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.
Dr. Doug McGuff's High Intensity Stud
