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CASE REPORT: Special Populations

Overcoming the Odds

Joy, Elizabeth A. MD, MPH

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Current Sports Medicine Reports: December 2007 - Volume 6 - Issue 6 - p 379-380
doi: 10.1097/01.CSMR.0000305616.80369.07
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Introduction

It's July, which in my house means the Tour de France. It's on when I wake up in the morning, and I often go to bed with the day's highlights on the television. One can't help but marvel at the fitness, skill, and intensity of these athletes. Even the least skilled rider in the Tour is a more finely tuned athlete than anyone I know. The stamina and concentration exhibited by these riders over 21 days of bicycle racing is incredibly impressive. They are, of course, professional riders who are paid to compete for a team that represents some corporate entity; they are also well trained, coached, and supported in their athletic efforts. However, for an athlete to make it to this competition level requires not only tremendous determination but good genetics. In the 70s, without maximum oxygen consumption (VO2max), these athletes wouldn't have a chance. Today, the vast majority of the population does not have the time, the coaching, the support, the skills, the stamina, or the genetics to exercise at this level. Yet somehow many get themselves to the gym or out on the road, or, in my case, onto an elliptical trainer 3 to 5 days per week. For those efforts, many of us are healthier and happier.

As a family physician, I try to take the approach of the late George Sheehan, MD, who titled one of his essays, “Every Patient is an Athlete.” With that perspective in mind, I have cared for some incredible athletes. Their stories of overcoming the odds to maintain physically active lifestyles and even compete are inspiring. They may not have the VO2max of Lance Armstrong, but they have his determination. These are the individuals that inspire and motivate me to help others achieve a physically active lifestyle.

Case 1

B.R. is a young man who, in his 20s, was competing as a mountain biker when he flew off a 50-foot cliff and landed on his back, which broke. He shattered his L1 and L2 vertebra, leaving him paralyzed from the waist down. After many weeks in a rehabilitation hospital, he started to walk again. He is now married, has a full-time job, works out in the gym, and walks his dogs. He says these activities help with his energy level, prevent depression, and reduce his pain. His level of determination is unlimited; despite profound chronic pain, he works toward living a “normal life.” On a daily basis he embodies many of the attributes exhibited by professional athletes—strength, stamina, and steely determination. He has applied those attributes to overcome a life-threatening injury and continue with a physically active lifestyle. Although he no longer competes on a national or international level, he would be the first to admit that “overcoming the odds” has been as rewarding as standing on a winner's podium. I have shared B.R.'s story with patients who have faced similar tragedies, and like to think that—despite individual differences—it offers hope that an active life after such an injury is still possible.

Case 2

T.A. was a soccer player who came to see me one day with a complaint of headache. Further questioning prompted admission to the hospital, where she was found to have suffered a stroke; extensive evaluation also identified an atrial septal defect (ASD). T.A. had no health insurance and her parents, who spoke no English and lived in Czechoslovakia, had to travel to a nearby store to communicate with US physicians via the Internet. Nonetheless, once charity care for her was identified, T.A. courageously went ahead with open heart surgery to close her ASD. Within weeks, she was asking to return to soccer training. Working closely with her cardiothoracic surgeon, she gradually transitioned back into the sport and was able to complete her fourth year of Division I soccer; she played superbly. Her determination to play inspired her teammates to elevate their level of performance, and the team had one of its best seasons ever. For the soccer team, T.A.'s “performance” remains a motivational factor: if she was able to overcome a stroke and open heart surgery and return to sport with sternal wires in place, then they can make it back after an anterior cruciate ligament (ACL) injury. At the end of her final competitive season, a local newspaper ran a story with the headline, “Heart of a Champion.” The statement could not ring more true.

Case 3

Finally, there is M.F.'s story. M.F. is a 76-year-old retired school teacher who, despite a healthy lifestyle, has developed type 2 diabetes, hypertension, and hyperlipidemia. Her body mass index is 26. She has osteoporosis, osteoarthritis, and some difficulties with balance. Although she is the primary care taker for her ill husband and has an active social life entertaining friends, playing bridge, and attending a book club, she came into my office one day and said, “I'm falling apart and I don't like it.” Previously, M.F. had done periodic physical therapy for various aches and pains, but had no regular exercise regimen. I suggested that regular exercise might make her feel better, get stronger, and be more resilient to musculoskeletal complaints. Given her lack of exercise experience, I referred her to a local personal trainer, to whom she took an instant liking. That was 3 years ago. She continues to meet with the trainer twice a week to walk on the treadmill, stride on an elliptical trainer, and do some resistance training. Since starting her regular exercise program, M.F. has more energy, feels stronger, and is seen less often in my office. Her chronic medical conditions are well controlled and she has not had any serious sequelae.

Conclusions

I continue to see many patients just like M.F., and imagine other physicians do as well. While I recommend physical activity to most—if not all—of these individuals, it is rare for someone to actually follow through and take my advice. It can be hard for patients, regardless of age or weight, to change the habits of a lifetime. As a physician, watching someone succeed is empowering; it signals that my efforts to get people moving are worth it. This concept of “exercise is medicine” is not new, but one of which both health care providers and patients need constant reminding. As physicians, our role is to help patients—whether elite athletes or average citizens—to overcome the obstacles keeping them from a physically active lifestyle. Yet physicians face competing demands for time when seeing patients, and taking the extra time to understand a patient's motivations and investigate possible barriers to exercise can be very challenging. Given this information, however, we can work with our patients to strategize, coach, and sometimes cajole them to start participating in some form of physical activity, whether rejoining a previous sports team or simply walking around the block.

These are the stories that sustain and inspire me as a family physician. It is my hope that they will encourage other physicians to think of the successes in their own practices and use those stories to help others overcome the odds.

© 2007 American College of Sports Medicine