Does your doctor speak TOJ?

Whenever you read a book or go to a website about exercise, somewhere will be a warning that reads someting like:

Before you start any exercise program, see a doctor.
Speaking as a TOJ, this could be dangerous advice. A better warning is:

Before you start any exercise program, see the right doctor.

Every medical student conditioned to follow this injunction: “First, do no harm.” It’s a handy reminder when they become doctors to practice cautiously so they don’t hurt someone (and risk malpractice suits). But it also makes many doctors very conservative when it comes to exercise recommendations, especially if their patient is older. There is a good reason for this: empirical evidence shows the older you are, the higher the odds that you will get injured doing exercise or even die. However, most TOJs are aware of the risks and, more importantly, are fit and healthy enough that odds are they won’t die any time soon.

Despite a volumious body of evidence on the benefits of exercise and nutrition, especially for un-youngs, many doctors remain woefully ignorant of both. Their training has taught them a lot about pathology, but little about wellness and prevention.

I work with doctors every day. About half of them get it and exercise and eat smart to improve their own health and well being, but the other half do not. If you are a TOJ, you need to be wary of the non-believers - they will not understand you and, with best of intentions, could do you harm by making you old before your time. The average doctor is okay if you need treatment for a step throat or minor laceration, but you don’t want to trust them with your metabolism, strength, balance and endurance.

Year ago I had to go to an orthopedist to get the torn meniscus in my right knee scoped. He was a serious fellow, only a couple years younger than me. You could tell he was one of those guys in high school who went home after classes, practiced piano, and then went straight to his room to do calculus problems. He had smooth, unscarred hands, and although he was not overweight, he had a soft, pasty look to him, like he probably didn’t get outside much or work up a sweat very often.
On the follow up visit after the surgery, he sincerely suggested that I stop trail running and take up golf. He warned that if I wasn’t careful, I’d be right back for an ACL reconstruction because while inside he took a look and the ligament looked like frayed fishing line. Three years later when I returned to have the meniscus on my left kneee scoped, he suggested again that I stop running and take up golf or I would risk getting arthritis. I could tell when he said it that he didn’t really think I would follow his advice, but felt medically obligated to make the recommendation. I bet he even noted it in my chart a second time.

He was half right. I did ignore his advice. It has been over 10 years since the last surgery. He did a great job on my knees. And I’ve run thousands of miles since. They don’t hurt much unless I torque them while carrying extra weight, like a backpack, so I avoid this.

Maybe someday he will be proven right when I have to get artifical knees, but maybe he won’t. So far there are no signs of arthritis. If I had listened to him, I would have missed out on many great runs and cut off a vital source of joy in my life. He was a fine surgeon, but when it comes to exercise, we speak different languages.

By way of contrast, my primary care doctor understands my mania. He is a much more centered person than me and almost 20 years younger, but he mountain bikes. We have even compared scars from falls. He still has some jock in him. You can always tell. He has that glint in his eye when sometimes he talks about his adventures in the outdoors.

He does what he can to help me age gracefully, and gives medical advice appropriate for a TOG, such as to get tested for calcification in my arteries as a precaution if I am going to max my heart rate with strenuous exercise. When people over 40 die during exercise, it’s usually because plaque breaks loose and causes a heart attack. He knows exercise and nutrition promote heart health, but are no guarantee of escape from cardiovascular disease.

But he never suggests I abandon the sweaty trail to happiness and take up golf. He knows that would kill me.

Book recommendations:

Written by doctors, both these books have the obligatory warnings, but also have very trustworthy information about exercise and nutrition.

Move Yourself: The Cooper Clinic Medical Director’s Guide to All the Healing Benefits of Exercise (Even a Little!) by Tedd Mitchell, M.D., Tim Church, M.D, Ph.D, and Martin Zucker

The Source: Unleash Your Natural Energy, Power Up Your Health, and Feel 10 Years Younger by Woodson Merrell, M.D.

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