Saturday, July 26, 2008

Wear out, don't rust out

I am just coming back from a farewell dinner that some of my friends in Little Rock threw for me, since this is my last week at the University of Arkansas for Medical Sciences. I don't want to make changing jobs a habit, but one nice aspect of leaving is that it allows me to positively reflect on what you have learned at your time at the institution.

One of my good friends here who was at dinner with me tonight was Arny Ferrando, who is an outstanding researcher in the department of Geriatrics, and studies sarcopenia. Sarcopenia refers to muscle breakdown. Many people are familiar with the terms osteoporosis and osteopenia, which are the thinning of bone that occurs with aging. Sarcopenia is the equivalent process that occurs in muscle.

I've learned a tremendous amount from Arny this past year, probably more than he realized. Before I get to the main theme of this post, I will make a quick comment about sarcopenia. Probably the single biggest thing I learned from Arny is to be cognizant of muscle metabolism as part of the aging process and as a stress response. It is my belief that some of the largest improvements we will see in medicine in the coming decades will be in limiting the process of sarcopenia in aging populations and high stress environments.

Now, to the main theme of this post- "Wear out, don't rust out." That's an expression Arny likes to use, and I love it. The patients I most enjoy working with are adult patients who want to continue physical activity, but the process of aging has presented certain barriers- whether it is musculoskeletal pain, slower recovery rates, medical conditions, etc. While one certainly can avoid activity, eventually you will rust out. Given the choice, one is better off wearing out rather than rusting out.

I fortunately came of age in medicine where the benefits of exercise are more fully appreciated (although, in my opinion, not promoted enough). When I am giving lectures to medical students on exercise, one of my favorite examples I like to use is a comparison between my father and my paternal grandfather. My grandpa Peter had a heart condition, and the advice from physicans at that time was to avoid activity so as not to overly stress the heart. I have only very faint memories of Peter, as he died when I was 4. I remember him as a very kindly and gentle man, but also as a very frail man. He rusted out.

My father is very different. He started developed heart problems at a younger age. The advice he was given was very different, though- he was advised to continue actively exercising. As if often the case, some of the best schooling I have is from watching people I love acting admirably, and dad has biked 10 miles daily for the past 25 years. He is now several years older than my Peter was at the time of his death. I had a scare this winter when my father tore his quadriceps in his thigh, which is not a trivial injury. But he's already back to biking regularly. Bless him. My dad is 73, and I am pretty sure that he is going to wear out rather than rust out. This is my personal bias, but I think this is a better way to live.

I think there is one main reason to wear out instead of rusting out- it's a heck of a lot more fun. I think of my happiest moments here in Little Rock, for example, and most of them are along cycling along the Arkansas River or hiking up Pinnacle Peak. I have my own associated aches and pains, just like all people in their 30s or older do, but I'm awfully glad that I can still move and do the things I love doing.

Relatedly, I just saw one of my favorite patients this past week for the last time. She is a runner in her 60s who has developed some bone related problems that will hold her out of running for a short while. She thanked me, and her main advice for me as I embark on my career in Pittsburgh was "thanks for not telling me I'm never going to run again." On the off chance that she reads this, it is my hope that she keeps running for another 30-40 years. Eventually she may wear out, but in the meantime keep doing what you love. I'll be there cheering you on.

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