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.
"Okay...so what are we going to do about that? "Do you have any ideas"
(to be continued...)
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..."
Okay, so let me ask you a question...what does New Year's Resolutions and Glee have to do with
's 1st Law of thermodynamics and how does it relate to you?" Newton
(to be continued...)