Thursday, February 7, 2013

Public Service Announcement: The Radiologist Can Basically Tell How Old You Are.

Today I was downstairs at Our Hospital, peering over the shoulder of an attending radiologist. I'm currently on radiology. I chose this rotation because I am going into emergency medicine, and the culture is to at least try to interpret the studies you order, though you await the radiologist's read before making big decisions. This is probably my last opportunity to get extended 1:1 time with a radiologist and drink deeply of radiology, so cheers!

As a student on radiology, the day's experience varies according to how much the people you're with have time to teach and feel like teaching. It's a lot like taking a long car - no - AIRPLANE trip and looking out the window with a tour guide who's extremely familiar with the terrain and tells you something cool about it now and then. And occasionally asks you to point out geographical points of interest. The mountains and valleys are already looking more familiar, and I really enjoy this time.

Radiology, like much of medicine, is a puzzle. It is not made easier by the common practice of willy-nilly choosing the first indication-for-study on the drop-down list when ordering the study from the emergency department. So the radiologists try to infer a lot from the studies they read, lacking much history from the ordering doc.

Here are some snippets of today's radiologist remarks - note the inferences they are able to make:

"Oh, man, that's not good...She's got way too much lucency along those vertebrae to be just 42. She's gonna have terrible osteoporosis."
"34! Oh, my God! He's already had a foot amputated. He's going to lose that whole leg by 40."
"Yeah, I really don't know if shoulder degeneration is inevitable. All I know is that all Our Hospital's patients have it after 60 or so."
"Oh, man that knee hurts."
"THIS guy uses his hands every day. Look at those articular surfaces."
"For a 55 year old? In This City?  Those lungs are what I'd expect. Yeah, they're not 'normal.' But they're normal for here and for that patient."
"He's only 20. Brain should be filling up that entire space." (Brain atrophies with age. Sad.)

All of this lumping and aging jarred me. I have known this vaguely all along, but, as with many experiences, seeing these junky shoulders, crusty knees, scabby lungs, and small brains makes a huge difference in my perception. Surgery held similar revelations, but more related to the evils of excess body fat. Again, I digress. Today's stint in the reading room revealed to me the extent to which I have regarded aging as optional. Unfortunately, wear, oxidative stress, senescence, dehydration of cartilaginous structures, take a somewhat inevitable toll.

These elements of aging are somewhat modifiable, it turns out. If you eat an excellent diet, exercise, and don't drink or smoke, the darnedest things can still beset your body, but you can stave off a lot of this wear-and-tear, often brought about by cumulative oxidative stress.

I think about what I eat a lot; I really do. I am sitting here eating peanut M&M's as I type this, but I do *think* about the fact that I'm choosing to do that. Today put a new spin on how I think about it. I'm young, but not too young. I've had a few minor health issues, some brushes with moderate health issues, and I have osteoarthritis in my left thumb. Stop rolling your eyes, you over-50 set people.  I know you think I'm a wuss and that you are about to stop reading this. Hold on, though! Don't let your boogered-up cartilage and small brains stop you from sticking with me :). (You can come visit and kick my butt. As long as you visit.)

All this reminds me to eat well, even when I don't feel like it. It reminds me to sit up straight, to exercise moderately every single day. You see, good foods that look like where they came from oxidize a lot less. Veggies can actually protect cells from oxidation. As for exercising, good stress sends the body signals to strengthen bone, ligament, tendon, and muscle - though this last tissue is the only one that's discussed because it's the one that gets all big. It all makes a difference.

SO: Those of you who wrestle with feeling like you're consistently doing the right things but the outside of you isn't changing - take heart! The inside of you loves it! So what if you're recently on the bandwagon. all those cheesy fries and donuts are a sunk cost - forget about them and move on. Choosing whole foods, good fats, and fresh vegetables is a supreme and unfortunately globally uneven privilege. Choose them! I just put down my peanut M&M's...for now at least. Junk is culturally embedded in me, and for many of us. I have a few peeps who just sail above the temptation to duck into McD's now and then, but Yours Truly? My husband will tell you: I salivate for french fries weekly...and eat them biannually.

So I don't have any easy answers for affording whole foods (the foods, not the supermarket) or for getting through temptation to put junk in the body...but I'm trying to work it out and will gladly take suggestions. Many of you love to grow stuff. So do I, but I'm mainly obsessed with seeds and habitually let about 75% of my crop fail because my heart was really in finding which seeds were still viable. Getting past the easy part and getting to the staking, weeding, and harvesting in a timely fashion will be this year's challenge. We all have strengths and weaknesses in the healthy living department. (Not the Health Department.) Today my revelation is only this: Your X-ray is telling on you. You can't cheat the effect your choices make on your tissues. But being humble and knowing this can maybe encourage you, like me, to think about your cartilage, your lungs, your bones, your articular surfaces...and to throw those thoughts over top of your thoughts about french fries. 

My best to all - especially the Over-50's who let me rib them and still read on...get it? Rib? Like an X-ray?

PS: If you know me well, you'll know that Match Day is March 15, 2013. I have been cool about it until the past week or so. Now I officially have inner turmoil...which is why I'm avoiding the subject entirely!

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