Walking the Talk

BVF ben downhill

The Journey and the Struggle

18 months ago I wrote about my plan for maximizing menopause preparedness.  As with so many missions, this one has experienced both successes and failures.  Since January 2016, I have grooved my exercise routine in the most awesome way.  I am all over the TRX, doing Spiderman push-ups, incline presses, pistols and more.  I get my cardio intervals and I’m foam rolling.  I feel stronger now than at any time since high school, and I’m proud of this accomplishment.

*sigh*

The eating, on the other hand, continues to be a challenge.  Earlier this year a patient looked at me without expression, and stated bluntly that I had gained 8.7 pounds since the last time he saw me.  Right after that’s kind of inappropriate, I thought, well, he’s right, I have been gaining weight.  Last March I wrote about weight loss strategy, thinking mainly about my exercise habit formation.  Sadly, my own weight has gone opposite to the desired direction, despite an honest attempt at adherence to my own advice.  Evidence suggests that weight loss really is about 80% diet and 20% exercise.  But sometimes you can only focus on one thing at a time.

Back in 2008, when I finished nursing, I thought, I can get my body back!  I knew I was not going to exercise, and I had no energy to police my food choices.  But I also knew I was eating too much, so I decided to just cut my portions in half.  It felt easy, decisive, and empowering.  I lost 25 pounds in 9 months, and got down to my wedding weight.  But eventually I acknowledged that though I was thin, I was squishy.  So I connected with my trainer in 2014, the primary goal being to get moving without injuring myself.  Right now I’m up 17# since my nadir in 2009, though I’m much more fit than the last time I lived at this weight.

Talking the Walk

I’ve always had a love-love relationship with food, and it shows in my weight/habitus.  I notice also that my own state of mind and body has influenced the advice I offer to patients.  Before I exercised regularly I spoke to patients a lot more about diet; now it’s more balanced.  One patient brought it up recently.  He asked, “What about the doctors who smoke, or the obese ones, how can they advise anybody about healthy habits?”  I’ve thought a lot about it, so I was ready to answer.  To me, there are three main options, all of which I have tried.

Disclaim.  We doctors can rely on our authority to tell people what to do to get healthier.  They notice our fat rolls, or smell cigarette smoke on us.  They see the dark circles under our eyes and surmise that we don’t sleep enough.  Maybe they can tell we don’t exercise.  But we admonish them to eat less and move more.  We say (subconsciously) to ourselves, “Do what I say, not what I do.”

Avoid.  Rather than give lifestyle advice at all, we can focus on prescriptions and referrals.  We feel we have no place instructing patients to eat more leaves, go to the gym, or quit smoking, when we don’t even do so ourselves.  So we don’t even bother, feeling like hypocrites.

I think both of these responses are rooted in shame and perfectionism.  And I think we should not fault physicians for choosing them—that would be meta-shaming–never helpful.  These are normal, human responses to our professional training and expectations.  Physicians have long held positions of authority and expertise.  Until very recently, our relationships with patients were mostly paternalistic.  But with burgeoning access to information, a culture evolving (rightly) toward patient autonomy, and physicians experiencing historically high levels of burnout and suicide, we cannot afford to burden ourselves with the illusion that we must be perfect in order to be credible.

Connect.  I think the healthiest response, for both patients and physicians, is for us doctors to acknowledge our own struggles; to empathize with the difficulty, the conflict, and the utter disappointment of not being able to control our actions and choices as we would like.  I think patients don’t expect us to be perfect.  But they do want us to be human and relatable.  I often find myself saying, “I know that feeling,” or, “Yep, that’s my weakness, too,” or, “Oh, and what about x-y-z?  That’s my problem!”  Only once has a patient said to me, “Shame on you!”  He was a perfectionist himself; I didn’t take it personally.

I stress eat. I eat when I’m bored.  I eat late at night, and I love sugar, starch, salt, and fat.  The struggle is real, and I know it all too well.  So when I ask you, “What small changes can you commit to in the next month?” believe me, I’m asking myself also.  And if you tell me something that has worked for you, I’ll probably try it.  I still think my ‘4 A’s of goal setting’ apply: Assessable, Actionable, Attainable, and Accountable.  I just haven’t found my 4A formula for eating yet.  But lately I have taken a more lighthearted approach to healthy eating trials.  Nothing is life or death, and I know iterative changes are best.  If one thing doesn’t work, hopefully I can learn something and move on to the next.  No dessert on weekdays.  Vegetarian on days I work.  No eating after 8pm.  No starch at dinner…  Meh, none of it seems to stick yet.  Even my cut-it-in-half strategy doesn’t appeal to me these days.  It’s so frustrating!  And it’s also okay, because I know I’m doing my best, just like my patients are.  We can all just take it a little more lightly, one step at a time.

So by the time menopause actually hits, I’m confident that I will be prepared to meet it, with grace and maybe a little irreverence.  I’m learning to judge myself (and thus others) a little more gently.  I’m learning to love my body, whatever shape it’s in.  After all, it’s the only one I’ll have this time around, and I need to maintain it for the long haul.  Turns out, my patients have been my best companions and consultants on the journey.

 

 

 

 

13 thoughts on “Walking the Talk

  1. A lot of us seem to be in the same boat these days. I’m generally okay with exercise, but eating can be a real demon. I find as I get older, I just can’t carry the same excess weight with ease, especially for running. I’m in a phase of calorie tracking and trying to meet my habitual choices with more thoughtful ones. Hopefully the tracking forces some mindfulness into my diet.

    Liked by 1 person

    • I hear ya, sister!! I logged food for two years when I first started training. I’m back at it now, but finding it more alarming than empowering. How fascinating! 😜Today in thinking I’ll try some tactical breathing and drink a glass of water whenever I know I’m about to eat something I’ll regret. We’ll see how that works!

      Like

  2. Thanks, Cathy, for an articulate exploration of the struggle familiar to so many of us—to manage our weight and maintain fitness as we age. It really is a journey, and it seems like it requires more time and attention as the years go by. Plus, it sometimes requires that we accept that there are things we can no longer do and we must modify our activities to stop stressing aging bones and joints. Reality bites!
    It’s always helpful to be reminded that our doctors face some of the same challenges. Your patients are lucky to have someone who listens and understands…and cares!

    Liked by 1 person

    • Thanks, Donna! It’s funny, since I posted this over the weekend, my conversations with patients today have a slightly different feel, even though I’m basically doing the same thing. I think sometimes just a little bit more awareness makes a big difference, so it’s always worth pursuing…maybe?? ;P

      Liked by 1 person

  3. Being well into menopause myself, I am all too familiar with the new battles… And the need to accept one’s self or go into a spiral of self recriminations. Thank you for YOUR permission and understanding as I continually seem to struggle with these same 5 pounds that seem to keep finding me over and over again when I’ve lost them. It’s amazing how much better I FEEL without them in my life! And being back on a full time night shift schedule probably doesn’t help, but it is the shift I prefer when doing 12’s, so…

    God bless you and your insights, Catherine. Maybe I should try to get back to my own blog… I think it might help diffuse some of my stressors.

    Liked by 1 person

    • Hello hello, and welcome back!! I’m embarrassed at the delay of this reply, please excuse me! I see you have moved back down to the lower 48 and you seem happy with the change–yay! And 12 hour nights, yikes. You GO! All the more reason to take care of yourself–you got this! And I very much look forward to reading more from the Bistro. 🙂 Rock on!

      Like

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s