Best of both worlds – Dr. Prakruthi J

I had the opportunity of attending the second national meet of Myoin Society held at
the lush green campus of St. John’s Medical College, Bengaluru. I reached home and woke
up to the alarm at 5AM the next day. Fighting the urge to snooze, I woke up to lure of
morning coffee, to find my significant other already awake. In the first fifteen minutes I
deemed myself unfit to go swimming as I had been tired from the day before. Sipping coffee
my significant other had a revelation. “Its a SUNDAY! Let’s climb Chamundi Betta”. Despite
being unfit for a swim I considered myself fit to climb the 1100 stairs with mild to moderate
cardiopulmonary risk. Fifteen minutes later we were ascending the abode of Goddess
Chamundi. Swimming, trekking, running… same same but different, I figured.

I set the record straight, to myself and mays significant other. I travelled to Bangalore
yesterday in car and sat for the entire conference and back to Mysore in car. That’s a lot of
sitting for a day. I might not be my best self. I was met with a “Rest when you need”. 100
steps scaled. Lo behold, my lungs were grappling. Soon my heart joined with runs of SVT
among a steady sinus tachycardia. Embarrassed, I gently remind myself, I vouched on behalf
of an auditorium full of people yesterday to improve the VO2 max yesterday.

I look up and find my significant other is not to be found for as far as I can see. Damn
You!! A word of advice to the Gen Z, upgrade or downgrade your partner’s fitness levels close
to yours or vice versa, sometime sooner in your relationship. Otherwise your partner will
always look cool for stuff like this in your eyes as well as your kids’. Nothing you do can match
this.

Trying to distract myself, I recall that VO2 max can be calculated. HRmax is 220-age
and so my heart rate max is about 180. Now to calculate the intensity I start counting pulse,
1..2..100.. 120… something deep inside me screams that there is no more oxygen left I body
to stand upright, forget about counting. Definitely maximal intensity by the time I reach
“Pandavara mettilu” (10 steps shy of 500). I decide to suggest this as the next incremental
ergometer test – climb the HILL in the next year’s meet. Anyway let’s list the MSAs, SRP,
HMGCR, Jo-1, Ha, Sn RNP, MDA5, PL7… I wanted to work the muscle! I mock myself.
And that’s when we reached the road hitting 600. Have I told you how much I like flat lands?
Its so nice and easy walking on them. I reminded myself that me and Po, the Kung Fu Panda
have at least one thing in common, – our enemy- STAIRS! Oh and we love food! I switched
the debate to whether I should consider Mediterranean diet or stick to the traditional south
Indian breakfast to fuel my not so happy quadriceps, hamstrings and glutes. At this point type
IIa and type I were all exhausted all the way down to mitochondria. I bet if you stained my
muscle right now with NADH, COX, SDH stains would light up with neutrophils. While I
was revelling in muscle and memories of myoin meet , I find my significant other waiting with
a smile way ahead of me. Does this person ever get tired?!

We finally made it to the iconic “Nandi statue” with hardly any glycogen left and I was
certain now that if I enrolled for MRI STIR and FAPI PET MRI , they would both agree
that there is acute inflammation in all the muscles tricking all the way to endomysium. I take a
short break and decide to check if score on the MDAAT tool. Some parts of my working
memory harked back to the session, to clarify that is applied for “WITHIN PAST FOUR
WEEKS”. I huffed and puffed my way up recalling the oral presentations, wondered if my
muscle kinetics would have been with a shot of anabolic steroid, and even considered if I
would be eligible in the acute myositis cluster if I cannot move after reaching the ground for
the week after or the fraility cohort. I quickly assessed my hand-grip strength, the presenter
had told that we Indian women faired well in this regard and voila, at least that’s intact. There
was another that debated over immunohistochemical markers- KLRG1 and now that was
cool. Myoin society meet was really next level. Scaling Chamundi Betta without breaking a
sweat cool!

At this point the stairs were practically full and my muscles felt less alone considering
there were people of all ages and all languages working their way up in unity, oblivious to all
things happening in the outside world, flexing their legs almost like dancing to a melodious
tune. There are all kinds of people, some quietly climbing and a few who stop for every step,
bend and apply vermilion to each step , while some carefully manoeuvring a burning
camphor on each step. I look around to find many septuagenarians, wondered if they were all
vaccinated as per protocol. All these people, divided by a million things and united by
MUSCLE. I recalled my senior and fellow rheumatologists who are constantly engaged in all
kinds of fitness activities. Being the change they want to see in the world.

I, for a brief moment mused about how difficult it might be for a person affected with
myositis to be able to climb the flight of stairs to reach his first floor room, while I was panting
here. It dawned on me how important it is to spend time with each of them to understand
what they can presently do and how we can set realistic goals for them and help them achieve,
one tiny step at a time. I dreamt about the day when my Dermatomyositis affected cute ajji
would walk two flights of stairs comfortably or the young mom with anti synthesise syndrome
would reach the level of fitness to do HIIT. I humbly make a note to always put myself in
their shoe and walk a mile. Just as I opened my eyes I was there! At the TOP!. I profusely
thanked Goddess Chamundi for my and my family’s health and felt pure gratitude to be able
to climb the hill and seek her blessings.

Just like the last time, I made it a point to pledge to improve my fitness levels to my
significant other, at least quadriceps strengthening if not for anything. And then hit the
endorphins. They screamed MOUNT EVEREST, here I come!