- Written by MattLopez
- Category: stories
- Hits: 756
Four days ago, I was told my cousin died. They said he did his usual daily routine: in the morning he left home to open his store, then he left his store to go to the city hall to renew his business license. He returned home for lunch. He passed by our house around one pm, laughing and sharing a joke with my brother on his way back to reopen his store in the pm. Alone in the store, he fell unconscious. He remained non-responsive. He was pronounced dead on arrival in the hospital.
Though I deal with strokes, heart attacks, traumatic brain injuries, accidents everyday in my place of work, I was still shaken and frightened by the news. My cousin’s demise is closer to home. His death felt like mine too because we came from the same origin, we grew up in the same environment, we ate similar food and drank the same water, we were neighbors all our lives and he was only eight years older than me. There is this warning voice that says, ‘if it can happen to him, it can happen to me too.’ No one of course could live forever. I know I too would die one day. But so soon?
There are many things we hope we could accomplish before we die. Many of us have this anticipation to live a little extra to see our kids become parents themselves, to see our grandchildren, to be strong and active enough to teach them how to fly a kite, or ride a bike or a horse or for them to hear the stories of our past. We’d like to have that extra time to explore places we’ve always wanted to see, learn things we’ve always wanted to understand and enjoy, celebrate one more holiday or reunion with our family, old classmates, friends, old playmates, neighbors, community. There are so many things we must do before the journey is over.
My cousin, alas, had his journey prematurely end due to massive heart attack.
Most people would attribute that to fate but is there any way to alter this kind of fate? Based on current medical and health literature and evidences, it is possible to alter it but requires proactive approach.
By now, we are probably aware of the things that predisposes a person to heart attack. Family history, congenital or undiagnosed or misdiagnosed heart disease, sedentary lifestyle, obesity, smoking, poor food choices, stress, complications from medical procedures, bad interactions of medications, hypertension, diabetes, high cholesterol, these are a few of the multilayered possible causes of heart attacks. In fact I can even add sudden change in lifestyle or activity or weather or level of excitement or emotion that can potentially lead to it.
It also means that one of these or a combination of these factors can attack your heart. It could also be a single massive attack or a culmination of many lesser attacks until the proverbial ‘last straw broke the camel’s back’ happens. Given all these knowledge at our disposal, why then do we still have this statistics?
Approximately 71 million Americans have one or more type of cardiovascular disease, with 40% of them over age 65 years. Each year 450,000 deaths due to heart attack and heart failure occur before patients can reach a hospital or emergency room.
450,000 deaths similar to my cousin’s death. The frightening truth behind these numbers is - some of us live assuming we are not counted among those 450,000, we are exempted.
The heart may be our best friend now but it is a sneaky friend, it is silent if it is damaged, does not tell you if it’s working properly or not, it pretends to be ok when it is not, and when it is finally ready to admit and succumb to its failure, it may be too late. So - we all need to check it every now and then. Much like the engine of a car, we can probably get away with troubles when it’s brand new, even subject it to a lot of stress but somewhere in time, especially when it has accumulated too many mileage, and the warranty is over, we might want to lift up the hood to take a good look at it, listen to its sound, its roar, its spin, its impact on the performance of the whole body.
I am very conscious of the CVD(cardiovascular disease) everyday not only because I see its victims in my line of work, I am also at an age when people I know suffer from its devastating impact. And it is absolutely essential for me to not only educate myself but also apply the current evidence-based preventative measures against it.
There are a few things we can do to determine if we have CVD or high risk for developing CVD. Check with the MD. An ordinary visit may read your BP, a quick EKG, pulse, weight. A quick blood test can determine your blood sugar, A1C, cholesterol, among others. You don’t really need to spend a lot of money for this visit and battery of tests, actually these are covered 100 percent by most health insurance companies. A thorough investigation by your physician may prove to be a big security blanket in your life.
Assuming you’ve got high flying marks as far as your Physician is concerned, don’t become complacent and start eating anything, smoking and getting lazy because, as I've stated before, there is such thing as proactive approach to health. This is where other professionals (including me) can get involved. Now, I don’t imply you need to hire Nutritionists and Nurses and Physical Therapists, Wellness coaches and Personal trainers etcetera (hey if you can afford them why not?) to maintain good health but these are the people you might want to consult with if you don’t know anything about keeping good health or if you want motivation. But unless you’ve been living in a dark cave for the last 20 years, you must already have an idea as far as managing your health is concerned. Some of us may need additional push from professionals but others have this internal capacity to manage their own health once they set their minds into it. Some of us may need a car technician to do every mundane job for our cars but some, well, they can handle majority of its maintenance. I am one of them.
As a healthcare worker, it is imperative that I practice what I preach. I am not the smoking Respiratory Therapist or the morbidly obese Personal Trainer. Being healthy goes with the profession. I don’t know everything about being healthy, let me clear that up first, but I try to educate myself about it everyday. I learn through books, internet, my patients and myself. Being sick is very scary. Being healthy is heaven. That is quite clear to me.
But to avoid being sick, and in this case, having a CVD, there are a few steps I must do to keep it at bay. And most of these are given: no smoking, eating right, exercise, avoiding stress, avoiding extremes, good sleep and rest, and taking appropriate medications to manage my my risks to CVD. I have Diabetes type 2 and borderline hypertension.
So far, I have dodged the bullet. But only because I see my MD regularly, take my meds, monitor my biometrics periodically and live the healthy lifestyle I am preaching about. Should I ignore these steps, I have a high risk of developing CVD on top of the complications resulting from diabetes. My life’s quality and quantity are dependent on as simple as doing something about my health or doing nothing about it.
For lifestyle management, I do not smoke, I do not drink, I am not interested in illicit drugs, I try to eat appropriately, exercise almost everyday between 1 hour to more, complete my sleep, avoiding being stressed at work. I would like to have more time to indulge in yoga and pilates. I maintain my BMI at 23 (160 lbs). I used to be greater than 25 (181 lbs). I lost more than 20 pounds by simple self discipline and desire to lose. I do not subscribe to any magic diet formula except eating the right way and the right kind. (See my Diet section).
For exercise, I do love running and I can run from 5 miles to 15 miles in one session. At 53, I am more into ‘running for health’ instead of competition. In the real world, a person may just need 30 minutes of moderate exercise (walking briskly for example) to be assured of daily dose of exercise. Overdoing may not be something for you. I do long runs only because I have been doing them for the last 10 years. And I am preparing for a half marathon. I also include (and this is important) resistance training, endurance training and stretching in my weekly dose of physical activities. Soon I’d like to incorporate yoga and pilates into my routine.
For medical management, I see my MD as he deems appropriate. I am very interested with my BP, daily blood sugar, AIC, cholesterol, metabolic panel, EKG(if I feel some abnormal heart beats). My blood work is done every three months but my BP, pulse rate, blood glucose, weight are metrics I can check as often as I can. I need some instruments for these and they come cheaply at any drugstore, supermarket or amazon.(See photos). Right now I am taking metformin and lisinopril. And I am hoping to limit my meds with these two. Being cheap that I am, I get them free from Publix.
This is what I use for regular BP readings
What I use for blood sugar monitoring
Everybody should have a weighing scale to live a healthy lifestyle
Now that my cousin is buried and his family are picking up the pieces he left behind, I sit on my chair and wonder what could have been the alternative world that might have prevented his premature demise. I heard that in the morning, he casually mentioned to my brother that he was feeling not his regular self, like having the flu. Then, he had a very excitable day, leaving his store and going to the city hall to renew his business license involving falling in line and waiting for hours. It was also mentioned that he ran out of BP medications for 2 days and went to the drug store to pick his new supply. He did not check his BP. He went to lunch which was salty, (according to his wife), and still skipped taking his BP med as he walked back to his store at around 1 pm. It was the hottest temperature of the day. He collapsed soon after.
In the alternate world, he should not have skipped his BP med for 2 days, he also should have checked his BP the moment he felt different first thing he woke up. Next, he should have avoided the excitement of the morning and rested especially when he did not feel well. Maybe, just maybe, if the BP was controlled first thing, the heart attack could have been prevented or if not, lessened in severity.
Maybe the BP control held the key, or maybe it was not that simple.
It was also rumoured is that he had an undiagnosed heart disease : a congenital heart condition or heart rhythm problem or cardiomegaly that had he made an appointment to a cardiologist to treat it, he would still be alive today.
There are many possibilities and rumours. So many post-mortem theories. But we can not beat a dead jose back to life.
The best alternative scenario for my cousin was that he checked with MD and had a Cardiology follow up if an unknown cardiac pathology was suspected. And then he did regular monitoring of his overall cardiovascular health and got a little proactive to minimize his risks. Then maybe, just maybe, he would still be alive today.
I still mourn his loss no matter what.
CVD Definition by Mayo Clinic Staff
Heart disease describes a range of conditions that affect your heart. Diseases under the heart disease umbrella include blood vessel diseases, such as coronary artery disease; heart rhythm problems (arrhythmias); and heart defects you're born with (congenital heart defects), among others. The term "heart disease" is often used interchangeably with the term "cardiovascular disease." Cardiovascular disease generally refers to conditions that involve narrowed or blocked blood vessels that can lead to a heart attack, chest pain (angina) or stroke. Other heart conditions, such as those that affect your heart's muscle, valves or rhythm, also are considered forms of heart disease.
Many forms of heart disease can be prevented or treated with healthy lifestyle choices.
- Written by MattLopez
- Category: Physical Therapy
- Hits: 817
Pete thinks he is about to have patellofemoral pain syndrome. Not the high fidelity version but the one that whispers “Ooops, it happened”. It is about to rear its ugly head. Pete wants to do something to stop it from getting worse.
Pete is my friend so I am the one he approached about it. The first thing I said to him? Don’t dread it. Be challenged by it.
PFPS is knee pain that is elicited during the first ~0-30 degrees of knee bending. Pain is mostly felt at the front of knee cap [can be felt on sides too]. Of course it can mimic other knee conditions such as chondromalacia patella(involving cartilage), osteoarthritis, baker’s cyst, meniscal tears, quad strains, patellar ligaments sprain. To suspect PFPS, first find its cause.
Before I go there, let me invoke some esoteric principle as to the root cause of most injuries: imbalance. And I am not talking about unsteadiness when standing on one foot here. I am talking of the all-encompassing imbalance our bodies get subjected to before the point of failure. If there is extra phlegm for example, the body balances it out through coughing. If there is too much bad microbes in the stomach, the body expels them through diarrhea. If there is an injury, or infection, the body switches into inflammatory response, swelling, redness, pain, spasms, this is in fact the body’s way of isolating the injury while protecting the rest of the body. Imagine humans without inflammatory response - we will keep on injuring and destroying all our body systems without knowing it.
Imbalance in PFPS results from many factors. Overstressing, increased outside pull of the kneecap due to weakness of the inner part of thigh muscle, weakness of hip muscles, abnormal angulation of the knee in relation to the hip (called Q angle), weakness of calf muscles. The weakness on one muscle is compensated by its opposite muscle. If you have weak quads, the hamstrings will pull more thus messing up the knee[or hip] joint. If you have weak inner thigh muscles (VMO), the outer thigh muscles and the iliotibial band will pull more thus messing the kneecap(patella), if your hip muscles are weak, the muscle of the core and back and knee will compensate messing up the joints they are attached to. And this goes on and on and on. It’s the principle of balance.
That is precisely what happens in PFPS. PFPS results from imbalance in the strength of muscles that dynamically mobilize the knee cap during sports and exercises (most notably running). This is the case with my friend Pete. Pete’s problem is what ails most runners: the tendency to do more if everything feels right. Pete usually runs 20 miles per week and then one day, because the Florida weather was good and the roads looked beautiful and he felt inspired by some running article he read, he bumped up his weekly mileage to more than 40. Fifteen of those in a long run that lasted more than two and a half hours. Still feeling good, he followed that up with intervals the day after.
I may call it stupid but c’mon, we all get stupid sometimes. I reminded Pete again, Don’t be intimidated by this injury, (whether potential or real), but be challenged by it. The first rule of the game is determine the extent of injury. In the case of Pete, it was very minor since it did not affect his daily routine. He can walk, climb stairs, exercise using bike and ellipticals. The only thing he cannot do is, obviously, running. If the case is different, for example it is a full blown sprain or strain involving soft tissues, then Pete will go through the normal phases of healing:
Inflammatory Phase that lasts up to 72 hours after the injury
Regeneration Phase lasts from 48 hours to 6 weeks
Remodelling Phase lasting from 3 weeks to 12 months
Pete of course will not take that much time to heal. The current management of soft tissue injuries have progressed since days of old. Remember the old PRICE approach:
I - Ice
Professionals lately have added additional approaches to PRICE so it was modified to SPRICEMMM. Quite long eh?
I - Ice
So there! Most of these are self explanatory unless you have been hiding under a rock in the last 2 decades. The thing is, the management of injuries have improved so much that instead of complete immobilization, the patient is allowed activities/mobility given the appropriate support and protection. The trouble with complete immobilization (we are talking of soft tissue injuries here ONLY) is its impact on the soft tissues and joints. Immobility reduces their elasticity, they atrophy /shrink and the involved joints get their synovial fluids frozen leading to tightness and contractures. Different professionals dealing with soft tissue injuries have, through the years of research and experience, accumulated vast knowledge of maintaining motion while protecting and supporting an injury. They employ bandaging, bracing, splinting, taping, ‘correct’ kinesiology techniques, edema management, use of assistive devices such as crutches and walkers and wheelchairs etcetera just to make sure the injured person isn’t confined to staring at the ceiling(or watching tv or surfing the net) during his healing process. The added triple Ms refer to modalities (ultrasound, electrical stimulation, soft tissue manipulation, manual therapy, ice, graded progression exercises, home instructions), movement (refer to previous) and medical reference which are pretty much covered under the guidance of professionals such as Physical Therapist, Chiropractor, Sports Medicine Specialist, Athletic trainer, some seasoned coaches, and of course, a medical Doctor.
Well, Pete need not have all these professionals manage his very minor injury because it does not affect his normal day to day functions (except running). In other words, he can do everything except running. His problem is this: he loves running so much his happiness rely 50 percent on it. I know he is kind’a sick in a way that way but I kept my mouth shut. There is actually a protocol for doing no harm to injury(during the first 72 hours) which, surprisingly, is represented by HARM:
H- Heat. Please apply no form of heat on the injury since heat will just open up your blood vessels and propel the flow of blood increasing swelling to the site of injury.
A- Alcohol. Drinking alcohol increases capillary permeability (similar to heat).
R- Running. Or any other form of activities/sports. This is what I had to emphasize to Pete. Do not do any heavy intervals after a very very very long run (especially if ‘something’ is bothering you) no matter how good you feel. Which he did anyway.
M-Massage. Sorry guys, massage during the first 72 hours will only promote swelling. It will be ok eventually but not at this time.
Here lies the question:
Is there anything in this world that can be substituted for running without running?
Heck of course. After the inflammatory phase is over, Pete should be eased into graduated activities. Which he did.
His normalization (rehabilitation) was much quicker and easier due to his very minor injury. Soon enough, he was doing VMOs, quads, hams, gastrocs stretching and strengthening followed by closed kinetic chain exercises, squats and his favorites - cycling and ellipticals. Soon, after 4 days, he was doing short stride jogs on grass, very slow and short in distance, stopping the moment the pain is reproduced. Walking eased the pain.
At the end of his last session, he had this big smile on his face. He never realized that ellipticals and bike can get tougher than running if you push hard enough on them. Now he was eyeing the bike and elliptical like seeing a beautiful woman for the first time.
Ok, ok. I shook his hand and shook it tightly saying, ‘Listen nugget head, stop being stupid and learn to slow down. You are 55 years old’. He smiled as he shuffled away from me.
Remember this: obsession with anything and anybody is the root of all evil.
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.
- Written by MattLopez
- Category: Exercise
- Hits: 721
Ok my friends, it is that time of the year again. Time to renew my PT license here in Florida and to do that, I needed to accumulate a minimum of 24 hours of continuing education, which I am glad to say, I have completed. For the last couple of weeks I was immersed in everything from the latest management of injuries, joint replacements, kinesio taping, health coaching, I even dabbled via online in some basic yoga and pilates. Some of these may apply to my hospital work, some may apply to my personal quest to live a healthy life, some, well, some may just be useful in the future. But they are done. I think I’ve completed 30 hours.
Also, I have this feeling I’d finally be able to run a half marathon again. Yes, I have been training for it again, at age 53. I have no desire to compete with anyone, neither to compete with my previous personal records, which (ha ha ) are nothing to brag about. But something is different this time. Whereas in the past I had to squeeze in my running into my very heavy work schedule, today, I have lots of time due to less work hours. Whereas before I had to wait until sun up to park in a public park ( I didn’t trust my neighborhood’s roads), today I can run toward the beach no matter what time of day it is, yes, even in the dark. Whereas before I thought I was the healthiest bull around, today, I am dealing with diabetes.
I am at least 5 years older than the last time I ran a half marathon, and I ran more than 10 of them. This time I am more realistic about it. Running is simply a component of my total healthy lifestyle instead of being its driving force. Lately in my training, I am getting more conscious of proper form, sufficient resting, cross training, nutrition, hydration, supplementation, injury prevention more than competition. Did I say competition? Hah! I don’t think that will ever cross my mind again although, seriously, human nature can not refrain from trying to better the next person or the last personal time it took to run the same distance.
I am also in a different health level now since I am certifiably diagnosed as diabetic type 2. On top of running what pace, what distance, what time of day, I also need to know my sugar before during and after, how to maintain a safe sugar level while running, what type of gadget to use to prevent hypo or hyperglycemia etcetera. So far I was able to do a long easy paced 11 miles last weekend and no side effects whatsoever was noted on my sugar levels though I am feeling a little knee discomfort now and then.
Which I felt and had recovered from in the past. Running more than 10 miles is no picnic for ordinary people like me. And as a PT there are a few things I should watch for when training:
Overtraining is my number 1 problem. The solution for this is hiring a good running coach but I can’t afford one. Sure there are hundreds of online running coaches that may be excellent but I prefer to self-coach which can be good and bad. Good because I can have an impromptu internal voice telling me what to do, bad because that voice can be wrong. Yeah, there can be many causes of overtraining: you feel good so you go all the way; you read an article about improving pace and time and suddenly you want to be on the road applying all of what you read; you see a person beside you who looks similar in your built and age and you want to beat the hell out of his pace; you bought a new pair of shoes and you want to test how much better they are by running on them like you’d never ran before. Oh yeah, overtraining is real and dangerous and one of the reasons why most people quit after trying to run for a couple of miles. The solution for this is simple - listen to your body and don’t hesitate to stop immediately the moment you feel any sign of pain (especially localized pain). And if this pain lingers the next time you train, then it’s time to abandon running for a couple of days and switch to another form of cardiovascular training (swimming, cycling) which will still work on cardio build-up without damaging your legs.
Cross-train, cross-train, cross-train. Listen, majority of people over 50 won’t probably be aspiring for the Olympics anymore (unless you are shooting a target or bowling or something else) but for running, forget about beating Mr Bolt when over 50. Focus instead on beating heart disease and diabetes and kidney failure and cancer and depression and smoking and stress and poor bones and balance and oh so many enemies other than running records. In order for the body to manage itself well, it is important to address its totality instead of a specific part. This may be the problem of specificity of exercise. Sometimes we get so focused on one particular exercise we forget the others. Running is good but it involves movement of the body mainly in sagittal plane. Forward alternating legs and arms, some rotation of trunk, static head and neck. Running misses the muscles that involve side(lateral), rotational, oblique and backward movements. All those movements require muscles and they are not being strengthened (except for minor recruitment) by running. Cross training is like corrective nutrition: the more variety there is, the better. Solution: Lets come up with the weekly plate/tray of exercises then. They should not really blend but each should be given specific emphasis on a given day of the week. Cardio 3 out of 7 days preferably a day is in between. Strengthening 2 out of 7 days preferably a day is in between. Play can be 1 to 2 out of 7 days, any day.
The tray which is a rough draft of my thoughts is something all exercise coaches have been emphasizing all along. There should be balance and harmony and totality with healthy lifestyle. First, exercise must NOT, NEVER be the priority of life. There is life, God/spirituality, family, livelihood/financial, social commitments, mental harmony and improvements, all of these should take precedence in healthy lifestyle. Exercise should be labeled as play/fun/recreation. It is important but should not be the driving force of one’s existence, UNLESS, it is your source of livelihood. Like in my case, I think about it everyday because I employ it in my work with patients. I love studying exercise and applying them on me because these are my tools to improve the lives of my patients. It sharpens my knowledge and experience thus helping me empathize better with them. This is my livelihood.
And life by itself is full of challenges, progress and setbacks, triumphs and failures and these should always be put in proper perspective everyday. It doesn’t mean that because you failed miserably in one area of life the whole body should collapse. What matters is how to recover from the setback, how to put brakes and accelerate when needed, how to internally assess and re-assess your own well being, what tools you need to use. For example (this is my case), if running gives me pain, I switch to cross training to give my legs time for full recovery. Just like good nutrition, I have plenty of variety in my plate. If I can’t run, I bike; if I can’t bike and run, I swim; or I do weights; or I play basketball, or … you get the picture. The point is - movement and active life should be fun. And if trouble happens, as in injury and medical condition, you need not sit in a corner and contemplate the end of existence. There will always be a professional that can help you deal with that.
Setbacks are inevitable. I am myself not immune from them. Since I started preparing for the half marathon, I felt soleus pain and recently a left patellar pain and sure I get really frustrated with these. As a Therapist, I self-analyze constantly and pretty much know what I am doing wrong - but - when fun is immense, I also forget. But these do not deter me from my quest. I slow down, I scale back, I lessen the impact by changing running variables like distance, speed, techniques, elevation. If discomfort is persistent I don’t hesitate to quit and switch to other forms of cardiovascular exercises such as biking or swimming. I also include strengthening. If all these don’t work, I rest. To deal with setbacks, one can either stop or work around it or switch to another activity or hire a specialist who can stabilize the problem without you losing the momentum or gains. There are many options.
I am prepared to do it alone. This may sound anti-social but I am one of those who enjoy doing things on my own. At my age, it is somewhat unrealistic to expect all my friends to join me whenever I feel like doing exercises. At my age, people are completely immersed in their own lives, hardly fitting exercise into their schedules, much less exercising with someone. At this age, my friends have college kids to support, mortgages to pay, marital issues to deal with, easy fatigue from work, medical issues etc. The last thing they want to do is probably hook up with their old friends at a certain time of day to play. Regularly. Schedules at this age are erratic and unpredictable. It is the tail end of my prime and I am too vulnerable to injuries if I keep pace with the elite young and too vulnerable to performing sub-optimally if I join the much older group. When exercising alone, I create my own pace, I do my own routine, I plan everything according to my needs. And I am fine with it.
My PT colleagues often ask, “How do we keep patients complying one hundred percent with our recommended exercises?” That is probably the most asked question not only in PT field but also in general scheme of things. How do we encourage children to move and exercise more? How do we keep the adult population active? How do we eradicate this epidemic of obesity? How do we reduce health cost by changing lifestyle? The real issue here goes back to the previous blogs I have posted. People have become passive in their lifestyles because of a culture that assures them that all things can be solved by someone else. All they need is a good medical insurance and voila, they can have all the medical experts in the world, all medicines from pharmacies, all therapists and personal trainers and gyms and nutritionists and nurses and exercise gurus that sell DVD of the latest craze etcetera that can solve all the problems. Not. A PT may give you a home exercise program of three sets of this 2 times a day. After a week, that home exercise handout is just lying on a corner table gathering dust. We buy an expensive treadmill that becomes the proverbial ‘expensive towel rack, a space waster in our living rooms’. We all buy videos of some attractive exercise guru and after a week or two, we are starting to get attracted to another guru. Of course, attempting something is better than nothing but at the end of the day, the main driving force of life is the individual herself. Imposing an exercise program and luring her into the latest craze and fad via media and apps may work but the real motivator of all is the knowledge behind all the huffing and puffing. Education and self knowledge are the key. Which is better, to tell a person do this and that and soon you will become this and that instead of, ‘Let me tell you why we are doing this and that and you decide if it will work for you or not’. When a person asks me what is the best exercise to lose weight and be healthy I ask her back, ‘What is your idea about it?’ And we start from her own understanding and we build on that, again and again and again.
- Written by MattLopez
- Category: Exercise
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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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