Thursday, June 23, 2011

Fitness Fanatic

I have a pretty bad history with physical fitness. In fairness, I need to say at the outset that I’ve been blessed in that my life has had it’s issues, but one of them has not been a battle against weight. I was born a stick person, raised a stick person, and been a stick person my whole life. It’s not my Mom’s falt, either. While she only does two really good meals…Passover and Thanksgiving, both with all the trimmings…and she goes through phases like veal burgers and the ever-popular Sgt. Harriet’s Indiana Baked Chicken…it’s not like there were never brownies or Froot Loops in the house. I suppose it comes naturally, as my Dad was a stick person until he quit smoking in his 30’s. Since then, he’s become gradually more Santa-like, but I think he’s getting more jolly as well. So I’ve always known the weight was coming, but I’ve been fortunate to be able to avoid it until the past year, when thanks to the acute observations of my Cousin Sara the term “muffin top” has entered my vocabulary (and not in the sense that I wish it would have twenty years ago, when a muffin was a college girl and a muffin top was probably the sweater you were trying to talk her out of. Ah, memories).

As a result of my good fortune, I’ve always had a strange relationship diet and exercise. I’ve always been able to eat pretty much anything I want, and I’ll be the first to admit I’ve abused this privilege. It was at it’s worst during my public health years, the best way to get the attention of the STATE HEALTH GUY dedicated to HEALTH and HEALTHY LIFESTYLES was to present an idea with a couple of Hostess Twinkies in your hand. (I’ve since moved on. Now it takes a Suzy-Q, and in deference to the fine people in the dairy industry I chase it down with a glass of milk rather than the preferred Vanilla Coke. I’m just sayin’.) However, one of the great advantages to working in public health is the ability to justify things. So a single Starburst became a serving of fruit, and spearmint lifesavers became vegetables. Twinkies fell into the breads and cereals group, and were a way to show my commitment to the Kansas wheat growers as well as the petrochemical industry (I know the “cream filling” is actually plastic, but I do love it so.)

There is a downside of being a stick person, however. For me, it’s always been a healthy fear of the beach, the swimming pool, and short sleeve shirts. I look like Mac in the Charles Atlas ads on the back of the comic books of my youth, and he’s the one getting the sand kicked in his face. Slow dances made me nervous, because there’s nothing “hunky” for a girl to hold to. And with no upper body musculature, chin-ups and rope climbs in gym class were a nightmare. Most of my life I would have given just about anything to have another twenty pounds on me. So from time to time I would invest in a huge jar of “nutritional supplements”, mix the grainy powder in milk and drink the gummy residue four times a day. After three months I was able to pack on a whopping two pounds, and my Brother-in-Law, whom I actually like because he shoots, kills, and eats things and is my survival plan for the Zombie Apocalypse, laughed at me for trying. So that was the end of that.

I’ve had an even less successful relationship with exercise. From time to time I decide I need to work out. This usually goes well for a few weeks until boredom or pain (whichever comes first) sets in. Then l’m back to my sedentary ways for another year or two. Last year my try at fitness was to buy a Wii. I loved the thing, and for the first couple months of ownership I made sure to a seven game set of tennis every day as well as nine holes of golf. It was great while it lasted, but after six weeks I was still winded going up the steps. Since I live off instant gratification, I decided the Wii wasn’t working, so I shifted to Rock Band. (Note: Taking a top floor apartment with a cathedral ceiling so nobody’s living on top of you seems like a great idea when touring units. When a middle aged guy is dragging groceries up the steps? Not so much.)

The next step was to upgrade to Wii fit. This is a great program. Lots of exercises…cardio, yoga, and balancing work. I especially liked one of the later programs, where you had to sit quietly and unmoving for three minutes until an electronic candle burned itself to the nub. To me, this was the perfect exercise. Don’t move and get fit. And so I still do this exercise, sitting quietly on the floor for three whole minutes at least four times a week whether I need to sit down or not.

This year’s entrant into the fitness sweepstakes is going to be either P90x or the Shake Weight. P90x is the DVD-based workout program featured on late night TV, and it actually seems to work. However, it has started to fall in my estimation because it’s really hard, and my work ethic took the lottery money and is still off on vacation. In addition, a few months ago I saw a guy in the ER who had finished his first round of work and had managed to break down enough muscle tissue that we had to admit him to make sure all the newly-liberated proteins didn’t clog up his kidneys. I was almost as disturbed by the knowledge that his could happen to me as I was by the fact that he came to the ER in 30 degree weather wearing only black boxer shorts with pink and red hearts with a suspiciously open fly, sobbing while holding buckwheat pillow.

(As an aside, it was kind of funny to see how we addressed his issues. We gave him pain meds, of course…good stuff, not skimping…but he continued to whimper. At that point, we shift our internal paradigm for patient care from “poor, poor thing” to “buck up and get some balls.” Interestingly, we never ask female patients to “acquire an ovary.” No doubt a topic for further review.

Pain control is a controversial issue in emergency medicine, and in many states it’s become a political football as well. Most doctors feel they treat pain appropriately, while most patients…at least those who answer surveys… are convinced that they do not. I won’t claim to have any magic answer, or to be the perfect purveyor of pain pills and potions. A lot of it is still a judgment call based on how much pain the patient appears to have (do they look truly uncomfortable or not) and the degree to which the patient’s complaints of pain match the overall appearance. But I do have my own internal list of patients who can have whatever pain medicine they want without argument, no questions asked. You can have whatever you want if:

1) You have just broken a bone
2) You have allowed me to put a clamp, knife, needle, or tube in any orifice, place or space it doesn’t normally belong. (Routine injections, IV's and urinary catheters excluded.)
3) You have cancer.
4) You are in a hospice.
5) You have a toothache. (First visit only.)
6) You ahve a kidney stone.
7) You have a burn.
8) Your care is delayed because the doctor you really need to see, like a surgeon, is either busy in the operating room or is “operating” at home, the local golf course, or the Hotel of Illicit Gratification, hoping that flash in the background was just lightning and not a camera phone.

These criteria stand in contrast to the patient I saw last week, who came in requesting a refill of her narcotic pain medication she had received for a rib fracture six weeks before. I had a chance to look at her records before I saw here, and in addition to her three previous visits for narcotic refills, she had a repeat x-ray that had shown the fracture to be fully healed. I told her that I would be happy to evaluate her, but that I was not going to be comfortable refilling her narcotic prescription for a fracture that was no longer there. At that point I become in turn, “The worst doctor I’ve ever seen, ”the rudest doctor they’ve ever had here,” and the guy who, "doesn’t understand that YOUHAVE TO GIVE ME WHAT I NEED, AND WHAT I NEED IS PERCOCET” Seeing I was not moving from my position, she refused further evaluation and left the ED. The sad part is that it took me longer to document the encounter, dictate addendum notes, and cover my bases from a risk management standpoint than it did to examine, diagnose, treat, and write up a woman who came in just a few minutes later with a life-threatening heart condition. But in this era where medicine is business, the customer is always right, and the ER doctor is nothing more that another disposable vendor of services, dissatisfied people complain and sue. Those who are truly sick are also those who value your care. But the whiners win out in the end, and that’s American medicine.)

So I’m thinking that if a really buff person can kill his kidneys doing P90x. and then cry like a girl about it, the last thing I need is to be dragged into the ED sobbing, my stick physique and my favorite pair of Justice League underwear on full display (although the fly does lie within a picture of Superman…heh,heh,heh). But as I am now the owner of a nascent “muffin top,” I need to try again. Maybe if I downgrade to something like L45q I could pull it off. Or maybe I can use the Shake Weight that they advertise on TV, because it looks like I can do that sitting down. And if I focus on my upper body, it’ll be good to have both forearms the same size again. My right forearm is about an inch larger around than the left, a permanent reminder of several years scooping Baskin-Robbins hard ice cream in high school. Of course, nobody thinks that’s the real reason one forearm is bigger than the other. For the purposes of dispelling that rumor, let’s just say that I dress left. And well.

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