Friday, December 11, 2009

How smart patients keep fit ! An Expert Patient's first person account

This is a guest post from a friend, Amit Goela.


Dear Doctor Malpani,

The following is a fairly detailed account of all that has transpired over the last three months. I will tell you a little bit about health and habits first and then try to give as many details as possible of the events since September.

I have had high BP for almost 12 years but it was always controlled with a small dose of Atenol. I have also been over weight, have been a heavy smoker (about 10/12 cigarettes a day) for almost twenty years and would have drinks a couple of times a week but in very moderate quantities. The only thing I was addicted to was smoking and had a sweet tooth. While in Reliance, Mr Ambani inspired me to run and I started doing it fairly regularly. One thing led to another, and soon I found myself participating in the Mumbai Half marathon for the first time in 2007. While my running did change some habits of mine, I continued smoking and in fact became more careless about my food as I felt I had earned the right to finally eat whatever I wanted. The reason being I was burning the calories. However, as time passed my running became a little irregular till October 2008, when I decided to climb Mount Kilimanjaro. This motivated me to get back into a routine of exercise and running and culminated in me running the half marathon in January 2008 and climbing Kilimanjaro in Feb 2008. I think this went to my head and after March 2008, it was a steady decline. I kept falling sick every few months and almost stopped all exercise. Food habits became bad and on hind sight the daily routine was quite sickening. I put on some more weight and would generally feel extremely lethargic and sluggish. One thing led to another and I finally went for a health check up.

I remember the day distinctly. I had just returned from Kolkata where I had to get my parents to call a doctor home for acute stomach pain and general ill feeling. He checked my blood pressure and found it around 160 and then asked if I was a habitual drinker. It was extraordinarily embarrassing to be grilled in front of your old parents like that and I said to myself I will get a proper check up as soon as I return to Mumbai. Went for a health check up on Saturday ....... to Health 360. By the end of the day I had started feeling something was not right and in the evening went to Dr Kirti Punamiya who is my neighbor as well as a good friend. I told him everything and he also took the BP which came at 170 odd. He said to come and meet him as soon as the reports were ready.

I collected the reports on Monday, the 2nd September around 5 and went to his house around 9.30 pm with my wife. After, going through the reports, Dr Kirti started by saying there is a problem. He then went on the explain that my cholesterol was not right, lipid profile was not right, BP was out of control and the CT angio showed stenosis in the right artery. He said that an angio may be required. I was completely devastated and all kinds of morbid thoughts went through my head. Was I a ticking time bomb waiting to get a heart attack ?

I think the next twenty five minutes will turn out to be among the most important twenty five minutes of my life. Kirti first explained to me the physical implications of the problems in the report as well the long term consequences of my current life style. He then laid out the treatment plan, both immediate and medium term as well as the life style changes I need to make. Finally, he said that everything is in my hands and mind. By the time he finished, my mind was in turmoil and almost in a state of shock. I guess I said all the right things to Kirti and then came home. On the way up the stairs I promised Anju my wife, that I will smoke one last cigarette once I get home and that would be it. She looked at me and just said I have heard it many times ..... you had to be there to see how disgusted she was with that statement of mine.

Anyway, I came home, immediately went to the Balcony and had the Cigarette and that was it. I have not smoked since that day and now it is almost 95 days. While I hardly slept that night, I made a promise to myself that come what may, I will fix myself ..... at least I will do everything I can to remedy the situation and leave the rest to Kirti and the almighty.

I came to office the next day and around noon, went and told the entire situation to Rakeshji. Along with that , I requested for a week off , to which he readily agreed. He told me to take care and call him in case I need anything or any help. I have to say that after that he completely left me alone for almost one full week .... not one call was made regarding any work or official matter. He only called to enquire how I was doing and his silent encouragement was one of the major reasons why I have been able to accomplish so much over the last three months. After speaking to him, I called the research team and back office boys and explained to them my health situation and that I will not be coming for the next 7 days. I took care of some housekeeping and then I was home. The urge to smoke was at its peak by then and I was almost ready to explode. I managed to survive the first day and then the next two days. I just kept to myself and whatever little talking I did was like a dog barking. I don't know what Anju and Roshni , my daughter, went through those days but they did whatever they could to make things easy for me. The three days were extraordinarily difficult and it took everything I had both in physical and mental terms to get over the urge to smoke.

From the fourth day, things became a little easier and I started feeling a little better. The new medication prescribed by Kirti must have also started having some effect. I met Kirti in the evening and he encouraged me big time to hang in there. The next day, was almost normal except that I started feeling a little bit more confident. I had a long chat with my wife, then opened the net and started reading about Blood Pressure. I must have spent the entire afternoon and evening reading all kinds of articles on BP as well as some stories about individuals. Later that night, armed with a little knowledge but lots of enthusiasm and confidence, I went to Kirti's house again. I told him, I am ready to do everything that can be done to fix the problem but I needed a game plan and some handholding. The fact that I had stopped smoking conveyed my seriousness to him and he explained the next steps to me. The initial focus was on diet and life style. He said that he will tackle the exercise part after the Thallium stress test which he said I need to take after the blood pressure stabilizes a little. So my next step was to focus on my food. It may sound simple or like a fairy tale but I actually did it ... I just cut out all the salt and sugar from my food ... period. The only little salt I was having was in dal or sabji. The surprising part was that I did not miss salt or sugar a lot because by then I had almost started feeling a little different. I started feeling that I suddenly had a lot more energy and generally felt lighter on my feet.( Even today my lunch comes from Raju Bhaiyas house and I eat the same salt free diet which he has ) Meanwhile, the BP had started coming down and Kirti who was kind enough to check me almost every third day said it is time for the Thallium Stress Test. So the next mental battle became conquering the stress test. I asked Kirti if I could start stretching a little and go for long walks which he agreed to. Finally I went for the stress test with a huge amount of apprehension but the reaction of the doctors was completely different than the day of the CT Angio. Somehow I had a pleasant feeling and the reports confirmed it the next day. You cannot imagine how happy and elated I was when Kirti saw the Stress test report and said no Angio was required. Anju also must have smiled for the first time in three weeks.

Meanwhile you had also given me the books on hypertension. I started with Dr Stephen Sinatra's book because it had a remedy within 8 weeks on its cover. The book really helped in getting a better understanding of Hypertension and the fact that it can be conquered. So between Kirti, the books and the net, I had picked up some rudimentary knowledge of Hypertension and some of the things I could do to get myself out of the hole I had dug myself in.
I had started following a routine of some sort with extreme focus on the right kind of food and some attention to exercise. A week after the stress test, I was chatting with Kirti when he mentioned about a program called ATS training ....... it is a weight loss and stamina building program conducted at the QI Gym. He explained to me that it involved intense exercise in a simulated high altitude environment which is achieved by controlling the oxygen levels. My excitement kept mounting as I listened to him and then asked him if I could do it. He said Yes with some checks and balances , which he would explain to the Gym staff as he was also going there every day. So the very next day, i walked into Qi and set up a time to meet the lady , Kainaz Doctor who runs the program. If you want to meet one tough person who will not compromise on anything it is her ..... she and her staff are amazingly demanding but the program they run changes your life. This week is my ninth week and you have seen the difference....... Now I can run almost non- stop for 90 minutes at a simulated height of almost 2200-2300 hundred meteres !

This is what I have done since September 2nd and it has paid off big time for me ...... and I am determined not to slide back. I think what will help me keep this going is how much better I feel both physically and mentally.

While being a little immodest, the reason I feel confident that I will not slide back is because I have discovered the magic formula .....The most amazing thing I have discovered over the last twelve weeks is that it is not all that difficult to say "no" if wants to say "no". I have said 'no' to so many things over the last twelve weeks that I have lost count , but nobody seems to mind’s okay to say 'no" when you want to take care of your health !

You might feel that I have made it sound too easy , but believe me it was..... once I was clear in my mind why it needs to be done and the fact that I was doing it for myself and the people who love me and depend on me and not for the doctor, it fell in place....... The one place where I lucked out was in terms of people..... starting with Kirti who was available whenever I wanted, my family, Rakeshji and office colleagues who knew what I was trying to do and made as few demands on my time as possible, the interest you took , the books you gave me to read, as well as all my friends who excused all my absence from almost all social occasions.

Want more information ? Amit's email is [email protected]

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