Category Archives: Motivating Chage

On Dyslexia And Backpacking

Freddie Nietzsche has referenced the impact of life’s difficulties in a much more eloquent way than I ever could, but with that said I do have the ability to turn something negative into something positive. 

 

I have mentioned my dyslexia in the past, but I think it deserves re-referencing here. As some of you know, I was unable to read in second grade. My teacher told my parents that she thought I was very bright and attributed this inability to poor vision. My parents took me to an optometrist who prescribed a very weak eyeglass prescription. I guess optometrists have to make a living.  

 

My 7-year-old expectations were dashed when I put on the specs only to discover that I was as illiterate as before. The fear that my parents would be angry at me pushed me towards a solution; I created my own method to make sense out of the jumble of random symbols that my mind was seeing. I feel that my alternative way of reading has given me an advantage. I may read slower than many, but I have superior comprehension. Beyond comprehension, I appear to have an excellent ability to understand the subtext and sub-connections in a written piece. My reading difficulty turned into a reading advantage for me.

 

I apply this concept to other aspects of my life; most recently to the subject of backpacking.In a past post, I wrote about my trip to Glacier National Park, and how it had a life-altering impact on me. A subplot in this post centered around backpacking. 

 

I enjoy day hiking, but I declined an offer from my friend, Tom to backpack with him. Tom is an inexperienced backpacker who challenged himself to hike in the backcountry armed only with knowledge from YouTube videos, and a healthy cash donation to REI.  

 

His 4 day/3 night trip turned into a 6 day/5 night experience due to dehydration, electrolyte imbalance, and physical exhaustion. Despite these barriers, Tom succeeded in his quest and enjoyed the experience. Further, he feels that he bonded even closer to his son, as they had to work together to accomplish their goal.

 

I am happy for Tom’s accomplishment, but I am also grateful that he brought me a wealth of information on this topic. I had thought a lot about backpacking and read extensively on it, but third-hand data can only yield so much real-world details. Through Tom’s narrative, I was able to get an up-close understanding of the experience. What were the primitive campsites like? How did he go to the bathroom? What would he change in future hikes? What were the positive things about the experience? What gear did he wish he brought? What equipment that he brought was unnecessary? It is one thing to watch a YouTube video from an athletic 25-year-old backpacker, it is another thing to listen to a 52-year-old guy’s first time out. Tom’s story gave real context that allowed me to visualize myself in his situations.  

 

My personality is such that I get enjoyment from learning information and skills. As a new area of interest, the topic backpacking offers both opportunities. Additionally, my solo day hiking trips revealed something about myself that surprised me. Despite being a loner, I very much wanted to share my experiences with someone else, and I wanted to do that sharing in the first person.

 

I already had a sleeping bag, and I decided to buy an inexpensive lighter weight tent. Other small purchases followed: a blowup pillow, Smartwool socks, a better headlamp. 

 

My next phase was to try out new behaviors in a controlled environment. I set up my little tent in the living room, unrolled my sleeping bag, and climbed in for a nap. Success!

Setting up my backpacking tent in my living room. Making sure my sleeping bag fits (and taking a little nap).

When Tom came off the trail he gifted me all of his Mountain House freeze-dried food with the statement, “I’ll never eat that stuff again!” I have eaten MH on occasion and found it reasonably palatable. However, Tom ate Mountain House for all of his meals, and quickly became sick of his soft and lukewarm diet. I would likely have a similar reaction, and so I have been exploring other simple backpacking meals. In fact, I have created a few homemade “freezer bag” meals that my official tester (my daughter, Gracie) said tastes better than the commercial stuff. 

Trying to rehydrate pasta and my own dehydrated veggies. Rehydrating commercial freeze dried veggies. Making my own freezer bag meals that will be compared with a MH meal.Thanksgiving dinner in a freezer bag. Just add hot water and wait 10 minutes! My meal rehydrated.

 

The next phase of my experiment will be to attempt a backyard sleepout. I’m curious if I’ll be able to stand up straight after sleeping on the hard ground all night. Pending the weather forecast, I will likely do this in the next few days.

 

So, will I backpack? Unfortunately, I have run into some pitfalls in advancing this process. My goal was to do a three-night hike with Tom next summer when he travels to Yellowstone National Park. When I mentioned this to him, he was receptive but informed me that he was thinking about a 5-6 night adventure rather than a 3-night trip. This long trip would not be wise for me based on several factors. Tom is younger than me but in similar physical shape. Despite drinking a lot of water, he became dehydrated, and due to the sequelae of electrolyte loss simple movement became difficult for him. It is also clear that he became physically depleted after day three of his hike; this was his energy limit based on his level of physical conditioning. Any additional days became ordeals for him to conquer rather than enjoy. I would likely have a similar experience. Lastly, the way that he coped with this exhaustion was to lengthen his trip, advancing his adventure from 4 days to 6 days. This expansion would be multiplied with a more extended trip. For instance, a 6-day trip could turn into 9 or 10 days. Based on all of this, it would be foolish for me to consider such a long hike. I did suggest to him that we go on a few short local overnighters, which would allow me to check out my ability in situ, but as of this moment, he isn’t too interested.

 

What about other options? It would be great to hike with my son, Will, but he has no interest. Julie has never expressed a desire to go backpacking. My other kids are busy with their lives, friends, and activities. 

 

I am starting to explore the option of an organized club or Meet Up group, but I wonder if the cohorts would be too advanced for me. I have even pondered finding someone on Craigslist, or some other public forum. What would I say in an ad? “Wanted a middle-aged or older guy who has never backpacked who would like to go backpacking with someone equally inept.” For some reason, I don’t think I would get a lot of takers.

 

At this point, I am enjoying learning about a new topic and testing out new skills. If this hobby advances further, all the better. With that said, I believe that learning new things is always useful, even when the knowledge doesn’t have an immediate practical purpose. Seemingly specific information can often be generalized. For instance, my ability to develop decent freezer bag meals is directly related to the many years of hotel room cooking that I did when I worked 2 days a week in Rockford.

 

My goal is to enjoy the journey and not negate the process by only focusing on the end game.

 

Today I told you about my backpacking transformation, but the same techniques can be used when dealing with much more difficult problems. In fact, these rules also apply to other issues, even trauma. There are several factors necessary to turn an unwanted experience (a negative) into one that is desired (a positive).

 

1. Understand the process. 

2. Explore the pitfalls. 

3. Practice the behaviors. 

4. Evaluate if the overall outlay of time and energy are justified.

 

This methodology works, and so I thought I would pass the tips on to you. 

 

Peace

How Doctors Should Talk To Patients About Obesity, An Open Letter To Doctors

Last week I had surgery, a long surgery that required over an hour of operating room time, but the operation was not my greatest fear as I approached this process.

What concerned me the most? I feared having to get a pre-op clearance from my internist; a simple visit that would require less than 10 minutes of contact time. You may be thinking that my primary care physician is mean, rude, and evil. Of course, this is not the case. He appears to be a nice man and a good doctor. If I felt otherwise, I would not work with him.

So Dr. Mike, what is the problem? First a little more background information.

As a person who has battled obesity all of my life, I have become acutely aware of the stigma that comes with weighing excess pounds. Few human attributes can be ridiculed and condemned in the millennial “microaggression” culture of 2018. Imagine criticizing or mocking someone because of their race, sex, religion, sexual preference, gender identity, physical stature, or a multitude of other differentiating human characteristics.

Making fun of “fat people,” is an acceptable national sport, even though the CDC reports that over 70% of adults in the US are now overweight. Of course, as the overweight population explosion redefines the concept of what is normal weight, there will always be those outliers who exist beyond a standard deviation from that norm. There will always be a group to abuse with fat jokes, both overt and covert criticism, and outright disdain. If you are obese, it appears that it is OK for others to assume that you are lazy, dirty, and stupid.

We would never make such assumptions for other medical epidemics. Imagine someone undervaluing you because of your high blood pressure, or your fasting blood sugar? Just like obesity, these illness are caused by multiple factors: genetic, environmental, and lifestyle. Unlike obesity, there are good medical treatments for these ailments, making them easier to treat. The majority of folks with high blood pressure can significantly reduce health risks with medication management alone. However, the majority of obese people will continue to be fat despite diet plans, medications, exercise, and shaming television shows.

I lost over 100 pounds about 3 years ago. I did this after failing many traditional techniques of weight loss. I feel that my weight loss was indeed a miracle that was fueled by common sense, rather than modern medicine.

We are humans, not machines. We are motivated and influenced by a multitude of factors. This variability can be considered a weakness, but it should also be acknowledged as one of our greatest strengths. We are complicated, and as such simple blanket solutions have marginal utility.

Over the three years since I lost weight, I have regained a small percentage of my weight. Most people have told me that I look better with a few extra pounds. They say I look less gaunt, and more vital with this increase. Additionally, I have long shifted from judging myself based on a number on a scale. My lifestyle changes have been just that, they are not strategies to lose weight and thereby achieve some sort of false utopia. “My life will be good if I am not fat.”

Three years into this process:

I still can wear my same wardrobe.
I still exercise every day, walking from 3.5 to 8 miles.
I still avoid all forms of concentrated sugar.
I still practice healthy eating.
I still make an effort to eat more natural foods.
I still assess and correct hidden forms of weight gain, like emotional eating.

When I determine my current status I would say that my efforts continue to be successful, but what about the matter of my small weight gain, does this one objective parameter signify failure? I would say, “No.”

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I sit in a chair opposite from my primary care doctor who is staring at a computer screen.

“You have gained weight.” My doctor says. My initial impulse is to apologize for my failing. I resist. My second impulse is to defend my position. I resist and remain silent. “Are you exercising?” I reply that I am and had already walked four miles before our appointment. “But what about cardiovascular exercise?” He retorts. And so it went. Three minutes of questioning that felt like three hours of interrogation. Pain always feels worse when inflicted on an open wound.

***********

Dear readers, I’m am a resilient person. Besides, I am good at using the counterbalance of logic when dealing with my emotional exaggerations. However, there is more to this story than just a detailed account of me stepping on the scale and my emotional response to that event.

Being a physician, I understand the power that doctors have over their patients. Patients come to us in an extremely vulnerable state looking for help. Studies have shown that a statement like, “You need to quit smoking,” will convert some active smokers into former smokers. Unfortunately, in medicine one size does not fit all. It is easy for physicians to generalize the above truth and think that simple pronouncements can be used to motivate all lifestyle change. However, a doctor’s command is a partial solution at best, and should only be used when wielded within a broader understanding of what causes people to change.

Many of the illnesses that physicians treat on a daily basis have a strong lifestyle component. My weight loss eliminated my need for blood pressure tablets, high cholesterol medication, and a CPAP machine. So why is it that physicals don’t learn and employ simple motivational techniques so they can move their patients towards health? I don’t ascribe to know all of the answers to this questions. However, I do know some of them.

Physicians in the US work in a production model. We get paid by the volume of the work that we do. See fewer patients, make less money. As medical practices get bought up by business investors the push for physicians to do more continues to increase. A good business model consists of finding ways to spend less and make more. This fact is contrasted by a simple truth; we are caregivers, and most of us want to provide care.

Our contact with patients is reduced by the use of physician extenders. Someone else takes our patient’s blood pressure and obtains their chief complaint. We employ electronic medical records (EMRs), which provide a clear notation of our treatment plan, but does so at the cost of patient interaction. Patients now have the “privilege” of answering our questions as our eyes are focused on a computer screen instead of them. Patients want care from us, and we want to meet their needs. There is a pill for everything, and today’s EMR makes prescribing absurdly easy. Is writing prescriptions the same as providing care? I believe that it is only a part of our job, and it should not define us in total.

When I retired from private practice, I was fortunate to have patients write goodbye letters to me. Almost universally they said that they valued their time with me because I listened to them, didn’t judge them, and guided rather than controlled them. To do these things I needed to spend time with them. I would have made more money if I saw 6 people in an hour, rather than the two that I scheduled. However, I would not have known my patients as well, and more importantly, they would not have known me as well. Trust is a function of integrity multiplied by time. Trust by itself offers a positive corollary to patient satisfaction and well-being. Besides, a career that includes connecting with others is eminently more satisfying to we providers than one that does not. A win/win.

One factor needed to motivate change is time. Unfortunately, extending the length of appointments may not be possible in today’s corporate medicine climate. There are indeed a variety of stop-gap strategies that doctors can do to build a connection, such as deliberately spending a few minutes directly with the patient before turning to a computer screen. Such simple changes can make a patient feel more connected, but they still don’t address the elephant in the room.

How should doctors interact with patients to create change? Fat people know that they are overweight, and should lose weight. Alcoholics know that they drink too much, and should stop. Diabetics realize the importance of blood sugar control, and that they shouldn’t eat that extra donut. We live in a culture that shames, and it is likely that some will avoid being humiliated by their physician by avoiding seeking necessary medical care. I admit that I have been an avoider in the past.

Big problems become smaller when shared with someone. I am willing to tackle projects that I would not usually attempt when I have someone at my side. This phenomenon is even more evident if that “someone” has expertise that I lack. If you have been reading my prior post, you know that I have been converting a cargo van into a camper. I dare to significantly modify my van because I am doing the project with a friend who has expertise far beyond mine in such manners. We, physicians, have expertise far beyond our patients in such manners as health. Most reasonable patients accept this, despite the advent of the Internet. A colleague of mine has a cup in his office that reads, “Please don’t confuse my medical degree with your Google search.” However, most patient’s intrinsically understand our expertise, which is why they are seeing us.

Doctors need to connect with their patients as human being to human being, and they need to do this on a level that patients can relate to. We need to become trusted knowledgeable friends rather than overbearing, critical parents.

We need to understand where our patients are coming from, and how willing they are to make change. We need to problem solve with them. Imagine if my doctor asked me, “Are there any barriers that prevent you from seeking medical attention?” Or, “Are there any ways that I can help you with your lifestyle change?” Those simple questions would instantly change my relationship with my care provider. I would want to meet with him, and I would look at setbacks as problems to be solved, rather than justifications for criticism.

Once a patient’s cards are on the table, all things are possible. Is the doctor’s goal the same as the patient’s? What are the barriers to achieving the desired goal? What steps should be tried? How will progress be measured? How is a reversal of progress addressed? Empathy joins, criticism divides.

A meaningful connection with a patient doesn’t happen all at once. Relationships develop over time. However, imagine helping your patients make a significant and real change. Imagine the satisfaction of having a substantial connection with them. What would it be like to work with real people instead of being a reviewer of lab data? What would it be like to end your workday with the knowledge that you truly connected with someone in a meaningful and significant way that changed their life? What would it be like to move from treating diseases to treating people?

We blame our patients for their failings, while we steadfastly hold on to methods and techniques that simply do not work. Imagine if our relationships with our patients were more as a knowledgeable and caring peer rather than a stern and critical parent? Imagine yourself as the patient. You are aware that you have a problem and you need help. Who are you going to ask? Someone who tells you what you already know, makes you feel bad, and offers no real help? Probably not.

Patient Mike