A case for exercise

Did you miss me?  Various things have kept me away from the blog for a while, but I thought I’d come back with a case.

You have a 58 year old white male patient who you’ve seen 4-5 times in your continuity clinic.  He has diabetes (uncontrolled, with HbA1c 9.5%), HTN (typically reads low 150s/90s in clinic), and hyperlipidemia (guess what?  He refuses medicines).  Oh, and his BMI is 36.

You’ve been harping on the miraculous benefits of diet and exercise all this time, and he’s finally decided to give it a try. He tells you that he’s joined Crossfit and is ready to start exercising, once you give the OK.

He wants to know:

  1. Don’t I need to have a stress test or something?  My dad got one every year before his last heart attack.
  2. How much exercise should I doing?  WHAT should I be doing? Can I just jump right in on the Workout of the Day?
What do you think? How would you answer him? If you aren’t sure what to say, vent about your patients like this (in a HIPAA compliant way, of course), or strategize how to get patients to exercise in the first place.  Or just tell me hello- let me know you are out there.  Any comments are appreciated.  And stay tuned,  some resolution and some more questions to come later this week.
Don’t be a Lurker, leave a comment!

 

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The Process

Our own Dr. Centor writes in his blog today about “the process.” It really hit home after seeing a patient today who never seems to make progress on his weight loss and diabetes goals.  We are constantly telling (berating) our patients to make major changes- quit smoking, eat less, exercise more, and on and on.  I feel like a broken record, and a frustrated broken record at that. And they never seem to take our advice.  But, as Dr. C opines, the result is not what is important, it’s the process.  As long as you are moving the ball down the field, you are doing good work. 

Each opportunity to work with our patients gives us a chance to espouse better lifestyle choices, better medication adherence, better processes. Our words are not magic. Sometimes they work; sometimes they just add another piece of straw. We must learn to focus on the process. We must try different motivational tactics. But we owe it to our patients to try, even if we believe that our actions are futile.
He makes a great point, and you should check it out the whole thing, as I haven’t done it justice.  http://www.medrants.com/archives/7401#comments

 Keep it up, and one day you will get that patient that quits smoking, loses 20 pounds, has a HbA1c move from 11 to 7 9 (well, it might be 3 different patients).  It really does happen, and those are the great days. 

While I’m thinking about it, only 41 more days until college football season.  Another one of the great days…