Wednesday, September 24, 2014

Having Respect for Limitations – in Medicine and in Life

Recently, I heard the story of a bright and ambitious young woman who aspired to be a physician. She finished pre-med in college but, as she started to get to know more doctors, she found that many were addicted to alcohol or drugs or just plain angry. She decided that she didn’t want that kind of life and went on to a different career.

In an earlier blog post I talked about some of the stresses on doctors today. ”The vast majority of physicians are sincere, caring people who are doing their best to treat too many patients in too little time. … Doctors work impossible hours; they are harassed and talked down to by insurance providers; and they must protect themselves (at great cost) against lawsuits for malpractice.”

What I see in the way medicine is practiced in the United States today is a lack of respect for limitations, both of the individual medical practitioner and of the field of medicine itself. As more and more patients are stuffed into doctors’ schedules, communication is limited, treatment is standardized, and subtle nuances are overlooked. All of this sets the stage for medical errors that arise, not from incompetence or a lack of caring, but from too little time for listening attentively and framing a careful response to the patient’s situation.

In addition to schedule constraints, physicians are limited by their individual education and experience. Diagnosis is too often guided by what tests are available and commonly applied rather than by the patient’s own medical history (which the doctor may not have had much time to review). In some cases, unfortunately, doctors’ training has predisposed them to believe that the solutions offered by modern medicine are always to be preferred and that if modern medicine doesn’t offer a solution to the patient’s problem, there is no solution. This school of thought often involves a blanket rejection of all supplements, traditional remedies, and alternative treatments.

When I was in my late forties, juggling a career and graduate classes, I tore something in the back of my shoulder. It was quite painful and, as the weather got colder, it got worse until I was having trouble sleeping. My doctor recommended over the counter anti-inflammatory remedies and then a course of therapy with a clinic run by the local hospital but none of it helped. After about six months of this, with no other option but surgery, I decided to try acupuncture. My doctor was scornful, “All that does is stimulate endorphins.” Over a couple of months, the injury healed; after that, I did stretching myself to restore normal movement in my shoulder. My doctor was so impressed that she later sent at least one other patient to the same acupuncturist.

I have enormous respect for modern medicine, which has probably saved my life a number of times, but modern medicine doesn’t always work and doesn’t have much to offer in some areas. Most athletes will tell you that there is little to be done for any but the worst soft tissue injuries. Rest, Ice, Compression, Elevation are what doctors and trainers alike will recommend; the body just needs time to heal itself. Another weak area is the wide range of food allergies and sensitivities and other digestive disorders termed “irritable bowel syndrome.” Doctors can’t do much about these so they don’t give them much attention, but for affected patients these conditions can lead to long term malnutrition.

Fortunately, there are remedies out there. Acupuncture and massage can accelerate the healing of soft tissue injuries; probiotics and enzyme supplements benefit many people with ill-defined digestive disorders. Unfortunately, most doctors won’t have anything to do with these therapies because they are not part of the standard canon taught in American medical schools. Doctors may also be motivated by fear of a malpractice lawsuit if harm comes to the patient.

A lack of respect for limitations, both the human limitations of doctors and the practical limitations of medical science, creates hardship for both doctors and patients. We need to find an approach to medical care that is more respectful of the individual and more open to therapies outside the conventional realm of medical care.

Wednesday, September 10, 2014

What I Like About mytrainerbob

If you’re already in decent shape and want to take it to the next level, the Bob Harper workouts are a good option. These are challenging, businesslike programs packed with a variety of well-paced exercises ̶ no jokes or funny voices and not much down time here. Based on the reviews in Amazon, I selected and tried a total of four DVDs, all of which have improved my condition, though not necessarily in ways I expected.

I started out with Totally Ripped Core and Total Body Transformation. Both of these came out in 2011 and are similar in format. Both come with shorter routines to do when you have less time. In both cases the first half or two-thirds of the workout is not too hard, working mostly with light or medium weights, the last third is difficult-to-almost-impossible, using body weight, isometrics, and jumping. My abs were pretty strong before I started so the Bridge series near the end was actually a relief. The planks and other isometric exercises were good for me because I don’t normally do much of those. The hardest move for me was the side plank lifting the top leg and holding it up. At first I couldn’t do this at all but now I can. For both of these workouts, I saw the most change in the muscles in the back of my body and my outer legs, abs not so much. The benefits you get from any workout depend on where you were strong to start with.

Total Body Transformation is billed as “the hardest workout ever” but for me Body Rev Cardio Conditioning is even tougher, working with a heavier weight (as well as a light one), more balance moves, and a generally faster pace. I don’t see this so much as a cardio workout, because my heart rate doesn’t get up and stay up high enough for long enough, but more as an intense workout with weights and body weight. I haven’t totally mastered this one yet but I’m working on it. BRC and Kettlebell Sculpted Body both appeared in 2010. The kettlebell workout features the GoFit contoured kettlebells that have flat sides and a vinyl coating that make them more comfortable to use than the traditional round variety. KSB is fifty minutes of squats, lunges, and lifts combined with pushups, mountain climbers and jumping jacks for a tough workout emphasizing the swinging weight of the kettlebell.

The first three workouts show Bob with a class. In each of them the standouts are women ̶ Shaela Luter in Totally Ripped Core and Total Body Transformation and Roxanne Mari in Cardio Conditioning ̶ and some of the men struggle. Kettlebell Sculpted Body features the amazing Stephanie Czajkowski, who manages to keep her sense of humor in spite of the hard work and some mischievous needling by Bob. Are the workouts designed this way because the intended audience is women? I don’t know.

I only have a couple of minor quibbles with these workouts. One is that at times they are unrealistically hard. At certain points you see form starting to fall apart because these very fit twenty-somethings are simply worn out. The other is that Bob doesn’t do all of the moves himself. I find it more impressive when the teacher actually does most or all of the workout with the class. Of course this makes it impossible to monitor and comment on how people in the class are doing.

Bob Harper is one of the trainers on The Biggest Loser. Since I never watch the show, I had no particular impression of him one way or the other. Last year, when contestant Bobby Saleem was agonizing about whether to tell his parents about his homosexuality, Bob supported him by telling him (and everyone else) that he is gay. I thought that this sacrifice of personal privacy by a celebrity was an extraordinarily generous act.