Why a Health Advocate Is Your Most Important Health Care Plan!

Advocacy_Graphic

This is the final article in my series on health care.  This article has been preceded by nine other articles.  There is no need to read them in order but if you have not read the other nine, you will be missing a good deal of information that just might help you live longer, healthier and happier.  As I finish this series on health care, I am gratified that over the ten weeks I have been writing about the subject, I have found only more evidence that confirms the advice and opinions I have given in this series.  In this final article, I want to talk about how important it is to have someone as an advocate when you enter the health care system in this country.  Let me tell you a personal story that illustrates this point very well.

Several years ago, my sister lay dying in hospice care.  Hospice care is a gentle humane way of helping ease out a person who is at deaths door.  By gradually increasing their doses of morphine, the patients’ bodily functions will eventually slow down and finally cease.  If a patient is accepted into hospice care, it is assumed that they are terminally ill.  What might be a slow lingering painful death without hospice, becomes a respectful and hopefully painless termination of vital processes and death.

My mother went into hospice care in 1994 and died in three days.  She had a terminal infection which was beyond treatment.  We (sisters and brother) sat with her until she expired.  My sister Sheri was also accepted into hospice care in 1999.  She was only fifty-one years old.  She was considered terminal due to her advanced cancer.  As a family, we began another vigil waiting for my sister to succumb to the cancer and morphine.  However, things did not go the same path with my sister.

We noticed that she would seem to come in and out of consciousness.  Often, when she came out she would seem quite rationale and even energetic.  The nurses did not seem to pay much attention to these episodes.  One day, the morphine drip somehow came unplugged.  My sister became quite lucid and wanted to know if it was time for her to do taxes.  She did not seem like a patient near death.  We demanded that they take her off the morphine.  This met with much resistance as I assume they thought my sister would be in great pain and that we would be the instigators of a now painful as well as inevitable death.  Such was not the case.  My sister revived and seemed very healthy.  In a day or so she was out of the hospital.  She moved in with my sister and lived another three years before she passed away in 2002.  The next three years were not always good ones for my sister but we never regretted the decision to take her out of hospice.

Advocacy-bannerThe point of this story is that if we had not been siting vigil at my sister’s deathbed, we would not have been able to prevent a premature death.  This is merely one example of the value of an “advocate” when you must go to a hospital.  I am sure everyone reading this blog has at least one example that highlights how important it is to have someone as an advocate when you are in the hospital.

A health advocate is a family member, friend, trusted coworker, or a hired professional who can ask questions, write down information, and speak up for you so you can better understand your illness and get the care and resources you need – giving you a peace of mind so you can focus on your recovery.

Nurses, doctors and staff all want to do a good job and provide wonderful healthcare.  However, our health care system is under tremendous pressure to cut costs and reduce expenses.  This translates to less time available to care for each patient.  Less time that a nurse or doctor can spend with each patient.

advocateAn alarm might go off in an intensive care room but not be noticed for quite some time.  I have personally observed many times when a patient needed to call someone for assistance but no one came.  Unable to get out of bed, a patient may have to wait a long time before someone is finally able to help them.  In many cases, an advocate in the room can help a patient with minor personal needs.  If more severe needs exist, the advocate can be of assistance if finding someone to help and making sure that the patient needs are not overlooked or even forgotten.

Advocates assist people with making sure their rights are respected. They help consumers to resolve complaints about health or disability services. They operate independently of government agencies, the Health and Disability Commissioner, and the funders of health and disability services.

70b2adaac53bf082bb116c279362275c_advocacy-clip-art-clipart-download-advocacy-clipart_1822-1415Another function an advocate can provide is to stand up for the patient when needed.  Most of the time when we are feeling sick or hurting, we are in no position to stand up for what we need or want.  In such instances, a patient only wants the pain to go away.  Hospitals and health care providers often have needs that transcend the needs of the patient.  The patient that must play second fiddle to a variety of administrative and financial procedures.  Another example might clarify this.

Three years ago, I went to the Mayo Clinic for prostate surgery.  The surgery went fine and I was sent to a room for recovery.  The night passed as most do in a hospital.  Interminable interruptions for pills, blood tests and getting up to walk the surgery unit for exercise.  The night nurse was polite and helpful.  She left sometime after 7 AM and a new nurse came on shift.  She immediately informed me that I had to be out of the room by 12 PM and I should try to do more walking.

I had thought that I was doing a great job of getting mobile but I had not met my new nurse’s standard.  I started to try to walk more and meantime I became fixated on the clock in my room.  I still felt like shit as I watched the hands on the clock move inexorably towards 12 PM.  I am sure that Cinderella did not feel as bad as I felt since she would only be outed as a pauper while I be would be viewed as weak, wimpy and unable to meet standards that every other male prostate victim in America had met.

Fortunately, when the witching hour arrived, I had my advocate intercede on my behalf.  My wife Karen who had kept vigil with me this whole time told them in no uncertain terms that I was not going anywhere until I felt better.  It was now 12 PM but with her assurance, I fell into a deep sleep.  I awoke two hours later and immediately saw that the clock hands were on 2 PM.  Somehow, this extra sleep time was all I needed.  I practically jumped out of bed and started grabbing my clothes.  Karen who had been napping in a chair beside my bed woke up.  I said, “Lets go, we are getting out of here.” She replied, “but we are not packed.”  I replied, “I don’t care, I want to get out of here now.”  Karen grabbled whatever we could and we made the 2-hour drive back to Arizona City from Scottsdale.  I was not sure how I was going to handle two hours in the car post-surgery but I did not care.  I wanted out of the Mayo Clinic and back in my own bed.  To this day, I wonder how much stock my second nurse had in the Mayo Clinic.

Preserver wNew Shadow-logo tagline

My rule now is this.  I will never let a friend or relative go to a hospital for treatment (regardless of how minor) by themselves.  If I have a friend who has no one to go with them, I will be their advocate.  If Karen needs to go to a doctor, clinic or hospital for any reason, even a hangnail, I will go with her.  Hospitals can be places of healing but they can also unexpectedly be places of death.  No one should assume or take for granted what might or might not happen at a hospital.  I could provide many more examples of unintended consequences that happened to friends and people we knew when they went into a hospital.  Better to be safe than sorry.

Patient advocates can work to help patients and their families by providing a variety of services, depending on the patient’s needs and the advocate’s area of expertise. They may help them to secure health care, manage insurance, or make treatment plan decisions.

Your advocate is your best health care plan.  Your advocate can have your back when you are under the weather or unable to defend yourself.  Your advocate can help make sure that the hospital and its providers live up to their own expectations.  Your advocate can help watch over you when everyone else is busy with other patients or administrative tasks.

Pity the poor person who goes into a hospital without a personal advocate.

This now concludes my series on health care.  I hope my blogs on health care have been useful and that you have found some ideas that will help you to lead a healthier, happier and more robust life.

Time for Questions:

Can you think of a time when you wished you had an advocate?  Were you ever an advocate for someone else?  What role do you think an advocate should play in healthcare?  Do you agree that everyone needs an advocate?  Why or why not?

Life is just beginning.

“For he who has health has hope; and he who has hope, has everything.”  — Owen Arthur

 

Will Yoga or Physical Therapy Help You or Kill You?

yoga

I started doing Yoga in 1972.  I am still doing Yoga three times per week and for over 45 years now.  My first Yoga instructor was a gentleman from India who did not look anything like Arnold Schwarzenegger.  He was short and a little on the pudgy side.  I credit him for giving me a wonderful grounding in both the physical and spiritual characteristics of Yoga.  I have since had many Yoga instructors but my first one still stands out in my mind as head and shoulders above the rest.

Over the years, many people have taken up teaching and doing Yoga.  Many of these “so-called” Yoga instructors are really Jazzercise or aerobics instructors in disguise.  Taking Yoga from some of them is a little like taking music lessons from someone who can only play an “air guitar.”  You will not get the true flavor of Yoga from someone who does Yoga to a four count hip hop beat and keeps shouting “work your buns.”  I feel privileged that I know the difference between real Yoga and “fake” Yoga.  Real Yoga has been a vital aspect of my weekly exercise routine.

When I started this blog (Which will be the 8th in my series on exercise and health care) my spouse wanted to know “Whether was I was going to say something negative about Yoga?”  I reassured her that it was not my intention to disparage Yoga or to say anything off putting about the practice.  Indeed, I think everyone would be happier and healthier if they did Yoga at least three times per week for ½ hour per session.  However, I did note in an earlier blog that Yoga and physical therapy could make your health worse.  As with anything in life, there is always a possible downside or negative impact which can occur with any activity.  If you lay in your bed all day long, your house could be hit by a tornado, earthquake, hurricane, flood or falling airliner.  Everything in life has a risk.

ManDoingYoga_0

The greater risk in life (IMHO) is doing nothing.  It is always easier to do nothing.  Whether your doctor has given you a regimen to practice physical therapy or whether you have a schedule for Yoga, there are many nights when you will just feel like doing nothing or perhaps simply eating.  It often goes like this in our house:

5 PM

John:  Let’s do Yoga today at 6:30 PM.

Karen:  OK

6:15 PM

John:  I sort of got behind on some things I was doing.  Could we make it at 7 PM and eat dinner after?

Karen:  OK

8 PM

John:  Dam that took longer than I thought it would.  Shit, it is now 8 PM.  I am hungry and tired.  Would you mind if we skipped Yoga tonight?  We could do it tomorrow instead.

Karen:   OK

One problem with Yoga (as noted in the above discussion) is to skip doing it.

yoga cat

Another problem can be overdoing it.  Yoga must be practiced carefully.  The formula “no pain, no gain” is a prescription for disaster when it comes to doing Yoga.  That is the issue I have with Jazzercise instructors who think that they can teach Yoga with the same philosophy they use in their Jazzercise classes.  Yoga should be slow and gentle.  Yoga should not be frenetic and schizophrenic.  Some people might feel that there is little benefit to doing something that does not result in pain or sore muscles.  However, with the wrong philosophy, you can do real damage to your muscles or joints while attempting to do some Yoga exercises.

worrier poseBeing overly competitive might be a good formula in exercise programs where you attempt to outdo other participants, but this can be another recipe for disaster when it comes to Yoga.  Each participant in Yoga needs to pay attention only to their own body; not to the other participants or even the instructor.  If the instructor has his/her legs at a 180 degree angle to their torso and you can only make 30 degrees, you are best advised not try to imitate your instructor or other participants.  A good instructor will repeatedly advise you to only go as far as you can with any Yoga posture.  Pushing the envelope may lead to torn muscles or dislocated joints.

I have lumped physical therapy in with Yoga exercise.  I have done this recognizing that though they are two very different practices they actually share several things in common.

  1. They are both healthy alternatives to pills and surgery
  2. They both require discipline and a regular routine
  3. They cost a great deal less than surgery or pills
  4. They have less side effects than pills or surgery
  5. You can do them in the privacy of your home and you do not need a prescription
  6. You can target particular areas of the body where you have some type of soreness or imbalance
  7. You can do them regardless of the physical shape you are in since the level you do each at can be adjusted to your present condition
  8. You can do them forever and they will help prevent future problems
  9. They are both proven in terms of health and therapeutic value

Many of the yoga practices that have now become routine in physical therapy are derived from Yoga exercises that go back thousands of years.

“A co-worker of mine recently had knee surgery and said he is in physical therapy. I am always curious as a Yoga teacher what the medical community does to treat ailments via physical movement.  He graciously copied his sheet of exercises his physical therapist prescribed to him.

I saw immediately that the actions being taught in physical therapy mimic many of those in asana, with asana being a bit more extreme in range of motion.” — From Home Yoga Practice

For a more in-depth analysis of the similarities and differences between Yoga and physical therapy see the following article:  Yoga and physical exercise – a review and comparison by Ramajayam GovindarajSneha KarmaniShivarama Varambally & B.N. Gangadhar

Conclusions:

Yoga can be an excellent addition to your weekly health routine.  The exercises (called asanas) will help to keep you flexible and limber.  Yoga will also help with your balance and posture.  Flexibility and balance are two of the six key pillars for a healthy lifestyle.  I would argue that for good health, you need to address each of the following six pillars on a weekly basis:

  1. Flexibility routine
  2. Strength routine
  3. Balance routine
  4. Stress routine
  5. Good nutrition
  6. Aerobic routine

If you supplement your weekly Yoga with an aerobic exercise program, strength program and good nutrition, you will have done the most that anyone can do to insure a long and healthy life.  The rest will be up to your genes and lifestyle.

Yoga set394Start doing Yoga once or twice a week.  You can get a Yoga mat, strap, blocks and some used Yoga DVD’s for less than $30 dollars.  With some Yoga tapes and a DVD player, you will be able to do Yoga in the privacy of your home and as often as you want. I have found Rodney Yee, Patricia Walden and Susan Deason to be great instructors.  Gaiam Yoga tapes can often be found in Goodwill or other thrift stores for a few dollars each.  On frigid days, it is a real pleasure not to have to get dressed and go to a gym.  It is also great to have an instructor on DVD that I do not have to keep paying weekly fees to.

Time for Questions:

Do you do Yoga?  Why or why not?  If not, what would it take for you to get started?

Life is just beginning.

“Yoga is not a religion. It is a science, science of well-being, science of youthfulness, science of integrating body, mind and soul.” — Amit Ray

 

 

 

 

Why Diet Programs Ignore Common Sense! Or How to Lose Weight without even Trying!

marthas-vineyard-detox-diet

There are two rules of wisdom that I think most of us believe in.  They are:

  1. If it is too good to be true, it probably isn’t
  2. There are no free lunches

I have found the above precepts to be good guideposts for my life.  They are so often noted that we begin to take them for granted.  It could be argued that perhaps they are not true in every situation, but I believe that they are more often true than not true.  This brings us to the issue of diet programs.  Consider the following statistics:

  • An estimated 108 million American adults were dieting in 2012.
  • Each year, more and more adults are trying to lose weight
  • 80% of dieters try to lose weight on their own
  • In 2012, Americans spent an estimated $65 billion trying to lose weight
  • 90-95 percent of all dieters gain their weight back

(Statistics are from Fitness for Weight Loss)

HT_rocco_dispirito_book_jef_140109_16x9_608If I go to Amazon.com and type in “diet books”, I find that there are 184,291 books available to sell me on a strategy for losing weight.   There were 424 “Diet Best Sellers” in 2016 and 209 “Best Sellers” published already in 2017.  These are only the “Best Sellers.”  There were a total of 39,673 diet books listed as published in 2016.  Many if not most diet books do not make the “Best Seller” lists.  In terms of magazines dealing with diets and weight loss, there are over a dozen magazines that you can buy each week at your local grocery store (that you will find stocked right next to the chocolates) that will tell you how to lose weight “without even trying.”

fad-diet-adsHowever, the above statistics are only the tip of the proverbial iceberg.  If I go to Google and type in the words “diet strategies” in parentheses, I find that there are over 319,000 listings concerning various diets, stratagems, plans, tips, secrets, etc., that will show you how to lose weight “without even trying.”

Here are some typical headlines that you will find as you peruse any of the above information that is offered for those of us that need to lose weight “without even trying”:

  • The Harcombe Diet 3-Step Plan: Lose 7 lbs. in 5 days and end food cravings forever
  • 1200 Calorie Diet Menu – 7 Day Lose 20 Pounds Weight Loss Meal Plan
  • Win at Slim: New Secrets to Lasting Weight Loss
  • Outsmart Your Cravings: Sweet, Salty, Crunchy
  • How I Lost 42 lbs.
  • Eat, Drink, Shrink: No Diet Ways to Fight Holiday Gain
  • No More Guilt: Stop Dwelling, Start Enjoying

no exercise or dieting

The beauty of all these weight loss schemes is that you can lose weight “without (you guessed it) even trying.”  Any half-way intelligent person would regard these titles and by applying either of the two rules noted earlier decide that they were pure bunko.  Lose weight without trying!  End food cravings forever!  Lose 7 lbs. in 5 days!  No sane person would believe any of this BS.  Nevertheless, the diet magazines, diet plans and diet books sell like crazy.  Every year a plethora of new diet strategies replace last year’s models.  Why do people continue taking the bait when they know that it is a sucker’s game?  The simple answer is that when it comes to looking like Jennifer Lopes, Christie Brinkley or any of the Kardashians, all brain power and rational thinking goes down the drains.  Everyone in America wants to be thin and beautiful “without even trying.”

SUPER-SHRED-DIET-ROTATOR-617x241Every new diet strategy renews hope for the downtrodden and overweight oppressed masses.  Every new diet plan offers the possibility that beauty and slimness might be had before Christmas or at least before the New Year.  Every new weight loss scheme provides the potential to become the person that we dream of being.  Hope springs not just eternal in the human breast, but perpetually, irrationally and beyond all measures of logic or intellect:  To hell with “no free lunches!”  To hell with “it probably is not true!”

If even the remotest opportunity exists that I can lose weight “without even trying”, I will take the bait like a mouse eats peanut butter or a cat eats catnip or a bear eats donuts.  “Dam the torpedoes, full speed ahead.”  Who cares about logic?  Who cares that no evidence exists to back these claims up?

before and after maleSo now we come to the real issue.  You wanted to know if there actually might be a method for losing weight “without even trying.”  My answer is YES!  But there is even better news.  I will send you the secret strategy for my quick weight loss “without even trying” plan that I have developed for only $9.95 plus postage and handling.  In six weeks or less, I will give you a money back guarantee that you will lose twenty pounds “without even trying” or I will send you a full refund.  This offer is good for only thirty days after you read this blog and it will then expire.  The following stipulations also apply:

  • You must reside on a lake
  • You must be over 99 years of age
  • You must have been born in Last Chance, New Mexico
  • You must be at least 100 lbs. overweight at the start of this offer
  • You must believe everything you read or hear

Time for Questions:

Do you need to lose weight?  Have you been trying to lose weight?  How successful have your efforts been?  What has worked for you?  What did not work for you?  What would you like to change in your diet?

Life is just beginning.

“I believe that parents need to make nutrition education a priority in their home environment. It’s crucial for good health and longevity to instill in your children sound eating habits from an early age.” — Cat Cora
 

 

 

 

How Can We Set Realistic Exercise Goals as We Age?

time to set goals concept clock
Goal setting is as American as mom, God and apple pie.  Every exercise book, life improvement book and management book has a section on goal setting and accolades for the process.  I too once subscribed to the philosophy that those who did not set goals for their life were losers, losers and losers.  Winners set goals.  When winners reach their goals, they up the bar and set them even higher.  That is the American Way.  Set unreachable goals and if you should meet those goals, then move the bar up, ever up, ever higher.

Well, I am going to tell you that everything in the above paragraph is STUPID advice.  Most of the wisdom around goal setting is simply dumb.  Unfortunately, when it comes to your health, it is not only dumb, it is dangerous.  It was not until 1986 that I met the man who would change my mind and my attitudes towards setting goals.  This man was the renowned quality expert and statistician Dr. W. E. Deming.

demingI had just finished my PhD program in Training and Organization Development and joined the consulting firm of Process Management International.  One of the founders Lou Schultz was a follower and friend of Dr. Deming and I was soon introduced to Dr. Deming and his world.  It was a world based on 14 Principles of Management which defied everything I had been taught in my business classes at the University of Minnesota.  Dr. Deming, upon meeting me, challenged me with the comment that “Everything they taught you in your business classes is wrong.”  I was stunned and somewhat chagrined by his comment.  It struck me as rude and extremely arrogant.  In six months, I learned that Dr. Deming was more than ½ right.  In side of three years, I learned that he was at least 99 percent right.  Do not think I was brain washed.  I have always verified new knowledge by theory and personal experience.  Considering the hypothesis that Deming threw out, I was provided a new theory.  I became religious about testing his ideas and seeing if he was wrong.  Time and time again, Deming proved correct.

Deming’s 14 Points for Management are as follows:

  1. Create constancy of purpose for improving products and services.
  2. Adopt the new philosophy.
  3. Cease dependence on inspection to achieve quality.
  4. End the practice of awarding business on price alone; instead, minimize total cost by working with a single supplier.
  5. Improve constantly and forever every process for planning, production and service.
  6. Institute training on the job.
  7. Adopt and institute leadership.
  8. Drive out fear.
  9. Break down barriers between staff areas.
  10. Eliminate slogans, exhortations and targets for the workforce.
  11. Eliminate numerical quotas for the workforce and numerical goals for management.
  12. Remove barriers that rob people of pride of workmanship, and eliminate the annual rating or merit system.
  13. Institute a vigorous program of education and self-improvement for everyone.
  14. Put everybody in the company to work accomplishing the transformation.

Note number eleven above, where he says to eliminate quotas and numerical goals.  How can he advocate this when every single expert in the world says to do the opposite?  Setting goals and establish quotas and targets is the refrain most often heard in business.   Dr. Deming says that following the traditional rules on goal setting is counterproductive.

“Management by numerical goal is an attempt to manage without knowledge of what to do, and in fact is usually management by fear.”  — W. E. Deming

Problems with Goal Setting:

exercising

There are several problems with goal setting which I would like to discuss.  You need to understand these problems to understand why goal setting my hurt your health.  If you have some knowledge of the statistical concepts that Dr. Deming puts forth so much the better.  However, I will try to explain Deming’s opposition to goal setting for the reader that has no statistical background.  The four major problems are:

  1. Where did your goals come from and how realistic are they?
  2. Is your system/body capable?
  3. What is your apex?
  4. Are your goals sustainable?

I will try to explain how each of these four problems impacts the goal setting process.  I hope you will have a better idea of the pros and cons of goal setting after reading this blog.

  1. Where did your goals come from and how realistic are they?

Dr. Deming always said that if you do not know what a process is capable of (measured by standard deviation and CPK) than any attempt to set a goal would be foolish.  Under these conditions, it would just constitute wishful thinking.  For instance, organizations will often set sales goals by simply decrying that they want a 10 percent increase in sales over the previous year.  The first question I would have is why 10 percent?  Why not 1,000 percent?  Ridiculous you might say to a 1,000 percent increase but it is no more ridiculous than 10 percent if I do not have a system that can handle or produce that kind of an increase.  Any goal is ridiculous if you do not have a system and a process capable of achieving that goal.  Unfortunately, too many goals are simply pulled out of thin air and have no roots in reality.

  1. Is your system/body capable?

set huge goalsLet me illustrate the problem addressed by this question with an example from my own life.  Several years ago, I had just turned sixty years of age and I thought it would be cool to be able to do twenty pullups.  I could usually do about ten or so and so I thought it would be a snap to increase my routine and get to the goal of twenty.  At first, I simply increased the number of pull-ups I did each week but this did not work very well as I soon plateaued.  I then decided to find some “established” routines.  These established routines generally involved doing at least three sets three times per week and having the number of repetitions in each set increasing each week.  The formula upon which these increases were based was never disclosed.

recon ron

I tried several different routines including the Marine program, a program called Recon Ron and several online programs that outlined a systematic way to reach twenty pull-ups.  In each case, I followed the program but after six or so weeks, I would reach a point at which I could not advance to the next level.  Sometimes the number of reps required for the next level was down right ridiculous.  For instance, one day my total repetitions might be five sets of 10- 13 pull-ups each set.  The next day, they would have five sets of between 13-16 pull-ups.  The jump between 13 and 16 was like trying to jump across a mile-wide chasm.  No way could I make the transition.

myth of sisyphusIn hopes of salvaging the program, I would often drop back to the previous level and try to continue my progress.  However, every time I started to progress again, I would reach a point where my body could not obtain the increases dictated by the regime I had selected.  I once reached as high as sixteen pull-ups before I crashed.  The crashes would usually take the form of having an acute muscle pain or sometimes getting sick and not feeling like I had the energy to continue.  Laying off for two weeks or so to recover, I would find that when I tried to start the program again, I had now dropped down to a much lower level than I had previously attained.  It was like starting all over again.  Over the years, trying to reach my twenty pull up goal, I have felt like Sisyphus pushing the rock up the hill and nearly reaching the top only to have the rock roll all the way down again.

exercise-stress_640-480

I am now of the belief that first, at my age, I may not have the system or body capability to achieve twenty pull-ups and second, (more importantly) that I am not doing my body any good by trying to push it to some arbitrary goal.  What is magic about twenty pull-ups?  Am I going to be any healthier or fitter?  Furthermore, trying to achieve some arbitrary goal, I could end up doing real damage to my shoulders or back.

  1. What is your apex?

hippo to unicorn

An apex is the top or highest part of anything.  Most athletes reach their physical peak at about twenty-nine years of age.  This is true for many but not all sports.  I did my best 10K run of 38:48 when I was thirty years old.  Since then, my running times have become slower and slower.  Some athletes, particularly swimmers may maintain their peaks for many years past their apex.  This is not the general rule.  It is more likely that whatever sport you excel in your apex performance will deteriorate with age.

The importance of one’s apex performance lies in the recognition that it will be impossible to maintain this performance over time.  Moreover, it is foolish and unproductive to try to use such prior performance measures as goals for one’s fitness.  The outcome will likely be pulled muscles or worse.  What makes more sense is to set “maintenance goals” that are well within your reach and work towards or with them.

A maintenance goal is much different than a stretch goal.  Most books on physical fitness emphasize stretch goals.  This concept of stretch goals represents a state wherein you are constantly setting lofty goals and moving them forward as you accomplish them.  This is very dangerous and frustrating.  The first problem with the stretch goal strategy is that they are arbitrary and have no empirical relationship to how fit you are or want to be.  The second is the danger of hurting yourself as you constantly try to increase the number, weight or time involved with each goal.

In a maintenance goal, you decide first on the level of fitness that you think makes sense.  For instance, do I want to be able to bench press 150 lbs. or do I want to be able to bench press 50 lbs. three or more times?  If I am working to become a champion weight lifter than lifting large weights is a must.  If I am working to have good muscle tone, flexibility and a relative level of arm strength necessary for normal every day lifting, then being able to life 25 lbs. ten or twenty times will make much more sense than being able to bench press 300 lbs. once.  Furthermore, with maintenance goals, I am much less likely to injure myself by tearing or pulling a muscle.

Perhaps you have never had an apex performance in any sport.  This is not important.   An apex performance simply gives you a relative benchmark based on your best ability at a certain age.  If you have never worked out a day in your life, then simply start with what I call a 1-1-1 program.  I developed this concept when I was being discharged from the Air Force after serving four years.  I had to go in for a discharge physical with 12 other men.  After the physical, the doctor called us all together and told us we were all overweight and fat.  I was so embarrassed, I determined to start exercising the next day.

The following day after my physical, I had my wife drive the car about a mile down a dirt road and drop me off.  I told her to drive down to the end of the road and wait for me.  I started to jog down the road.  I did not even make it half way down the road before I became sick to my stomach.  I walked the rest of the way to the car and asked my wife to take me home.  Once home, I went to bed and stayed there until the next morning.

I knew right then and there that I had to start off small and work up.  I decided to walk about a block each day.   Do one push up each day and attempt one pull up each day.  Eventually, I shed my excess weight and got back into the best shape I had seen in three years.  I labeled my program, the 1-1-1 program after my three goals or starting points.  I allowed myself to progress naturally and not to adopt any outlandish and wishful stretch goals.  Later, I started competing regularly in running, biking, swimming, canoeing and skiing events.  I continued this competing until I burnt out on the extra load that competing places on one’s body.  As the years went by, I could clearly see I was not going to win any gold medals.  Based on a knowledge of my body and the realization that my goals needed to adapt over time, I set a series of basic maintenance goals which over the past ten years I still try to follow.   My goals are:

  • 4 or 5 runs per week with an average run of 30 minutes for the month. Average 60 percent “days run per month” based on 30 days in the month. 
  • 10 Pullups 3x per week
  • 200 bicep curls with five lb. weights, 3x per week
  • 45 Triceps presses, 3x per week
  • Calf stretch and knee bends, 3x per week, 3 minutes stretches with 1 minute for knee bends
  • Yoga 25 minutes, 3x per week
  • Ab exercises 8 minutes, 3x per week

The above routine is my basic routine which I do each week.  I do not increase my goals.  I do not try to stretch myself.  I measure and monitor my routines each week to accomplish what I consider to be my maintenance goals.  I call them maintenance goals because I am focused on simply maintaining my present state of fitness.  This is a level of fitness that enables me to do the activities I enjoy and not feel exhausted or overly worn out.  I can hike, bike, canoe or do a relative amount of physical labor without my body protesting too much.  Just a few weeks ago, I helped my stepdaughter move into her new home.  Her boyfriend and I rented a U-Haul truck and did all the furniture moving ourselves.  I had no unusual aches or pains the next day.

Some experts would say that I am going to decline in fitness since my body will acclimate to these goals and then my level of fitness will deteriorate.  My reply would be to have them wait until they are 70 years old and see if they still believe this.  The truth of the matter is, I occasionally must adjust my goals downward some months.  If I have been sick, been traveling or had company and not able to exercise, I may not be able to make my maintenance goals.  I will set my sights lower for a while and then work towards getting back to my maintenance level of activity.

  1. Are your goals sustainable?

fitness goalsThe fourth question you will want to address concerns the sustainability of your goals.  I raise this question since the Second Law of Thermodynamics says that all systems will deteriorate unless energy is put into them.  Our bodies are simply physical and biological systems interacting with our environment.  Over time the energy that we can put into our systems will inevitably decrease with age.

The effects of this decline will mean that any goals, maintenance or otherwise that you have set for your body will be that much harder to attain.  Just like a clock runs down when the battery gets weak, your body is going to run down as your energy level declines.  This decline will be caused by a combination of age, physical condition, life style, motivation and illness. There is no escaping this.  However, this does not mean that you need to give up.  The goal you need to have for your body is to be in the best physical condition possible given the exigencies facing you each day.  This is going to be different for each of us.  My goals, your best friend’s goals, the goals in some exercise book are not going to be the right goals for you or anyone else.

Conclusions:

Don’t let me tell you what your goals should be.  Don’t let anyone else tell you either.  Decide what your priorities are in life and set your goals or exercise program to match your priorities.  Keep in mind that if good health is your priority, you will need to spend some time in physical activities that promote good health.  How long and how hard your time and activities will need to be will depend on how you feel and how you want to feel.  Start small and remember that progress is not always upwards.

Time for Questions:

Do you exercise?  Do you have a written exercise program?  Do you have goals?  What has been your experience with goals?  Have you ever had any bad experiences with goal setting?  Can you share them in the comments section?  As you age, how have your goals changed?

Life is just beginning.

“An individual will of course have his own goals.  A man may set his heart on a college education.  He may resolve to finish this chapter by morning: I give myself a deadline.  Goals are necessary for you and me, but numerical goals set for other people, without a road map to reach the goal, have effects opposite to the effects sought.” — Dr. W. E. Deming

“A goal such as “improve throughput by 20%” or “reduce lead time from 10 days to 5 days” is incomplete or worse, unachievable or irrelevant, because it doesn’t relate to the process capability. The danger of setting goals without understanding the process capability is twofold.

  1. If the goal was set beyond the process/system’s capability (or expected range of performance), the only way to achieve the goal is to change the process. However, in many cases, the critical variables in the process are outside the control/scope of the people who are tasked with achieving the goal.

For example, you are getting 25 miles per gallon from your car in the last 3 fill-ups. If you don’t know the capability of 20-30 MPG fuel efficiency, it doesn’t matter if your goal is set at 35MPG (because of your desire or economic need). You might try to change driving habits, keep tires properly inflated, use some additives, or perform more routine maintenance. You might even get rid of some stuff in the car or pick a route with less stop and go traffic. What you will find is that despite great effort, your MPGis still below 30. In some rare occasions, you might achieve 35 MPG or greater because it’s mostly downhill. But you know you would give up the gain when coming back uphill.

  1. If the goal was set within the process capability, there is always a finite probability of achieving it without any effort or change in the process. The goal without an associated probability target is pointless.” —- Goals and Process CapabilityFang Zhou

 

How much Pain is Caused by Aging Versus Laziness and Ignorance?

lazy_workout

Have you ever head the saying “no pain, no gain?”  This is one of the most idiotic pieces of advice ever given.  Pain is a signal that our body wants us to stop something or that it needs help.  I have little doubt that many people have been severely damaged by this so-called piece of wisdom.  However, taken to the other extreme, we see people who are so afraid of hard work and exercise that they have become couch potatoes.  I believe that many Americans have veered so far off the trail of pain that they have gone to the other extreme.  Look around you and what do you see?  Fat people everywhere you look.  We have an epidemic of obesity in America.  Regard the following facts: (From the Center for Disease Control)

  • The prevalence of obesity was 36.5% (crude estimate) among U.S. adults during 2011–2014.
  • The prevalence of obesity among U.S. youth was 17.0% in 2011–2014.
  • From 1999 through 2014, obesity prevalence increased among adults and youth.

The above data pertain to the frequency of obesity in the USA.  Keep in mind that there are many more people who are overweight than there are who are obese.  Obesity is defined as: “Excess amount of body fat with a BMI of over 30.”  Overweight is defined as: “Having more body weight than is considered normal or healthy for one’s age or build.”  If we were to include the amount of people who were both overweight as well as obese, the figures for “fat” people in the USA would skyrocket.

Several years ago, I attended a World Future Conference.  The former founder and CEO of Medtronic was one of the keynote speakers. His talk was on the topic of rising health care costs.  Many people focus on only one or two causes for the escalation of health care costs.  However, Earl Bakken presented a pie chart which showed several reasons for the rise.  These included:

  • Increased cost of technology
  • People living longer
  • Increased percentage of older people in the population
  • Litigation
  • Inflation
  • Lifestyle choices

obesity-is-preventable_52fc767facaae_w1500

Earl noted that all of these issues have had an impact on health costs.  You will notice that the last issue in his list included “lifestyle choices.”  This category includes such problems as diet, smoking, obesity, drugs, alcoholism, lack of exercise and poor health choices.  Contrary to what many people think, this issue was not the major cause of health care cost increases.  Nevertheless, the category is one of the factors linked to the increase in health care costs.

Looking only at obesity as a contributor to health care costs, we note the following facts: (From the Health Care Costs of Obesity)

  • Obesity is one of the biggest drivers of preventable chronic diseases and healthcare costs in the United States. Currently, estimates for these costs range from $147 billion to nearly $210 billion per year. In addition, obesity is associated with job absenteeism, costing approximately $4.3 billion annually and with lower productivity while at work, costing employers $506 per obese worker per year.  As a person’s, BMI increases, so do the number of sick days, medical claims and healthcare costs.
  •  Obese adults spend 42 percent more on direct healthcare costs than adults who are a healthy weight.
  •  Per capita healthcare costs for severely or morbidly obese adults (BMI >40) are 81 percent higher than for healthy weight adults. In 2000, around $11 billion was spent on medical expenditures for morbidly obese U.S. adults.
  •  Moderately obese (BMI between 30 and 35) individuals are more than twice as likely as healthy weight individuals to be prescribed prescription pharmaceuticals to manage medical conditions.
  •  Costs for patients presenting at emergency rooms with chest pains are 41 percent higher for severely obese patients, 28 percent higher for obese patients and 22 percent higher for overweight patients than for healthy- weight patients.

 People who are obese, compared to those with a normal or healthy weight, are at an increased risk for many serious diseases and health conditions, including the following: (From the Center for Disease Control and Prevention)

  • All-causes of death (mortality)
  • High blood pressure (Hypertension)
  • High LDL cholesterol, low HDL cholesterol, or high levels of triglycerides (Dyslipidemia)
  • Type 2 diabetes
  • Coronary heart disease
  • Stroke
  • Gallbladder disease
  • Osteoarthritis (a breakdown of cartilage and bone within a joint)
  • Sleep apnea and breathing problems
  • Some cancers (endometrial, breast, colon, kidney, gallbladder, and liver)
  • Low quality of life
  • Mental illness such as clinical depression, anxiety, and other mental disorders
  • Body pain and difficulty with physical functioning

Please notice that the CDC list does not explicitly include hip, knee and back problems.  Of course, many people who are not overweight suffer from these problems, but there is considerable evidence that obesity contributes to these problems.  People who are obese often lack muscle tissue and ligament flexibility which help support their knees, backs and hips.  The less exercise they get, the more the problem is exacerbated.  They may go to doctors and chiropractors to get help but the underlying cause of obesity is seldom treated.  Finally, surgery is performed when exercise, diet and physical therapy could be more effective treatments.  So why do so many people get surgery or pills when there are cheaper and more effective treatments with less side effects?

Let’s go back to what I said in the title of this blog.  Laziness and Ignorance.

too lazy to exercise

Laziness and Ignorance:

Every year, it is a well-known fact at health clubs across the country that right after New Year’s Day, the membership will increase dramatically and the parking lot will fill up with new members. This phenomenon will last about 15 weeks after which the new members will slowly drop off and the parking lot will go back to normal.  Why do you think this happens?  I will give you two reasons:

First:  The assumption that they will get instant results.  Too many people read the magazines at the grocery store promising “Six Weeks to Abs of Steel” or “Lose 40 lbs. in Eight Weeks.”  I would argue that if you can lose 1 lb. in a month, you are doing a great job.  As for the abs of steel, first you will need to lose a large amount of body fat and second, it may take you a year of hard dedicated disciplined ab exercises.  As someone who does regular ab exercises, they hurt.  They are no fun.

20170406_155206There is a difference between pain and hurt.  When I tried to continue my ab exercises after my prostate surgery and then after my hernia surgery, I experienced pain.  I wanted to get back into shape too quickly both times.  I stopped the exercises and worked on other routines that did not cause pain.  Mind you, the ab exercises still hurt and I have been doing them for six years.  I am making a big distinction here between pain and hurt. Perhaps, I should say they “burn.”  Burn is the athletic euphemism for hurt.  Most people don’t like hurt.  However, if you expect that you can get in shape without some discomfort, you are destined for life as a couch potato or in a surgery ward.

Second:  People are ignorant when it comes to exercise.  How many Americans do you think have ever read a book on exercise?  Unless, you are willing to become a student of exercise or trust in an athletic trainer, the knowledge that most people have regarding exercise is insufficient for them to attain the results they seek.  Sadly, most medical practitioners are just as ignorant when it comes to the role of exercise and diet in a healthy lifestyle.

How many exercise books do you think make Amazon’s “best seller” list.  To determine this, I went to Amazon and pulled up their top 100 best sellers.   In the entire list, there was not one book on exercise protocols.  There were two books on dieting at number 41 and number 42 in the top 100 list.  You could find several books on menus and cooking.  It is much easier in the USA to eat, then it is too exercise.

kaelinAmericans are enamored with diets and each new diet best seller promises fantastic results in a short amount of time.  The Amazon number 1 best seller in the health and exercise category was a book titled “Big Fat Lies.”  The author promises you the “truths” that helped her to lose 65 lbs. “without giving up pizza or ice cream.”  The author is Kaelin Tuell Poulin and the book has a very high rating in the customer reviews section.  Ninety-eight percent of the 235 reviewers gave it a 5-star rating.  However, while I often put a great deal of store in ratings, you must be careful about inflated ratings.  The one negative rater had this to say about the book: (typos in the review were not changed)

“Dont be fooled into purchasing a book that was reviewed by 200 hundred women who never read the book (her followees) I have read the book it is subpar at best and not worth the money. My origional review included picture evidence of her asking for reviews but it was removed because it included her identity i suppose. I hope this one stays up so no one else is fooled into buying this. I give this book 1 star only to post. She is a salesperson and she is a great one at that! but if one person reads this and doesnt feed into the hype it was worth the time and effort to type it.”

I would not call the above review a particularly good piece of criticism.  However, the author does alert us to the possibility that the book suffers from a sort of follower worship.  Nevertheless, I would risk the small cost of the book if I were looking for a diet program.  Consider the following review from one of Kaelin’s “ladyBoss” more ardent followers:

“This program has TWO things that every other weight loss program out there is missing.  For ONE Kaelin was heavy once she was 185 pounds herself but with hard work and dedication lost the weight and has kept it off for 5 years.”

This is a great testimonial.  I am not sure if “every other weight program is missing” these two factors, but I am sure that dedication and hard work were necessary for Kaelin to keep the weight off for five years.  One problem with many exercise and diet programs is that the participant is naive and believes that once they lose the weight, their hard work is over.  They may also lack the discipline to continue the work once a certain goal is achieved.  Lack of discipline?  Laziness?  Ignorance? This is a volatile mix.  They seem to go together like salt and pepper.

WWS-Obesity

There is one final factor that we must discuss and that studies have shown have a direct bearing on obesity and poor health.  This is the factor of poverty.  Many studies have shown a direct relationship between income and obesity and between income and exercise.  Poor people get less exercise and generally have poorer nutrition.  There are several explanations for this.  We can posit some possible cause and effect relationships:

  1. Lack of education leads to obesity
  2. Poverty leads to high fat diet and poor nutrition
  3. Lack of education leads to poverty
  4. Poverty leads to low exercise priorities

You might notice that there is a kind of circularity to the above relationships.  Perhaps, if they are circular it does not matter which is cause and which is effect since the result is the same.  The outcomes for poor people are poor nutrition, lack of exercise and obesity.

There are some who dispute the above correlations.  The claim is made that the relationship between poverty and obesity is not linear but varies by age, gender and ethnicity.  It has also been pointed out that rich countries throughout the world have a higher incidence of obesity than poor countries.

“While all segments of the U.S. population are affected by obesity, one of the common myths that exists is that all or virtually all low-income people are far more likely to be obese. In this generalization, two facts commonly are overlooked(1) the relationship between income and weight can vary by gender, race-ethnicity, or age and (2) disparities by income have been weakening with time, particularly for adults.” — Relationship Between Poverty and Obesity, Food Research and Action Center

However, if we look at obesity from an aggregate point of view and disregard the effects of ethnicity, age and gender, we find the following evidence to show a linkage between poverty and obesity:

“Poverty rates and obesity were reviewed across 3,139 counties in the U.S.  In contrast to international trends, people in America who live in the most poverty-dense counties are those most prone to obesity.  Counties with poverty rates of >35% have obesity rates 145% greater than wealthy counties.”Poverty and Obesity by James Levine (2011)

Furthermore, even the Food Research and Action Center admits to the problem that obesity poses for America and state on their site that:

“While all segments of the U.S. population can be affected by poor dietary intake and obesity, low-income and food insecure people are especially vulnerable due to the additional risk factors associated with inadequate resources and under-resourced communities.” 

Note the above statement that “poor people” are especially vulnerable.  Let me tell you the following story that illustrates some of my admittedly selective experience with this issue of poverty and obesity.

One day, Karen and I went to Scottsdale Arizona to visit and do some shopping.  We went to several art galleries and jewelry stores.  When it was time for lunch, we found an authentic looking Mexican restaurant and decided to eat outside.  We were right in the heart of Scottsdale and many people kept walking by our table.  It was fun people watching, but something kept nagging at my mind.  I was not sure why, but there was a difference between the average people I was used to seeing and the people I saw in Scottsdale.

Suddenly, I realized what was bothering me.  In the hour or so that we were eating, we did not see one obese or even moderately overweight person walk by.  All the people that passed by us were healthy and athletic looking.  This was my first realization of the connection between wealth and obesity.  I don’t know about the rest of the world but ever since then, I have observed that most overweight people I see in America are either poor or middle class.  In my opinion, rich people have much lower incidences of obesity in this country.

Aging and Pain:

You will notice that I have not attributed pain to aging.  This is not an oversight.  Neither is it denial.  You can have pain when you are young and you can have pain when you are old.  In either case, there is no way you should just accept the pain.  Unfortunately, what medical practitioners often diagnose and treat with young people, they are willing to accept with old people.  Let me give you another personal example.

20170406_155432Two years ago, I started developing a pain in my right shoulder. I was not sure where it came from but after several months of it getting worse, I went to see an orthopedic doctor.  He asked what if anything I might be doing to aggravate the shoulder.  I mentioned that I swim frequently and am aggressive with my laps.  His simple answer was “Well then, stop swimming.”  I decided to follow his advice and for the next year, I stopped swimming.  However, my shoulder pain did not get any better.

A year later, I went to see another orthopedic doctor and he could not find anything wrong with my shoulder.  He did no MRIs or X-ray’s.  I suggested he give me an injection of cortisone, which he did.  I had moderate pain relief for about six weeks and then the pain resumed and continued to get worse.  At this point, I decided to do some of my own research into shoulder pain.  This research was very productive.

I found some very good descriptions of the exact type of pain I was incurring and a few different suggestions on how I could treat the pain without pills or surgery.  The best and most positive ideas I found came from a Doctor John M. Kirsch in Wisconsin.  Dr. Kirsch put his ideas and supporting evidence for his theory of what causes some types of shoulder pain into a small book titled “Shoulder Pain:  The Solution and Prevention.”  I have since been following his treatment regimen with good results.  My shoulder pain has been decreasing and the range of motion in my right shoulder is improving.

I mentioned earlier that I am 70 years old.  I think that there is too often the attitude among people my age and the doctors they see that “pain with aging is inevitable.”  If it is inevitable, then we should just “suck it up” and live with it.  Sometimes, this might be true.  However, the assumption that aging and pain need to go together is a prescription that does not serve any of the elderly very well.  I have talked to many older people and I often find the same set of attitudes either on their part or their doctors.  It is basically “Well, getting old is a bitch and you just have to live with pain.”

No, you do not have to live with pain!   

I have been running 4 or 5 times a week for over 40 years now.  During this time, I have had shin sprints, knee pain, hip pain, big toe pain, back pain, Morton’s neuroma, plantar fasciitis, sesamoiditis, corns, calluses and blisters.  Each time the pain came, I have gone through the following sequence of activities:

  1. Awareness of discomfort
  2. Try to ignore it
  3. Discomfort moves into the pain stage
  4. Take over-the-counter meds
  5. Go to see a doctor
  6. Pain improved by prescription pills or shots
  7. Pain returned in a short while
  8. Do research on other remedies
  9. Trial and error with other remedies
  10. Voila, eventually find the right remedy (no surgery and no prescription drugs)
  11. Pain goes away and does not return
  12. Sometimes, continuous exercise such as leg stretches and yoga are necessary to keep conditions from returning or getting worse. g., must do calf stretches 3x per week to stop plantar fasciitis from returning.  

20170406_155233Some people are not so lucky.  However, I hesitate to call all of my good health “Luck.”  There is a saying by Thomas Jefferson that “The harder I work the luckier I get.”  I have worked hard to stay in shape.  I exercise regularly.  I watch what I eat.  I try to avoid excesses.  No doubt, I have had some luck that goes beyond hard work and discipline.  Nevertheless, I believe that hard work and discipline has played a large role in my ability to be healthy and still active at my age.

I wish I had a dollar for everyone that has come up to me and said “I wish I could run but I have bad knees.”   Many people do have bad knees.  But many people do not see a connection between their “bad” knees and their obesity.  Their cycle is more like this:

  1. Overeat
  2. Gain weight
  3. Do no exercise
  4. Get pain someplace
  5. Do less exercise
  6. Get more pain
  7. Go to doctor
  8. Get knee or hip or some other surgery
  9. Continue being overweight and doing little or no exercise
  10. Take pills

4 weeks to a healthier

The only way the above activities relate to aging is that it takes some time to destroy your body through lack of exercise and poor diet.  I guarantee you though, it will happen eventually depending on how much you abuse your body.  It may happen when you are young or it may happen when you are old.  The longer you wait to do something about it, the more difficult it will be to repair the damage you have done.  It seems like my body takes more time to repair itself the older I get.

Finally, you do not have to be rich to have good health.  Money will not bring you good health if you abuse your body, overeat, drink too much, smoke too much and avoid exercise.  You can pay all the doctors in the world and you will still have bad health if you follow the 10 steps listed above.

Time for Questions:

Do you exercise regularly?  Why or why not?  Do you have a program to help keep track of your weight?  Why or why not?  Do you have a weight problem?  What do you do about it?  How effective have your efforts been?  What do you think would help them be more effective?

Life is just beginning.

“My mother was a P.E. teacher, and she was kind of a fanatic about fitness and nutrition growing up, so it was ingrained in me at a young age.  As I get older, I’m finding out it’s not about getting all buffed up and looking good.  It’s more about staying healthy and flexible.” — Josh Duhamel
 

 

 

 

 

 

 

 

 

 

 

 

%d bloggers like this: