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The Unreal World

'Louie' gets the 'treatment' after exercising

Would a patient be hospitalized and kept for observation after collapsing at the gym?

September 20, 2010|Marc Siegel | The Unreal World

"Louie," "Gym," FX, 11 p.m. Sept. 7

The premise: Comedian Louie ( Louis C.K.) does not lead a healthy life — as the episode begins, he is eating a large bowl of ice cream in bed, which prompts him to have a hallucinatory dream about a female television news anchor who showers him with erotic vulgarisms.

Although Louie feels exhausted by his life as a single parent for his two daughters, his friend Chris ( Bobby Cannavale) persuades the out-of-shape Louie to join him for a workout at the gym. As Louie jogs on the treadmill, Chris turns up the speed so much that Louie becomes short of breath. He pleads with Chris to stop, but Chris encourages him to keep running.

Next, Chris puts Louie through sets of weightlifting and push-ups until Louie passes out.

He is put in an ambulance and brought to a hospital for overnight observation. Louie's friend Ben ( Ricky Gervais), a physician, is one of Louie's emergency contacts, and he comes to the hospital dressed in his white doctor's coat. When Louie regains consciousness, Ben stuffs cotton into his mouth.

The attending physician who is assigned to Louie, Dr. Drake (Stephen Bradbury), then arrives and keeps the practical joke going by warning Louie about the serious condition of his heart (which he calls "myocardial defecation"). Louie is frightened until he realizes the doctor is kidding. Louie is eager to return to the gym, but Ben warns that he may be too far gone physically to exercise safely.

The medical questions: Can eating too much ice cream lead to bizarre dreams? Is it safe for a sedentary person with a poor diet to begin strenuous workouts without first being checked by a physician? What would cause someone to suddenly collapse while working out? Is it reasonable for such a patient to spend the night in the hospital? What tests would routinely be run? Is it appropriate to joke about the patient's medical condition? Is a patient ever too out-of-shape to benefit from an exercise routine?

The reality: Eating sugary foods, such as ice cream, can cause big fluctuations in blood sugar levels, says Samantha Heller, an exercise physiologist and registered dietitian in New York. "These shifts in blood sugar when awake can lead to mood swings and fatigue, and when asleep can contribute to vivid dreams," Heller says.

It is important for anyone, especially someone who is overweight or unfit, to get checked by a physician before beginning an exercise program. A doctor can assess cardiac risk factors and help establish safe and realistic goals, including making "recommendations regarding the appropriate mode of exercise and the gradual implementation of the program," says Dr. John P. DiFiori, chief of the division of sports medicine at UCLA.

Older individuals or those with a history of heart disease should have a cardiac stress test before embarking on an exercise program, adds Dr. Gerald Finerman, former chief of orthopedics at UCLA.

The cause of a sudden collapse while working out is presumed to be a heart problem until proved otherwise, DiFiori says. In an adult older than 35, the most common type of heart problem that would cause this is coronary artery disease. It is reasonable to observe such a patient in the hospital overnight, according to DiFiori. Doctors would routinely order an EKG, an echocardiogram and overnight continuous cardiac monitoring, along with a blood test to check cardiac enzymes for signs of a heart attack and general blood chemistry. A cardiac stress test on a treadmill would typically follow.

It is both unprofessional and inappropriate to joke about a patient's condition after a significant medical event, Finerman says.

All three experts agree that there are some cases in which uncontrolled medical conditions, such as heart or lung disease, would have to be fully assessed and stabilized before initiation of an exercise program. But then, in most cases, a program can gradually be implemented. "I believe everyone can benefit from an exercise program done in a careful and professional manner," Finerman says.

Siegel is an associate professor at New York University's School of Medicine.

marc@doctorsiegel.com

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