As a physician now for over 25 years I have been blessed with a
lifelong of learning. Part of having a base medical knowledge is to
also know what you don't know. Probably most important is knowing
where you can get the right answers and the knowledge that you need
for the particular medical problem. I thought that I had a good base
in nutrition. My medical school, the University of Nevada was a newer
school and fairly progressive with a concentration in primary care.
As I subsequently found out, medical school education in nutrition is
scarce or lacking except in clinical rotations. We would learn about
rare nutritional deficiencies in pathology which in our modern
society with abundance of easily obtained food sources are fairly
rare. This compared to the days when our ancestors had to deal with
famine or shortages on a regular basis. At one point I thought I was fortunate
because our medical school actually had 1/2 semester course in
nutrition. This is more than many other medical schools. I carried
this knowledge out in my practice and personal life for many years.
As an Emergency physician, you deal with the acute and urgent
problem. Because of the busy nature of the emergency medical field,
there's not a lot of time for things such as nutritional counseling.
We are dealing with the end results of many chronic conditions such
as hypertension, diabetes mellitus, chronic kidney disease, and
cardiovascular disease.
Because healthcare
professionals make the worst patients, you tend to self
treat based on your own knowledge. I have had a love-hate
relationship with food and weight beginning in late adolescence. I
was always physically active playing sports such as JV wrestling,
cross-country, and varsity baseball. I began getting into some weight
training to build lean muscle mass however my passion was running.
After high school when I began working two and sometimes three
part-time jobs in addition to going to college, I quickly noted
weight gain. Suddenly, as I was testing for positions in law
enforcement, I realized that I was overweight and out of shape. In
those days, I ate as much as I wanted, whenever I wanted. It was easy to go out and start running a few miles regularly
and get in better shape and cut some weight. Ultimately, I did get
hired in law enforcement and continued to struggle with weight off and
on for my 14 year career particularly when working night shifts. In those days, when my
uniform pants and belt started to get tight it was easy to try to
outrun my dietary stupidity. After 10 years in law enforcement, I
decided to try to attempt a career in medicine. I was back in school
full time while working full time and taking care of a family
full-time. My exercising fell by the wayside and the weight jumped.
During my first year of medical school I was working full-time in
addition to attending classes full-time. This is when things first
got really bad. By the beginning of my second year of medical school
I had gained 30 pounds. I was gassed during our sophomore versus
freshman class football game. During third and fourth year clinical
rotations which mirrored resident schedules, sometimes doing 36 hours
on call, you grab whatever junk food you can get, and deal with sleep
deprivation and stress. As I have subsequently found out these are
major drivers in weight gain. By the time I graduated from medical
school, I was at my heaviest up 65 to 70 pounds from my weight at the
Sheriff's Department.
During internship,
the long hours, stress, sleep deprivation and bad eating continued. I
knew it was time to get a handle on things. Despite having very
little time, I joined a gym that I could bicycle to from my house; I
bicycled to the hospital, and I began my running again. Within a
year, I had gone from 260 pounds down to 182. Towards the end of my
third year of residency, I crashed my bike and injured my heel on a
curb. I could no longer run without pain. After graduation, I entered
the world of private practice emergency medicine. Due to financial
pressures and debts run up during medical school and residency, I
began working almost the equivalent of two full-time emergency
medicine jobs picking up every extra shift I could find. What fell by
the wayside? Yes, exercise and back into bad diet. In addition, I was in
the United States Air Force Reserve medical core and struggled to
maintain weight and ultimately was passed over twice for promotion
because of my excessive weight and inability to complete training.
Although I did receive an honorable discharge for my three years of
service, again I knew it was time to do something as I had
ballooned to over 255 pounds. I would moderate my diet, and
again, trying to outrun my dietary stupidity. 10 years into my
emergency medicine career, I had lost 60 pounds again. I tried to
maintain this despite dealing with stress, travel, shift work and poor sleep habits.
I always thought that if I could moderate my calories I could eat
whatever I wanted. I was a carbohydrate addict. I loved pasta, pizza,
Mexican and Chinese food. I would grab fast food while I was
traveling. I was frequently overtired after a long overnight shift and
facing a long drive I would caffeinate and stop several times on my
drive for food. I did try to maintain my gym routine and actually
worked with a personal trainer. I became frustrated because despite
all of this, I was still gaining weight all over again. At this point, I gave
up in frustration and very quickly was back up close to 260 pounds
again. This was much like the treadmill that I frequently ran on, a
vicious cycle that got me nowhere.
So this was just
nine years ago. Where does the story go from here? I will continue
the journey in the next post.
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