Thursday, June 2, 2011

Hippocrates' PRs

The setting: a tent on the grounds of the Washington Monument, about 20 minutes after the picture on the right of this blog was taken.

They've made me sit on a cot, and I'm a bit annoyed.  My warm clothes are in my checked bag, and the longer I wait here, the longer I'll have to wait to get them.  I'm futzing with my Garmin, and trying to remember exactly when I hit the stop button.

A woman stops by, in a shirt that indicates she's "medical personnel."  I note that she's considerably younger than me -- most likely a medical student.

"So, exactly what happened?" She's a bit hesitant, and trying too hard to exude confidence.   Most likely a junior medical student.

"Um...I'm not exactly sure.  My chest just got really tight as I got close to the finish line, and I had some trouble breathing.  I think I just started my kick too soon."   I have no idea whether she knows what a "kick" is.

"Hmm. Do you have asthma?"

"Not to my knowledge."   I shift on the cot. I'm definitely getting cold.  "Any idea when I can get out of here?"

"We'll let you go in a bit, but we're supposed to keep you for at least 30 minutes.  Were you experiencing any breathing problems earlier in the race?"

"Nothing like this.   I was definitely pretty congested -- I think all the tree pollen got me."   Damn trees.

"How about shortness of breath?  Were you breathing hard?"

"Well, yes, I was definitely breathing pretty hard, especially in the second half of the race."   I'm reminded of the warnings on the gym treadmill -- discontinue use if experiencing shortness of breath.

"So, what do you think happened?"

"I gotta admit, I'm not quite sure.  I know I was running pretty hard, and I think I just started accelerating towards the finish line too soon."  I decide not to use the term "kick" this time.  "Obviously, I'd rather this not happen again."

"Hmmm.  One way to avoid this in the future might be to try running slower?   Try not exerting yourself so much?   Next time you feel yourself breathing hard in a race, just slow down a bit?  Or you could even walk."

I look at her, dumbfounded.  

"But it's a RACE!"


Doctors are not like you and me.  Especially if you and I are runners or other athletes.

Or maybe a better way to put it is: runners are not like most patients.

Medicine is based on population norms, and the US population is increasingly sedentary and unfit.  Those of us who are active and have relatively high levels of aerobic fitness are really a sub-population, with our own norms that differ from society as a whole.  Runners' resting heart rates can trigger all sorts of alarms -- apparently a RHR below 60 is defined as bradycardia.  My RHR?  It's 42, which is pretty normal for a fit runner).

In some cases, this can lead to frustrations.  Once I complained to a doctor of substantial fatigue, providing the example that, despite great conditions and being rested and fueled, I had gone out for a 6 mile run but had to stop after 2.  The response?  If you can run 2 miles, you're not fatigued. 

Another time I was instructed to perform an "exercise tolerance test" to exhaustion to test for exercise induced asthma.  The test was ended when my heart rate hit 172, as they had pushed me to my "maximum".  My protests that I knew my maximum heart rate, that it was quite high, and that 172 was generally a reading I saw during the first half mile of a tempo run were all disregarded.  In each of these cases, I was assessed against population norms, not my personal norm.

Advocates for the obese note the issues that they sometimes face in getting their medical concerns acknowledged by the medical community.  Ironically enough, the fit face similar difficulties, albeit for different reasons.  Our deviations from our norms are not far from population norms, and so we're proclaimed fine when that may not be the case.

However, the greater frustrations come from the disconnect between runners and most doctors when it comes to injury.  I think this is because (again), doctors base their assessments and treatment recommendations on their experience with the general population.  And the general non-athletic population, when faced with painful injury, simply want the pain to stop. 

Many people pick up a fitness activity not because they enjoy it, but as forced penance in response to some perceived flaw (i.e. excess body weight).  Thus, when told that they need to cease that activity in order to end the pain, they don't object.   They didn't particularly enjoy the activity anyway, and their primary objective in seeing the doctor was to address the pain, which ceasing the activity clearly does.  And now they have a ready made excuse.  No wonder a doctor's first response to "it hurts when I do that" is "don't do that".  It's easy and quick to say, and fixes the patient's problem. 

In the story above, the student doctor assumed that I simply cared about being able to say I completed the distance, and that I didn't want to have breathing problems again.  Viewed in that light, her advice makes total sense.  But there was an obvious disconnect between her and me.  I wasn't upset at the breathing problems per se; I was ticked off that I had fallen down before the timing mat and added precious seconds to my finishing time.

Unlike others, we crazy runners see our bodies as performance machines, rather than soft sheltered aspects of the self.  When injured, our primary concern is the ability to return to full activity as soon as possible, pain be damned.  Thus, "don't do that" is received...poorly.   Tell one of us that something hurts, but the only way to fix it is to run through it, and we're delighted.  Tell one of us that something that barely hurts still requires several weeks of rest, and we're frustrated beyond measure.

And worst of all is when we're not given a timeline or even a diagnosis, but just "don't do anything, and come back and see me in 6 weeks."  We're goal focused, with training schedules and objectives.  We compete in a sport where we complete a specified distance while aiming at a goal time, with mile markers on the way as intermediate checkpoints.  It's not surprising that open-ended recommendations don't sit.

And therein lies the disconnect between runners and doctors trained to treat the general population.    I consider myself to be the CEO of my own body, and doctors to be highly paid outside consultants.  However, when those consultants provide advice targeted at getting me somewhere I don't care about being (i.e. painfree regardless of the cost), the advice given is a poor fit.  The answer, in business-speak, is to find a doctor who understands and is aligned with one's objectives.  For us runners, that's usually going to be a doctor with substantial experience treating athletes -- someone who's familiar with our subset of the population.

That's hard to do, though, and that's why we treasure our running-focused doctors so very much, when we find them, sharing their names in the same way others do the locations of fine restaurants.


  1. That last line is so true! I usually try to seek out doctors who are runners themselves.

  2. I can't even imagine going to a doctor that doesn't understand runners. What a complete waste of time.

    My dad is a runner and was in cardiac ICU a few years ago. The nurses kept panicing because his heart rate was in the low 40's. He's FINE! Just really, really fit.

  3. I know sports medicine is it's own specialty, but more often than not it refers to ortho only, and even then it's not 100%. It would be great if there were GPs who could specialize in it too. Or maybe there are, I just don't know any.

  4. Amy, my GP is a sports medicine guy who "gets" runners. Cris, awesome post. Nothing is more frustrating than a doctor who doesn't understand. I love the business analogy!

  5. HA! Welcome to my world! I have to work with them daily! ;p

    Seriously though, great post. It's def frustrating dealing with medical personal that does not understand runners. I do have to ask, how did you know the medical personal in the tent was a Dr?

  6. I love your posts & have tried to comment on them for some time now. I am 10 weeks out after having a stress fracture in my foot and the ortho's advice from day one, was "do nothing". Sitting on the couch is just not in my vocabulary. Anyway, LOVE your blog. Pool running was my saving grace during my injury!

  7. you seem to have the ability to choose topics that are relevant and deconstruct them in a way that is detached and logical. i really enjoy reading these kinds of posts.

    (my RHR is 44 and my normal BP is 90/60 and always seems to cause alarm when I go see a doctor, so I'm with ya there!)

  8. Definitely agree with being CEO of your own body!