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The Informed Parent

When Is Too Much, Too Much?

by Louis P. Theriot, M.D., F.A.A.P.
Published on Dec. 31, 2001

Tara is a 15-year-old sophomore student in a local high school who is very motivated and a real “go-getter.” She is a straight A student, class vice-president, is involved in a number of school service clubs, plays club soccer and is one of the best runners on her high school cross-country team.

Her sophomore year started off just fine. The cross-country team was doing great as was Tara, who was turning out “personal best” times almost every time she ran. By mid-October she had taken a full 90 seconds off her best time from last year. It didn’t come easy, however, because the team started training back in May...just one week after track season ended. Tara worked extremely hard for her number two position on the team, training all through the summer and fall.

Club soccer started up shortly after the cross-country season got into full gear. That now meant two night practices a week after a full cross-country workout or meet. As a result, it also meant that homework didn’t get started until 9 PM on those nights and would extend into the wee hours of the morning. Undaunted, Tara pressed on, put “her nose to the grindstone,” and worked even harder. But by early November, when the cross-country season was coming to an end, Tara’s times started to slowly increase. She just didn’t seem to have any kick or energy left over at the end of the race. Her mom would find her sound asleep with her head resting on an open book in the middle of doing her homework at 10 PM. She had become moody and irritable, almost withdrawn, which was totally out of character for Tara. It was discovered that Tara’s best friend had been diagnosed with infectious mononucleosis (mono), and that prompted a visit to my office.

Tara sat in the office wearing a sweatshirt and jeans and certainly wasn’t her cheerful or bubbly self. In fact, she seemed distant, almost indifferent about being in the office. Her mom did most of the talking and proceeded to tell me how Tara’s cross-country times had worsened, how she had no energy, that Tara had dark circles under her eyes and had become a real grouch. Not even when her mom all but accused Tara’s friend of giving her mono did Tara’s face change expressions; she just sat there motionless as her mom went on.

When she finished, I asked Tara how she was doing, how she felt, and what she thought was going on. I had a good rapport with her and she felt comfortable talking to me. On more than one occasion I had to motion to her mother to not “butt in” and just let Tara talk. I sensed that Tara appreciated this. After we talked at length, I told Tara that I wanted to examine her. She did not have a fever, her blood pressure was normal and her pulse was that of a trained athlete, 56 beats per minute. Her exam was completely normal and I paid particular attention to her thyroid gland and anything that would suggest mono. All was normal.

I told her that I could not find any clinical evidence of an illness or process that would be the cause of her fatigue, but I wanted to do some lab tests to be certain. In the office I did a hematocrit which showed that she was not anemic, a blood sugar that excluded low blood sugar or high blood sugar (diabetes), a mono test that was negative (and got her best friend off the hook), and a urinalysis that too, was normal. As we were going over these results, mom’s cell phone rang and she stepped out of the room to take her phone call. I spoke frankly to Tara about possible drug use, sexual activity or any stressors in her life that might be a factor in all of this. She vehemently denied any of this and I told her that I believed her but had to ask to be thorough. She understood this and was not offended.

When her mom returned I took out a legal pad and mapped out Tara’s daily schedule for an average week. From 6:30 in the morning until midnight, Tara did not have a free moment; she was constantly on the go. What came out of this discussion was Tara’s realization and admission that she truly didn’t enjoy soccer anymore. It had become work and not fun. In fact, she dreaded every time she had to go to practice but felt that everyone expected her to play and do well. She didn’t want to let them down, and least of all, she didn’t want to quit something that she started. As she was talking big tears pooled in her blue eyes, yet there was a sense of relief as if a big weight had been lifted from her shoulders.

I was relieved when her mom jumped in and said, “Thank God! I hate soccer myself. It cuts into whatever family time we could hope to have together, especially those awful weekend tournaments in who knows what city." Tara was surprised by her mom’s outburst and her tearful sadness was quickly replaced by an uncontrollable giggle. “I thought you wanted me to play soccer,” she asked her mom who rolled her eyes as if to say, “No way.”

It was clear that Tara had pushed herself beyond her limit. There was no medical cause for her fatigue and she certainly was not depressed. What was certain was that something had to give and it was soccer. This decision made a big difference in her life. By mid-November, when her team was in a close race to be league champs, Tara was back in peak form, tying her previous personal best time. Her mom called me to say that “the old Tara is back. It is so wonderful to see her so happy and doing so well.” She thanked me for “all that I did” and I assured her that I did nothing other than listen to Tara. All too often we get on a treadmill and become so involved and busy that we cannot see the forest for the trees. We lose all perspective and can’t see the big picture. It took someone who was removed from the situation, and not emotionally involved, to put it into proper perspective. It also takes someone such as Tara who could be honest with her feelings and not promulgate the situation by trying to continue to please “those people," whoever they are.

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