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I looked at my last blog post. It was from June 28, 2021.

I had just met my new primary care physician. Since then we had made slow changes to my health. I tried to eat better and exercise more. It has been a journey of trying to implement what I preach. The progress was slow.

Last year, to help my physical activity endeavors (and because I have a huge interest in martial arts), I decided to start training at a local Karate school. The school I attend teaches Enshin Karate a style that traces it’s roots back through Ashihara and Kyokushin. Shortly after that time I noticed my Apple Watch was notifying me about tachycardia (faster than normal heart rate) when I was at rest. At first it seemed random and I tried increasing my water intake. I noticed that lying down and elevating my legs would help to improve the heart rate so I thought this was the problem.

After a while it bothered me that these warnings continued. And I soon realized that the days I got these warnings were on days I attended Karate class. My heart rate, I concluded, was having a delayed recovery back to a normal rate. But I wasn’t quite sure what to do about it.

So I met with my primary care physician to discuss what was going on and we decided to order a holter monitor and refer me to cardiology. The holter monitor would be worn for two weeks. I hoped it would catch these episodes where my heart rate would race. I hoped that I would be able to use it to a class or two.

When I finally got it I was able to wear in to one class. We concluded the class with three 2-minute rounds of sparring. By the end of those three minute rounds I was gasping for air and totally “gassed.” When I later received the report from the heart monitor I learned that my max heart rate was at 7:28 PM when I was sparring. My max heart rate was 200 beats per minute.

I was kind of worried about that so I backed of training for a while until I could see my the cardiologist. It turned out that I saw someone who I had met and trained under when I was both a medical student and resident. The recommendation I received was to start intense lifestyle modifications and he actually encouraged me to exercise 45-60 minutes per day and to utilize high-intensity interval training (HIIT). He asked me to set a goal of 6-7 days per week of exercise. It hurt to hear that as I was happy with 2-3 days before this. But I knew he was right.

On the one hand I was glad not to need to start medications. On the other hand, it sounded so daunting. I met with the cardiologist in late August. It is now late October. From the August to the present time I have increased my exercise but I also had gaps where I was not feeling well (ill) and other days when the kids weren’t feeling well and the madness of life got in the way of my exercise time.

I have had to accept the fact that I won’t be able to perfectly follow this plan immediately. And no matter what happened yesterday, I can try again today. I don’t have to wait until the next week or the next month to try and do it right. That perspective change has been helpful.

But I also can say that I fully understand the struggle my own patients have when I ask them to push for their own lifestyle changes. It’s hard to do. Maybe we can do it together.

A few months ago I had a virtual visit with a new primary care physician. My prior primary care physician had left the practice and I had to find a new one. I’ll admit that I was sheepish. You see, although I am a physician I will be the first to admit that there is a lot I am not doing to take care of my own health.

One major area for improvement is lifestyle — specifically my diet and exercise. As we spoke she summarized: “you know what to do; how do you we get you there?”

And so, the physician became the patient.

I speak to many patients about what they should be doing. Speaking/teaching/educating is the easy part. The challenge is that each patient needs to own their plan and execute it. One of the main strategies we employ is providing the education so that the patient is able to come up with their own plan. It’s human nature — we prefer to do the things we decide to do rather than the things we are told to do.

Unfortunately, it isn’t infrequent that I hear patients tell me that they didn’t do what they intended to do. They tell me that they know better and they just need to do it. I fully understand. From a diet perspective, carbohydrates are my weak spot. I am not saying that one shouldn’t eat carbs, but there definitely is an upper limit of what is healthy. I also know what it feels like to come home from work and wanting nothing more than to lounge on the couch and unwind. So I do understand the struggle.

There is a part of me that hopes blogging about my pursuit of better health will help me to stay focused. I’m hoping that because I am writing publicly about it I will be more motivated to keep it up. I have even considered letting my patients know that they can check out my blog to see how I am doing whether I am doing well or not as well as I hoped. Maybe this transparency will help someone else.

I guess I’ll have to just wait and see.