Six Pack

We are still in the midst of winter. Due to very cold weather, I have not gone out for a run for almost a month now. I even have not gone to the gym for several weeks as well, due to consecutive snow storms we had that piled up the snow and ice on our streets making driving a little tricky, especially when its dark.

But I have not been totally inactive even though I have not run or went to the gym. Because lately, I discovered my wife’s exercise videos and I was working out following them here at the comfort of our home. It’s better than not doing anything at all.

Since Jane Fonda produced those workout videos in the 1980’s, there’s a lot of them available. Are you picturing me doing them in my leotards? Sorry to disappoint you, but I am not donning those. Maybe pajamas, but not leotards.

I will not say that they are less intensive than running or doing cardio and lifting weights in the gym. In fact, I find my wife’s workout videos challenging.

One particular workout video series she has is the “Hip Hop Abs.” Yes, they are mostly dance moves, Hip Hop in particular. But if you do it for 30-45 minutes, it is really exhausting. Maybe even more exhausting than running 3 miles.

I also find it challenging since my feet have no rhythm at all. I can’t dance. I have two left feet!

My wife just laughs, for I lack the grace and coordination. But she let me do my thing and even joins me at times, exercising with those workout videos.

I think this Hip Hop Abs is really effective, as I feel the burn in my abdominal muscles and core muscles when I do them. Maybe if I do it long enough I’ll develop those muscular abs just like the workout video instructor. Or maybe I’ll do them until it is warm enough that I can run outside again.

Perhaps some people think that it is a waste of time working out or going to the gym, for there are more important things to do in life.

I remember a quote by Robert Mugabe, former Prime Minister of Zimbabwe. He said, “No girl will choose six pack over six cars….so stop going to the gym and go to work.”

Of course there’s truth to that. But I tend to disagree. What if you can strike a balance and get the best of those two worlds? What if you have both?

Just so you know, I don’t have six cars. I don’t have six pack either. But I’m working on it.

To be clear, I’m not referring to a six pack of beer.

Out of Shape

The other day, one of my partners requested me to supervise a cardiopulmonary exercise test (CPET) that he ordered on a patient that he saw in our clinic. Since I would be in the hospital all day that particular day, and the exercise test would be done in a lab in the hospital anyway, so I obliged.

CPET is usually a test that we request if the cause of shortness of breath remains unclear even after initial evaluation. Most of the time when we request a CPET, we have already done lung imaging (like a chest x-ray), a pulmonary function test, and basic heart evaluation to rule out gross cardiac problems. Definitely we don’t want a patient having a heart attack and keeling over while we are performing the test.

During CPET, a patients walks/runs on a treadmill or pedals on a stationary bike, while having all these body monitors to measure the heart rate, blood pressure, and oxygen saturation level. Then they also wear a mask, like the super villain Bane in the Batman movie, that is attached to a breath analyzer where we measure not alcohol content, but the volume and gas content (oxygen and carbon dioxide) of the air they inhale and exhale. At the peak of the exercise, we also draw a blood sample to measure the level of oxygen, carbon dioxide, and lactic acid. We may not be experimenting on Captain America, but it is an intense test regardless.


cardiopulmonary exercise test (image from BMJ journal)

By the way, lactic acid is a byproduct of “overstressed” metabolism. It is produced when there’s not enough oxygen supply to the contracting muscles, so the muscle switched from aerobic to anaerobic metabolism. The build up of lactic acid in the muscles is one of the cause of having pain in your muscles few hours or few days after a viogorous exercise. I hope I am not bringing back bad memories from your high school physiology teacher.

The exercise test is usually ended in several possible ways: a patient cannot exercise anymore due to exhaustion, or we have achieved the maximum target heart rate (which is: 220 minus patient’s age), or we have reached the end of the designed exercise protocol, or the patient developed an alarming symptom, like severe chest pain.

The information we gather in this test help us delineate what is the limiting factor causing the shortness of breath, whether it is a heart problem, a lung problem, a muscle problem, or plain deconditioning. Sometimes elite athletes undergo this test to gain data on how they can improve their performance. I’m sure Gatorade lab performs lots of this.

Perhaps the most common diagnosis we reach considering the group of patients we deal with, is deconditioning, or in simple term, being out of shape. Definitely this is a scientific way, albeit expensive, to say to a patient that he is too lazy or is too fat.

The duration of the CPET is mostly less than 15 minutes, and with our patient population, it rarely last more than 10 minutes. Not a big deal for me to supervise the test, as it is short and quick.

I was busy that day so I was not able to look beforehand at the chart of the patient whose CPET I would supervise. What I just know was the time I needed to show up in the lab, the name of the patient, and his age.

I knew that the patient was in his early 50’s, a couple of years older than me. Even before meeting the patient, I already have a diagnosis in mind, as I was expecting a middle-aged man who is overweight, maybe a couch potato, and perhaps cannot accept the fact that he is way out of shape, and instead blames something is wrong with him, thus we are doing this CPET. Since I have a few half-marathons under my belt, I thought I could show him how to “exercise.”

When I came to the lab, I met our patient who was already sitting on the stationary bike. He looked fairly trim, and to be honest, he looks younger than his age. I introduced myself and explained the test that we will administer.

To get some idea of his condition, I asked him about his symptoms. He told me that he felt this “disproportionate” shortness of breath when he is running.

Sensing that he is a “runner” like me, I asked if the shortness of breath happens early, or during the latter part of his run. He answered that he experienced this shortness of breath relatively “early” in his run. I asked him then to be more specific, like how many minutes after he started his run.

Then he said, “I have this ‘unusual’ shortness of breath after running 20 to 25 miles.”

What?! Who considers 25 miles as early? Most people are not short of breath, but may not be even breathing at that point!

That’s when I learned that he was an ultra-marathoner, and runs 50 to 100 miles or more when he competes. He said that after 25 miles of running, he usually catches his “second wind” and feels good the rest of the way through.

All my preconceived notion flew out the window. Life is never short of surprises. Another lesson learned. Never assume.

I just told the lab staff to commence the exercise, and brace for a long, long test.

Turkey Run

Here in the US, there are two occasions in a year, that people are strongly compelled to exercise. During these times there is a considerable spike in gym attendance. This is based at least in my observation and purely my opinion only.

The first one is during early January, when everybody is jumping on the band wagon for the New Year’s resolution to exercise, lose weight, and join the gym. However by the end of January, some if not most of them, have already fallen off the wagon.

The second occasion is right after Thanksgiving, when many are feeling guilty they over ate during the holiday. According to one study, an average American will gobble 3000 calories during Thanksgiving dinner. But with all the snacking throughout the day, it can easily amount to 4500 calories in that day alone.

Some will reason that they can burn all those calories when they go shopping on Black Friday. However, unless you go jumping rope while shopping or you’re hauling or carrying a piano, the amount of calories burned is not even close.

One exercise physiologist estimated that in order for a 160-pound person to burn 3000 calories, he has to walk 30 miles. Or if you want to burn them faster, you can run. For 4 hours!

So this weekend, I avoided the gym altogether since I know it will jam-packed. This morning, I decided to run outside instead.

The problem is during this season, in this part of the world, it is already pretty cold. In fact, we already had snow and freezing rain this past week. Today is no different, the temperature was subfreezing.

Good thing is that I have invested on nifty cold-weather running apparel that I can be warm and toasty even if the temperature is below freezing. So I layered up, summon the spirit of the Black Ninja runner  (see previous post), and ran.

I was a little chilly when I started but by the second mile, I was already feeling warm that I took off the hood from my head. By the third mile, I already unzipped my outer layer. I ended my run after 4 miles, and I was all sweaty and hot that I even took off my jacket, at least temporarily, as I was walking to cool down.

I checked on my smart phone, and the temperature was a nippy 29º F (-2º C).

I believe my run will partly burn off all the turkey I ate. Though I still have to burn all the kare-kare* and krema de fruta*, which were what I really feasted on during the Thanksgiving dinner.

Now I’m feeling hungry. Where’s the left over kare-kare?

(*traditional Filipino dishes)

Old Man Running

I ran the Des Moines half marathon (13.1 miles) this morning.

Compared to my previous runs (this is my 5th half marathon), this was my least prepared race. I usually start training around 3 months prior to the race. I gradually increase my run and by the time of the race, I should have at least run a 10-miler or more.

But due to interruptions in my training this year, like my unscheduled trip to the Philippines, my extra weekend calls, and other lame excuses, I never really had my training up to par. Though I don’t want to waste altogether the effort I placed on this for the past couple of months, so I still decided to participate anyway, and just have fun.

I never ran more than 7 miles this year. Well, until this morning.

While I was standing in the starting line among the throng of runners (it was estimated that there were about 10,000 participants – for the marathon, half marathon, and 5K), I saw a familiar face. It was one of the cardiothoracic surgeons whom I worked with in the hospital.

When I approached the surgeon, he told me that he was running the half-marathon as well. He asked me what pace I usually run, and I said to him that I’m just going to “go slow” this time, due to lack of preparedness. He then asked me if we can run together. Of course, I obliged.

I told him that I commend the fact that he as a heart surgeon, have the credibility to advise his patients that he performed cardiac bypass on, to live healthy and exercise, for he himself follows that advise. I wish we doctors will all practice what we preach.

So we ran together the whole 13.1 miles. As we ran, we shared stories of our lives and our families in between gasping breaths. It was my first time to run with somebody the entire race, and I enjoyed it. We even finished with a decent time: 2 hours and 35 minutes. Not bad. Not bad at all.

After crossing the finish line, and when I was walking back to my car, I suddenly felt my age. How many more years would I be doing this?


But did I tell you that the heart surgeon that I ran with was in his mid-60’s and has recently retired from his practice? He’s almost 20 years older than me but still in very good shape. I just wish I can still run when I’m his age.

Although honestly, he kept me going on that race. If I was running alone, I would have run more slowly, or even walked part of the course, or who knows even stopped and quit. But I was too embarrassed to slow down, given the fact that I was much younger than he was.

After getting home and getting some rest, I felt good except for some soreness in my legs and feet. I just moved “slowly” the rest of the day. Just like an old man.

Running the First Mile

Not too long ago, I saw a patient that was referred to me for pulmonary evaluation. The complaint was “shortness of breath.”

Me: What’s going on?

Patient: Doctor, I cannot run a mile. I ran out of air. And I use to run before.

He is in his 40’s and is on the heavy side. OK, overweight. I already reviewed his chest x-ray and pulmonary function test (it’s a stress test of sort for the lungs), and both were normal. My nurse has tested and recorded in the chart his pulse oxymetry (measure of oxygen saturation in the blood) at rest and on walking, and it too was normal. You see, I have all the information I needed even before I lay eyes on the patient.

Me: Do you have chest pains, wheezing, or cough?

Patient: No, no, and no.

Me: When was the last time you were able to ran a mile?

Patient: 25 years ago.

I almost fell off my chair!

You may snicker at him, but I took him seriously. I told him that I do not believe he has anything wrong with his lungs. Although I cannot rule out conclusively any other diseases, like heart conditions, but I am almost certain of the diagnosis.

I told him that his shortness of breath is from being overweight and deconditioning. In more simple terms, he is way out of shape.

I coaxed him that it’s not easy to run that first mile. But I reassured him that with more training and persistence, he should be able to run a mile, and more.

I will be riding a 50-mile bike course tomorrow, as part of the RAGBRAI (Register’s Annual Great Bike Ride Across Iowa). In three months it would be the annual Des Moines Marathon, which I hope I can participate again.

Even though I consider myself fit and have been exercising somewhat regularly, there are days that I struggle to run the first mile. What I am trying to say is, it is not always easy to run a mile. No, let me rephrase that. It is hard to run a mile.

Running a mile and beyond, is not like a faucet that you can turn off for a long time, and then when you turn it on, you expect it to be flowing freely again. No, it is more like a pump, that you need to prime first, before it flows again. Running or any other endeavor for that matter, takes time, training, and dedication.


For all of you out there, who are struggling to run a mile, don’t lose heart. Many times the hardest part of a long run is the first mile. But the good thing is, it can be done. And it must be done. For your health sake.

As a popular Chinese proverb says, ” A journey of a thousand miles, begins with a single step.” If I may add, that single step will eventually lead to the first mile.

(*photo from here)

Gym Watching

I admit it. I have been slacking!

I have not been to the gym regularly lately. Like in the month of January, I think I only went to the gym three times for the whole month. Well, it was bone-chillingly cold. I was jet-lagged from the Philippines’ trip. I was busy in my ICU rotation. The dog ate my alarm clock (we don’t even have a dog). Black Ninjas barricaded the gym……

No more excuses!

In reality I miss going to the gym, not just for the health reasons, but for the amusement as well. Because I am a gym watcher.

My first gym experience was right after I finished my undergrad course in Manila. I asked my father if I can use the refunded laboratory fee deposit of 400 pesos from my tuition, to sign up to a gym for the summer. I then enrolled in a gym located somewhere in Quezon Avenue.

On my first day, I was intimidated by the hunky muscular guys and athletic-looking gals working out in the gym. I was a measly 115-pound in a 5′ 8″ frame person. I was a wimpy kid! In fact, I spent more time in the gym that day, sitting in a corner, watching people.

Fast forward to today (25 years later), I may have gained 40 more pounds of muscles (and bilbil) and I may be more adept now in using the gym’s equipment and machines, but that has not stopped me still from watching people in all sort of shapes and sizes, and the different personalities and their idiosyncracies.

Here are some of the personalities I have observed over the years. Though they are real people, they may not be just one person, as in every gym there is a similar version or so, of them.

1. The gym rat. She goes to every exercise machine, from the treadmill, to the stationary bike, to the elliptical machine. She looks emaciated, like she just got out of the concentration camp. I guess she doesn’t know when to stop. She doesn’t look healthy at all. Just like everything else, even if it something good (like exercise) if it is done in excess, it is not good.

2. The chicken-legs guy. He has big burly shoulders. Heaving chest and pectorals. Hulking biceps and triceps. But thin legs. Chicken legs! I think he forgot that he needs to exercise his legs too. Legs are important you know. They hold you up against gravity.

3. The perfect make-up gal. It is 5:30 in the morning and she looks perfect with her full make-up on. Going where? To the gym! To sweat! I think appearance is so important to her. Aside from exercising, she also socialize, as she seems to know and greet everyone in the gym. Maybe she’s running for a popularity contest.

4. The slob. Almost opposite of #3. He looks like he just rolled out of bed, with his bed hair and clothes that he seems to have worn to sleep. The shirt is an old tattered college shirt with a visible food stain. Maybe he really slept in the gym. Maybe he really don’t care what his appearance is. Maybe I should cut him some slack. What is important is that he gets his exercise.

5. The grunter. He grunts when he stretches. He grunts when he runs. He grunts when he lifts weights. And not just silent grunts, it is a guttural noise that you can hear across the gym. It is as if calling attention to all, how fast he is running or how much weight he is bench pressing. It is kind of uncomfortable to be near him. Sometimes the grunting sounds he makes is as if he’s choking and I wonder if I need to jump behind him and do the Heimlich maneuver.

6. The hog. When he uses a machine, he hogs the equipment and does not let others  use it in between his 21 reps (or that’s how long it seems!). He will definitely make your gym time longer. Make sure you get ahead of him or you’ll wait till kingdom come. He doesn’t know how to share.

7. The silent observer. He seems to be minding his own business yet he is keenly observing all the people around him. He is not a stalker, but beware of him. He will write about you in his blog.

Muscles and Luxury Cars

I have read in the news that the number one New Year’s Resolution in the US, is to lose weight. In fact, it was the most popular resolution every year for more than a decade now. So it is not surprising that the attendance in a fitness club is the highest during the month of January. However, according to one article, by April, there is already an average of 20-30% dropout rate for those who started their membership in January. Really? It takes them 3 months to quit? I was expecting it to be shorter.

If you are a member of a health club, you are among the millions of people who do. I hope you are not one of those who will drop out by April. According to the International Health, Racquet and Sportsclub Association, the membership to a gym reached an all-time high of 50.2 million last year. So fitness clubs, sportsclub and racquet clubs are such a lucrative racket. Sorry for the pun, it was intended.

According to that article also, different states in the US have different participation rates. I find it interesting to learn that Iowa was ranked 24th, with health-club participation rate of 14.8%.  That was better than I thought actually. I was expecting it to be worse, with the high percentage of obesity here. We are not the number one producer of pork chop for nothing, you know. Massachusetts was the number one gym-friendly state with 25.1% consumers.

As I pulled up in our local YMCA parking lot this morning, I have one observation that has been consistent over the 10 years and more, that I have been a member of a fitness club. I have observed that there is a higher proportion of expensive vehicles or luxury cars and SUVs in a gym’s parking lot compared to other parking lot, like the hospital’s, or the mall’s, or Wal-Mart’s. Lots of BMW, Mercedes, Cadillac and Porsche. (No Batmobile though.) Do you know why?

this Wal-Mart parking lot is an exception

The first possible answer is that, with cost of fitness club membership, that is about $30-$60/month for general purpose gym, to about $50-$200/month to a Spa/Country Club/Racquet Club gyms, that attendance to this clubs are skewed to the more wealthy portion of the population. And therefore these rich people also own those luxury cars in the parking lot. Or maybe the club’s owner owns all those expensive vehicles, and just parks them outside the gym.

The second possible answer is that people who join these health clubs are people, who are very particular on their outward appearance, thus they go to the gym to look trim, hunky and sexy. These people also have the propensity to choose luxury vehicles to project their classy image. I tell you, people can be vain. Or maybe they just feel good about themselves. But hey, it’s a free country, they can do whatever they please.

The last possible answer I can think of, is that maybe, people who go to the gym are more driven individuals, who strives to be in their best, including their health, and thereby they exercise routinely. These motivated individuals, are also likely to be more successful, and thus the more luxury cars in the gym’s parking lot. In fact, there are several studies linking regular exercise and business success.

Whatever the real reason behind the link between toned muscles and luxury cars, I am really not sure. But maybe you can join the gym too and find out for yourself. Or perhaps you are already one of those driving a hot, exotic car.

(*image of Batmobile from here)

Burning the Turkey

Despite of what the title might suggest, this article is not about cooking. Let’s make it clear – I don’t do the cooking. I leave that to my wife. For if I do, that’s exactly what I will do: “burn” the turkey.

This morning, I went to the gym and found that it was jam-packed. All the treadmills and exercise machines were occupied. Even the open floor for stretching was full of people. What’s happening? Since I am a regular to this gym, I knew this was not an ordinary phenomenon.

Then I realized, it was the first day after the Thanksgiving weekend. That was it! People perhaps felt guilty of all the feasting they did and stuffing themselves with food (so it was not just the turkey that was stuffed!) during the holiday and now they are trying to “burn the turkey.”

I read in one article that according to the University of Michigan Health System, an average American devours 3000 calories during the Thanksgiving meal or dinner. Screaming turkeys! That much for one dinner? And since most of us also do a lot of snacking throughout the day, it will amount to about 4500 calories consumed for the whole Thanksgiving day. That is more than twice the recommended caloric allowance for a day. And considering that some people gobble ( gobble? yes, pun intended) that much calories whether it is Thanksgiving or not, no wonder we have an obesity epidemic.

But you may argue that you could have burned all those calories perhaps when you did your Black Friday shopping. Yes, you might have walked, ran, pushed, pulled, shoved, lift, and even jumped to get the best deals on the biggest day of shopping. That will certainly burn some of the calories you chomped, but it is not enough. Not even close.

An exercise physiologist from the American Council of Exercise stated that in order to burn the 3000 calories, an average 160-pound person need to walk 30 miles. Holy turkey smokes! That’s more than the distance of a full marathon! Well, if you want to burn much faster, you can run, right? Then you need to run at a moderate pace for 4 hours. And if swimming is your thing, you need to swim for 5 hours to burn that 3000 calories you packed from the Thanksgiving dinner alone.

After the holiday, we perhaps still have a lot of leftovers that we are trying to consume, even if it is in excess of what we really need. I know it is very hard to have good food go to waste, especially in some cultures. Coming from the Philippines, where food can be scarce for some families, it is inculcated in us by our elders, that it is almost like a heinous crime to throw away food. But you know what, in some instances, it may be better to have the excess food to be in the garbage, than the “garbage” to be a part of your belly fat, where it will stay there for a long, long time.

Now that you are enlightened, put down the turkey and start walking. The whole 30 miles of it.

(*image from here)

Debunking Folks’ Medical Advice: Part 1

I have received and heard a lot of medical advices from my folks when I was growing up. And now that I have the title MD behind my name, I would like to weigh-in on some of those counsels. It is not my intention to be disrespectful to our elders, I would just like to examine if there is really medical truth on these ‘sage’ advices.

1. Huwag maligo kaagad kung galing sa trabaho o ehersisyo, at baka ikaw ay mapasma.

Don’t take a bath right after working or exercising, for it may cause “pasma” (sorry, no accurate English word for it, though the closest is “spasm”).

There is no medical truth to this. In fact most athletes take a shower after a strenous work-out. After working or exercising, your body heat production is high. This causes your blood vessels to dilate to dispense the heat, which make you look flushed, and your veins more visible. And I think the advice stems from the thought that bringing the body temperature drastically with a bath is harmful. But no studies have shown to support this.

It is then thought that a warm shower after a work-out is acceptable and probably will relax the muscles. But there has also been a practice by few elite athletes of taking an ice bath after an intense activity. The thinking is that the cold water will reduce the production of lactic acid (by-product of anaerobic muscle metabolism) and reduce muscle pain. Several studies published in sports medicine journal however have not shown benefits of the ice bath, but it has not shown ill effects also.

So with our current knowledge, taking a bath after work or exercise is not deemed harmful. For me it is more harmful not to take a shower, not to you, but to the health of others who have to smell and be suffocated by your body odor.


2.  Huwag maglaro o magtrabaho pagkatapos kumain, at baka ikaw ay ma-appendicitis.

Don’t work or play right after eating, because you might have appendicitis.

Appendix is a blind-ended tube connected in your cecum (part of large intestines). Appendicitis is inflammation of this organ when it is blocked by a fecalith. What  is triggering the blockage and subsequent inflammation is not very clear. However, it is definitely not by any activity right after a meal.

When we eat a meal, it takes 4-6 hours before our food leaves our stomach. Then the partially digested food particles will travel through more than 20 feet of small intestines, where most of it will be absorb. Whatever is left undigested will make it to the large intestines. So the food you eat now (or whatever is left of it), will probably arrive at the vicinity of the appendix by tomorrow. Not right after eating. You may feel sluggish though, especially after a large meal, as most of your blood circulation pools to your digestive system. So it may not be the best time to do your work-out also.

The bigger question is why do we have the appendix and what is the use of it. Nobody knows for sure, though some experts believe it contributes to the immune system. A research a few years back suggests that the appendix is a “safe house” for the good bacteria in the gut. If you ask my friends from surgery, they will tell you, that it is there for them to operate on.


3. Huwag kumain ng manok, o ng pakwan, kapag may malaking sugat. Ang mga pagkaing ito ay malansa at baka hindi gumaling ang iyong sugat.

Don’t eat chicken or watermelon if you have a large wound. Those foods are “malansa” (sorry again for no exact English translation, though “fishy” is close, but in this context, “dirty” is more appropriate), and your wound might not heal well.

Wound healing is dependent on many factors, like adequate blood perfusion to the site, nutrition, absence or presence of infection and others, like proper wound care.

Chicken is a source of protein, which is needed as building blocks for growth and wound healing. As long as it is properly prepared and cooked, I don’t see any reason that it will hinder wound healing. Watermelon on the other hand is rich in vitamins and anti-oxidants which are vital not just for wound healing but for overall nutrition as well.

So go ahead and gorge on watermelons, even if you have an open wound. Unless your open wound is in the stomach or GI tract, then it’s a whole different discussion altogether.

4. Matulog nang maaga para mas lumaki ka.

Sleep early so you will grow more.

The science of growth is very complicated. The growth process depends on the intricate interplay of genetics, hormones, nutrition, exercise, and possibly sleep. One hormone that affects growth is the growth hormone, which is secreted by the pituitary gland. This is released throughout the day, but studies showed that in children, it is released more intensely during stages of deep sleep.

While adults needs 7-8 hours of sleep a day, children needs more than this. Kindergarten or younger kids, need 10-12.5 hours of sleep a day, and older elementary kids need 9.5-11.5 hours of sleep. Inadequate sleep can cause growth problems, including slowed or stunted growth. Recent studies also showed inadequate sleep to be related to obesity.

If you are an adult and is way beyond the growth period, I don’t think sleeping more than 12 hours a day will add any more inches to your current height, and may just earn you a label of being lazy. However, if you are really requiring more than 12 hours of sleep a day and still sleepy, it’s time to seek medical advice.

So does sending your kids early to bed make them grow more? Yes, even with my board certification in Sleep Medicine, I have to admit that my mother was right.

Do you know of other folks’ medical advice? Let us investigate them if there’s scientific truth behind them. However, I know knowledge is power, but only if we show repect that we gain wisdom.