Purpose

You may not know what you want to do with your life, you may be somewhat certain you want to be healthy though. Nobody ever regretted eating well and exercising. Your future is guaranteed to be better if you do these things. It does not guarantee you health and happiness but it gives you a better chance at both.
-Unknown 

You may be asking yourself, “What is the purpose of being healthy? It seems like a lot of effort to change my habits but what is the point? We all get sick and die anyway.” Generally, the point of being healthy may seem obvious. Maintaining good health and avoiding illness and injury is good for us and we should do things that are good for us. Right? Having good health, or rather not being limited by poor health gives you much more freedom in life to do the things you want to do. But I think asking yourself this question in the context of your own life may lead you to an even bigger question. What is the purpose of your life? I am not a philosophy professor or a religious teacher, so I may not have these answers. However, I may be able to give you some insight into the point of being healthy and how your health is ultimately tied to your life's purpose. From an orthopedic perspective, the purpose of being healthy is to maintain a well functioning musculoskeletal system so you are physically able to do the things you want to do. As far as your life’s purpose goes, that is up to you to decide, but I would be willing to bet that being physically able to do what you want for as long as possible is certainly beneficial.

It is a pretty good idea to ask yourself, “What is my purpose?”, early in life and at different stages of life. The answer will likely change at different points in time as you consider the role of family, friends, career, and hobbies in your life, but physical ability may also play a role especially as you age. For young adults, they may have significant freedom in defining their life's purpose. As you age, you may have responsibilities that require sacrifices of one category over another. An example would be switching from spending time with friends to time caring for children or time spent on your hobby for time spent on your career. We are all familiar with these sacrifices. 

Now, I want you to consider how health issues could require further sacrifices. In my practice, I rarely need to discuss a patient’s life purpose when they are young. Not only do they have less responsibilities, but their physical injuries or setbacks are often less impactful to their lives in the long term. There are instances where I may need to discuss career prospects with a young adult if I believe an injury may limit them in certain fields. An example would be a young adult who has completely healed from a wrist injury, but may be prone to some degree of wrist arthritis later in life.They would likely be able to tolerate a certain degree of wrist arthritis without symptoms as they age, but someone with an occupation involving repetitive forceful wrist motion may have significant symptoms. For this reason, I may advise them to avoid a career that requires such activity. Other patients may have fully recovered from a back or lower extremity injury that could lead to some degenerative changes in middle age. This is a good opportunity to advise them that people who maintain strength, flexibility, and a healthy weight tend to tolerate the chronic effect of injuries better than patients who are weak, stiff, and overweight. Most individuals do not consider how an injury may affect their future abilities and ultimately their purpose, but an injury is likely the best time to start building healthy habits. Young adulthood is also the time when former high school or college athletes make the transition to ‘weekend warriors’. I often warn these patients that “If Tom Brady just showed up and threw footballs on Sunday his arm would fall off”. In other words, you are no longer able to just show up and play. You need to concentrate on nutrition and fitness, or you will be forced to give up your sport sooner than you would like. I will add that I’m a firm believer that you do not stop playing because you got old, you got old because you stopped playing.

Defining your life’s purpose is no easy task, and as stated before I am not a philosopher. For the context of this blog, I am simply regarding your purpose as being able to do the things that are important to you. If you are interested in the philosophy of purpose, I’d like to mention Ikigai. This Japanese philosophy aims to help define your life's purpose. I will consider diving deeper into this subject in future blogs.

The body can be the machine that takes you on life's adventures or the cage that prevents you from going
-The Real Dr. House 

The patient who is approaching middle age may have a different answer to the life's purpose question. Often, the responsibility to children may alter the emphasis on career and family. It also may change some of your hobbies. You may have less time for some of your previous hobbies and some of your new hobbies may require keeping up with people much younger than you. For those with health oriented habits, this period of time will be a breeze with few to no hiccups in terms of orthopedic ailments. This will be the busiest time of many peoples lives. People who invest in fitness, nutrition, stress control, and sleep often have far more energy to dedicate to their family and career. Simply put, people with energy and emotional control have better tools for succeeding as a parent, a spouse, and in their career. For those who do not invest in their health they will usually start to struggle physically during this age. They may find they do not have the energy to be the parent they thought they would be, they may not be able to participate with their children in physical hobbies, and their health could start to hinder their career and ultimately their earning potential. The check engine light of the human body often goes off during this age.

In his book Outlive, Peter Attia M.D. discusses the four horsemen of chronic disease. They are heart disease, cancer, neurodegenerative disease, and type 2 diabetes and related metabolic syndrome. These chronic diseases are some of the top causes of death in the United States and are all related to chronic inflamation. Modern medicine has made advances in managing these diseases but has not cured them. What they have in common is they are silent killers until the advanced stages. In many cases, the check engine light is the orthopedic injury or ailment related to chronic inflammation that could be warning of things to come. Patients with healthy habits may have occasional issues but will heal quickly even if the injury requires surgery. Patients with unhealthy habits often have difficulties with minor traumas, take much longer to heal, and occasionally never fully recover. For example, one patient may dive for the ball on the athletic field or court with significant force and get up and finish the game while another could fall with similar force and miss weeks or months from work. This could be a financial burden to the family and decreases the chances for further financial security. Not only does it limit your ability to work but it may limit your ability to participate in hobbies or activities with friends. It may limit your overall joy of life. It may limit your purpose. When these illnesses of chronic inflammation add up they are often a sign that the four horsemen are saddling up and heading your way.

The best time to plant a tree is twenty years ago, the next best time is today

-Unknown

As children get older and become self-sufficient,  parents may enter a transition phase and will need to ask the life’s purpose question again. They often have more time than they have had since they were young adults. Will they focus on hobbies that fulfill their lives? Will they have more time for old friends and build new friendships? Will they refocus on their career or even start a new one? This is the time many people can reset their financial goals and consider their own financial security in their approaching retirement. Many even consider their role in contributing financially to their children as they explore their path forward in the world. Again, those with healthy habits are much more likely to have good health and more options moving forward. I consider these individuals the “Young at Heart” group. They can often retire at the time of their choosing. They may even decide to start another career. They can enjoy friends and family and not be left behind due to health problems. They can also take up new hobbies that require a level of physical fitness. I think of my wife as an example who took up tennis at age 49 and horseback riding at 53. These are activities that she had always wanted to do, but put aside as she put her children's activities before her own. Despite a busy schedule of raising four kids, and one husband, she maintained healthy habits and as soon as time allowed she still had the physical and mental ability to add new fulfilling hobbies. People with unhealthy habits usually see the daily medicines and yearly surgeries stack up. Some of the four horsemen may have arrived and they are learning to live with them. They may notice options regarding their relationship with family, friends, career and hobbies start to narrow.

During this phase of life, some patients join the “it sucks to grow old crowd.” There is often still time to make lifestyle changes, but many may feel like it’s too late to make the changes and will question the purpose if we are all going to die anyway. They may even point out someone who lived a healthy life and died early anyway. I refer to these individuals as the “black swans” and I will discuss them in a future blog. Others get sick and tired of being sick and tired and begin to make changes. They just refuse to give up some of the options they have in life. They may see the decline of older friends and relatives and refuse to go down that path without a fight. Others have no interest in making the changes and form the backbone of an orthopedic practice. They are ‘frequent fliers’ and we will hold them together as long as possible with medicine, injections, therapy, and surgery. They are often our favorite patients because we see them often and know them well. Despite that, our goal as physicians should be to help more patients join the “Young at Heart” group and avoid the “It Sucks to Grow Old” group. 

The final group are the retirees. This is where the wide array of health inequalities is most evident. We have all heard of the person who basically worked themself to death only to die shortly after retirement. Others have big plans for retirement, but find out their mental and physical decline has left them unable to carry these plans out. The people who have maintained healthy habits have a much better chance of enjoying their golden years. They can be a huge help to their children caring for their grandchildren rather than needing their children's care themselves. This group can focus on their hobbies and friendships. Of course everyone faces some physical or mental decline with age, but people who have health oriented habits are the ones who give up running and sports for walking and hiking. They move from tennis to pickleball and maybe even ping pong if needed. They continue to live independently without the financial burden of needing part time or full time care. A few generations of independence can lead to family wealth.

In Outlive, Dr. Attia introduces another concept that is critical to the purpose of being healthy. He urges patients and physicians to be less concerned with lifespan and more focused on health span. How many healthy years you live is more critical than how many years you live. Too many people begin dying at 25 years old but are not buried until they are 75 years old. He introduces the centenarian decathlon. This is a list of fitness tests you should be able to do as you age. Simply put, if you want to travel and tour a city by foot at 75 you better be able to hike up a mountain at 50. If you want to be able to carry a 20lb child up a flight of stairs at 80 you better be able to carry 50 lbs up three flights of stairs at 50. Do not wait until you are elderly to start preparing for old age. If you wait until then, it may be too late to reach your full potential as a retiree. However you can always improve. It is never too late to focus on the baskets of health to make some improvements. There are plenty of exercise programs and nutrition programs that are focused on the elderly, and it is never too late to work on improving stress levels and overall mental health.

I have read many books on health and aging. Outlive shares many of the common concepts, but I have been focusing on it in these blogs because I appreciate the focus on health span as well as the organization of the five baskets of health. What truly separates it from other lifestyle books is the last chapter where Dr. Attia discusses the high price of ignoring his own emotional health. It is a topic everyone should consider when asking themselves “what is the purpose of being healthy?”. Afterall, if you are feeling miserable, it may be difficult to see the benefit of living longer or healthier. He is a great example of someone putting in the hard work to improve his own mental stability. Struggles with anxiety, rage, self hate, or depression could certainly impact the relationships around you and make steps toward better physical health more challenging. The first step will always be to admit the problem, and be honest with yourself in admitting your role in the problem. Then, make a plan, work with the plan, and persevere through the challenges of improving your mental and physical health. When you look back at the purpose of your life I hope you will be satisfied with the answer.

Regrets I have a few, but then again too few to mention.
-Frank Sinatra “My Way”

The following video is about the importance of honesty in self assessment that I think is beneficial to keep in mind.

Where do you go from here? You take a close look at your purpose, and an honest look at your habits. Are you doing everything you can to fulfill your purpose? If so, congrats. If not make the first step to change your habits. As previously discussed, your willpower will build as you use it to implement these habits. As these actions become habits you move closer to fulfilling your life’s purpose.

He who has a why to live for can bear almost any how
-Friedrich Nietzsche