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Monday, December 23, 2013

Three Weeks in a Boot

I fractured my 5th metatarsal and sprained my right ankle three weeks ago with a clumsy misstep in the middle of the night down the stairs.  Today was my three week checkup.
According to my orthopod, this is an improvement from the initial x-ray.  As I'm not having much pain, he's pleased with my progress.  In another three weeks, I will have another check-up and presumably at that time if all is well, I'll be out of the boot.

My mental state through all of this has definitely improved.  I'm swimming, riding a stationary bicycle and doing spin classes, weight training, and even doing a little yoga.  My goal is to maintain my fitness and improve my eating a bit.  Because I thrive on structure, I've asked my coach to continue to give me a "schedule" of activities, like when I'm training.  It's just that the focus of my training is a little different.

At poolside, about to do my first post-injury swim workout.

A week after my injury, I headed back to the pool.  I can't kick, but I can swim with a pull buoy supporting my legs.  I've noticed that a full swim workout with a pull buoy tires me out slightly more than a standard swim workout.  Getting in the water, I have the chance to flex and extend my ankle a bit more, which is good because with the boot I feel like I have less range of motion.  The pull buoy forces me to rotate my torso, something my coach Gerardo has been telling me I need to do more when I swim but I really haven't truly understood until now.  Last week I swam six times.

I can ride a stationary bike, and can even do a spin class.  I just can't stand on the bike, which is fine by me, because I think that standing on a bike in spin class is a little silly because I don't spend much time standing on my bike when I'm riding on roads.
Sometimes selfies are fun.  That's me getting on a stationary bike a little over a week after my foot fracture.  I felt determined to get in a good workout, no matter what my limitations were.  A lot of people who get on the bikes at the gym aren't necessarily pedaling very fast, and often they seem more interested in looking at their smartphone than working out.  I'm not sure if I got more strange looks because I was the only one on a stationary bike pedaling fast, or because of the boot.  Regardless, after that workout, I felt the best I had since my fall.

I'm doing more strength training, some with my personal trainer Corey, some on my own.  Corey comes up with some good workouts, like step-ups on a bench, hopping in sand on one foot, and the usual upper-body challenges like push-ups, pull-ups, and tough core work.  And, when I'm not training with him, I'm doing some strength workout on my own a couple more days a week.  I have decided to challenge myself with exercises like one-legged burpees, which is a tough cardiovascular and strength workout, and as you might imagine yielded a few odd looks.

I've used my injury to my advantage in counseling patients, and perhaps it helps me empathize.  When a patient tells me he or she cannot exercise due to back pain, knee pain, or whatever issue they have, I can point out my own injury (because it's hard to hide a large orthopedic boot) and talk about how I am finding ways to exercise in spite of it, and encourage them to try to do the same.

I miss running more than you can imagine.  But I'm not focusing on that.  Fractures heal.  This is known.  I will be back to running in a few more weeks, maybe 3 weeks, maybe a little longer.  And in the meantime, I'm going to stay fit, and positive.

Thursday, December 19, 2013

New Cholesterol Guidelines

Recent updated guidelines have been released regarding treatment of cholesterol.  Specifically, this statement suggests who should and should not be on cholesterol-lowering statin medication.

There has been a lot of controversy regarding this document.  And, as a cardiologist, I don't necessarily agree with its conclusions.

What's new -- new research?  New studies? No.  This is just a group of experts coming together to give their opinion.

The recommendation that patients with known significant arterial disease -- including anyone who has had a heart attack or stroke -- should receive statins is definitely supported by clinical studies.

But, the guidelines also suggest that many patients who do not have disease should receive statins.  They present a new risk calculator, and if the risk of the patient is greater than 7.5% for a cardiovascular event (heart attack or stroke) that the patient should receive statins.  That would mean millions more patients on statins.

The major problem that I see with the guidelines is the suggestion of statins for primary prevention.  But, the literature on that topic does not suggest a strong benefit.  To prevent one heart attack or stroke over the course of five years, one would have to treat about 150 patients with a statin pill every single day.  So, when looking at a huge population, yes you see a reduction in the number of heart attacks and strokes. But, odds are, if you are one of those 150 people being treated with a statin, there is a 149/150 chance that taking a pill every single day for five years will not prevent any type of event.

Further, there have been meta-analyses, which are studies pooling data from several other studies, that demonstrate that amongst the primary prevention population, there is no reduction in mortality.  In other words, a statin won't prolong your life.

There's a great editorial from John Abramson and Rita Redburg in the New York Times on the new guidelines, similarly skeptical of expanding the use of statins.

So, if you feel good, why should you take a statin, which is a pill that has a decent chance of causing muscle aches and is known to slightly increase the risk of diabetes, has a less than 1% chance of preventing a heart attack or stroke in the next 5 years, and won't prolong your life?  It's a good question.  Can you get the same benefit from improving your lifestyle?

YES!  In fact, lifestyle will give you even more benefit than a statin pill!  Daily cardiovascular exercise for at least 30 minutes, but preferably an hour, will help you feel better, lose weight, drop the cholesterol numbers, and reduce your risk of a heart attack or stroke.  Diet is potent too -- and, a whole-food plant-based diet will make you practically heart-attack-proof.

I'm not a big proponent of statins for primary prevention because the data to support them just isn't that strong.  While the guidelines do support lifestyle, I think that we as a profession and society need to do more to encourage people to be more active, eat better, manage stress, and maintain a healthy weight.  And that is how we will prevent heart attacks and strokes, not by feeding everyone a statin.

Sunday, December 08, 2013

From athlete to gimp

With one clumsy misstep on the stairs, and the snap of a metatarsal bone, I went from athlete to gimp.

It's been tough.  I am in an orthopedic boot. I can walk short distances in the boot, but anything longer and I use my crutches, because I've found that walking too much leads to quite a bit of pain. I am taking ibuprofen 800 mg three times a day, and an occasional Percocet.  My foot is still swollen, but it's not quite the blue swollen mess with five sausage-like toes as of just a few days ago.

Other than a short weight training session, I have not been exercising. I'd love to do some nonweightbearing exercises with the boot on, but even shaking around the foot with the boot in place gets to be uncomfortable. And I am afraid to get in the pool to swim for fear that my unprotected foot will hit a wall, the lane marker, or even my other foot. Even the slightest touch to the foot can be uncomfortable.

It's been six days. I feel different. I definitely feel more tired. I have a lot more free time. I'm trying to free time to good use by reading. I'm also getting more sleep than I did on my typical two workout days.

Then there's the emotional impact of all of this. I envy my friends and teammates who are racing.  I wish I could be out running swimming and biking with them. I fear what will happen to  my body without exercise.  I worked so hard earlier this year to get into the good shape that I am in and I don't want to lose it.  I am trying so hard to eat less so that I don't gain weight.

I am so fortunate to be surrounded by good friends, family, and an incredibly supportive boyfriend.  From coming over and bringing me dinner to taking out my trash cans, or hanging out and watching a redbox movie or just being a sympathetic ear, I couldn't ask to be surrounded by better people.

It takes only six weeks for this fracture to heal, but it feels like an eternity.  And I am trying to be positive. But it's tough.

Tuesday, December 03, 2013

When life gives you lemons, make lemonade.

Life has handed me lemons.
My dogs started whining in the middle of the night.  I came downstairs to let them out.  Half asleep, I thought I was stepping my right foot on the floor, when in fact there were a couple more steps.  I landed on the outside of the foot and fell to the floor, fracturing my 5th metatarsal bone.

I am in an orthopedic boot for the next six weeks.  While I am permitted to bear weight on the foot, I am using crutches because bearing weight on the foot is simply too painful.

Needless to say, I cannot run, and I will not be running the Carlsbad Marathon on January 19 as I had planned.

I suppose I could throw myself a little pity party.  And I'll be honest, as I lay in the emergency room this morning while my foot was x-rayed and splinted, I cried.  No honestly I sobbed.  Not from the pain, but rather because my running is being taken away from me.

I choose to be more positive.  I am going to take a few days off from exercising.  Then I can swim.  I can't push off the wall with my right foot, but I can get in a good workout.  I can lift some weights.  I can aqua jog.  And I'm sure my personal trainer Corey will come up with some fun stuff like one-legged burpees to keep me in shape.

As much as I'd love to become the one-legged fitness wonder, Coach Gerardo asked me to take the rest of the week off from training.  That is to keep me from doing more damage.  He suggests that one can take up to 2 weeks off from training and not lose fitness.

This will be a challenge but I will get through it.  Maybe my body could use the rest.  The last time I was in an orthopedic boot and couldn't run was 8 years ago.  It was during that time that I began swimming and riding my bike.  Ultimately, when my foot healed, I put it all together and became.... a triathlete.  Which I am to this day.

I will take on this new challenge of not running.  I will listen to my coach.  I will rest as I should.  And, in the next six weeks, I am going to become an awesome swimmer.