It's
one thing to tell patients they should exercise regularly. It's another
thing to do it yourself. A recent study showed that doctors who were
overweight or obese were less likely to talk with their patients about
weight. I read this study and noted the same behavior in myself. When I was thinner, I had no problem bringing up body mass index with patients. But lately, I'm reluctant to do so, because it sounds ridiculous coming from me, with the way I look. Granted, I had a baby last summer, but that was last summer. There's a
statute of limitations on how long the baby weight should stick around.
As
much as it feels awkward, I do bring up body mass index at the
end of every physical exam, especially if the patient does not have a normal BMI. The
medical assistant weighs my patients before the exam. If the number
bothers patients, they may bring it up before the office visit starts. Most times, they do not bring it up at all. I know they know, and they know I know. They wait for me to bring it
up. Usually when I do, they are relieved that I did, and then we start talking. I'm often able to engage them
most on this topic. It's a tough topic! I don't have any magic pill or
diet or exercise routine to recommend, but I do like to encourage
patients who have already modified their lifestyle, to keep going. I encourage them tell me what they like about exercise and how it makes them feel. I'm their cheerleader.
I used to think back
pain limited my ability to exercise. A
few years ago, a horse threw me while I was riding in the Andes
mountains. The horse and I did not get along leading up to my fall, but he was
the only way up and down the mountain. Since
then, I've had intermittent chronic low back pain. I
stopped running outside on pavement, because I thought it caused my back
pain to flare up. I used to run in Rock Creek Park in Bethesda, MD every day after
work. The scenery was enlightening and beautiful, and I maintained a
reasonable BMI. But I stopped when my back started to ache again. I went
to the gym instead and worked out on the more forgiving elliptical
machine. Now, it's spring in Boston, and I want to run outside. How do I
reconcile my love of running with my poor aching back?
I
went to a few Pilates classes last year. One Pilates instructor told me
that my back hurt after I went running because my pelvic and abdominal
muscles were weak. What?! No health care provider ever told me that, or
did they? Did someone mention it, and I just didn't hear it? I'm
supposed to know better. Of course, that makes sense for
me as a doctor to say it to patient, but not for me to say it to myself. I needed self-realization. I looked on the Internet for folks who had back pain with running. I found an article wasn't exactly about that, but did reinvigorate my desire to run again.
http://news.harvard.edu/gazette/story/2012/04/chasing-down-a-better-way-to-run/
One
of my patients told me he lost weight by using an iPhone app called
"Couch-to-5K." I looked at the app and gave it a try. My back seized up
in a tightening bind the day after my run. I stretched out my back and legs before, during, and after the next run. I shifted my weight during my run onto the balls of my feet, instead of my heels. I stretched more. I felt better. My back didn't hurt while I was running, only afterward. Could it be my posture? (Yes.) Are my core and leg muscles tight and weak? (Yes.) Was I trying to diagnose myself again? (Ummm, yes.)
I'm not sure what the answer is to my back or my running, but I've been running outside again for the last week, and I've been OK. It's possible to exercise and feel great. I feel less guilty advocating exercise to patients, and I can empathize with where they might be if they are dealing with injury or pain.
No comments:
Post a Comment