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.


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.





On the Lightness of Moving the Body


NaBloPoMo 2016, Letters to Patients, Day 7

To Patients Who Struggle With Exercise:

Anything is better than nothing!

Are you a natural exerciser?  Do you move your body every day because you just can’t help it, as opposed to the rest of us, who do it occasionally because we know we ‘should?’  If so, this post is not for you.  But I do have a request:  The next time you’re with us, the unnatural exercisers, don’t judge us.  We are secretly inspired and awed by you, even as we hate you.  Your active non-judgment, which serves as passive encouragement, may be just enough to lower our threshold for doing something.

Okay so, for the rest of us:  How can we overcome the exercise barrier?  Wouldn’tcha know it, I have a suggestion!  Wait for it…  Do anything!  It sounds silly, right?  Too simple?  I have learned that simple is key, and silly can be fun.  Three years ago I was decidedly a non-exerciser.  In early 2014 I connected with a personal trainer and have since rediscovered my inner athlete, one baby step at a time.

Our initial sessions focused on awakening my core (apparently I had gluteal amnesia).  I never knew I could break a sweat holding a simple yoga pose.  I got discouraged at the prolonged lack of progress in cardiovascular endurance and strength.  But little by little, I could do more.  Early last year I downloaded a free workout app and aimed to exercise 7 minutes (read: get through one circuit, however feebly), 3 times a week.  Holy cow, how humbling to discover how 30 seconds of jumping jacks could make me so breathless?  Suffice it to say, I established an unequivocally low baseline.  But somehow I was able to let go the judgment of the failure to be fit already.  I congratulated myself for trying at all, and decided to keep going.  I bet I can get better, I thought.

And that’s the point:  We can always get better.  So often we don’t even try because our expectations are unattainably, if unintentionally, high.  We can tell because it feels pointless.  The workaround is to set our expectations stupendously low, guaranteed success-low, simple- and silly-low…  Then trust that iterative success will drive progressive improvement.  By mid-year I had a smiley sticker for every week, mission accomplished.  This year I set a new goal: 5 times a week, 3 times ‘intense.’  Don’t get the smiley stickers every week, but now it feels positively abnormal to not move for more than one day.  That progress is remarkably gratifying.

When we take our short-term goals more lightly, we allow for the freedom of modifications (push-ups on the knees at first) and trial and error.  We become open to previously unseen options.  We live in the present and appreciate what we can accomplish already today.

If it helps, read this article and repeat to yourself, “Floss one tooth, ” or “One push-up.”  ONWARD!