Family Medicine Vital Signs

By Briana Rueda, DO

I always prided myself on being a “health freak”.  I received my bachelor degree in nutrition, ran marathons and competed in bodybuilding competitions.  I read nothing but health magazines and self-help books on lifestyle medicine.   I ate, slept, and breathed every day in a never-ending, never satisfied, effort to be the healthiest person possible.  I woke up long before dawn to train.  I home cooked my food and packed all my meals for the day in a cooler the size of a carry-on suitcase, living on perfectly calculated portions of plain chicken breast, egg whites, broccoli, brown rice, apples, and unsalted nuts.  I logged everything I put into my mouth on an iPhone app, making sure to end the day with a perfect 2,000 calorie day with less than 5% saturated fat and 1,500mg sodium.  I hadn’t had a carbonated beverage since junior high school.  I hadn’t had a restaurant pizza in five years.  And I hadn’t bought a carton of juice in over three years.  I was the poster-child for our nation’s nutrition guidelines.  Looking at my medical records from a year ago, I had a blood pressure of 90/55, a BMI of 19.5, a lipid panel with LDL 29 mg/dL, triglyceride 27 mg/dL, HDL 99 mg/dL, an HgbA1c of 5.0%, and a hsCRP of 0.43 mg/L.  An insurance company’s dream!  I thought I was the perfect role model for my patients, for who wouldn’t want a doctor who walked and talked the bible of health?  I honestly believed I was healthy…but I wasn’t.

For five years, we lived on the El-train in Chicago in a 500 square foot high-rise studio condo.  Surrounded by concrete with two windows facing on office building, neither sunlight nor peace and quiet was a part of our lives.  I filled my days taking the condo’s elevator down to the gym for pre-planned workouts, cooking and portioning out “clean” meals, studying endlessly on the couch, and rewarding myself with occasional TV re-runs.  It was clean, controlled, and colorless.  I knew something needed to change, as I began to realize that life was far from fulfilling and time was slipping away.  Ready to start an entirely new life, my husband and I decided to leave our current toxic environment and head for the open lands of the West.

Just prior to moving to Utah, I had a final visit with my previous primary care provider.  In all my years of seeing her, she had always applauded me for my enthusiastic efforts to improve my nutrition and exercise.  However, at this visit, she was prepared to have a different conversation with me.   With a concerned expression on her face, she asked, “Have you ever considered adding some fat into your diet?”  She knew that my husband and I wanted to start a family soon, so she proceeded to review my latest labs with me.  My DHEAS level was low at 68 mcg/dL, my leptin level was almost undetectable at 0.9 ng/dL, and my thyroid panel was still low even on a heavy replacement dose.  It suddenly became clear; here I had been striving for perfection in health, yet my body was shutting down hormone production as a survival mechanism.  And it was that moment that I finally realized that I didn’t feel good either, physically or mentally.  Tired, depressed, hungry, anxious, bored, I realized that wellness is far more than what we see on paper.  Even with my quest for model health, I had to admit it; I was far from “well”.

Upon arriving in Utah, I decided to fully embrace this new chapter in my life and take the opportunity to make some strides toward true wellness.  I made my new health goals entirely subjective, numberless, and open for spontaneity.   My goals were simple- to achieve an emotionally fulfilling, spiritually satisfying, and physically enjoyable life.

Since making these goals, I have made conscious effort to venture into unfamiliar territory.  I have started to embrace the plethora of outdoor activities Utah is known for.  Instead of dragging myself through repetitive boring workouts, I now find myself in the mountains; hiking, cycling, skiing, jogging and walking our new dog through God’s most beautiful scenery.  I listen to my body and do whatever activity I feel like doing at that moment.  Long-gone are the monotonous dinners.  I’m now relishing cooking up satisfying dishes made with rich ingredients like real cream, olive oil, grass fed butter, and garnished with salt to taste.  I like to think of it as intuitive living, and I love it!

Today, I have no idea what my blood pressure or cholesterol is, and I honestly could not care less.  I have never felt so liberated!  At a time in my life when I’m expected to be overwhelmed, stressed, and miserable, I can truthfully say I am the happiest I have ever been in my life.  With my new approach to wellness, I can say that I genuinely feel healthy.

Admittedly, I suffer from perfectionism and obsessive-compulsive disorder.  However, my previous attempt at flawless health didn’t stem from thin air.  Modern medicine is enamored with objective measures.  We categorize people based on their BMI, their ASCVD risk score, their abdominal girth.  We scrutinize lab values and set health goals in increments of integers.  We set our standards of care to meet objectives opined by experts and calculated by statisticians.  And we physicians are rewarded when our patients achieve placement in the “good” categories and are penalized when they do not.  No pun intended, but perhaps this is not the healthiest way to gage a patient’s condition.  It wasn’t for me.

Since joining family medicine at the University of Utah, I have been pleasantly surprised by the department’s culture.  Rather than strictly concentrating on objective criteria to define improvements in health, our providers promote a more holistic approach to both patient and physician welfare.  I have been impressed with the vast array of mental and spiritual health resources we offer, the flexible approach we take in collaborating therapy goals, and the support the department has for patients who embrace alternative medicine.  I could not be more appreciative to work in an environment that aligns with my own newly discovered emphasis on patient (and personal) wellness.  But our department is merely a link in the chain of medicine.  The medical field, as a whole, must recognize that it is essential to foster health not solely through tests and guidelines, but with things like pleasure, fulfillment, and vitality.  For patients who may be the picture of health on paper, may not actually be well.

Briana Rueda, DO is a second year Family Medicine Resident in the Department of Family & Preventive Medicine at the University of Utah School of Medicine.