Wednesday, December 8, 2010


So, got my annual physical today, from my doctor.  She is a) very practical and blunt (which is why I like her); and b) a non-athlete.  One of the questions I had on my list to ask her was whether I should get a bone density test done of my feet.

To put this request in context:  I have a history of bone density issues stemming back many, many years, and have gotten a scan every 18-24 months to track my progress -- the scan focuses on pelvis, femur, and spine.  Over those years, via running and proper nutrition, I've managed to get the bone density of my pelvis and femur OUT of the osteopenic range, and into the normal range (the spine's bone density is trending the other direction, which is why I had added in heavy barbell squats and good mornings to my weekly workouts -- until I broke my foot, anyway).

My last scan was in March of this year, so my doctor asked me what exactly I would gain from having a second one done so soon, especially of a different area.  Her point was that even if it read horribly for my feet,  she wouldn't recommend medications like Fosamax, given the risks of those drugs and the readings of the previous scan with respect to important stuff like spine, hip, femur.

So, I told her that I was exclusively pool running right now, but at some point was going to return to normal running.   I've been operating under the assumption that a large part of my running will be replaced by pool running even after I'm fully healed and back to speed, but knowing what the bone density of my feet is (and whether there's a specific concern there) will help my coach and I decide the proper proportions of pool running versus land, when that time comes.

Her response:

a) well, you broke your foot, so you already know there's an issue.

Can't argue there.

b) why do you have to split pool running and land?  Is there really that much difference?  Why not just stick to the pool from now on?

I was...flummoxed.  I've always struggled with situations where it's clear that someone doesn't get what is just so blindingly obvious, and this was no exception.

How do you explain the difference?

Finally I stammered out something about:
a) I really enjoy competing, and there are no pool-running races.  You need to race on land, and thus some proportion of your training DOES need to be running.
b) Pool running can be horrifically boring -- you're not going anywhere or getting outside, just doing little cool blue circles for hours.
c) I hate hate hate chlorine, and the stiff hair, dry skin, and dissolving nail polish that accompanies it.
d) Pool running belts really aggravate my acid reflux.
e) I look decent in a pair of running split shorts, but I have yet to find a flattering bathing suit.
f) I just bought a new pair of Kinvaras in the most awesome colors ever (black and electric blue), and I'm going to cry if I never get to wear them.

[answers C, D, E and F were in my head].

We settled on my getting my next bone scan some time next spring, and getting the feet done at that time.

But still -- how do you answer a question like that?  I was stumped.


  1. I think it's because the average American non-athlete sees any form of physical excursion as 'exercise' instead of 'training.'

    I totally know what you's the athletic 'norm' bumping up against the mortal 'norm.' Glad you got your bone density scan! Good luck :)

  2. LOL!! This: "I really enjoy competing, and there are no pool-running races." is hilarious. Seriously, I can't believe just how much your doc doesn't "get it". To suggest you just do that torture? Crrrrazy. Congrats on being able to get the scan eventually.

  3. How's the landscape when you run in the pool? Maybe when it warms up you can try lake running. WTF?!?!

    Seriously, no more non-athlete doctors for me. Period. They don't have to be runners, but they must "get it".

  4. I had to read that twice. Here's what you say next time: "Imagine you're in an accident and have to have your jaw wired shut for a few months. You eat by inhaling liquified foods through a straw. Now, would you be willing to eat that way for the rest of your life? After all, you'd be getting your nutrition that way. Plus it makes planning, shopping and cooking so much easier..."

  5. Hey Darkwave -

    This is Rovatti - I'm new to your blog.

    I never heard of a bone density scan of the feet - are you sure it exists?

    There is a nuclear bone scan (the kind that finds stress fractures and metastases) - but it's not for bone density.

    Anyway, I enjoyed reading your blog.

    - rovatti

  6. Look, she may have sounded clueless but it sounds like she legitimately wanted to be educated on the matter. There was a opportunity there. It's too easy to be dismissive and snarky.

    Primary Doctors don't know everything about ancillary health and fitness and the good ones will admit it.

    In a time when most people don't do anything she is probably just pleased as punch your are doing something and wants to see it continue.

  7. Thanks y'all. Julie -- that's probably the best explanation I've heard yet -- I may try it.

    Rovatti -the bone density scan I'm referring to is a DEXA scan - Most commonly done on spine, hip, and femur, but it can be done in other locations as well.

    Anonymous (2) -- you had to be there, but that really wasn't how the situation presented itself. She's always been open about the fact that she thinks that running is not the best exercise (she prefers golf or walking), and she's not athlete focused. And I've always been clear with her that I am athletically focused, and she's accepted that (albeit with the occasional suggestion that I consider golf).

    I like her a lot, because she's very good on women's health issues, and there's no one I'd rather have in my corner if I ever had to wrestle with an insurance company over a major medical issue. And I also value her bluntness.

    But she definitely isn't athlete-focused, and so there's a disconnect there that can lead to amusing exchanges.

    I definitely agree that doctors don't know everything about fitness. There's a point where fitness and health diverge, and most doctors are focused solely on health (I come from a family of doctors, none of whom know what VO2Max is, or understand the difference between slow twitch and fast twitch muscle fiber).

    And add to that the facts that a) doctors gain knowledge from working with a population of patients, and b) most doctors see almost exclusively a population that is ever more sedentary -- a population that considers wii-fit to be an excellent way to improve fitness -- and it's not hard to see how the disconnect widens. It's actually pretty fascinating, when you think about it, how far health and fitness have diverged. Health is based on population norms, and you see where that gets us....