When it comes to a healthy lifestyle, the phrase that I do my best to live by is "Practice what you preach." Unfortunately I rarely live up to this lofty standard, and the phrase that much more closely resembles my reality is "Do what I say, not what I do." Yes, I freely admit that I am terrible at taking care of myself, and even Mrs. Bastard's efforts often aren't enough. She always encourages me to eat a balanced diet, exercise, floss my teeth . . . you know, all the stuff we all know we really ought to be doing but just don't. Because of reasons. Instead, my diet usually consists of skipping breakfast, a Coke for lunch (fuck you, Pepsi), and a ridiculous dinner that provides me an entire day's calories and several day's worth of fat and cholesterol. Mmmm . . . fat and cholesterol.
Any semblance of real exercise has been difficult for me to achieve ever since I finished medical school. I used to run or play basketball almost every day, but then life just . . . happened. I got married, had children, and chose a career that precludes nearly everything other than my family. I tried to keep up with staying active; I even tried yoga. Yes, I tried yoga. Fuck yoga.
These days the only exercise I get is running from idiot to idiot while trying to keep my head screwed on straight. I can't say this actually gets my heart rate up very much, so in lieu of actual running, I decided some time ago to take advantage of my busy work situation. Instead of taking the lift (elevator), I now take the stairs whenever possible. It may not be much, but at least it's more than nothing.
Perhaps not surprisingly I've found that walking up from the ground level to the 8th floor has gotten progressively easier as time as elapsed (what an amazing thing), so I decided to start giving this excellent activity advice to my busy, overworked patients. I thought the first time would go over well.
I thought wrong.
I was asked to see Otis (not his real name™) by one of my internal medicine colleagues due to severe abdominal pain. It had come on rather suddenly and rapidly, encompassing his entire abdomen. Though he had no prior similar episodes, he did have some rather pertinent medical history, including a myocardial infarction (heart attack) and subsequent coronary artery bypass graft three months prior. As soon as I heard this, the alarm bells started ringing in my head:
WOOP! WOOP! Acute mesenteric ischaemia! Acute mesenteric ischaemia! Operating theatre, stat!
I feared that the blood supply to his intestine was compromised just like the blood supply to his heart had been three months ago. The same mechanism that had caused the blockage in his coronary arteries may very well also be happening in his gut. The treatment for ischaemia is the same everywhere in the body- get rid of the blockage before tissue starts dying.
For confirmation, I got him down to the CT scanner rather quickly, as I did not want surgery to be delayed. However, what greeted me was a bit of a surprise, and not a bad one for a change. His mesenteric (gut) vasculature had some atherosclerotic disease, but it was mostly open. However, his ascending colon was inflamed. His clinical picture was consistent with chronic mesenteric ischaemia, a longstanding decrease in blood supply to the intestine that had gotten slightly (and temporarily) worse. Fortunately for Otis this is treated with supportive care and bowel rest rather than surgery. Otis was unsurprisingly pleased that I would not have to whack out half his colon.
Over the next few days Otis improved rapidly and was discharged home with his colon intact. He came back to see me in my office several days later for a follow-up visit, and he reported continued improvement. After I finished my examination, I began discussing how his lifestyle choices, including smoking, poor dietary habits (ahem), and lack of exercise (AHEM), had all contributed to both his recent heart attack and subsequent intestine attack (yes, "intestine attack". Why not? It's the exact same as a heart attack, just with the intestine, damn it).
"Yeah but Doc, I'm really really busy. I work 12 hours a day and I got no time for exercise."
Fully expecting that excuse (which I use with regularity), I immediately launched into my prepared activity speech. As soon as I got to the "take the stairs and avoid the lift" portion, he stared at me intently. And silently.
"Um, did I say something?" I asked him after an uncomfortable silence.
Otis continued to stare at me.
I started to fear that I had inadvertently said something patently offensive and started silently reviewing every word I had just said. What was it? What did I say?
And still he stared.
Just as I started to open my mouth to apologise for saying . . . whatever it was I had said, his lips curled into a smile.
"Doc, that would be kinda hard for me. I'm an elevator repairman."
He laughed. I laughed with him. Because he actually was an elevator repairman. Really, what are the odds?
For me: 100%.