wrestler off the mat, but you can’t take the wrestler out of the man.”

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Published in: on August 18, 2012 at 10:17 pm  Leave a Comment  

Do we love our bodies?

The Bible is a living document in part because our understanding of the text changes as we change. One can read a passage multiple times and read it a certain way and then read it from a different perspective and have a significant epiphany. This happened to me with a passage I have probably read 20+ times. Ephesians is one of my favorite epistles and I’ve read it many, many times in part because of the passages on marriage. It also contains the longest passage that I have memorized. I’ve been reading it for the last few weeks and read this passage again with a completely different insight then I have ever had:

Ephesians 5:28 In this same way, husbands ought to love their wives as their own bodies. He who loves his wife loves himself.

It’s a beautiful call to husbands to love wives as much as they love themselves. Coming from a Reformed and relatively Calvanistic background it’s been assumed that husbands love themselves. In-fact here’s part of what Calvin says about this passage:

“An argument is now drawn from nature itself, to prove that men ought to love their wives. Every man, by his very nature, loves himself. But no man can love himself without loving his wife. Therefore, the man who does not love his wife is a monster.”

Almost every sermon or commentary I’ve heard/read take it for granted that we (as husbands) love ourselves, tend to be self centered and selfish and we are to love our wives in the way that we already love ourselves. I agree with that sentiment but….I realized this week that it actually says something a little more than that. Here I’ll include the next verse:

Ephesians 5:28-29 28In this same way, husbands ought to love their wives as their own bodies. He who loves his wife loves himself. 29 After all, no one ever hated their
own body, but they feed and care for their body, just as Christ does the church—

The passage is not really telling us to love our wives as we love “ourselves” meaning the “our personalities” or “our Ego” (in the Freudian sense). It’s literally saying love our wives as we love our “physical bodies”. It’s not implicit, it’s actually explicit when taken with verse 29. Calvin seems to take it for granted that this would be true, but he’s never met an American. It’s clear that most of us hate our bodies! We don’t get the rest, exercise or fuel that our bodies need. We choose TV and facebook over sleep. We choose convenient frankenfoods (“because they taste better”- what a crock) over healthful homecooked meals. We say “when I get home from a long day of work I’m too tired to exercise” though what we really mean is “I want to watch TV when I get home even though a walk would actually make me feel better while the TV makes me feel even less energetic.”

Anyone who has been cornered by me recently knows that I’ve been pouring an incredible amount of energy into thinking about the root of the American obesity epidemic, while also getting back into “fighting shape” myself. Dorothy and I hit a low of fitness about March 2011. It had gotten pretty bad. After Ruthie was born June 2010 we really let our exercise go. We were tired, I was still figuring out how to juggle my schedule here, and by the time Ruthie started to sleep it was the brutal Jerome winter. Starting around April 2011 when I started doing Kung-fu and Dorothy started going to the YMCA to work-out. After a series of energy sucking meetings that ended in spring 2012 I upticked even more in my exercise and have really basically gotten back into what I would consider very good condition again. In many ways I would consider this my “normal” as I spent many years through the end of medical school and residency in this kind of shape when I was racing triathalon or bikes. I’ve also got my diet and appetite more in line with good health simply by not eating so much dang dessert (our diet was pretty clean all along). It turns out from review of my old exercise journals that I spent a long time around this weight also (averaging about 162 right now).

One outcome from this has been a noticeable increase in my libido and more specifically finding my wife much more attractive and desirable than I had while my fitness had been less. Not to say I didn’t find her attractive before (seriously she’s hot) but I found myself wanting to spend more time and physical energy on her as my fitness improved. I’m using the multiple definitions of attractive here, not just in the sexual/physical way. I’ve also find myself wanting to support her return to fitness. We likely have many, many years of marriage ahead of us and it would nice to enjoy them with energy and without the disease of poor health that I see plaguing Americans wholesale. Arthritis, diabetes, heart disease, poor balance, nursing homes….these are the realities of retirement in America. I never hear those that maintained good health and fitness say “the Golden years aren’t so Golden” it’s usually former smokers or the obese who can’t figure out how they got to this place of debilitation.

So men: this passage is first an explicit call to “love your body”. Not self worship, not narcissism but getting it the rest, exercise and fuel it needs. CHOOSE health. From there we are to love our wives as we love our bodies. If you are married, make the changes needed because I can tell you from personal experience it becomes easier to love your wife better. If you are unmarried make the changes ahead of time, health probably won’t hurt in helping you find a wife.

Women: I’d guess that if men are called to love their bodies….the same is true for ya’ll. Likewise if (which is usually true even in two income homes) you do all the shopping or cooking you can do your part by making better choices about what fuels are even available in the house. Take control: a household that contains no soda, cookies, or frankenfoods makes it much easier for everyone living there to make good diet choices.

Perfect hair night for delivery. My gorgeous wife.

Published in: on August 11, 2012 at 3:21 pm  Leave a Comment  

Sissies

I saw some of my dear friends Kate and Josh this weekend. I forget how much I miss some of my old friends until I see them. Josh, Kate and I have a way of talking about things and thinking about things that I don’t have with other friends. It’s probably a combination of having been through medical school together but also all having been athletes (Josh having competed at the highest level of the three of us). The course of our 3 hours of socializing brought a few related ideas to the surface of my mind. For clarity I’ll break them apart into two seperate sub-sections:

De-Sissification
The approximate quote from Josh: “Rowing was good for de-*&%^ification.” The word there being another word used for a cat. I’ll use the word *sissy* from now on for what Josh was refering to when he was quoting another of his friends related to the benefits of having been a rower. I am however thinking of that other word every time I use it. Josh competed as a rower at a very high collegiate level, having been teammates with Olypiads and having competed in national level competitions. He is not a *sissy* for many reasons but rowing certainly didn’t hurt. It made me again think of what *sissies* most Americans are. I can’t tell you how often people’s excuses for various things I’m advising them on could be tranlsated as “I”m a *sissy*” (if they could only realize what it was they were actually saying).

A few brief examples: 1) “Health food is to expensive” in response to my advice to eat less food. I’ll go on to argue with them that making a whole wheat sandwhich at home is the same or less money then a fast food meal and they’ll look at me like I have 4 arms. What they really meant was “I’m a *sissy* and fast food is easy, tastes good, and I’d rather watch tv after eating in the car on the way home then have to “make a sandwhich” when I get home.” 2) “I get to hungry (insert other adjective like “weak”, “dizzy”, “low blood sugar”, etc) when I try to diet.” when I advise people to try to lose weight. Again could be translated as “I’m a *sissy* and I’m incapable of tolerating any mild discomfort other then being stuffed from over eating or being constipated from my terrible diet. “Oh…and I’ll probably come see you for medicaiton about my reflux or constipation which is brought on directly from eating to much”.

This American diffuse and pervasive *sissiness* could be cured by giving PE teachers the green light to actually push kids in gym class again. Now most schools don’t even have PE and you certainly couldn’t push a kid to their limit, in fact the 1 mile “run” is school is actually a “let the obese teens walk”. Or make all teens work for a summer on a farm. Let a farmer be their parent for a summer, *sissiness* reduced by 50% in 3 months guaranteed. Manditory 2 years of service in the National Guard after high school? Most kids need boot camp, the problem is that they need to be de-*sissyfied* before their 18. Many kids are obese before they are teens now. The wide availability of food, the sendatary life styles of their parents, and kids are often way behind before puberty hits.

Pain Tolerance
The second related idea is this: people who tell you (as a physician) that they have a high pain tolerance: probably do not. I’d say that 9/10 times that someone tells me “I have a high pain tolerance” it probably means a) I have a low pain tolerance and a moderate injury that most people wouldn’t need pain medication for or b) I’m a pain medicaion seeker/abuser/addict/salesman and I don’t really even have an injury. With that said I had been smuggly thinking in my own mind “I have a pretty high pain tolerance” though I would never say it outloud because of the above required translation.

I took only 6 of my opioid pain medications after my surgery on Monday. I was getting around petty well and felt I had recovered quickly enough that I was thinking I was pretty tough. Then I saw Kate yesterday and realized I’m closer to being a *sissy* then actually having a high pain tolerance.

She had a similar procedure surgery to my laprascopic appendectomy and took NO pain medication. She also was back to work 5 days after her surgery (which was yesterday for me and I was still moving pretty stiff). I do feel loads better today, bordering on normal at times, but I’m sure glad that I don’t have to go to work for another two days still. There’s always somone tougher then you. Being smug usually ends with you looking a fool.
Proverbs 14:22-24
22 Do not those who plot evil go astray?
But those who plan what is good find love and faithfulness.
23 All hard work brings a profit,
but mere talk leads only to poverty.
24 The wealth of the wise is their crown,
but the folly of fools yields folly.

Published in: on April 3, 2011 at 6:59 pm  Leave a Comment  

On The Other Side

I’m about 30 hours out from joining the legions of appendectomied people. For me the actual appendicitis wasn’t that terrible of an experience. Sunday afternoon had a vague feeling of abdominal discomfort. Largely right sided, though somewhat more around the belly button. (For anyone not medical reading this: my description of symptoms is basically directly out of a textbook for presentation of appendicitis.) We went walking around 3:30 PM and my babies bottom bouncing against my lower abdomen was sort of uncomfortable. I tend toward constipation so I was thinking constipation or gas pain.

As the evening wore on I developed increasing (right lower quadrant) RLQ pain. Around 9 PM I emptied my bladder which evoked a somewhat more significant but brief RLQ pain. I came out to the living room and was lying on the floor examining myself and telling Dorothy “I wonder if I have appendicitis” to which she responded “shut up”. I went back to playing at the computer and about 11 PM I took a shower and was starting to feel vaguely ill- like mild body aches. Dorothy has had a cold so I started hoping “please start getting a sore throat”. I was asleep for about 30 minutes when I was awakened to terrible nausea, significant chills, and somewhat increase RLQ pain. I still only rated the pain at 3/10 at the worst. The nausea is what sent me to the ED. That was terrible. I knew at that point what I had. I called up to St. Ben’s to make sure that we didn’t have a surgeon available (we didn’t) so I drove myself to St. Luke’s for evaluation.

What a strange, bordering on fun (if having appendicitis and eventually getting a few thousand $ bill can be called fun) experience being a patient. I had been to the ED once before for something minor, never for anything major. I have a vague memory of getting stitches in the ED at age 3. Early Monday morning about 1:45 AM: They got met settled in, IV placed, the Physicians Assistant came and evaluated me (listened to my heart and lungs through my gown). Labs drawn. Then I carried my IV bag to X-ray and had my first ever chest x-ray and abdominal flat plate. Lying on the X-ray table was very uncomfortable with appendicitis. It’s a very flat and hard table that they must chill to about 10 degrees. I gave a urine sample after that, which was tricky with a gown on and my IV bag slung over my shoulder. Then I saw the ED doc (also examined me through my gown). He was basically like “you’ve got appendicitis and the surgeon is on his way in”. Yup, I sorta thought the same thing. WBC was 10.5 (barely elevated), CRP was 2.9 (very elevated- a general marker of inflammation).

I also saw Garth, whom is my favorite Murse of all time (one of my favorite nurses over-all too, but that’s largely because he acts and sings and I saw him in a local show of Jekyll and Hyde and he killed it as the main role of Jekyll/Hyde- unfair advantage), in the ED. He gave me a shot of promethazine after the 2 shots of Zofran had not touched my nausea at all. I did not enjoy the promethazine. It made me very altered (keep in mind it’s now about 2-2:30 AM and I haven’t really slept). Drowsy but not exactly falling totally asleep. I was slurring my words and couldn’t think straight. I think next time I’ll just stick with the nausea. It was bugging me that I wasn’t clear headed enough to pray. I later wondered if they had given me some morphine or something too, though I don’t think so, I told them I wasn’t having much pain and didn’t need anything.

It dawned on me later that I was never afraid. I wasn’t just being tough or stoic. I knew what was wrong with me and I just simply wasn’t afraid. My personality is somewhat like that (see my post about bike racing- I had to quit doing that because I had become afraid) I don’t get nervous about much anymore, which definitely comes from surviving the experience of medical school and residency- it changes you. It also just never really felt life or death to me, I pretty much felt like it was going to turn out fine. I really never was that “sick”.

Sometime after the promethazine I saw Dr. Blair, who’s quite a young guy. He’s a very calm person, I liked him immediately. I could barely follow him because I was altered. They took me to the pre-op area, which I can’t remember well because of the promethazine kicking my butt. I had to stip down (I left my socks on) and pee in a urinal so I didn’t have to get a foley catheter. I peed all over the edges of my gown. I think I was having more pain at that point and being all altered from the promethazine, not being able to stand up straight from pain, and trying to pee in a urinal in front of people was pretty awkward. I could feel my pee from the bottom of my gown on my leg.

They wheeled me back to the OR and I vaguely was aware of the anesthesia person giving me something in my IV. I scooted over to the OR table and my next memory is about 3 hours later with a nurse asking me all these questions and me falling asleep. The nurses were turning over at 7 AM and the outgoing nurse was trying to get her work done before the next nurse came on. It was sort of comical. I’m pretty sure I asked “Is my appendix out” which is so classic- ahhh anesthesia. Then about 8:30 I really woke up. Another very strange feeling. I was really awake. I was feeling pretty comfortably tucked into a bed and knew where I was and was clear minded. No pain to speak of, no nausea. I hit the button and called the new nurse in because I felt I needed to pee. Jessica was my nurse for the rest of the day and she was very nice. Getting out of bed was awful. I’d rate it as the worst pain I’ve ever felt. What’s weird was the pain was now in the LLQ (left lower quadrant) where the biggest of the laparoscopy ports was. I imagine that pain is what it feels like to be stabbed. If the appendicitis pain was 3/10 this pain standing up was about 8. Peeing in a bed-side urinaral while a female nurse is 6 inches away was pretty weird. Trying to get the flow of urine started with 8/10 pain and a female nurse standing 6 inches away was not easy. I got about 600 cc and struggled my way back into bed. She gave me 2 mg morphine IV and two hydrocodone right after. I slept away much of the morning. I called various family members and eventually my wife and baby came to visit which was nice. Later I micturated an amazing 750 cc of urine!

I improved quickly through the morning. Getting out of the hospital bed was still a 6/10 pain struggle, but even walking or sitting up wasn’t that bad. I had solids for lunch and walked 150 feet in the hall without much trouble. I even danced a little jig for Jessica near the nurses station. Eventually I saw Dr. Blair and he discharged me home. I was home 13 hours after getting my appendix out.

I’m home now. I’m doing ok, still pretty painful moving around, but it’s a different kind of pain now, more like “man I worked out to hard” type of pain. I let myself go a little long without pain meds last night and had a weird response to the pain- shivering. Happened again in the middle of the night after I had slept soundly for 5-6 hours. Shivering for about 10-15 minutes until the pain medication kicked in. Very weird. At first I was getting a little spooked that I was having a sepsis response or something, but it definitely faded with my pain and it didn’t start until I tried getting out of bed in the middle of the night. It’s amazing how much you use your abdominal muscles. Even weird little things like passing gas or flushing the toilet uses a surprising amount of abdominal muscle.

I can’t say that I really learned much about how to be a better doctor or about how we can provide better health care at our hospital as a result of my experience. I’ll probably just have a bit more empathy going forward. I really feel for C-section patients more then before. The amount of pain I have from these little port sites, I can’t imagine the C-section incision- even more so because you want to get up and take care of your little baby. Less c-sections! Actually the one thing I think I’d like to see is a change to how we handle the call light at St. Bens. Every time I hit the call light someone (upwards of three different CNA’s and three different nurses) came in within 1 minute to see what I needed. At St. Ben’s the ward clerk hits the button to try to found out what the person needs- often the TV is blaring or there’s background noise, the person not talking loud enough, etc. I think a personal drop in by a CNA would be better patient care and patient’s would feel more responded to.

The worst part for me (besides the eventual bill) is not being able to play with Ruthie. I really can’t get down on the floor yet and I definitely don’t feel up to picking her up yet (she’s very squirmy). Just picking a shirt up off the floor is tough! I’m also sad about having to take several weeks off from Kung-fu. I was really starting to get into shape again. I imagine I’ll be able to practice some of the forms again in a few weeks, but I definitely won’t want to do anything aggressive for 6 weeks. That sucks.

Our first major medical situation as a family! I can’t thank my wife enough, I can’t imagine trying to get through stuff like this without her. Even just knowing that if I needed her to she would get me something without griping about it- that’s love.

Published in: on March 29, 2011 at 3:39 pm  Comments (1)  

Poison!

I had the interesting experience as a physician and father a few weeks ago of having those two competing interests at odds with each other. It caused me a significant amount of psychiatric grief, something I’m not much prone to.

It begins with me taking a 4 month old child to Maui. I wouldn’t normally chose to travel to such a far destination with my child, for one reason that’s how you get kids sick. My little Ruthie did end up with her first cold a few days after coming back. For another thing: children don’t care about time zones. Their body tells them when they should go to bed and when they should get up, we try to adjust that by “sleep training them” but time zones through things for loop.

So we took Ruth to Hawaii, it’s a 1.5 hour drive to Boise, a 1.5 hour flight to LA, then a 5-5.5 hour flight to Maui. Keep in mind that as recent has a month ago my daughter cried for upwards of 4 hours straight the last time we tried to drive longer then 30 minutes (1.5 hour drive to Hailey and then several hours of crying after trying to put her to bed). It seemed daunting. The start of the trip went off without a hitch.

The thing about Ruth is that she is a social-a-holic. She loves being out and seeing people, even at the expense usually of taking a nap. I’ve joked about it many times before that no one even believes we have a fussy baby. When she’s a church she’s a smiling angel, but the drive home will be continuous tears and then nap refusal and fussy afternoon because of being over tired. So flying on the plane, and transfer, airports was constant social stimulation for her longest stretch ever. We got to Maui 4:30 Maui time which is 8:30 PM here. She is now 2+ hours over her bed time. We loaded in the car over an hour later. We clicked her into the car seat and she cried for 45 minutes straight to the resort.

Now we come to the crux of the conflicting internal emotions. We had a plan in place to give the baby a tiny dose of Benadryl to sleep when we got to the resort the first night and hopefully help her “sleep in” and adjust time zones. The doctor in me has given that advice at times and knew it to be reasonable. The father of a doted upon, precious, darling, 4 month old little girl was crying out “Poison!!!”

Let’s look at this analytically. Benadryl is an allergy medication. It’s an anti-histamine. It’s not a sleeping medication, per se. It helps people sleep because the molecule diphenhydramine blocks histamine receptors and histamine receptors are involved in both allergy but also sleep. By blocking the H1 receptors in the skin and nose it reduces allergy, by blocking it in the brain it makes you tired. It also cross reacts with another category of receptors called the cholinergic receptors and medications that do that often make one drowsy also. It’s pretty safe from a medical perspective at the correct dosing. The side effect is “drowsiness” not “life threatening coma and death in infants”.

I rarely advise it to parents as a physician because over-dosing a child on it can be dangerous and there are deaths linked to doses much higher than appropriate (for example I found an article about a day care provider using 6x the dose I used on my 4 month old on a 3 month old and it dying). I rarely advise it because I can’t be there to assure that the parents understand concentrations and dosing of medications. For me it’s intuitive what 12.5 mg/5ml means and how much 5 ml is. My typical patient doesn’t even know what that sort of formula is or how to use it. I spend a lot of my day during cold and flu season explaining how to dose Tylenol (fortunately most parents UNDER dose that and their kids come to my office with a fever of a 102 on a half dose of anti-fever medication- so maybe it’s unfortunatly).

So again, the MD in me was pretty comfortable with our plan to give our baby one does of Benadryl. The father in me was shouting internally “Kids have died!” Keep in mind that this was only like 2 weeks after I really fell in love with my daughter on the walk from my last blog post. We went ahead with it, giving her a ½ teaspoon, she spit/coughed/gagged most of it out and we put her to bed. She woke up at 4 AM and I couldn’t help but think “maybe we should have given her a little more”….

Published in: on October 30, 2010 at 2:47 pm  Leave a Comment  

Sustainable Love

This is a two part entry based around this picture.

Part 1 Sustainable Exercise

I have been reading a book called Blue Zones by Dan Buettner about the places in the world with the longest life spans and the factors that lead to the “hot spots” of centenarians. I haven’t finished the book yet, but the thing that the book has really impressed upon me is the importance of what I’m calling “sustainable exercise”. The two places I’ve read about in Blue Zones the people are forced by lifestyle, geography, work, etc to exercise at a moderate level….indefinitely. This is very different then how I have lived most of my life. There was a time when I lived on Capital Hill that I walked a lot and the period during medical school that I commuted by bicycle. That has not been the norm and most of my exercise in my life has really been “training” for races. I’ve been in very good shape at different times, late high school I was in excellent shape. About 2-3 years ago I was in excellent shape, racing bicycles and/or running races. The bicycle racing was not sustainable for me however- see my other post about that.

I’ve been running semi-regularly over the summer and was getting back up to 5 or so miles with my weight having come down some and my fitness returning. The problem being that I would feel sore during the early part of the week, tired from work during the later part of the week and got to the point where I only ended up running on the weekend. Three days of weekend warrior running was not a sustainable program. So as I’ve been reading this book I came up with this idea of trying to just make moderate sustainable exercise a regular part of the daily activity. For me this probably isn’t going to be running. Biking maybe. Swimming (if that was available to me) would probably work, but there is no pool during the winter available in Jerome for lap swimming. Driving to Twin for exercise during the winter doesn’t seem to fit the idea of “sustainable” to me. So Dorothy and I started walking in the mornings before work. It’s about 1.5 miles round trip on the gravel road which we did every day this week so far- it takes about 30 minutes for us. The picture above was taken on Tuesday. It’s nice and cool in the mornings, we enjoy each other’s company, the sun rise and the exercise. It has been great for all of us (see part 2 below). This “sustainable” exercise will be supplemented on the weekend by much longer walks, running and eventually hiking and backpacking again. I’ll very likely get a mountain bike which I think will be sustainable exercise. I’m not sure how well this will work come winter as the temperatures get very low, but we’ll see, layers may just make this sustainable despite very cold temperatures. Maybe they make baby balaclavas?

Part 2 Scales in the Favor of Love

The picture also marks a turning point in my feelings about and my relationship with my daughter. We (Dorothy and I) have had a rough transition to parenthood. Few have seen our difficult times because Ruth seems to be pretty well behaved in public, but as recently as 13 days ago she cried for 3 straight hours while we tried to get her to bed. I have loved my daughter because she’s my daughter but honestly the joy I got out of having a child was far exceeded by the pain, inconvenience, crying, etc. The scales were tipped until Tuesday this week to “I kinda wish I hadn’t had a child” or maybe “there’s no freaking way I’m doing this again”.

Then something changes Tuesday morning. We had such an amazing walk that I had Dorothy take a picture of us on my camera phone (the one above). She was so cute, talking through 3/4 of the walk, which is mostly “ahhhhhgrahhhhhahhhhgrahhh”. The talking was punctuated by her looking up at me and smiling and then going back to looking to the side (much as she looks in the picture) and talking. For the last 1/4 she cuddled up to my chest and fell asleep. On Tuesday I could not stop thinking about her at work. I kept looking at that picture and showing to everyone. I was counting down the minutes until I could get home and see her. I worked late and got home just about as Dorothy got her to sleep and for the first time in Ruth’s life I was disappointed she was asleep.

Why the sudden turn around? Part of it is that our daughter has now been napping for about 12 days. The difference in a child from three 5 minute naps in a day to two-three hour long naps during the day, is pretty remarkable. She has been less fussy, more fun, more interactive and easier to get to bed at night. All things that have improved the mental health of our household. The difference started when Dorothy stopped drinking coffee two weeks ago today. Over-night change.

Before when people asked “How’s little Ruthie?” or “do you love being a daddy?, I’d respond one of two ways 1) those that I thought could take it I told them the truth “being a father kind of blows” or 2) those that I didn’t think could take the truth I told them “she’s really growing” which is a true statement but not quite the whole truth.

Now I can really say “I love my little girl”. A deeper love then the “I’ve decided to love and support my child (see my feelings about love in my previous blog post “You Complete Me”) that I had before. This is a “I adore my baby” kind of love. Several sagely fathers a little further down the road had told me “Just survive the first four months and it gets better”. Her 4 month birthday is tomorrow….I guess I’ll know what my advice to fathers will be.

Published in: on October 1, 2010 at 12:26 am  Comments (2)  

Fatigue

I really learned about fatigue in residency. Residency is rough, 80 hour work weeks for much of the year. Stress. Trying to live a normal life. They make for a lot of fatigue. I found that after working for 30 hours straight I was actually better off staying awake through that next day and going to bed at basically a normal time. The times I did come home at 1-2 PM in the afternoon and got to sleep after being awake since 7 AM the day before I would inevitably wake up at 11 PM feeling terrible, have a bite to eat, go back to bed and wake up the next day feeling even worse. Better to feel moderately bad and tired all afternoon then that terrible feeling the next day. Not everyone did that, but it was what worked for me.

I raced bicycles through much of residency and the affects of fatigue were incredibly evident with that. There was a 4 week criterium series in Nampa at the parking lot at the convention center. That was on Wed nights and was tough for me to make it to because of trying to get out of work, etc. I did however make all 4 races my 3rd year of residency and 2 of the weeks I was relatively well rested and 2 of the weeks I was post-call. The two weeks I was rested I got top 5. The two weeks I was post-call I couldn’t even finish, I had to “sit up” meaning I didn’t have the strength to even stay in the main pack and draft off the leaders. Amazing difference.

I was starting to feel extreme fatigue earlier this week. I was on call this last week, which wasn’t terrible but I did get called a handful of times in the middle of night. Mix that in with a few diaper changes at 4 AM and a baby alarm clock at 6 AM and you start to feel tired. I had Monday off but a meeting at 6 PM, work Tuesday and another meeting Tuesday night. I hate meetings. By Tuesday with a full day of work and another meeting staring me in the face I was starting to melt down. Friday’s (today) schedule was light on Tuesday so I had “the girls” reschedule those appointments and I’m taking the day off. So today was going to be my big day of rest and I actually went to bed pretty early last night-10:30! Then diaper change at 5 AM and I’m wide awake. Six and a half hours of uninterrupted sleep isn’t terrible for me, I do ok with that, but 5:30 is still too early to be up.

I was partially thinking about a blog post that I’ve been working on for some time about some of the differences between men and women and as I was starting to type out the title of it my wife hands me our daughter (now 6 AM) and says “She’s awake”. We played for the last hour and now she’s asleep again (she almost rolled over again today= 10 weeks, wow!). Needless to say I’m feeling fatigued and have no energy to write about something heavy and insightful. Maybe tomorrow morning….

Published in: on August 13, 2010 at 1:22 pm  Leave a Comment  

Fruit

I remembered this post idea I had awhile back after going to Rudy’s twice in a week. Rudy’s is the local cooking/wine shop and first we went the wine tasting “First Friday” even last friday and then cooking class this week. The class was taught by a fairly well known chef name John Ash. He knew Julia Childs (if you haven’t seen Julie and Julia yet go to netflix and move it to the top, best movie I’ve seen in awhile), had a show on the early Food Network, has award winning cook books, and a top restaurant in California and somehow teaching a class in Twin Falls to 30 Idahoins. We had a wonderful time and Rudy’s is a great place, good wine selection especially given our local, see more here: http://cooksparadise.com/

So anyway, being immersed in foodie/wine culture twice in a week made me remember the hazards of being a discriminating palate. Anyone that knows my mother knows that I was raised in a food/wine culture. A comment I made at the age of six or so was “My mother doesn’t cook she makes recipes”. Which at the time was basically an insult to my mother’s complicated cooking, but now as an adult the fact that the list of foods I don’t like is limited to like 2 things (which I can’t think of right now) speaks to the diversity of exposure in my youth. My mother can tell you about the time I ordered the $30 Pheasant (again probably age eight) meal at a restaurant because it said “half off any entree under age 12”. The margin on fresh caught pheasant is presumably fairly tight and the restaurant could not honor the previously stated arrangement for the pheasant. And no they had not every run into that problem before.

I also have a very good sense of smell. This delicate nose of mine can be quite a problem in my profession as we are frequently dealing with the smell of rotten butt abscesses or various other discharges of the nether regions which are unpleasant to the olfactory system of any person. With wine however it makes me quite astute as picking up subtleties that others perhaps don’t appreciate. I admit that my wife is somewhat better at brainstorming what she smells and we make a very good pair to taste wine. It’s the thing I miss the most about pre-pregnancy is drinking wine with my wife. The result of this wine enjoyment has been that I have built up a fairly impressive collection of expensive wine and I’ve tasted or drank some amazing wine as a result of this passion.

So I have a refined palate, broad food enjoyment potential and oenophelia. This however comes with it’s draw backs. The main drawback and the one that I’ll finish this small discussion is a degree of snootiness that borders on the wasteful or absurd. I originally thought of posting something about this when I found myself getting ready to throw away a piece of fruit at work. I don’t now remember the type of fruit, but the details were essentially this: the fruit was not spoiled, it did not taste bad, it was not bruised, it had no mold, is just simply was not very good. So I was going to throw it away.

I’m a little horrified at myself even now. I caught myself and finished eating the fruit as I should have in the first place. But the simple fact was that for a brief second I knew I had had better fruit before and I was not interested in finishing that piece of fruit despite being hungry and globally needing more fruit in the diet. This is my concern. It’s easy to do this with wine also. Have a few sips of less than delicious wine at a party and think “I’m not drinking freaking Merlot” (Sideways reference…if you haven’t seen that go and put that at #2 on Netflix), despite the fact that you are having fun at the party and the wine does not have poison in it.

It’s the rich stockbroker forgetting that they came from poverty and not associating with “common folk” anymore. Similar idea. In fact it was after that fruit incident that I decided I would use my wife’s pregnancy as an opportunity to revisit cheap wine (I went through a stretch where the average price of wine I was drinking was around $30!) and do what I did when I first really got into wine.

My wine turning point for me was an expensive bottle of wine ($60) I bought at the Co-op in Boise, which my mother still talks about to this day. I decided to splurge for my own birthday and on 5/26/2006 we drank a bottle of 2001 Elderton Shiraz, which had received like 96-98 points from one of the wine magazines. This wine was amazing, the quote of the night was “this is the best shiraz I have every had” –Susan Kern. I liked wine before that, but not like this. It totally changed my view on what was possible with taste. We had an amazing meal and it was after that that I really, really started getting into wine. I started buying about one good bottle per month to save away (which I’m still basically doing) and drinking a lot of cheaper wines to learn about the various tastes, sites, smells, etc. Overtime as I had more money available I stopped drinking as much of the cheap stuff. After the fruit incident and after my wife became pregnant however I have been going back to the $7.50-10 price range to re-hone my palate and prepare myself for enjoying wine again.

So it’s important to remember what not so good wine and not so good fruit tastes like so when the really amazing stuff comes along we appreciate it even more. I think this has broader applications in life, but I’ll leave it to you to decide on that since this post has already gotten pretty long…

Published in: on May 14, 2010 at 1:22 am  Leave a Comment  

A Tale of Two Disabilities

If it wasn’t clear to me that disability is a state of mind, it has become so over the last month. I have two patients with bad disease, but the wide difference between them has been weighing on me. Both are about the same age and both have what some might argue are self-inflicted disease.

One is applying for disability essentially because he is so obese that he cannot work. It is hard for him to get out of the house. We- the state tax payers- already pay for his medical bills because of his poverty. We sent him for evaluation for gastric bypass, but he was too heavy, needing to lose ~15 pounds to show that he was mentally ready for such a drastic change in his life. He has since gained weight and I have since filled out some paperwork related to his new disability claim. A lawyer out of Utah that specializes in “Bariatric Law” is helping him.

The second patient is a lifetime smoker. Until recently he has smoked upwards of 3 packs per day. He now has terrible lung disease at a premature age as a result. He has been in my office with an O2 saturation of 75%….having just come from work. This is a guy that continues to work despite the fact that he cannot wear his oxygen while at work. His lung disease is so bad that it is giving him heart failure. His 5 year survival rate is around 30%. All this guy wants to do is work. It would not take him a lawyer to get on disability; it would take quitting his job. That’s all, he already qualifies for disability, but he does not want to quit his job. We- the state tax payers- now pay his medical bills, but he previously was paying for office visits out of his own pockets and continuing to work. Last time I had him in the hospital he wanted to leave before I thought he was ready because he didn’t want to take any more time off work. This is not a bikini model sun tan lotion applier kind of a job. This is a factory job, on a line.

Self inflicted disease? Perhaps. Totally different world views? Clearly. The problem for me is the emotional reaction each of these patient’s evokes in me. I probably don’t really even need to spell it out, because I suspect most people would feel the same way. Many would be quick to point out that it is very hard to weigh over 400 pounds, the strain on his body and joints is immense and he probably really can’t work. Which is probably true, but the other patient is literally killing himself to work (wearing his oxygen all the time would basically help halt the heart damage and help him live longer and healthier).

Regardless of what anyone might feel about these patients, the obviously underlying message is that disability is a state of mind. Two patients with disease which results directly from a combination of addiction and bad genetics (not everyone that smokes gets lung disease and not everyone that over-eats gets to be 400 pounds), but one has whatever feature of personality that lets him continue to work and the other is perfectly content to let us pay for his 3500 calories per day just to maintain that weight lying in bed all day. Oops that sounded like judgementalism. I need a cigarette

Published in: on April 13, 2010 at 7:02 pm  Comments (5)  

The Drawbacks

I went out for beers last night with a buddy of mine who’s a physician in Twin Falls, the neighboring larger town with the referral hospital.  Doing that and the conversation that we had led me to think this morning about the two worst things about my job (for me in particular).  Number 1 is I often feel like I can’t drink alcohol.  Number 2 is managing chronic pain.  I’ll elaborate briefly though, these don’t require much more than that.

Not drinking alcohol. This isn’t that huge of a problem I guess.  I gave up my brief stint of drinking regularly to excess quite some time ago.  In the meantime however I do very much enjoy a hoppy beer or a glass of wine. I often feel like I’m limited in my ability to do that however because of the nature of my job.  Even last night I met my friend for a beer about 6 hours after finishing a C-section.  The patient’s doing fine, she didn’t need my attention, but the possibility of something going wrong still exists and after two beers I would then have to dump this problem on the doctor on-call.  More commonly I feel the weight of my next OB patient’s looming due day on my consciousness.  I think “She could go into labor anytime, I’d hate to miss her delivery just for a glass of beer.”  Which is both for the financial impact of missing a delivery, but that’s also my favorite part of the job.  So what I’ve been doing is if I have a patient coming due, I generally will only have a glass of wine on Friday nights which is the night that I turn my work phone off and sign out.  But “women coming due” can be a fairly long time period and if you have 2 within a month’s time, it at times doesn’t leave me much window.  At the end of the day, it’s not really about actually having the drink because I might not drink much more then I do anyway, but it’s about the lack of control over my time and my lifestyle.   If I weren’t a physician I’d probably have a small glass of wine every night for the health benefits.  I still collect wine and will continue to do so, I just have to pick my times to actually imbibe them. 

Number 2 is a huge problem in this country.  Upwards of 20% of people in this country have used prescription pain medications for “non-medical” reasons.  Upwards of 9.5% of 12th graders in this country reported using Vicodin without a prescription in the last year.  It has gotten to the point that it’s often hard to tell the real chronic pain patient that is responsible from those selling/abusing them.  The street value of narcotics (last I did research into this)  is around $1 per milligram of drug and it’s not uncommon for a pain patient to get in the neighborhood of 1800 mg per month!  That’s not even on the high end, that’s pretty typical.  So if your doctor ever seems reluctant to give you prescription pain medications, that’s why.  I have a policy of not writing narcotic pain prescriptions for new patients.  That cuts down on the drugs seekers quickly because word gets out.  Some doctors pass them out like candy, why come to me if there is someone else that the “pill popper” community knows will probably give you some, but I do still get a patient that comes in and first visit needs a refill of their $2000 street value of prescription pain pills.  That conversation often goes poorly.  It’s sucky.

Published in: on March 23, 2010 at 1:38 pm  Comments (1)