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Lifestyle Change
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For the last couple of years I have been planning on resuming my half marathons but school and work virtually wiped all my free time.Then I was diagnosed with diabetes (something I expected due to family history). Then a family member got sick so I had to be a caregiver in my own home. The half-marathon training was placed at a standstill.
But my work as a Physical Therapist continues, albeit as per diem (after 20 years of full time). I work in an acute trauma hospital. I used to be the official ‘floater’, one who gets assigned anywhere there is a need for PT. Recently my daily work is focused on acute-rehab. Each of my patients is required up to 3 hours of rehab per day (with rest during sessions of course) and the main goal for them is home discharge with community/family support.
Every now and then I go out to acute. I have been an acute PT all my life. Two weeks ago I offered a few hours of PT work in a local nursing home close to my place to get acquainted with their software (casamba). Being a dual degree holder of PT and IT, I am very very interested with the latest apps and softwares being utilized in hospitals and PT-related facilities.
Because I am a lot older now in this business, I feel more inclined to frequently reflect on my job, my patients and myself. My empathy gets the better of me because most of my patients belong to my age now. And I am not far behind from the age-group of my nursing home patients either. There is no day when I am reminded how the patient I am treating now could be me. And lemme tell you, the outlook can be scary with the current healthcare system. Just let me give you this advice : Stay as healthy for as long as you can. It is no fun being old and debilitated and poor and alone during non-productive years.
I am a PT inclined to self-reflection. I check my patients’ labs and make a ‘mental’ data collection and correlation between them and their conditions. For example, if I have 5 patients with acute stroke on one particular day, I take a mental picture of what is common among them. High blood pressure? High sugar? Stress? Heart problems? Weight? Race? Gender? I am focused on stroke because it is one of my most dreaded medical conditions. I also have a family history of it and I know how much it can destroy quality of life in its aftermath.
So far, two significant conditions are prominent in my very unscientific sampling of stroke patients. High blood pressure and high blood sugar. The other thing that I find interesting too is this - a few of these patients stroked out on account of ‘missing’ their meds due to having no money to buy them. I wish all of them rely on the cheaper metformin and lisinopril and generic statin (which you can get free or at only a few dollars in any drugstore) but a lot of them have too many co-morbidities (other medical problems) that need meds as well. I have read ER admission lines that begins with, “The patient developed right-sided weakness, numbness and slurring of speech after missing to take his BP meds for three days”. Delving deeper, and in private conversations, the patient confesses with extreme embarrassment that, “I could not afford all my pills.”
Then I sit down and reflect on this. If this patient cannot afford a few dollars worth of medicine, how in the world can he afford healthy food, fitness gyms, nutritionist? We can create all these wonderful gadgets and apps but this particular patient in my list will have the remotest chance to avail them. And so, I sit down with this patient and talk.
Talking about healthy lifestyle with patients sometimes feels like talking to the choir. Sometimes I get dumbfounded reactions. Sometimes I see bored faces. Occasionally I see a face lighting up with new understanding.
But it is a good start.
I often wonder how Hippocrates and Florence Nightingale would react to the current healthcare system in the US. Yes, it can be highly advanced thanks to the billions spent for its research and development but what happens to its heart and soul?
It seems to me that being healthy today costs money. I conclude that because that is what I see everyday. Pay premiums to see a Doctor regularly, buy meds, healthy food will cost money, being fit may cost extra more in joining a gym and that precludes the training and diet programs guaranteed to work if you’d let the ‘experts’ manage your lifestyle for a fee (of course). Health Coach, Fitness Coach, Personal Trainer, Nutritionist, heck, even a personal Physical Therapist can be available to trim your body good for a fee.
And I certainly do not think all this is bad - if you have the resources please use all the experts to keep healthy. But the real question is : what happens to those who can’t afford any of these?
This is where the problem of present day health care system lies : the propagation of the belief that ‘someone can manage my health as long as I hire the right expert’. In other words, a lot of people believe that no matter how unhealthy they live, it is ok since there is a Doctor or a Specialist or a pill for that. Much like saying, ‘don’t worry about your problem, there is an app for that’.
Surprisingly, not all medical problems can be solved medically or surgically. In fact, most of the health related problems of the USA are lifestyle related and can be resolved through lifestyle changes. It goes without saying that a lot of our medical conditions are better treated behaviorally than medically.
Just look: type 2 diabetes, heart disease, certain cancers, kidney disease, depression, stroke, obesity - these top killers are reducible by lifestyle changes. And you don’t need thousands of dollars to manage those changes. Stop smoking, eat proper food, be active, avoid stress, increase rest, do you really need an expert to handle these?
All you need is discipline, resolve, courage and willingness to adapt and change. Yes. All of these involve behavior modification. And change of life perspective.
Moderation2.0
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Worth repeating: Moderate everything!
I am reminded again of the consequences of extremes in lifestyle management. I had a patient yesterday who thought he was the fittest and healthiest man in the world, workout two hours per day, six days a week, working full time 10 hours per day, spending one day each week with family for fun time and wham! he suffered from multiple bleeds in the brain.
I know my website is becoming gloomier and gloomier with my stories but they are the truth. I deal with these conditions everyday. Granted that this happened to one in a million of high-intensity exercisers, still at the end of the day it causes me to ponder. For the sake of HIPAA I keep both the patient and myself anonymous. Some of the people I treat are quite known and respected. And the things happening to them are not self-inflicted. They are accidents due to personal mistakes. Usually they recover and the last thing a recovered patient wants is to be reminded of a bad mistake. Mistakes are better forgotten. So no names shared here. Nobody should know the identity of anyone suffering unless that person is related or involved with the patient.
Enough said, let me expound again on certain hidden rules of exercises.
If you are young up to mid-twenties, you can work as hard as you can as long as you are healthy. This is the age for hard-core speed, strength, competition. At this age, regeneration of body tissues and bones is fast. At this age, medical history is usually non-existent. Immune system is excellent. (Parents should still have their kids pass through medical check-up prior to indulging in heavy sports or athletics). Recovery time after exercise usually lasts 24 hours.
By mid-twenties to mid-thirties, the body begins the decline. It is a soft decline but still close to the prime of life. By this time, the body had already been well accustomed to exercises and training (assuming you were active in earlier years). This is also the age of family life. Priorities are oftentimes scrambled and there is a possibility that healthy lifestyle is relegated to the back burner. This is the age when you need to get a good grip of your schedule since it will become tighter each day. And this is where ‘overdoing it’ becomes possible. Just like in your earlier years, you can keep the regular routine of improving personal bests, competitions, building muscles strength, endurance. However, recovery may not be as quickly as in your earlier years so allot longer rest periods in between hard workout days. Recovery time between 24-36 hours. The best case scenario:
Aerobics one day, anaerobics the next day, recovery the third day. Repeat.
Example (you can create your own variations to this):
Running one day, Gym strengthening the next day, rest (or do light cross training) the third day. Repeat.
From mid-thirties to mid-forties, let us admit it, we know we’ve most likely lost our physical primes at this time though we remain competitive albeit within our age-brackets. Sometimes we make it to the top but most of the time we surrender to others. This is the start of the decline. Our bones have fully matured (by age twenty five) and we are now entering a condition of slow ‘degeneration’. This is the age of prioritizing what we are best at and accepting our increasing limits. What is our strength at this age? Endurance. To those who had been working out throughout their lives, everything may decline but the endurance will remain. To begin with, the years of working out have produced sufficient aerobic and anaerobic endurance and though muscle strength may have already reached its peak, it is still capable of maintaining that peak. The capillarization of extremities and heart, the flexibility of joints, the stability of balance should compensate for diminishing bulk and strength. This is the time we get the kick out of beating a kid ‘half’ our age. Bear in mind that the kid has probably not yet built a strong foundation of his health, whereas, you - you have fortified yours. This is also the age of stability in terms of job, authority due to experience, sagacity worthy of respect. You are now entering true maturity.
Between ages 45 to 55, health’s trajectory gets into multiple directions. This is the time of reaping what you sow and sadly, there will be health determinants that may affect you negatively (or not) at this time of life. You health status will depend on how you spent your younger life. For example, sedentary, stressed, obese, uncontrolled smokers, drinkers and drug users develop major health issues. Those who are healthy will remain healthy.
There are other contributors to health beyond one’s control. Genetics, family history, accidents, injuries etcetera can affect people negatively or positively.
Exercise goal at this age range is to balance out aerobics and anaerobics forms of exercise. Strengthening workouts are needed because aging decreases strength, flexibility, balance, speed. Cardiovascular build up is needed because aging will start jeopardizing body systems through wear and tear. The heart and lungs and kidneys and digestive system and endocrine system and everything else will slow down no matter what. That is the Natural Law.
The things to watch for by this age are:
Possibilities of heart disease, diabetes, different forms of cancer, mental issues, strokes, heart rhythm abnormalities, kidney failures, injuries due to overuse or overstressing of the body, poor adjustment to declining abilities, neglect of rest.
Exercise should be moderated and balanced. Recovery is 48 hours or more. Immune system is easily compromised so put a prime value to rest.
By age 55 upwards, most will know by now their medical problems if they have any. Others will stay in denial. Generally, more and more are getting well informed and proactive about their health. There are two major reasons for this: the current health care system is becoming exorbitant. A 57 year old person I know has to pay more than 700 bucks a month on top of the 6500 deductible he has to shell out just to keep his health insurance. After being diagnosed with operable herniated disk, his annual expense for his medical is now upwards of 15000. That is a lot of money for an ordinary working American.
The other reason is the quality of life. A lot of people don’t want to live the lives their parents led a generation ago. The baby boomer generation has many things on his plate. He wants to travel, meet more people, enjoy hobbies, interests, be in the thick of active things, be relevant and useful till his last dying breath. This is the way things are getting nowadays. People are more informed and more serious about the high quality and quantity of their years.
Exercise goals by this time are way past the ‘looking good’ phase and are more into ‘living good’. I am getting close to this age (53). A few things happen at this time: first you hear about old friends who are now suffering from diseases, worse, a few who have died or hospitalized due to different illnesses. There are symptoms you got away ignoring in the past but not anymore - you have lesser endurance ( gone are the days of daily partying and hangover without a single effect on your daily routine); occasional heart palpitation here and there, increased pain, weight gain and shortness of breath with tasks that used to be easy. In my case, after a heavy full day’s work, I just feel like lying briefly on my bed to relax my whole body. ( I used to have sufficient energy to the gym or swimming or running after eight hours of lifting, walking and moving patients). I remember when I worked a full day’s caseload right after running a 15 miler in the morning. Those days are over. Here is the main issue at this age -- we need to get a medical check up because we’re most likely develop conditions we’re meant to develop. Heart disease? Check. Hypertension? Check. High Blood Glucose? Check. Prostate/Breast/Colon Cancer? Check. Obesity? Check. Thyroid? Check. Vision/Dental? Check.
Knowing one’s numbers and taking care of them will spell the difference between saving a lot of money from medical expenses with having a good quality life versus expensive unnecessary expenses with a life full of limitations.
There is no better age when we should be more mindful of our health. This is the time we optimize health. We don’t go to the gym to build those muscles for ladies to swoon over, we don’t run a marathon to win an Olympics gold medal. We do active lifestyle for the wonders it does to our well being. A few things do happen at age 55 upwards. We lose 1% of our muscle mass by each year, metabolism slows down, oxygen utilization is reduced, muscles and joints suffer the consequences of less flexibility, weakness and degeneration due to wear and tear. Our organs including the heart, lungs, digestive, kidney, liver are slowing down. Our minds become slower. This is on top of medical problems we may have on account of genetics.
So the focus of exercise by this time is a moderation of everything with special emphasis on cardiovascular. Still, we need to work on strength (mostly to keep muscle tone), flexibility (to facilitate handling of unwanted tasks such as getting up from low seats/beds/cars or floor), agility (to self-correct loss of balance quickly and avoid falls), relaxation (to free oneself of stress), mental exercise (to reduce risk of dementia or alzheimer’s). Most of all, keep medical conditions in check.
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