Thursday, January 7, 2010

Overcoming Inertia, (Part I)

Runner friends of mine who are familiar with my professional work often ask how my understanding of human physiology affects my development as a runner. The truth is that although I can explain precisely the mechanism behind the conversion of glucose to lactic acid when glycogen stores are exhausted and anaerobic respiration at the cellular level dominates in the latter stages of a marathon, the knowledge of such facts neither facilitates its prevention or ameliorates its effects for me as I'm running. (as those who've read my last few marathon race reports have gotten to know!). Rather, I think my clinical expertise helps me the most when I'm resting, recovering, or preparing for a run - in sort of the daily grind of everyday life - because those are often the times when fluctuations in hormonal levels have the most effect.

Personally, I am more intrigued by the question of how running affects my professional life as a pediatric physician. I always wonder if there are things I learn from my adventures on the road that can be appropriately adapted to the clinical setting. It is often difficult for me to imagine how learning to appropriately gear down in anticipation of hilly terrain or fighting the tough patches during a tempo long run can help me become a better doctor to my patients who often suffer from obesity, diabetes and other chronic conditions where mere walking a few blocks is considered an extremely strenuous activity. Still, I am constantly looking for opportunities where I can use my experience as a runner to help my patients make better choices in battling and dealing with their disease.

One such opportunity presented itself yesterday as I was seeing my last patient for the day...

Amy (not her real name) sat with casual ambivalence as her mother gave me a brief rundown of how she got to be the way she is. "She was always a big kid growing up but every since she started developing, it's like she keeps on putting on more and more weight." She hands me the consultation request from her pediatrician and continues "We been to specialists, doctors, nutritionists, and nothing has worked. She'd lose a few pounds after starving herself for a few days but then her weight would go right back up again. Dr. B wanted her to see you to see if there's anything more to be done." I glanced over the consultation request quickly to pick out the pertinent information and sent Amy's mother out into the waiting room before continuing. Before she left, I was able to ascertain that Amy doesn't eat much at home, drinks juices and water at home, and has almost no physical activity

"Hi Amy, I'm Dr. Lam. It says here that you are obese, pre-diabetic and have symptoms suggestive of PCOS. Do you know what all these fancy terms mean?"
She shrugs her shoulders, pauses slightly for effect, than continues. "I guess it means that I'm fat?"
"And how do you feel about that?"
She shrugs her shoulders again.
"Do you think you're fat?"
She gives a slight nod before her eyes drift off into space.
" what are we going to do about that? "Do you have any ideas"
She shrugs again, then silence. I let out a small sigh under my breath and walk over to the sink to watch my hands. Oh God, please, why now, why today...All I want to do is finish work, go home, run a few miles and get down to business devising my marathon training plan, and this teenager won't even talk to me. What do I do now?
I washed my hands, dried them with a few towel and turned back toward my patient. "I tell you what...let's not talk about fat for the rest of this visit...let's assume it doesn't even exist. But you have to promise to answer my questions, okay? So, how were your holidays? Did you make any New Year's resolutions for 2010?"
"No, I don't believe in New Year's Resolutions/"
"Did you watch any TV during break? What's your favorite show?"
"Cool, that's my favorite show too! It also says here in my chart that you are an honor student at the Bronx High School of Science. Have you taken chemistry or physics yet?"
"Well, I took chemistry last year and am taking physics right now."
"Good. So you must know about the Newton's Laws of Thermodynamics..."
"A little..."
Okay, so let me ask you a question...what does New Year's Resolutions and Glee have to do with Newton's 1st Law of thermodynamics and how does it relate to you?"

(to be continued...)


Jamie said...

I'm interested to see where you take this.

Katie said...

I can't wait to read the rest of the story!

I would imagine that all the running you do makes you an excellent role model for your patients. That might not seem like a big deal, but I wonder how many positive role models kids have today...

lindsay said...

umm what?!? :)

what a cliffhanger. i am anxiously awaiting the answer to that question b/c i certainly have no idea.

Anonymous said...

Lam, you sounds like such a wonderful doctor! I can't wait to read the rest.

Psyche said...

Cliffhanger! Argh!I am completely drawn in, so you better deliver Part II pronto!. You know, I'm not a physician, yet I really relate to your desire for your running to be able to help others. In 2008 I started an after-school program for 3rd and 4th grade boys called Boys On The Run (total rip off of GOTR name, different agenda). Working with 9-10 year old boys has really opened my eyes to how, without encouragement to do otherwise, these boys' lives default to inactivity and overeating- a very bad set-up for their later years. IMHO, we all need to take responsibility for turning this around.

Anonymous said...

no fair with the cliffhanger! i think it's great that youre working in such a positive way with kids and i totally think that youre experiences impact them in some capacity, even if the kids appear unresponsive. kids tend to absorb more than they let on

GISRunner said...

PLEASE post Part II very, very soon!

... Part I was intriguing enough to bring this lurker out of lurkerdom ...

Julie said...

Greetings Laminator,

You are killing me!!!! This is such a good story and I was all into be continued! Really? I will wait for the rest of this story.

I am sure that you handled this one like an ace:)

Morgan said...

This weekend Spike & I watched a documentary on obese children and I thought of you. You are such an inspiration to all of us as a runner, I can only imagine where this will go... you are amazing!

Anonymous said...

Sounds like you are good at developing rapport with your patients- tough to do when they don't want to talk to you. I like your creative persistence!

Anonymous said...

I LOVE when you talk about endocrinology and obese kids and PCOS and all that. Write more of it! And soon!

T-na said...

Looking forward to part 2.
With inertia in the title, I thought you were going for Newton's First Law of Motion (Law of Inertia) but, surprise! you went with first law of thermodynamics and lost me.

Can't wait to read part 2 and see how you tie it all together!

Scott Brown said...

Your blog exemplifies why I don't like facebook or Twitter. I mean it is far more interesting for me to read well thought out and written stories than what you are scratching now. Yes, I don't think I'll be following you on Twitter.

Anyway Lam I'm not criticizing, it is just my way of encouraging you not to give up your blog. Still, don't leave us hanging too long we are busy people and like to get out and run sometimes too ;)

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