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I am here now, how about you?
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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 (rehab options). 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.
Mid-century Runner
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Many of you who read this blog probably know by now my love affair with running -- both as a leisure activity and a tool for weight management. I ran through my aging process, through full time and part time works, through sickness and health, through schooling for a second college degree, through disease-free status and then diabetes, through becoming overweight and then achieving appropriate BMI. I don’t have a single regret about it.
But it is one thing to praise and worship running as an enjoyable activity and another thing to face its ‘not-oh-so-awesomeness’ and contradictions . Running is both good and bad; it can lead to pain and relieve pain at the same time. Running can help your heart if done moderately and damage it if done extremely. Running can help you escape depression but skipping it for a couple of days might lead to depression albeit temporarily. People will talk about running all the time : how to do it correctly, how it should be avoided, how it should be embraced, how it could lead to one’s healthy life and how it can ruin it too.
Through all these multiple and conflicting claims and theories, what do I think about running?
My answer is based on my personal experience so there is nothing scientific and evidence-based in what I’m about to say. This is a blog and not a peer-reviewed article meant for scientific journal publication. This is actually a mere story. And it is very subjective.
Running for me was not some activity I picked out randomly somewhere to accomplish a certain objective. I chose running as a component of my quest to save my body from damages resulting from smoking, borderline obesity, carelessness with food choices, stress and being overworked. Running doesn’t require special skills as it only requires me to advance one leg after the other, or special equipment (except for good running shoes). It doesn’t involve targeted training, no need for a team play and best of all, I could indulge in it for personal leisure or competition (even if only beating my own running times). Running helps me control-alt-delete my brain and reboot it with fresh ideas on the business of the day. I believe that my running have mitigated the destructive complications of diabetes and helped me continue with my work as a PT without injuries, disability, or failures.
Now that I have reached my not-so-young age of 54, I have noticed that the baby boomer wolves who ran alongside me on my trails in my younger years have gradually vanished and were replaced by much younger x-gen and millennial wolves. I unhesitatingly slow down when my body tells me no matter how much these young ones lure me to keep up with their paces. In being left behind, I often wonder where the old runners went. Did they retire their running shoes to better and more enjoyable brisk walking or golf or swimming? Did they abandon the sport due to injuries or fear of injuries or in compliance to the advice of their primary care physicians? Am I the lone aging wolf left behind while the others have wandered to greener and more interesting trails? I entertain these stupid thoughts at times while I plod my feet on the road.
But one thing is true about me: I have matured gracefully with the help of my running.
Have I been injured? Of course I have but I recovered without disrupting my life. There were a few days or weeks I skipped regular running due to pain or very busy work schedule but I returned to it quickly. I have likewise gone through running technique experiments, committed mistakes, wasted time in over-analytics, unnecessary obsessions, frustrations, infantile knowledge and raw ignorance about running. I used to be the first one to buy new gadgets, latest shoes based on current fads - shoes for supinators, shoes for pronators until I realized the best ones for my feet were the neutral. I talked my ass off about running like a parrot, to the point of perseveration. Every day I shared unsolicited info about my running distances or improved times or improved endurance as if expecting some applause or expressed admiration from listeners who were, deep inside, rolling their eyes in utter boredom.
Yet my running persisted. But like anything else, time has the ability taper us all down. That unwelcome phenomenon called aging soon got a hold of me, and unwittingly crushed all my confidence and feeling of invincibility. At fifty I was diagnosed with diabetes and concomitantly its twin siblings of high BP and high cholesterol. You can not imagine how shocked I was. Me? How is it possible a man who had run at least 11 half marathons be positive for diabetes? I felt betrayed by running that I considered as my armor and shield against all form of maladies. I felt embarrassed when I came face to face with my non-runner friends who were actually much healthier than me.
But that did not stop me from running even when the kids ‘round the block yelled ‘Run Forrest run!’ at me at 6 am while they waited for their school bus. Diabetes did not stop me from tying my Mizuno shoe laces in early mornings to challenge my legs to cover the distance from point A to point B. I am just glad to listen to my Pandora and occasionally peek at my running app for a feedback on my distance, pace, frequency.
Through the years I developed my own personal running rules, revising them constantly, depending on current evidence-based studies. Here are the personal rules that I keep:
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I still believe that running too fast, on elevation, covering a longer than usual distance done at the same time is a sure way to sustain running injuries. This can be solved by breaking them down, one day for speed, another day for elevations, another day for long distance with lots of resting days in between.
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I still believe that abrupt increase of weekly mileage is akin to inviting injuries as well. One should not increase mileage more than 10 percent each week.
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I also believe that modifications to running, whether incorporating intervals, increasing speed, lengthening/shortening strides, changing footwear, any experiment with running techniques should be done gradually paying close attention to how the body responds and responding appropriately to what it tell me.
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It goes without saying that any sign of discomfort, especially the localized type of pain anywhere in the body should not be ignored, it should in fact be acknowledged quickly by stopping before it gets worse.
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As I get older, I am getting more and more acutely aware of emerging indications, contraindications, trends, warnings on exercises and running. For example, having a medical check up is absolutely indicated before trying any form of intensive exercise. There is also a contemporary belief (by no less than cardiac specialists) that heavy-duty cardiovascular activities are increasingly associated with heart damages suggesting that moderation is the key to healthy and longer life. On a personal level, my aging process and diabetes are slightly affecting my muscle girth (atrophy ) and balance thus strengthening and balancing are also some activities I should indulge on top of my running.
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Finally, life is not all about exercising and running alone. I also need to focus on relaxation, rest, proper nutrition, spirituality, financial stability and social interactions especially in my community. I must also work on challenging my brain constantly to keep a sharp memory, solve problems. I am not exactly thinking of Sudoku and crossword puzzles. Hey, this is the age of technology - people like me should code in advanced computer languages, create killer apps, design awesome graphics and blog like there is no tomorrow.
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