Lifestyle Change- the "Secret Weapon" for great health outcomes

I saw a patient today who impressed the heck out of me, and he gave me permission to tell his story.  I'll call him Fred for the purposes of his story, to protect his anonymity.

Fred's a middle-aged, high functioning executive, referred to me because of numbness in his hands and feet.  On examination, I picked up some findings concerning for compression coming from his neck.

I also expressed to him my concerns that he was undergoing some of the lifestyle changes I see in some of my most wonderful patients, where they are feeling health consequences from the complexity of their lives.  Fred is what I would consider "hyper-competent"- he's very smart and thoughtful, charismatic, a great people manager, and just gets stuff done.  As a consequence of his hyper-competence, he has the "reward" of getting more and more stuff to do, which does give him emotional satisfaction, as well as more money.

But it comes with a cost.  As we reviewed some of the symptoms I see in patients with too much complexity, some patterns emerged.

First, he has sympathetic overdrive.  The sympathetic nervous system is part of the autonomic nervous systems that handles the "fight or flight response", and Fred is always primed and ready for action.  Some negative consequences:
- heart arrhythmia
- resting heart rate over 80
- difficulty "shutting his brain off"
- trouble sleeping, replaying conversations in his head from earlier in the day
- muscle tension
- tinnitus (ringing in the ears)

He also has some signs of hypogonadism (low testosterone):
- fatigue
- lower energy levels
- decreased libido
- sleep apnea
- some days hard to focus and concentrate
- less frequent morning erections
- still has morning erections, not sure if it's every day
- harder to obtain orgasms than before

I told Fred my preferred approach is to focus both on the focal (his neck), and the global (Fred as a human being, rather than as a collection of body parts)

We imaged his neck, and sure enough his cervical MRI demonstrated some disk disease affecting his nerve roots and touching on his spinal cord

I also ordered a comprehensive hypogonadal assessment, which showed:
- low testosterone
- high estrogen
- elevated glucose

I discussed with him that the body is in a constant battle between being anabolic (building up) and catabolic (breaking down).  You need both, since you need catabolism to healthily remodel tissue.  But his system was out of whack, and was in the process of breaking down from the load of complexity in his life.

So we put a plan in place.  To Fred's credit, he bought in 100%.  (.... I was afraid that he would insist on buying in 110%.  That would have made things worse - I needed him to resist the temptation to do too much- I didn't want him doing the mathematically impossible).

I am so impressed with Fred.  Changes he's made:
- changed his diet to a 1:1 protein:carb diet, using tracking software to stay accountable
- used propranolol 30 mg at night to help with sympathetic overdrive
- started meditating at night to help with sympathetic overdrive and sleep
- prioritizing sleep
- modifying job to allow his brain to be less intense
- drinking less coffee (needs less now that he sleeps more, and excessive coffee was increasing his sympathetic overdrive)

The next major step for him is getting him to be in compliance with the American College of Sports Medicine exercise guidelines, particularly in regards to aerobic conditioning

I may eventually perform some injections in his neck, but Fred has already seen how lifestyle changes have made a huge impact in his well being, is costing him less money (less medications!), and will make any spinal procedure I perform on him more effective

Fred- thanks for being an inspiration!