Steady-State Activity: Travesty

By Douglas McGuff, MD

Published In The SuperSlow® Exercise Standard

Ken Hutchins Editor

January 1998

Here is a story I thought that you would find interesting. Several days ago, while working in the emergency, I picked up a chart that had “medication refill” written in the box for chief complaint. This is not uncommon in emergency medicine. People run out of medications, not realizing that they are out of refills. People on out-of-town trips forget their pills and leave them at home, or they simply lose them. So, as I walked toward the exam room, I thought “piece of cake”… How wrong could I have been?

As I walked into the room, I saw a 53-year-old gentleman, who was pale, shaking, drenched in sweat and covered in goose bumps. His pupils were hugely dilated. I then looked at his vital signs. His blood pressure was elevated, his pulse was 128 and his temperature was 102F. In short, this man appeared to be full-blown narcotic withdrawal. This immediately raised my suspicions that this man was going to be a typical narcotic seeker (another common encounter in the ER).

Rather than the usual evasive stories told by most “drug seekers,” this man was very honest and straightforward. He told me that he had been taking Demerol R tablets 4 times per day for the past 15 years and that the regimen had been prescribed by his family physician for debilitating arthritis in his hips and knees. Recently, his family doctor had died. He then temporarily found a doctor willing to care for him and who had continued to prescribe Demerol. The patient had been unable to hold a job long enough to obtain health insurance which he desperately needed so that he could afford to have total hip and knee replacement surgery.

Unfortunately, random drug screening at his workplace uncovered his Demerol use and he was dismissed. At about the same time, his replacement physician had left practice and his care was transferred to another physician who refused to refill his Demerol. The new physician gave this patient referral to an area psychiatrist so that he could be placed on a detoxification program to wean him off narcotics.

Unfortunately, the patient could not get an appointment with this (or any) psychiatrist without insurance. Without narcotics, this man was unable to function due to arthritis pain and narcotic withdrawal…hence, no job… and, no insurance, no relief, no detox. Quite a Catch-22 scenario.

What I thought was going to be a “treat’em and street’em” case turned into a two-hour nightmare, as I had to give him intravenous narcotics and Valium R to get him out of acute withdrawal. Then there were the multitude of phone calls to the state psychiatric hospital to try to set up narcotic detoxification and methadone maintenance, as well as numerous phone calls to area family doctors trying to find someone who would be willing to carry this uninsured patient along for a few months until he could get into the state hospital’s program.

Finally, when I thought I was through and was about to proceed to the charts that had been piling up on this busy night, I was confronted by an ER nurse insisting that I go back and speak more with this patient. When I asked why, she said, “Do you know how he got addicted?” to which I responded. “Yes, he was on narcotics for debilitating arthritis.” The nurse (who is aware of my profound hatred of aerobics) insisted I go in and ask him how he had come to develop such a bad arthritis.

As any good doctor knows, when a nurse insists you do something, you had well better do it. Hence, I engaged the patient in consultation once again. The patient told me that in the 70s, he had gone through a very bitter divorce and had become depressed. He went to his family doctor for help, thinking he needed psychiatric referral or possibly antidepressant medicine. His family doctor had also been through a period of depression, but had been successful in improving his mental outlook when he took up running.

At that time, running was the new rage, both in medicine and society at large. At the insistence of his family doctor, the patient took up running. Initially, his mileage was low and his performance was poor, but he did find his depression was resolving, or at least he was able to cope. (Eric Hoffer was right when he wrote, “In a modern society, people can live without hope only when kept dazed and out of breath by incessant hustling.”).

Gradually, his performance at running improved, as did his mood, but he found that if he quit (or even decreased) his running, his depression would return full force. Eventually the patient became very involved in running. He and his doctor ran together in a running club and began to run in races, eventually working their way up to competing in marathons. Gradually, he worked up to weekly mileage of about 100 miles. Simultaneously, he began to develop pain in his knees and later in his hips. However, because of what he thought were offsetting health benefits, he continued to push through the pain. Gradually, the pain became so severe that the patient had to reduce his mileage and again the depression returned.

His family doctor empathized with him, and also felt somewhat responsible for this situation. He began to prescribe a limited amount of Demerol so that the patient could continue to pursue aerobics health and happiness. The use of narcotics masked the pain, and he continued to prescribe the Demerol because of his profound feelings of guilt for what had happened. Unfortunately, (like most physicians) he did not plan on dying before his patient.

Now the patient is in this predicament. Interesting, as well, is the fact that this patient now has 2-vessel coronary artery disease, which he fells is related to his current level of inactivity. The patient put it best when he said, “I can’t believe I used to run 100 miles a week and now I can’t walk across my living room…running ruined my life.”

This is why I made the statement in my speech at the Guild Convention, “I HATE aerobics.” How many people’s lives have been destroyed by this nonsense?...and 99 times out of hundred, it doesn’t even get the blame for what it has done because the debilitating results are delayed in onset. Our Surgeon General has released a statement saying in effect that normal activities of daily living are just as beneficial to our cardiovascular health as more vigorous aerobics exercise. It amazes me that people pursue this incredibly destructive activity in the quest for cardiovascular health, when all they are really doing is destroying their joints and wasting away their muscles so that eventually they will be unable to carry out the activities of daily living and thus destroy their cardiovascular health.

This patient was very kind to allow me to tell his story, but for privacy reasons, I cannot disclose his name and unfortunately, he declined to tell his story first hand….too bad. In my opinion, a person such as this would make a great keynote speaker as the American College of Sports Medicine Convention or, perhaps, at Club Industry. Perhaps then these people would realize that what they promote as a way to better health is actually maiming and killing untold thousands of people.