Fat – The Enemy Within

Well the new consulting career is officially begun!  I’ve just returned from a two-day engagement as a member of an advisory panel for a pharmaceutical manufacturer seeking input on the future of medical treatment for obesity and its complications. It was an interesting and enjoyable event. Most of what we talked about is confidential of course, but our more general discussions covered much of what is commonly known about the conditions of obesity and overweight. Common or not, two things struck me as worth writing about to an audience interested in health and wellness.

First, if you’re significantly overweight, your fat cells are working against you.  It’s easy to regard fat as just so much excess baggage, perhaps causing some bodily wear and tear, but otherwise inert.  It’s really a much more serious situation.  Fat cells are anything but inert.  They’re highly active metabolically, releasing and causing to be released chemical factors that adversely impact your internal physiology in multiple ways. I’m not going to go into the details, take my word for it, these guys are bad actors. To use an analogy from the headlines, think of your excess fat as tiny cellular Russians working to disrupt your body’s politics. You don’t want Putin hijacking your physiology’s executive branch.

Second, most obese and significantly overweight people suffering from diabetes or other physiologic disruptions never get much better.  Why not?  Well, that was an interesting discussion!  We all have our thoughts.  You’ve heard most of mine before, but here they are again:  People are weak, temptations are hard to resist. Life is hard, people are stressed out, and food is emotionally comforting; often the more comforting, the more unhealthy. Losing weight is hard work, and mostly we don’t like hard work.  Like water, we tend to take the path of least resistance, and the wide river of American popular culture empties its contents into the lake of obesity.  (And there are also some more “hard-wired” biological reasons that it’s very difficult to lose weight – hence the interest of pharmaceutical manufacturers)

But, as we also all know, some people get remarkably better.  We all know a few. How did they succeed where others try and fail or fail to try?  Once again, an interesting topic with no exact answers.  Here are my observations:  Some people simply “wake up” or “snap out of it” – having a sudden recognition and acceptance of their issue along with a willingness to do whatever it takes to get better.  (Maybe caused by a medical event or health crisis – e.g. a heart attack or needing to start insulin.) Some have a more gradual building of their awareness and resolve to levels sufficient to enable positive action. Many appear to need to hit an emotional and/or spiritual “bottom,” admitting their defeat and enlisting the help of God and others. The common theme is that some sort of internal shift occurs and then it’s a whole new ballgame.

If you’re struggling with your weight, or if you’ve even given up the struggle, have hope, because some people get remarkably better.  It can be done.  You too can do it, but first you need to have that mysterious “internal shift” and I can’t give that to you.  However I can invite you to shift, perhaps you’re almost there already and just need a nudge over the line.  Consider yourself invited – snap out of it and get going!

Most importantly, know that God can change you.  God wants to change you, and he has all power.  He never fails.  Turn to him to become the person you can’t be on your own.  And, as always, let me know if I can help.

Grace and peace,

Pete

_______________________________

PS – for you movie fans – snap out of it!

More Compassion, Less Piling On

compassionnoun
sympathetic pity and concern for the sufferings or misfortunes of others

Sharon was out of town last weekend, and I thought I’d relax and watch a late night movie. Perusing our small DVD collection I ran across MASH, a film I’ve preciously enjoyed, and thought “that’ll do.” Sometimes it’s nice to just go mindless for a while with a movie that I know already. So I hit the play button and settled in for the evening.

Twenty minutes later I was unsettled. The film wasn’t sitting well with me. The lead characters are arrogant and mean, and their meanness bothered me. I’ve seen MASH before, many times, but this time was different. I was uncomfortable trying to enjoy it. It didn’t seem like something that I should enjoy. Eventually I hit eject and went to bed.

Although this seems to mark some sort of internal shift for me, I have been thinking about meanness versus compassion for the last few months. My social media feeds have way too many mean spirited posts and comments about people suffering the consequences of drug addiction, criminal behavior, or just plain bad judgment. Some comments are shocking in their nastiness. Do the posters truly think that the foolish young man deserved to die (probably after torture) at the hands of North Korean officials? God help them.

In healthcare, and in life, we all see a lot of undeserved suffering. Disease and misfortune befall people for no reason other than “bad luck.” Knowing that we too are vulnerable, we can be moved to compassion. But just as often, or maybe more, people create their own mess. Smokers get lung cancer. The texting driver crashes and dies. Shall we be indifferent to their suffering, or even cruel, piling on with hurtful commentary? Apparently a lot of people believe we should.

I don’t think Jesus would agree with that. We are to be compassionate, and we should be able to see that “there, but for the grace of God go I.” That doesn’t mean endorsing bad or foolish behavior. Some things are simply wrong. Nor are we compelled to fix everything (even if we could) for those suffering harsh consequences of their behavior.  But we can be compassionate.

I don’t know if  anyone can summon compassion in every circumstance; some behavior is truly heinous, but ending the piling on in social media seems like a good place to start. God help all of us.

___________________________________

“Do to others whatever you would like them to do to you. This is the essence of all that is taught in the law and the prophets.” – Jesus, (Matthew 7:12 NLT)

Back to the Books

Now I remember why I didn’t want to be an endocrinologist!

My internal medicine board certification is set to expire at the end of this year. It lasts for ten years at a time, which seems pretty long until the end gets in sight. Well, the end is now in sight. Bummer.

The internal medicine certifying exam is quite hard. A lot of the questions end with a twist. I’ll be reading the clinical vignette thinking – “I’ve got this! Yes it’s an unusual case but clearly the diagnosis is __________” only to find the question at the end is not “what is the diagnosis? but rather “the best treatment is __________” and five potential treatments (all of which are good for that condition) are listed. Which is best? Why? Back to the story for more clues. It can be pretty frustrating.

I don’t really need to be board certified anymore. My clinical practice days are over, and my most recent administrative jobs have been very high level. But it feels bad to let the certification go. So I’ve decided to hit the books and take the test.

I’m enjoying the studying. It reminds me of when I was a “real doctor” and medicine is indeed very interesting. But it’s also a bit intimidating. There’s so much to learn. A lot of new things in ten years, but even reviewing the basics is a massive and daunting undertaking. Did I really know all this once?

Honestly, I put my chances of passing at 50/50 with the amount of work I’m willing and able to accomplish in the next 4½ months. More will be revealed.

In any event, I’m trying to learn more than just the facts. What higher-level messages am I getting during this process? Here are a few that I already knew (and you probably do too) but are coming to me with renewed force:

Your physiology is very, very, very complicated and finely tuned. Everything interacts with everything else. It’s all connected. Your body really is extraordinary, a marvel, even a “miracle.” If you’ve never studied biology, it would be worth it to learn just enough to be convinced of this through your own study. It could change how you think about your health – or your life.

When something goes wrong, other things are apt to go wrong. This is a natural corollary of “it’s all connected.” I learned this from simple observation in resident clinic. Serious conditions occur together. If you have one, you’re likely to have a bunch. Not all of them are avoidable, but try not to get that first one. Take care of yourself.

Many serious illnesses don’t have an identifiable cause. Some are autoimmune conditions, but then what exactly causes auto immunity? Others are more obscure. Perhaps unidentified genetics or environmental issues are at fault. We just don’t know, and perhaps some cause will be identified sooner or later. For now, sometimes what you get is what you get and there just is no explanation. That’s a hard message.

Doctors have a tough job. There’s so much to know and a great deal of judgment is necessary to balance risks, benefits and competing priorities in managing any reasonable complex individual patient’s situation. Normal physiology is complicated. Pathophysiology is more so. Then you’ve got the various diagnostic tests – sensitivity, specificity, risks, indications, contraindications, etc. – and the treatment options come with a similar set of issues. Back when I was a doctor, this was everyday stuff, not something to moan about, but now that I’m out of practice I have a growing respect for those who are still in the trenches.

As my studies progress, I’ll try to revisit what I’m learning, but this seems like enough for now. My basic message – It’s no fun to be sick, and sickness often snowballs. Take care of your health as best you can. Even then, things might go wrong for no apparent reason. If they do, find a doctor you trust to walk with you on your journey.

And, although it’s not in any of my study materials, trust God.

Pete

_______________________________

You made all the delicate, inner parts of my body
and knit me together in my mother’s womb.
Thank you for making me so wonderfully complex!
Your workmanship is marvelous—how well I know it.
Psalm 139:13-14 NLT

Beach Attitude

The week before last, Sharon and I headed to St. Pete Beach for a few days of rest and relaxation. I wanted to go there to “decompress” a little bit and the beach is certainly good for that. We headed to the gulf side of the state which brings back childhood memories for me. In fact we stayed at the same hotel at which my family used to vacation when I was a boy.

The trip went well. We accomplished our basic agenda – enjoy the beach, see a few sights, sleep a lot, eat well and just hang out together – and we had a good time. The beach is a special place, a place where I find it easy to appreciate the beauty of nature and to slow down. So it was good, as expected.

One thing I did find surprising was my comfort level with the crowd. The hotel was full, and it seems the beach is always crowded. We had a ground level beachfront suite with a small patio. Just beyond our patio was a common grassy area with chairs and tables, and the beach bar was 30 yards off to the left.   So there were people, coming and going past our place all day long.

I really like sitting on the patio, and I wasn’t too sure about having an audience, but it was fine. The younger kids played in the grassy area. They were fun to watch.  Everyone who passed by smiled and nodded or said hello. I wasn’t the only one on the porch in pajamas.  No one was worried about how they were dressed (or undressed). No one, including me, seemed too concerned about privacy, and everyone was friendly.

Same thing down at the beach. Masses of people – of all shapes, sizes and colors – enjoying the sun and the water while in close proximity to each other.  Clothing options varied from extreme sun protection to almost nothing.   Everyone was getting along, even when the football or Frisbee went astray or a little sand got kicked up into the wind.

One afternoon I stopped at the bar for a pina colada (just one) and found the patrons also to be a happy bunch. That’s not too surprising I guess, but overall I was struck by my sense of relaxation and enjoyment despite the relatively crowded resort. Why was that?

My theory is that, at the beach, everyone had the same agenda – just relax. I didn’t hear anyone talking about Trump, Comey, North Korea, or Russia. Nobody was rehashing office politics. The only guy selling anything was the bartender. We were pretty much a collection of strangers, so perhaps no one felt a need to impress anyone else. No one has any “status.”  It seemed understood that, here at the beach anyway, you’re just another human being and “what happens at the beach stays at the beach.”   It was very nice.

How can I keep this beach attitude going now that I’m back in “real life?”

Pete

PS – The trip inspired me to change the colors on this blog.  Green was peaceful, but I think these “beachy” colors are more cheerful.  I hope you enjoy them.

PPS – Recommendations if you go:
Alden Suites Beachfront Resort
Ted Peters Famous Smoked Fish
Sunken Gardens
Salvador Dali Museum

One Day You’re an Expert

I’ve been experiencing a great deal of change recently, and another big one is right around the corner. In two weeks I’ll be leaving my current employer to become an independent consultant in the healthcare industry. It’s pretty exciting. I guess it could also be scary, but I’m trusting God and I’m ready for this particular change.

Having dinner with a younger colleague last week, and discussing my plans, the more general topic of career progression came up. After I explained my career journey, he had a couple of questions. “So, how does one get to be ‘an expert,’ to arrive in a position where others seek you as a consultant? Any advice to pass along?”

I don’t know that I had too much smart to say. Most of my thoughts on the topic are pretty basic, and my answer was something like this: Do your best at your current job. Keep learning. Pay attention to what works and what doesn’t. Research what others are doing. Go to conferences and meetings. Read. Talk with colleagues. Eventually one day, perhaps after many years, something will happen to cause you to recognize your own knowledge and ability and you’ll realize that you’re an expert. At least that’s what happened to me.

Something similar seems to have happened with my emotional wellbeing. I’ve thought about this kind of career move before, but it seemed too scary, too distant. Now it seems at hand. I’m finding myself to be calm and at peace with this major change. Also as you’d expect, I’m trusting God. It feels good, surprisingly good. It’s surprising enough for me to ask myself, “Wait a minute! Why am I not more worried about this? How and when did I become a calm, peaceful person? When did I get this faith?”

I think the answers are a lot like those involving my career. Do the best you can at following Jesus. Pray. Listen. Talk with others of like mind. Pay attention to your emotions. Have whatever faith you can muster. Read the Bible. Work through your emotions as best you can. Eventually one day, perhaps after many years, something will happen to cause you to recognize your own inner state and you’ll realize that you’re a calm and peaceful person of faith. At least that’s what happened to me.

Praise God.

Peace,

Pete

Change Happens

“Lookin back at my background tryin’ to
figure out how I ever got here.
Some things are still a mystery to me
While others are much to clear.”

Migration – Jimmy Buffet

 

Like I said a few weeks ago, things can happen fast, and change is a constant. But it sure is hard to get used to, isn’t it? I’ve spent the last week or so reflecting on all of the recent (and not so recent) changes in my life, and thinking about how I, myself, have changed. While recognizing that I am certainly the same individual human being as I was in high school, I also feel like a “different person” in many respects. It’s a strange feeling – I’m still me, but a different me.

A casual conversation on this topic with my friend Curt (who is into music), led me to pull out my Jimmy Buffett CD collection, and I’ve been listing to them in the car all week. His music really takes me back. I can remember the various stages of life I was in when each album came out, and the music brings back memories of good times as well as stressful times. I’ve been enjoying his lyrics and melodies for over 40 years.

Can we agree that Changes in Latitudes, Changes in Attitudes is clearly the best Jimmy Buffett album?  It has really withstood the test of time for me.  I still love it, every song.  Everything may be different since 1977, but that recording endures, unchanged by time. Maybe it’s that sameness that’s the reason his songs bring up such memories for me, and why music often seems to take people back to the past.

Constancy, stability, sameness. We don’t get that too much in life. Maybe in certain foods – Oreos are pretty much the same as decades ago – but otherwise change is the rule. People, places, organizations, things, jobs, relationships, and technology – everything seems in constant flux. And it’s all speeding up.  What’s a person to do?

“It’s those changes in latitudes,
changes in attitudes nothing remains quite the same.
With all of our running and all of our cunning,
if we couldn’t laugh, we would all go insane.”

Changes in Latitudes, Changes in Attitudes – Jimmy Buffett

Jimmy is right. We have to roll with the punches.  It’s good to have the ability to laugh, to be lighthearted, despite and through life’s inevitable changes, but what can allow you to do that? What’s helping me through is placing my trust and confidence in Jesus, God the Father, and the Holy Spirit. God doesn’t change. He doesn’t forget his people or his promises, and his arm is never too short. Facing uncomfortable changes? Seek the Unchanging. I’m nobody special; God will help you too.

Take care,

Pete

___________________________________________

What, then, shall we say in response to these things? If God is for us, who can be against us? He who did not spare his own Son, but gave him up for us all—how will he not also, along with him, graciously give us all things? Who will bring any charge against those whom God has chosen? It is God who justifies. Who then is the one who condemns? No one. Christ Jesus who died—more than that, who was raised to life—is at the right hand of God and is also interceding for us. Who shall separate us from the love of Christ? Shall trouble or hardship or persecution or famine or nakedness or danger or sword? As it is written: “For your sake we face death all day long; we are considered as sheep to be slaughtered.” No, in all these things we are more than conquerors through him who loved us. For I am convinced that neither death nor life, neither angels nor demons, neither the present nor the future, nor any powers, neither height nor depth, nor anything else in all creation, will be able to separate us from the love of God that is in Christ Jesus our Lord.

Romans 8:31-9 NIV