Random Thoughts from a Restless Mind

Dr. Darrell White's Personal Blog

Cape Cod

Archive for February, 2016

Measuring Health Part 3: Emotional Well-Being “W”

2016 is an Olympic year. We will hear stories, as we do in every Olympic cycle, of the extraordinary physical accomplishments of Olympians in sports which require otherworldly amounts of what we in the CrossFit world would consider “Fitness”. Strength, speed, and agility. Uncanny feats of coordination and accuracy, some performed over distances and times that are so far beyond the reach of the average human as to defy credulity. Many of these athletes, certainly the ones we will meet through the intercession of NBC, will match our expectations of the happiness that must certainly accompany such outsized achievements. Mary Lou Retton, anyone? Indeed, what we will see on our screens will fairly scream “Healthy”.

But there will be others, too. And for all of their physical fitness, expressed so dramatically for our viewing pleasure and patriotic zeal, the lack of emotional health will make it obvious to anyone that they are not healthy. Bruce Jenner, anyone?

Remember our proposed definition of “Healthy”: Able to perform in all ways at the farthest limits of one’s potential capabilities. Health is therefore the state in which no infirmity is, or can in the future, impede this ability to fulfill a potential. It takes but a moment to think of how mental illnesses such as depression, bi-polar disease, and schizophrenia can be hidden from view when examining only physical metrics. There are examples all around us. The woman who partners with a 1400 pound horse in the rigorous, physical tasks required to compete in the three-part test that is eventing, so poised and accomplished in the arena, who retreats to solitude outside the barn because she is incapable of overcoming her anxiety around people. The outdoorsman who in his manic phase performs feats of strength and endurance others can only marvel at, and then plunges into the depths of depression from which he cannot see the noon-day sun. Much more prosaic and much more common is the individual who continually increases his or her fitness by any and all measurements due to a deeply held sense of low self-worth, perhaps even self-loathing, pursuing an unreachable ideal and always falling short.

A truly universal measurement of health must include some element of emotional well-being. Let’s call it “W”. You could certainly call it the “Happiness Factor”, and some undoubtedly will. I imagine criticism directed toward this to take the form of “Happy Face” mockery. No matter. Well-Being is a better term for this part of our equation because it encompasses more than whether or not you are happy, whatever happy may mean to you, when you are measured. Are you content with your circumstances at the moment? Do you have the ability to persevere under duress?  What is the state of your relationships? A recent study of Harvard men carried out over decades found that both happiness and longevity were tied quite closely to the quantity and quality of your relationships with family and friends. Where are you in your pursuit of your goals, your dreams, and how do you feel about that? How much stress do you perceive in your life and how are you managing that? All of these make up what one might think of when we consider Well-Being.

How, then, should we go about measuring ‘W’? Remember, all of our tests should meet the dual imperatives of being accessible to pretty much everyone, and as inexpensive as possible. We could certainly use something like the classic anesthesia “smily face” pain scale, relabeling the figures, but this feels too simplistic and too momentary to be truly applicable. Our measurement should require a bit more thought than that. I have to admit here to countless hours of internet crawling trying to find a validated test of emotional well-being that has a track record in a heterogenous group that mirrors our population; most have been utilized in very specialized populations (e.g. soldiers) with a very specific research interest. Those that might apply must typically be purchased.

John Pinto is a well-regarded consultant in the world of my day job, ophthalmology. He has long had a list of clients that spans the gamut of pretty much every measurement you could think of in a group of doctors. Men and women. Young and old. Fantastically successful doctors and those that could only be described as spectacular (if unexpected) failures. As part of his quest to better understand his clients in order to better serve them, John used a questionnaire that measured emotional well-being. He found that external measurements of success such as volume of surgeries, income, and professional acclaim did not always coincide with his clients sense of success, their emotional valuation of their professional lives. These were certainly variables that mattered, but his happiest clients were not always his wealthiest, and his least happy not always those who had less. The assessment he used is the best one that I’ve been able to find, notwithstanding the fact that it is not free.

(http://psychcorp.pearsonassessments.com/HAIWEB/Cultures/en-us/Productdetail.htm?Pid=PAg511 ).

I am not wedded to the Psychcorp assessment and would happily review any alternatives. Especially if they are free! As is the case with ‘M’, our traditional health metrics like blood pressure and serum lipids, I expect a vigorous debate as to the relative weight of ‘W’ in our final Health Index. My bias is that ‘W’ is a current factor with a greater impact on health, and it should have a correspondingly greater weight in our formula. Let me start the “bidding” with double; however the final formula shakes out ‘W’ should have twice the value of ‘M’.

Mental health is an inextricable part of health. It must be included in any serious definition and measurement of health. Our variable is “Well-Being” or ‘W’.

 

The Other Side of the Stethoscope: A Surgeon Undergoes Surgery

You know you have a problem when T’ai chi hurts. Quite a come down for a guy who’s been doing CrossFit for 10+ years to be so uncomfortable that this ancient Chinese exercise causes enough discomfort that I have to sit down. Oh, it’s nothing exotic or even interesting. I have a companion sports hernia to the one that was fixed 16 years ago (note for CrossFit haters: 6 years prior to discovering CrossFit) to go with a couple of inguinal hernias. A quick little visit to Dr. Google reminds me that weakness in the pelvic floor is an inherited trait. I have a very vivid memory of my Dad joining us for a golf boondoggle wearing a monstrous, medieval apparatus called a truss to hold his hernia in while he played. Again, not CrossFit-related, but definitely messing with my CrossFit Rx for health.

It’s really weird being a patient. On the other side of the stethoscope as it were. I’m not under any illusions that my experience is a run-of-the-mill patient experience. After all, I’m a mid-career specialist who is going to have surgery at the hospital where I’ve operated for 25+ years, one that is run by my own internist and good friend. My surgeon was chosen after talking with the surgical assistants who see everyone operate. They told me who THEY would let operate on themselves and their families. My pre-op testing was arranged around my schedule in a way that was most convenient for me, the patient, and not the hospital, surgeon, or system. I picked my surgical date to coincide with a planned 4-day weekend.

Like I said, not your typical experience heading into surgery.

Nonetheless, this whole patient thing is strange. As a surgeon I am accustomed to being in control of any aspect of the surgical process I care to be involved in. Whether to do surgery and what kind of surgery to do are decisions in my hands. My herniacopia surgery? Not so much. I know that my surgeon is planning laparoscopic surgery, and that both inguinal hernias will be fixed for sure. There’s no way to know the extent of their effect on my most pressing symptoms (see what I did there?), but now that I know they are present I am hyper aware of what they are doing to me in addition to my presenting symptoms. Here’s the rub: I am convinced that it is the Spygelian or sports hernia that’s messing with me, but since it is not obvious on my pre-op CT scan my surgeon is not promising that it will be fixed. There are few things more distressing to a surgeon than not being in control of surgery, and despite all of the wonderful advantages I enjoy because of who I am, what I do, and where it’s happening, this side of the stethoscope is distressing.

What’s the big deal, then? He doesn’t see a hernia he feels is worthy of attention and only does the 2 basic, standard issue inguinal hernias. Less surgery is better than more, right? Sure. Of course it is. Unless it’s not, and that’s the big deal. I had discomfort and weakness as a 40 year old due to a Spygelian hernia on the left side. That hernia was diagnosed by a classic old-school general surgeon without any fancy imaging tests. Just an eerily well-placed index finger and a loudly yelped “YES” when he asked me “does it hurt right here?”, and off to the OR. Why he didn’t fix both sides then I’ll never know, because it was only a matter of time until the right shoe dropped.

Although CrossFit did not cause any of these problems it was definitely CrossFit that let me know I had a problem. Not only that, but it is precisely my performance, both degree and detail, that has convinced me that the Spygelian hernia is enough of an issue to fix. We measure everything in CrossFit. Time, weight, reps. We compare our results with previous efforts as a way of evaluating our fitness, and to some degree to monitor the quality of our workout programming. Gradually, over the course of 12 months or so, I have lost the ability to brace and maintain my mid-line with my abdominal muscles. In a classic cascade of calamity my secondary pelvic support muscles–gluteus medeus, piriformis, obturator, and that rat-bastard the extensor fascia lata–took over and eventually began to fail. At first it was just a little discomfort, followed by a little weakness, ending up in constant cramping and pain in all of them. At this time last year I pulled a lifetime PR in the deadlift; this weekend I could barely do reps at bodyweight.

The first place I felt pain was in that tiny little area that old-school doc poked so many years ago.

Meh. Tough spot, for me or any other patient. I’m not bringing unrefereed information from the internet to the game. I had this same thing 16 years ago, and I have objective data from my CrossFit gym that supports my contention. How best to present this to my surgeon? In this regard I am little different than anyone else with pre-op questions. At our initial visit together I laid out my symptoms and my history. During our post-CT phone call I reiterated my concern about not fixing the Spygelian hernia, however small it might be on direct visualization. Not gonna lie, the thought of having the surgery and continuing to have the same issues when I exercise makes me nauseous.

What’ll I do? Well, I guess this is the place where I really am just like everyone else when it comes to being on this side of the stethoscope. I will just have to have confidence in the surgeon I chose that he will do everything that needs to be done to solve my problem. After all, just like anyone else, I’ll be asleep while it’s going on. Kinda tough to have any input right then, ya know? It will be weeks before I will be able to really test out my results, and those weeks will likely be filled with all sorts of exotic physical therapy exercises geared toward strengthening my abs and accessory muscles, and getting my gluteus maximus to start firing again. Turns out my pain in the ass has actually been a pain in the ass…your glutes turn off in response to losing the ability to brace with your abs.

I am SO ready for this to be fixed, and I’m thinking I feel pretty good about how it’s all going to turn out. If not, well, I’m sure I’ll at least be able to enjoy pain free T’ai chi. My surgeon will undoubtedly take my concerns to heart when he is doing my surgery. After all, we will still share the same side of the stethoscope after the surgery is done.

Measuring Health Part 2:The Traditional Metric ‘M’

Any measurement of health must provide some sort of predictive value with regard to the likelihood that one will remain healthy. While the entire idea of screening tests is fraught with controversy–both false positives and false negatives bring with them real risks–there are still a number of health measurements in the realm of traditional medical care that have a proven value when trying to predict downstream adverse health events. The trick, of course, is to decide which ones matter, filter that group to come up with tests that are as close to universally available as possible, and then decide how much weight each particular test in the group of survivors should receive in the single cumulative metric that is then created. This measurement, call it “M”, will be one of the variables in our calculated health measurement.

Let’s start with the simplest of all medical inquiries, a medical history. More specifically, let’s include a brief family history in our calculation of M. While it is becoming increasingly easy to obtain a very accurate genetic profile that identifies very specific health risks, these genetic tests are both controversial and expensive. Until the very real societal issues of knowing your exact genome and the risks it includes have been worked out by both ethicists and elected government, we should take a simpler and more narrow approach and ask two very simple questions: Has anyone in your family died from heart disease? Has anyone in your family died from cancer? Equally simple follow-up questions (How young were they? What kind of cancer) would allow us to add risk (reduce M) or ignore the historical note since the disease is not hereditary.

From here we move to an equally spartan individual medical history. Again, just two questions in this part: Do you smoke? Do you drink alcohol? The negative effect of smoking on an individual’s health, both in the present and future tense, must be accounted for in any measurement of health. It weighs so heavily on what we know about future risks that we will see it as a negative integer in M. Too many studies to count exist pointing out the deleterious effect of excess alcohol consumption to count. One compelling study, The Eight Americas Study in PloS One, found alcoholism to be the single most powerful lifestyle variant after smoking when predicting the life expectancy of groups studied. A recently published study of Harvard men found that alcoholism was the greatest second greatest influence on the happiness of the men studied, just behind the presence of loving friendships. Unlike smoking, however, there is a volume component to alcohol consumption. Indeed, a modest intake actually INCREASES longevity, while no intake DECREASES longevity. So M will see a small bump from moderated alcohol intake, an equally small decrease for teetotalers, and a dramatic negative effect from heavy alcohol intake.

So far we’ve managed to obtain some variables underlying M through the use of simple inquiry, costing only the time it takes a subject to fill out a questionnaire. At least two other variables are as accessible and inexpensive: blood pressure (BP) and a measurement of body habits. Once upon a time you had to visit a doctor or hospital to get your blood pressure checked. Now? Heck, for $20 you can buy a reasonable accurate BP monitor and take your BP at home! Minute Clinics in pharmacies, health clinics in the workplace, and coin-operated machines in the local Mall now make it easy to get a BP without visiting a doctor. While there is ongoing controversy in the medical world about what constitutes Hypertension it is safe to say that health risks are higher with a systolic pressure >140 and a diastolic >90. Above or below these levels is our toggle for M, positive or more healthy for lower and the opposite for higher BP.

Using body habitus is controversial, mostly because the measurement that is routinely utilized is so inadequate. The Body Mass Index, or BMI, is wildly inaccurate when it is applied to the fit. 4-time winner of the CrossFit Games Rich Froning, arguably the fittest man on the planet, would be deemed obese at 5′ 10″ and roughly 195 pounds with a % body weight fat of around 4%. Ridiculous, huh? The temptation, of course, is to use % BW fat as the preferred method of measuring body composition risk, but measurements that are accurate enough to be useful tend to be very expensive and difficult to access. On the other hand, all you need to determine the waist/hip ratio is an 89 cent paper tape measure and a calculator. A waist/hip ratio of >1.0 is associated with an increased risk to health from myriad metabolic illnesses including diabetes and heart disease, especially in men. Greater health in M for measurements under 1.0, and progressively less as that number increases.

It is impossible to utilize all that modern medicine has to offer when it comes to measuring health without spending a little bit of money. Several simple blood tests can be obtained with or without the input of a physician. The presence or control of diabetes can be ascertained with a HbA1c and a fasting glucose level. In the presence of a normal HbA1c an elevated fasting glucose may indicate a problem with insulin sensitivity, so it is important to include both. While it is far from settled whether or not it is cholesterol itself which is responsible for heart disease there is simply too much evidence that serum lipids can help predict cardiac events to leave them out of any health measurement. Our basic health index should therefore include the basic measurement of total cholesterol, HDL, LDL, and triglycerides, and M should reflect the negative effect of elevated Total Cholesterol, LDL and triglycerides and the positive effect of a high HDL.

How should we put all of these together to come up with our traditional health variable, M? This one is fairly simple; there are a number of “risk factor” measurements online that are good models. I envision a rather simple form on which one would add up weighted values for the measurements above, arriving at a straight forward mathematical sum. The final formula is being developed with the assistance of cardiologists at my medical school alma mater, the University of Vermont.

 

Comet CrossFit/CrossFit Bingo: End of an Era

Everything changes. Sometimes change means that something comes to an end. So it is with the White family’s CrossFit Affiliate. It’s a CrossFit story for sure, but it’s really more of a family story, actually. While it is surely sad–I’m certainly sad–it’s actually quite a nice story, and the ending is really very OK.

Randy gave college a try in the fall and winter of 2010 at the same school where Megan was a junior. After 2 trimesters it became very clear to him that he wasn’t really ready for a traditional college path, and that his journey would start another way. Randy and I hit up a CrossFit L1 at Rogue (my 4th, Randy’s 2nd), and then Beth and I packed him off to Brand X for a 3 month internship with the Martin Family and theCrossFit Kids team. He and I had done our original CFK cert in January 2010 as part of my 50th birthday gift from Beth: a Dad/Son Kids’ cert and surfing camp! That summer he spent his weekdays in Ramona coaching both kids and adults and his weekends traveling from London to Australia spreading the word about CrossFit and CrossFit Kids. He came home ready to begin his career as a CrossFit gym owner. When the application for Comet CrossFit was accepted by HQ he became the youngest Affiliate owner in North America.

While this was going on Dan was in his senior year in college, coming into his own big-time as student after a couple years of, oh, let’s call it intellectual wanderlust, making the Dean’s list to close out his days at DU. Home he came as a sorta/kinda pre-med grad, albeit one who managed to make it through college without taking physics, Continuing on the pre-med course would mean 2 years of classes and applications BEFORE starting the 8-12 years of medical training. Pretty daunting. He asked if maybe his brother could use some help in launching and running Comet, and thus was formed the Affiliate ownership team universally known in greater Cleveland as “The Boys”.

Those were heady times in the CrossFit Affiliate world. When Coach Glassman met the boys he was thrilled about their plans, telling them “it’s fun, and it’s easy!” Comet would be the 3rd CrossFit gym to announce its opening on the west side of Cleveland. In what can only be considered quaint now, The Boys insisted that their gym be located far enough away from CrossFit Cleveland and Coca CrossFit that there would be no way that anyone would consider them in competition with the first 2 gyms; athletes would choose their gym based on geography. This quite righteous and honorable decision made their row all the harder to sow because they chose a location far outside the reaches of their parents’ considerable contact list, but it also ensured that their successes would be built solely by their own efforts.

Comet CrossFit opened for business on Monday, October 11, 2011, with programming based on CrossFit.com and the original CrossFit Strength Bias article in the CFJ. The first WOD started out with 5 sets of Front Squats aiming for a 3-rep max, followed by 4 Rounds for Time of Run 400M/15 HSPU/15PU. Since that time Comet (and CF Bingo) have followed the classic training patterns outlined in “What is Fitness?” and on the pages of CrossFit.com, a traditional General Physical Preparedness gym with a modest strength bias. Literally hundreds of athletes have come through, coached by The Boys and eventually by their parents as well.

In time it became clear that Dan was destined for something else. He came home one day armed with a rather impressive score on an LSAT prep test asking for parental support to apply to law school. Off he went to THE Ohio State University, along with the bride he met at Comet CrossFit ( Brittany herself an accomplished CrossFitter and coach in her own right!). After 2 years of running an Affiliate now named CrossFit Bingo on his own, Randy has also come to the conclusion that he, too, is destined for something else. Randy will join his fiancé Katelyn as a full-time student, he to become a physical therapist.

And so it is time to wind down our CrossFit gym. Comet/Bingo has been an amazing experience for our whole family. We have among us more than a dozen certifications (Randy, Beth, and I are all L2, for example). Megan became a CrossFitter when she and her husband moved to South Carolina, like everyone else we/you know, finding a group of best friends in her new Box. The White family gym afforded both of our boys the time to grow that each needed in order to discover the next path they needed to take, while at the same time giving them the priceless experience of making people better. Indeed, no fewer than 3 neighboring gyms were spawned from Comet/Bingo. For Beth and I, well, we not only got the precious gift of being able to give our boys this opportunity, but we were also able to spend countless hours with them–right there WITH them–enjoying the adventure.

We leave behind our beloved gym, and we say “see you later” to our many member friends. We are not leaving CrossFit by any stretch of imagination. Both Randy and I will have little garage gyms at our homes, a literal and figurative return to an even more classic CrossFit (al la CFJ #10) than our gym. The White family is eternally grateful to CrossFit, CrossFit Kids, the Martin Family and the CrossFit community both in greater Cleveland and abroad for the love and kindness extended to us over the years. Randy, Dan, Beth and I are especially thankful for the support and friendship extended to us by Coach and the Glassman family over not only the 5 year life of Comet CrossFit and CrossFit Bingo, but also the entirety of the CrossFit experience that began with that fateful November day in 2005 when I picked up a Men’s Journal and read about this crazy new fitness thing out of Santa Cruz created by Coach.

Everything changes, and sometimes change means loss. I am so very, very proud of my boys and what they created and accomplished. I loved being with them, and my darling Beth, in their gym, and I will miss seeing my little guy, no longer little, almost every day for 5 years. Doing CrossFit in a CrossFit gym is a very special thing, all the more special when you have a hand in running that gym. We will all, each of us, miss the experience of helping our fellow CrossFitters become better. Beth and I are so very proud of what our boys did and how they did it. We are excited to see what they will do on these new journeys, journeys made possible because they owned a CrossFit gym.

I will miss our CrossFit gym, my CrossFit gym, immensely, but I continue to be comforted by the fact that I will see you all on CrossFit.com next week…

–bingo

Measuring Health Part 1: Rationale, Definitions and Background

In 2010 I had a bit of an epiphany. At the time I was a bit over 4 years into my CrossFit journey. It became painfully obvious that the genius that Greg Glassman had applied to physical fitness–a definition of fitness that invited measurement, and in turn the critical evaluation of the efficacy of different fitness programs–was nowhere to be seen in the fields of health and medicine. Indeed, an informal survey carried out in person by my friend Dr. Kathy Weesner and I made it clear that the majority of physicians couldn’t come up with an actionable definition for health despite the fact that we are charged as professionals with helping our patients become “healthy”.

At around this time Coach Glassman published a theory that health was precisely defined as “fitness over time”. In CrossFit Fitness is work capacity across broad time and modal domains. Fitness over years could be depicted as a 3-dimensional graph with axes time, work, and years. As I thought about his thesis, that a backward looking view of an individual’s fitness as defined by CrossFit was a proxy for health, I found myself with the feeling that the definition was intriguing but incomplete. In response I took it upon myself to develop a broader definition of health, one in which fitness was a primary, but not the sole marker or metric. That April I submitted a draft of my definition of health along with a new, broader base of proposed tests that would generate the data that could be used to measure an individual’s health. Over the years it has become clear that Greg and I are more in agreement than not, but a key CrossFit employee at the time had a fundamental disagreement with my thesis, and consequently the article was rejected by the CrossFit Journal. I published my draft here on Random Thoughts later that year.

For almost 6 years I have been mulling this over, threatening to return to the problem of defining and then measuring health in much the same way that Coach Glassman defined and then measured fitness. The quest was derailed by all of the usual time sinks of mid-life. In a humorous irony, the majority of my real, true free time was consumed by the task of helping my sons run their CrossFit Affiliate gym. It is time, now, for me to finish what I started in 2010 if for no other reason than to establish the provenance of the theory.

In order to effectively address any issue whatsoever it is first necessary to have a clear understanding of the definition of terms that may be important to the discussion. I made a similar statement in one of my earliest posts on the importance of understanding the difference between health, healthcare delivery (medicine), and healthcare finance. Here again I fall back on the genius of Greg Glassman: just as one cannot evaluate either fitness or fitness programs without first defining what it is that you are discussing when you say “fitness”, one must first have a definition of “health” before one can begin to measure it. What exactly is “health”? What does it mean to be healthy?

Let’s return for a moment to the physician survey that Dr. Weesner and I did in early 2010. During face-to-face meetings we asked groups of physician colleagues to give us their definition of “health” or “healthy”. The majority of the answers couldn’t have been less inspiring or more disappointing. Indeed, the most common answer was “I don’t know”! Not very comforting, that. The second most common answer was as anticipated: health is the absence of disease. In our American medical system of “disease care” this is an understandable response, of course, but as the basis for the development of a true measurement of “health” it is obvious on its face that this definition has never translated into any actionable metric. Why? Well for one it fails entirely to take into account the very real importance of “fitness”, the expression of health. More specifically, like fitness as a proxy for health, “absence of disease” also fails to address a key requirement for any measurement of health: there is no forward-looking predictive value to simply stating that you have no disease today.

A measurable, actionable definition of health is one that takes into account the degree that disease is present or absent at any given time. It must address physical fitness; to be without a named disease but to be unable to walk up a flight of stairs should not ever be construed as “healthy”. Of equal importance to these factors, any definition of “health” that will generate a meaningful metric must have a predictive value. Your Health Value should provide some measurement of your future likelihood of being disease free and fit. Our little survey of our physician peers did produce just such definitions. Given these requirements I propose that the following are actionable definitions that can be used in healthcare to create measurements in precisely the same way that Greg Glassman’s definition of fitness is used in that realm:

HEALTH: The state in which no infirmity of any kind suppresses, or has the possibility of suppressing the ability to express the full extant of an individual’s potential capacities.

HEALTHY: Able to perform in all ways at the farthest limits of one’s potential capabilities.

With these definitions we can move on to developing a “health metric”, one that can not only assess our present degree of health, but can also predict to some degree our ability to remain healthy. I believe this metric has three component parts: physical fitness as defined by CrossFit, well-being or emotional health, and a factor that addresses traditional or standard medical factors such as blood pressure, cholesterol, genetics and the like. Furthermore, I predict that these three variables are as evident and as logical for “health” as Coach Glassman’s definition is for fitness.

One can have an otherworldly degree of fitness as defined by CrossFit, but what good is it to have a 500 pound deadlift and the ability to run a 4:00 mile if your physical achievement is driven by self-loathing? By the same token, in addition to having a normal result in every conceivable medical test your countenance is as sunny as an 8 year old on vacation, your disposition so Zen-like that the Dali Lama himself wishes he were as happy and serene, but you can’t walk a mile. This surely cannot equal healthy. You are a world-champion long-distance runner, and yet you drop dead from a heart attack, unaware that you have a cholesterol of 800. Fit for sure, but hardly healthy. Fitness, well being, and modern health metrics all have a role in an actionable Health Measurement. Vigorous debate will be necessary to parse the relative weight given to each of these factors, but as I first proposed and wrote in April 2010,all three are clearly necessary components.

In short order I will offer follow-up posts that delve more deeply into each of these three components. I will include suggestions for what and how to measure them. I will conclude with a re-statement of my proposal for a single measurement of health with my suggestion as to the relative weight of the three variables, hopefully inciting the above-mentioned vigorous debate. By doing so I wish to document the originality and timeline of my proposal, acknowledge the intellectual debt owed to Greg Glassman for inspiring me, and reassert my contention that healthcare cannot reach its fullest potential without first agreeing on both a definition of health and how to measure it.

 

 

 

Mourn Like You Meant It

There’s been lots of loss around the White house of late. Lost parents, parents soon to be lost, lost innocence, lost friends, lost trust. Tons of loss. Some of those losses are inevitable of course, but others are sadly losses born of the choices made by others. Whatever. We–you and I and our loved ones–do not get to make choices for those who come in and out of our lives. While that knowledge provides little salve for the sting of loss it at least allows us to make a clean break, to leave behind a loss after a proper amount of legitimate, honest mourning.

A problem arises when mourning is tinged with regret. This is made all the more problematic when the regret is not honest regret, when it is disingenuous, the result of a conscious decision made without any consideration of anyone other than oneself. You know how this goes. “I wish I’d visited Papa more after he got sick.” “My best job was the first one I ever had; I should have gone back and asked if I could start again.” “Man, I can’t believe ABC is closing. No place was ever as good that.” “I wonder if it would be different if I’d gone and had that beer with XYZ.”

Some regret is real. I get that. You’ve got a crappy job and you need it, and you just can’t get on a plane to see your Dad/Mom/sibling. Deep down you think you were wronged in some way at some time by somebody, that your boss/family member/friend could have been better to/for you and you had no choice but to leave the job/business/friendship. Heck, there are some families where so much toxicity is directed toward you that the only way you can remain healthy is to separate from the family. I get that, but let’s face it, stuff like that is not the norm. In most cases everyone could have tried harder, done better. Including you.

You, and I, can legitimately regret that, not trying harder.

What’s the lesson here? Well, as I said some losses are unavoidable. Death comes for us all. Miss that chance and it’s gone forever. Suck it up and spend the time BEFORE it’s time to mourn. The person who departs gets no satisfaction from your regret, they simply left saddened by your absence.

All the rest? Well, your choices have consequences for everyone involved. Bad or sad things are at least partly on you, and protestations of regret (Oh I wish I’d; Oh I should have) make it infinitely worse. Suck it up and own your decision. Suck it up and own the consequences. A business that depended on you folded because you left? A friendship ended because you gave up? A family less close because you were all “Cat’s in the cradle” all the time? You chose one of your ‘wants’ over some meaningful someone’s ‘need’? Saying you miss this or that about any or all of these only makes it worse. You chose to miss it.

Listen, I’ve done all of the above and properly suffered because of it. Some things are too valuable to take a chance on needing to mourn them. It’s much less painful, and much more believable, when you’ve made every effort possible to prevent a loss. Then others will believe you when you say “I miss…”

More importantly, you’ll believe it yourself.

 

Thoughtfulness in the Age of Sharing

How much information is too much? Is there an element of timing in that question? For instance, is the amount of information that is ultimately enough (and not too much) subject to a schedule? I’m prompted to think about this by a couple of very current events, or types of events: instances of death resulting from police/citizen interactions and more than several instances of government officials enmeshed in scandal, or the appearance of scandal. You’ll not find commentary here about the particulars of any of these current events; I have no standing. My thesis, though, is that the twin virtues of transparency and disclosure have been tarnished by the evil twins impatience and entitlement.

Think about it for a moment. Events that are large and important fairly cry out for patience and a deeper, more thoughtful discussion. One that begins after facts have been extricated from the web of innuendo born in the bosom of opinion. The stampede of analysis now comes even as a story unfolds, before it even ends. It matters not whether we are observers of an event that touches on a certifiable “big theme” (e.g. racism), or one that is tiny, local, or personal (e.g. infidelity). The commonality rests not with the protagonists but rather within the observers, especially those who comment: it’s all about them.

Are you old enough to remember when it was considered unseemly to be a self-promoter? Even if you are, it’s tough to recall those days before the ever-connected world when blatant “look at me” or “listen to me” behavior was met with the collective cluck of a society bred for humility. This “cult of self-promotion” not only imposes itself on big events and grand issues (comments that begin with “I think…”), it also means that no one is to be allowed a privacy if the entitled self-promoters decide that they simply must know, well, whatever. “A universal, wrathful demand of the public for complete disclosure” about everything and anything. (Gideon Lewis-Kraus)

The need to know trumps all; one who asks the question in some way is granted all manner of primacy over one who might have the answer. It’s uncomfortable to watch at times.

The phenomena is not without irony. Witness articles critical of self-promotion that tell the story of someone who is almost famous for talking about not promoting him/herself. Nice, huh? It’s like a hall of mirrors, a kind of “Inception”. Trust that it doesn’t escape my attention that there are more than several folks out there who consider “Random Thoughts” a form of self-promotion. An irony within a discussion of irony.

There’s a certain power in thoughtfulness, a seriousness that induces thoughtfulness, in turn, in the listener. If we always know what you think or what you did precisely when you thought or acted, how are we to ascertain what, if anything, is important? If one demands full and immediate disclosure of any and all information, regardless of how significant or trivial it might be, or how public or private the consequences, how are we to order anything at all along the great/small continuum? At some point the primacy of the inquisitor must find its limit, if only for a moment.

A moment of peace for the rest of us, should we care to think about something deeper than the event in question. A moment of peace for an individual who might harken back to an earlier day, one when it was possible to graciously decline to offer anything at all, lest it encourage someone to be interested enough to ask for disclosure.

Fitness as Health Marker

The human body as a machine is an endless source of fascination. Designed at this point in evolution primarily as a vehicle to carry a brain, our bodies can withstand famine, thirst, and physical stress beyond what our brains can imagine. When one part starts to fail we have a series of “fail-safe” backups in many cases that allow us to carry on. Interestingly, the greatest harm to our “vehicles” is actually excess (gluttony) and lack of physical stress (sloth).

Kinda Biblical, eh?

There is a complex daisy chain of effects that can ever be traced back to a cause when our bodies begin to break down. My own musculoskeletal system is failing me miserably, and it has taken the eventual unavoidable breakdown of one of those fail-safe mechanisms for me to finally figure out the original cause. Last month’s programming with its emphasis on our core was the last straw.

For the better part of a year I have struggled on and off with progressively worse failures of accessory muscles for mid-line stabilization. The posterior chain (gluteus maximus, hamstring, erector spinae) precisely balances your anterior chain (rectus abdominus) in maintaining a rigid core so that you can do, well, everything. Progressive movement failures in the gym (massive retrograde numbers in lifts, need for major scaling of loads) has now given way to rather plebeian challenges: spasms of the gluteus medius, priformis, and obturator (not to mention that rat bastard the extensor fascia lata) which sometimes drop me in the simplest of movements.

My initial reaction, of course, was to address what must be a weakness in these accessory muscles due to inattention. Surely this would be all that I needed to return me to my previous level of physical prowess. Naturally, since these “failures” were actually the fail-safes going down, accessory work on these muscles only worsened the problem by OVER-working the already overburdened.

How, then, did I figure it out? Well, as I noted, the chariot that rolls along carrying our brain is ever set to do its job, and eventually it sends up a signal when all of the backup systems failed. A tiny little dull ache appeared in my lower abs, an annoyance that escalated to Def-con 1 whenever I braced my anterior chain for any task whatsoever. There was no difference between a back squat or a “bear in the woods” squat–I could not use my abs to secure my midline, and guarding against the pain had shifted that burden to all of those little helper muscles.

A tiny little tear born in an area of inherited weakness turned out to be the cause. My friend the general surgeon describes the defect as “a dime with aspirations of becoming a quarter.” A half-dozen really smart folks had failed to see it, all of them equally fascinated by the epic failure of my Piriformae. And so it is that I will engage the knife as I seek relief on behalf of my accessory warriors such that they may return to their proper roles behind the front line of the midline stabilization battle.

What’s the point of all this sharing you ask? It’s pretty simple, really. Very basic. Each one of us is, or should be, engaging the CrossFit prescription of strength and metabolic conditioning aligned with proper nutrition in the pursuit of better daily function. Better, clearer thought. Stronger, leaner, faster bodies. In order to do so it is necessary that we are ever aware of those bodies, ever vigilant in our pursuit. CrossFit provides us a metric that allows us to monitor the machine that transports our brain. My performance began to suffer. I stalled, then backed up. Measurable and observable that I was failing at repeatable. To discover the root cause I eventually used the degree and manner of those failures to work back to the source. I think fitness as we describe it is best seen as a real-time marker for health. CrossFit approached properly is the thinking athlete’s fitness program, the inquisitive athletes health monitor.

Now to be fixed and resume my quest.

 

You are currently browsing the Random Thoughts from a Restless Mind blog archives for February, 2016.