I Am Medication Free! For Now, Anyway……..

Right now I am medication free! No, I have not forsaken the wonders of modern medicine in any way shape or form, but in careful consultation with my rheumatologist I am taking nothing at the moment. How long this will be the case, I am unsure: we will reassess in February. If anything goes belly up, I’ll just make a phone call.

NEVER CHANGE YOUR MEDICATIONS WITHOUT YOUR DOCTOR’S APPROVAL.

Why is this happening? The medication I was on, my second inflammatory arthritis medication, was GREAT for the arthritis. However, it is considered not so great for my skin. This is my left arm a couple of days after the biopsies. This is the worst patch, always has been the problem area. Ignore the scar circled in black – that was the result of having a run-in, literally, with a broken fire extinguisher. The area circled in green is one of the biopsy sites.

Why is my suture not covered? Well, the steri strips started to come off, so I soaked them off. I can not use bandaids of any sort any more, my skin is so fragile – I remove them and the skin comes with them. Rather nasty, so I just don’t go there. It is bandages after bllod tests these days.

About two years ago we investigated my skin and it was then diagnosed as photosensitive eczema. It looked a little different back then. This November I have a completely different diagnosis. This does not mean the original diagnosis was incorrect – things change. In 2016 I was on different medications. Around the time of that first diagnosis I changed my arthritis medication and early this year (2018) I ceased taking medication for my hyperthyroid, having undergone radioactive iodine treatment. So a few changes in the two years.

My skin diagnosis now is atypical psoriasis, believed to be exacerbated (considerably) by my arthritis medication. My dermatologist discussed the matter with my rheumatologist and off the medication it is! I am starting UV B light therapy in the new year – can’t wait! I say atypical because it looks more like subacute cutaneous lupus erythematosus (SCLE) (per dermatologist) than psoriasis, but the biopsies, thankfully, told a different story.

My nails, which usually readers never see due to my passion for polish, look like this. Not all the time, it comes and goes, but the little fingers are particularly unhappy at the moment.

The next medication in line for me, agreed to by my dermatologist, rheumatologist and gastroenterologist, is methotrexate. By the time I saw my rheumatologist, I had been medication-free for a month and I don’t feel too bad at all. I asked about the possibility of seeing how I go without any medication. Other medical professionals are investigating some other symptoms I’m experiencing, some of my blood tests have been a bit erratic – it might be easier to isolate a cause if I’m medication free. That consideration aside, the less medication the better makes me happy. Methotrexate only takes four weeks to “kick in” and I’m certainly not going to be a martyr about it – if I feel I’m going downhill, I’ll be in my rheumatologist’s office very quick smart. I have backup medications in case I flare.

As I have to change medication anyway, it is an opportune time to try and see what happens. My arthritis related blood tests have improved considerably since late 2014 when I was diagnosed.

So how am I finding it? My feet have niggled at me a few times, both my knees are slightly grumpy at night if I walk too much during the day, the base of my thumbs hurt a little bit with certain grip actions (think holding my drink bottle to unscrew the top). If I have a really busy day I do stiffen up at night – but then that is not exactly new, I don’t think it has gotten worse – it is also more likely related to the degenerative changes in my lumbar spine than the arthritis. Other than that, I can’t complain. I swam 1,100 metres today, the first time I’ve managed a swim session over 1,000 metres for quite some time. I did 40 minutes strength training yesterday, my quad strength is actually improving. I did 9,000 steps (accidentally) on Thursday with no ill effects.

My biggest concern is my fatigue/lethargy may return. For me, that was a major problem. Settling the thyroid helped, of course. Now my bloods are indicating my parathyroid is not behaving – endocrinologist appointment in January to try to get to the bottom of that.

The BEST part is I can go out in the sun – sensibly, of course. I’ve spent two years avoiding any sunlight because of my skin, slathering sun cream from head to toe: slip, slop, slapping to within an inch of my life. Yes, I still have to be Sun Smart, but at least I can be normally Sun Smart now instead of paranoid! I also feel better psychologically: I felt as if I was a constant Seasonal Affective Disorder patient.

I don’t know if I will stay free of medication for the arthritis. I see this as an experiment. I do seem to be susceptible to the side effects of medications so if I can stay as healthy as I am now, I’ll be happy. Any deterioration, I’ll be in my rheumatologist’s office. It takes a while for the drug to wash out of one’s system, so I won’t really know for three months – I’m only a third of the way through.

I am very grateful to my specialists for allowing me to try this. It would not be an ideal option for a lot of patients, I know. I am certainly not recommending what I am doing and would definitely NOT be doing it without having discussed all the pros and cons with my guardian angel doctors. I am monitoring myself carefully.

The physical fitness and strength I’ve slowly spent four years building back up has certainly helped me manage my condition so far, but no, there is no guarantee by itself it is enough.

We shall see – wish me luck!

Magpie

Exercising in Summer When You Are Heat Sensitive

Many of us with chronic conditions are in the unfortunate situation of needing exercise yet at the same time, we are heat sensitive (sensitive is an understatement in my view, but it is what it is). Exercise makes us hot – or at least warmer than normal, depending on the intensity of our routines. How can we get through summer and keep up our exercise regime? We need to keep pain and stiffness away!

For those of us not native to Australian heat, it may be even more challenging. Well before I got sick, way back in 1974, I arrived in Melbourne on a February day. 38 degrees Celsius. Up until that point in my life, 23 degrees was a warm day! I thought I’d landed in Hades! I had a girlfriend living in Adelaide at the time whom I visited. If my memory serves, over there it was 43 degrees. I remember lying on her kitchen tiles to try to keep cool.

Earlier today I saw the magpie above, pictured here keeping cool under the protection of the leaves, with beak open and wings lifted from his body to maximise heat loss. I missed that image, but was pleased to see him looking cooler.

Over the years I had somewhat acclimatised, until I got sick. For many of us, heat intolerance/sensitivity is entirely new, so how best to cope?

Ensure Your Gym is Properly Cooled

This gives you some flexibility with staying active. Today, I will be walking inside, not outside. Treadmills are not my preference, I much prefer walking outside, but I found even walking at 6 pm last night uncomfortable and we are nowhere near summer yet.

Allow yourself to cool down before you venture outside.

Swim

If you can, swimming is a great exercise and the environment is cool. Getting to and from the pool may not be so cool, but with good air con in the car and a close car park most of us should manage.

If you have never learnt to swim, think about lessons. In addition to the physical benefits, swimming has been shown to have mental health benefits, so important to those of us managing chronic illness.

You may need to invest in a rashie for adequate UV protection depending on the time of day you prefer to swim.

Hydrate!

I wrote Hydration Habits – Are You Drinking Enough? recently, so I refer you to that article for the detail. Make sure you hydrate before, during and after exercise.

Cool Your Skin During Exercise

I have lesions on my left arm, the result of medication-related photosensitivity, which become bright red when I exercise. I run my arm under cold water between sets. A wet towel on your face, chest or back can help. Some gyms have large fans facing the cardio equipment – turn them on.

Change Your Routine

In Victoria we are into daylight savings time. Use it to your advantage. The UV danger window has shifted an hour and the evenings are lighter. Check the UV ratings every day, work around it. If walking outside, walk later when it is cooler, or earlier if you are an early riser. Early is not an option for many with chronic conditions as our energy levels seem quite depleted most mornings.

Hydrotherapy Pool

If you have access to a hydrotherapy pool, this can be an alternative to strength workouts in the gym. I find the water temperature a little warm for me personally, but I still do exercises in it. A quick dip in the normal pool to cool off before the trip home is a sensible move, or a cool shower.

Wear Light, Loose Clothing

I’m a minimal clothing person in summer, I always have been. The concept of long-sleeve shirts, rashies in the pool, sunnies and hats was never my style. Now I own long-sleeved shirts of 50+ protection fabric. Of course, while this helps my photosensitivity, it doesn’t help my heat sensitivity as much! Learn to juggle the clothing style, time of exercise and type of exercise that best suits your personality. Why is your personality important? Because we are all more likely to do something we are enjoying. If we HAVE to wear a hat and we hate hats, we will be less likely to go for that walk. Better to change the time so we don’t need the hat.

Summary

It is getting warmer now, so now is the time to experiment and plan for the warmer times coming. Know what you will do on really hot days, so when they arrive you are prepared. Know what temperature is your definite “Don’t leave the house” temperature. What will you do those days, to keep yourself moving? Double your stretches, maybe. Use thera-bands. Do body-weight squats and push-ups at home. Leg lifts with ankle weights. There are options. These ankle weights of mine have 4 x 575 gram removable weights, so super adjustable for home use.

 

If you are in a pacing UP phase, the UP may need to be put on hold on really hot days – it just may not be sensible to have that level of exertion. That’s OK, just keep moving.

When all else fails – get a manicure! At least the salon will be cool.

Manicure

 

Tiger Pacing

Pacing THRU, Pacing UP, Pacing DOWN

Pacing is very important in the management of chronic conditions, including chronic pain management.

A year ago today I wrote Pacing for Beginners, an article that essentially talked about pacing UP, In other articles, such as Beat the Boom Bust Cycle, I have referred to pacing, in the context of pacing THRU. What’s the difference? Isn’t pacing, pacing? Well, not really.

We need to understand the difference so we don’t get stuck doing one, when in fact the other or both may be more beneficial for our long-term condition management. We risk pacing DOWN.

Pacing THRU

Many chronic condition patients suffer fatigue. The degree will vary from day to day, the severity will be different for each patient. Natalie van Scheltinga has a very good description in Fatigue In Chronic Illness Explained, using “The Battery Analogy”. Some people find this analogy works better for their situation that the oft-cited Spoon Theory. Both are good illustrations of how the fatigue can affect one’s daily life.

We are all different. Both these images below are daisies, yet one has WAY more petals than the other. Think of each petal as a unit of energy. We could make this really complex and compare the size of each unit of energy, but let’s not delve that deeply today. Most chronic illness patients have a certain number of petals they can use per day. Increasing the number of petals, if possible, is a good thing.

White Daisy

Pacing THRU is about getting through the day with the energy we have. Yes, we DO have to be careful not to go overboard. Even now, as healthy as I now am, I am still technically “sick”. I know that a two hour commute to work would not be something I could do on a regular basis. On the days I do my strength workouts, the strength workout is the only major “task” I do that day. I am playing around with my routine currently, more on that later.

Pacing UP

Pacing up is used in clinical pain management settings. It is, of course, also used in sports, personal training and a host of other activities. I paced UP, over a four year period, from 5-minute walks several times a day to whole body strength work-outs and swimming. No-one runs a marathon without building up to it.

Pacing UP is not just about being able to walk further than yesterday or regaining the ability to sweep the floor. It is also about energy levels. As we improve our physical endurance and strength and reduce or eliminate our pain, we sleep better, energy levels improve, functionality improves. Our overall quality of life improves.

It should be noted pacing UP does not always involve movement. For example, if sitting causes pain, pacing UP may be used to extend the body’s tolerance to sitting. For the purpose of this discussion today, I am referring to movement.

Pacing DOWN

If we only pace THRU and don’t have a strategy in place to pace UP, we run the risk of pacing DOWN. When we pace DOWN we run all the de-conditioning risks I repeat regularly (some may say I repeat ad nauseam). We will get sicker, likely experience more pain, lose more functionality.

de-conditioning

Our quality of life will deteriorate, we risk losing our independence, our freedom and possibly our financial stability. Pacing DOWN is not good. As with pacing UP, pacing DOWN happens gradually. We may not even really notice it: until the day we realise we can’t do something we used to be able to do easily or we notice our pain has increased. Yes, for some this will be because of disease progression – for many others it will be the result of inadvertently pacing DOWN.

We are a little delicate, like the dandelion seed head. Remember as children blowing them? It doesn’t take a lot to blow us away either. Yet we are also stronger than we realise. Bring that strength to the fore, use it.

Dandelion

Pacing THRU and UP

It is a recipe. A lot of THRU and a little bit of UP to start. Mix gently and simmer over a low heat.

Most chronic illness patients will need to do both. Initially, more THRU than UP. The plan should be to reach a point where UP become easier and THRU becomes less of a concern. DOWN? Avoided totally.

Practical example from my own experience. For some time my routine has been two strength workouts a week, one  swimming session and daily walking. I’ve been pacing UP within those sessions; increasing weights, increasing swim set metres. This is where balancing UP and THRU comes into play. I have a target number of steps for the day, at the moment 7,500. When I am in the gym, I still clock up steps. When I am in the pool, I don’t, even though 1,000 metres is considered roughly 4,000 steps. So, if I were to increase my total swim use of energy, should I still aim for my 7,500 steps? I’d have paced UP my swimming, but I would NOT have paced THRU my day and run the risk of draining myself and paying for it the next day. Then I would possibly actually drop my activity level the following day, which is not to my long-term benefit. Sure, one day here or there is not a massive issue, but if a pattern develops, it becomes a problem as it can lead to pacing DOWN. Yes, my ultimate aim is to have both: increased swimming distance AND my steps target. I have to balance getting there.

The appropriate balance needs to be carefully planned out for each person, depending on their particular situation, conditions and degree of condition progression. Sometimes we can feel discouraged. Giving up, giving in, is not an option.

SMART Goal Setting

It is important to set goals to measure progress when pacing UP. Please click through to Make 2018 YOUR Year for SMART Goals, where I outline how and when to use goal setting to assist you. I know 2018 is drawing to a close, but the strategy remains the same!

I am looking at new goals for myself for 2019. That’s why I am playing around with my routine. When I moved from one strength session a week to two a week, I needed to be careful to not overdo any particular day. I increased my total for the week, but each individual session is less that my original single weekly session. If I increase my swimming, how much do I adjust my step target on those days? What will work for my body? So I’m trialing options at the moment. I’ve reached a stage of improvement where I can do that.

This article is of a general nature and does not constitute specific exercise advice for any individual person. For patients with particularly complex or advanced conditions, this may not be appropriate. If in doubt, seek professional guidance.

Contact me for a confidential chat as a starting point to pacing UP.

Main image “Pacing Tiger” Heather Ruth Rose/Shutterstock.com

Further Reading:

4 Resilient Ways to Cope With Chronic Pain – Huffington Post

Doctors and Exercise – Limberation.com

posture

Is Your Posture Exacerbating Your Pain?

What exactly IS posture? When I was a young girl we were taught “shoulders back, tummy in” and a lady NEVER looked down when descending stairs. We learnt to walk with a book on our heads. I am sure many of you remember similar lessons.

Good, or ideal, posture is when there is a state of muscular and skeletal balance which protects the body against injury AND/OR the progressive development of irregularities. More on that in a bit.

Faulty posture is when we sit or stand or move in such a way that we create a faulty relationship between various parts of our body, primarily musculature, which places undue/increased strain on some muscles and not enough effort is required of other muscles. This leads to imbalances: some muscles become weak, others may become tight. Some may become stretched, others shortened over time. Pressure can be applied to other soft tissues causing additional pain or discomfort or restricting function.

What all this can lead to is a worsening, or progression, of any musculoskeletal issues we may be having. As regular readers will be aware, I have several back issues, the reason I converted to kyBoot shoes in the first place.

It may not be chronic conditions that cause faulty posture. It may be chronic habits! The most common such chronic habit is sitting at a desk all day. Office workers can develop upper crossed syndrome (UCS). The person may end up with permanent forward head, increased cervical lordosis, rounded shoulders and thoracic kyphosis. This all involves tight/shortened upper trapezius and levator scapulae and six other muscles in the region. Seven muscles, including serratus anterior, rhomboids and lower trapezius all weaken. Not sounding good is it?

How are you standing?

Injuries that may result include headaches, bicep tendonitis and impingement of the rotator cuff. Chronic habits can lead to chronic conditions! It worth noting the rotator cuff is actually made up of four different muscles: infraspinatus, subscapularis, teres minor and supraspinatus.

What we tend to do is adjust how we sit, stand or move to relieve a discomfort or pain we may be feeling. This is called guarding. While this is certainly logical in cases of acute injuries, for example, if we have broken an ankle, in situations of chronic conditions like my back, guarding may not be so helpful at all over the long term as it can reduce the muscles’ ability to support the very structures you need those muscles to be strong enough to support. The muscles of the core and posterior chain support the spine for example, but if I don’t stand, sit and move correctly, over time those muscles will not function as well and the back pain I will experience will get worse. I know – I’ve been through it!

Personal trainers, fitness coaches, allied health professionals such as physiotherapists and osteopaths can all assess posture. A fitness professional may refer a client to an allied health professional for additional assistance if deemed necessary, or may prescribe specific exercises or exercise technique adjustments to help strengthen weakened muscles and improve posture.

What, as an individual can YOU do to help yourself when the professionals are not around to monitor your posture? Learn to be your own monitor. Make sure you know what good posture not only looks like, but what it FEELS like. I have a very good eye for detecting postural abnormalities in other people, yet I have had to focus really hard on detecting the same in myself. I know where my ankles should be in relation to my hips, where my ears should be in relation to my shoulders, where my shoulders should be in relation to my hips. But I can’t always see myself and we slip into old habits easily.

Habits are hard to break. We do a lot of life on auto-pilot: drive the same route home each day, walk to the train station without thinking about it. Our posture is also often a habit. We have to work hard at developing a new habit.

Knowing it and doing it can be two different things. When out walking, I will monitor my reflection in shop windows for example. I had, over the years, developed some degree of kyphosis and rounded shoulders (I was a desk jockey for so many years). As a result of the back issues I have, I had also developed a tendency to lean slightly forward. These aspects of poor posture are easily detected in a reflection. I consciously correct myself.

What if I am in the park and there are no shop windows? If I apply mindfulness to my body I can feel myself not standing tall, I know I do not have a neutral spine because I am leaning forward. I make the effort to correct my posture.

Fair warning: when you start doing this, it is actually tiring. The muscles have become weak over time and it does require physical effort to hold yourself in the correct position and keep walking. Just as those muscles became weak over time, they WILL regain strength over time if you persevere.

Yes, you may feel a twinge of pain as well as you straighten up – yet that passes and you actually think, “Gee, that DOES feel better!” A caveat on that – you may need to do strengthening and corrective work before you get to that point, depending on your current situation.

While a fitness professional or allied health professional may have prescribed daily exercises and these certainly will help, being conscious of your posture throughout the day will see results achieved faster.

This is not to say I never have back problems any more. I have degenerative structural changes in my lumbar spine. If I have a day where I completely overdo things, or do something I shouldn’t (such as sit for too long), yes, I will still end up stiff and possibly sore. With the right stretches, some walking and maintaining my strength workouts I now bounce back quickly without any need for pain medications. My kyBoot shoes have been a major component of my personal tool kit over the past twelve months.

I highly recommend consulting with a professional who can assess posture and prescribe exercises that will focus on the problem areas. Increasing or maintaining functional movement needs a long-term comprehensive program including footwear, stretching, appropriately targeted exercises (including strength work) and constant awareness to prevent lapsing into old habits.

For desk jockeys sit-stand desks are great, but be aware research is indicating neither sitting NOR standing all day are good for our bodies, there are health risks in both situations. Movement is the best medicine. I have a sit-stand desk in the office and I am also lucky in that I walk around a large campus quite a bit. Between alternating sitting and standing, and the walking, I move a lot during an office day. Not nearly as much as a nurse or a policeman on foot patrol, but more than many desk bound people.

Ensure you transition between sitting and standing with correct ergonomic positioning of your desk (and chair). If in doubt, ask your Occupational Health & Safety team for advice. The University of Western Australia has good reference material too, including a page on sit-stand desks.

This is an edited article originally published on the kyBun website.

Images used under license from Shutterstock.com

chronic conditions care courage consistency coaching

Care, Consistency, Courage and Coaching

Chronic Conditions

Care, consistency, courage and coaching are my “4 Cs” of chronic condition management.

Care

There are different types of care. Top of the list is great medical care. You must have a good relationship with your primary care provider (general practitioner, GP). I’m not suggesting you be family friends who go out for dinner (that could be difficult) but you should feel comfortable that your GP “gets” you and that you trust their level of care. This is the medical professional on your team that herds the cats (your specialists) and keeps the information flowing, in a sense the gate-keeper.

Self-care is extremely important. Self-care isn’t all bubble baths and scented candles, although those are nice. Self-care includes doing the things you MUST do to maximise your health, minimise your pain. Making the time to do stretches, walk, swim, lift weights, sleep, eat well: “doing the hard yards” as my father would say. Yes, the other sort of self-care, the time-out, rest, relax: also very important.

Mental health care is extremely important. As I have written about that in “We Need Mental Health as well as Physical Health, I won’t say more here. Reducing stress is part of mental health care.

Being careful is also a form of care. One example I have written about before is changing exercises where necessary. My own example is I no longer do dumbbell chest press because getting off the bench irritates my spine.

Being careful with our body weight is important – for many, weight gain can mean increased pain levels.

breakfast
Breakfast

Consistency

Consistency is paramount. When we were healthy, our bodies could recover from a week or two of no exercise, a night on the booze or day of crap food. Sure, we may have suffered a hangover or the scales may have jumped a kilogram, but we easily recovered from the damage.

Once we have a chronic condition/illness/disease not only are our bodies not as resilient, we are likely on medications that, while doing very good things for us, may also compromise other aspects of our “internal workings”. My own example is my rheumatoid arthritis (RA) medication suppresses my immune system – logical when you think about it, of course, given RA is an autoimmune condition, my own immune system attacking me. This means I have to be super careful not to catch bugs/viruses, as I recently did. I ended up in ED with what felt like a ping-pong ball in my throat.

Exercise, such as stretching and resistance training, will stop your body deconditioning and greatly assist with pain management. However, the gains we make can be lost VERY quickly once our bodies are unwell. Consistency is vital to ensure we maintain our gains and keep building on our achievements. I have discussed exercise in more detail in Doctors and Exercise, so please click that link for a more comprehensive presentation about the importance of exercise.

de-conditioning

During a consultation with my endocrinologist he asked, “Do you take your meds?” Frankly, I was shocked – what a strange thing to ask, I thought, of course I take my medications! He asked because my thyroid was misbehaving again and my blood tests were not within the reference range – again. Clearly some patients don’t take their medications as prescribed.

Most medications for chronic conditions require consistency to be effective. If you feel the dose or the medication isn’t working as it should, TALK TO THE SPECIALIST before changing anything. You may do more harm than good. If the problem is remembering, set alarms in your phone. Some medications can take three or more months to reach the required level of effectiveness.

Be consistent. With medications, exercise, diet, rest, sleep, hydration.

consistent exercise
Consistent daily steps

Even if you have to dance to get there!

Courage

Yes, courage. It takes courage to start AND to keep up the fight. “The cave you fear to enter holds the treasure you seek”. The treasure is maintaining quality of life for as long as possible. For some, the cave is MOVEMENT! It can be hard to think about movement when we are in pain. Or we feel we can’t “keep up” in the gym. Today is my swimming day. The predicted high is 13 Celsius. Do I REALLY want to get into my bathers and hit the pool, or would I prefer chocolate cake and a nip of Bailey’s Irish Cream? Consistency! Courage! Just do it!

leg press

The benefits are worth it. I have avoided a knee replacement and radiofrequency denervation of the lumber spine. Yes, I MAY need both some time in the future (distant future, I hope) but for the moment, I’m good. I’m on no pain medications.

Four years ago I started with four x 5 minute walks a day.

Now a gym session looks like this:

  • 4 sets leg press
  • 3 sets chest press
  • 3 sets shoulder press
  • 1 set body weight squats
  • 3 sets Smith Machine squats
  • 3 sets tricep extensions
  • 3 sets bicep curls
  • 3 sets lat pulldowns
  • 3 sets leg extensions
  • 3 sets pec dec
  • 8 minutes on the rowing machine

I got VERY annoyed recently when I lost muscle strength and had to drop my leg press weight down from 160 kgs. While we still don’t have a medical explanation, I am building back up again, so perhaps it was just a temporary glitch. We have temporary glitches.

I didn’t get to where I am now without care, consistency and courage.

Coaching

Professional athletes all have coaches. They have goals. WE also have goals (hopefully SMART goals)!

Perhaps we need to look at ourselves as endurance QOLs –  Quality of Life is the goal we strive for, not necessarily running 3,100 kilometres in 45 days! Our mental challenge can be just as extreme, even if our physical achievements are not. 8 Steps to Retain/Regain Quality of Life

People are all different, conditions vary greatly. Even so, the sooner you start managing your condition instead of your condition managing you, the better your chances of retaining your quality of life for as long as possible.

Sometimes all that is needed is help to get started. Sometimes a patient may prefer longer term support and encouragement.

Coaching helps the chronic condition patient take control. There is a fifth “C” – Control!

Too often patients feel they are “OK for the moment, I’ll worry about all this later” (when my job is not so stressful/the kids are older/the house is paid off). My advice is don’t wait. Start now to protect your future.

Contact me for a confidential chat as a starting point.

Note this article is intended for chronic condition patients who have a medical clearance or medical advice to exercise. This can be at any level from beginner.

Hydration Habits – Are You Drinking Enough?

Yes, the dreaded word – HYDRATION. Are you monitoring your fluid intake? Is it enough?

I, as an exercise professional, should have this down pat. Of course I drink two litres of water every day! Or do I? See if any of this rings true for you.

Yesterday I had a few minor disruptions to my day. Who doesn’t have disruptions? Driving home from the vet with my cat (THAT is a WHOLE other story!), I realised all I had drunk all day was three cups of coffee. One with breakfast, one after my manicure and one with lunch. It was now 6:30 pm. So I had drunk no more than 660 mls of white coffee. I’d had yoghurt on my breakfast, not even milk! I had thrown down the morning medications with some water, but what was that? 100 mls max?

As we get older there is an added problem – we tend not to recognise we are thirsty. Even before that stage of life hits us, we can think we are hungry when we are actually thirsty – and for those of us managing our weight in order to manage pain, eating instead of drinking is not a wonderful thing.

At my desk job I am good. As soon as I arrive in the office, I fill this water container. it is 900 mls and I finish it by lunch time. Refill, repeat.

When working out I am good! I may be a little too pink, but I’m good.

OK, you got me, two of those are protein shakers, but the shot does illustrate maybe I should try a change of colour next time. I DO have a dark blue water bottle as well. I’m not exactly short of water bottles: one permanently in the office, one permanently in my gym pack and a third floating about.

It is when I am home I find I am very slack. Why can’t I do the same thing at home as I do meticulously in the office and the gym, even at the pool? I do not know. I am working very hard on establishing better personal hydration habits.

It seems at home the water bottle is just never where I am. If I’m in the lounge, the water bottle is in the kitchen. If I’m in the kitchen, the water bottle is in the bedroom. Plus I have a tendency not to use a water bottle at home: I have a tap and glasses right there, after all!

It is spring in Australia, at least it is spring in the states that have four seasons! The blossoms are everywhere in Melbourne. In parts of Australia we are having a terrible drought, nothing is growing, in fact much is not surviving, let alone growing.

Like plants, we don’t do well without adequate and appropriate hydration. The Australian Government National Health and Medical Research Council has good detail about our need for water. Please click on that link and read the detail. Emphasis added in the quotation below.

Dehydration of as little as 2% loss of body weight results in impaired physiological responses and performance. The reported health effects of chronic mild dehydration and poor fluid intake include increased risk of kidney stones (Borghi et al 1996, Hughes & Norman 1992, Iguchi et al 1990, Embon et al 1990), urinary tract cancers (Bitterman et al 1991, Wilkens et al 1996, Michaud et al1999), colon cancer (Shannon et al 1996) and mitral valve prolapse (Lax et al 1992) as well as diminished physical and mental performance (Armstrong et al 1985, Brooks & Fahey 1984, Brouns et al 1992, Cheung et al 1998, Kristel-Boneh et al 1988, Torranin et al 1979, Sawka & Pandolf 1990).

If you feel thirsty, you are probably already dehydrated. If you have a medical issue that compromises your ability to recognise thirst, you need to be extra vigilant.

Adult men need about 2.6 litres of fluid a day and adult women about 2.1 litres. This is over and above the fluid intake from food. More may be required depending on activity levels, climate and body weight. Medibank has a handy calculator based on age and gender, but it does not take into account climate extremes, exertion or body weight.

Around 50-80% of our body weight is water. The higher our lean mass, the higher the water content. We need water for most body processes including digestion, absorbing and transporting nutrients, disposing of waste products and keeping our body temperature stable.

Source: Medibank

It is said our skin looks better if we are properly hydrated. From my personal experience, I totally agree. Dehydration can add years to the face and who wants that? Not me!

Those of us with health challenges need to make sure we give our bodies all the help we can: hydration is important.

How are your hydration habits? Please share in the comments.

Spring has Sprung! Annual Sun Protection Warning!

Yes, folks, it is finally spring. Days are getting longer, the sun is getting stronger. Time to revisit the need for sun protection, if you let your routines lapse in the colder months.

As I prepared to hit the gym today, I checked the UV rating for today. Yes, we need protection.

Despite the fact it is raining today, clouds are not protection. Start your good sun habits now so you’ll be on automatic pilot for the rest of summer.

Last year I wrote about the additional challenges those on medications may face – quite a few medications result in photosensitivity – we have to be extra vigilant with our protection. If you have recently started on new medications, I recommend you talk to your doctor or pharmacist about this topic.

I was speaking with someone recently who believed you could not get skin damage through car windows or glass. Yes, you may do, depending on the circumstances. Refer to this article on Skincancer.org for more details.

The Sun Smart website has a wealth of information to help you stay protected, including a reminder to check the use-by date of your sun cream.

One tip I learnt last year – you will find warnings on some sun protection brands re the risk of staining clothing. Trust me on this – those ones DO stain clothing! Because I wear sun protection all the time, not just at the beach, this is important. I now have two stained white tops I really liked. I can attest the Cancer Council brand did NOT stain my clothing, so I stick to that one these days!

Source: SunSmart.com.au

11 Tips for Dealing With Major Disruptions to Your Routine

I’ve been very quiet of late. There IS a good reason! Sometimes, despite the best laid plans of mice and men and women, our lives, our carefully planned routines, are disrupted.

A quick recap of the situation prior to the disruption. In 2016 I started part-time employment in a location that was a LONG way away from home. Relocating close to work was one of the lifestyle adjustments I made as discussed in Beat the Boom Bust Cycle.

This year, I had to move. As it turns out, this has been a GREAT change, but all of a sudden I was faced with home hunting, packing, organising the move, the paper warfare relocation involves and all the other bits and pieces that go along with moving. All on top of my normal daily commitments. Clearly, PACING was paramount if I was to come out the other side relatively unscathed!

I knew I just could not do it all without risking an arthritis flare or some other health set back. Writing was put on the back burner: it was one of the things that was, in reality, not a “Must Do” on the “To Do” list. Packing certainly was! Getting utilities connected certainly was!

The benefits? Beautiful leafy block (pictured above), quiet suburban street, cheaper and (best of all) GROUND FLOOR!

I didn’t come through it totally unscathed. Clearly moving is stressful at the best of times plus my rheumatoid arthritis medication is a immune suppressant. PLUS it IS winter! So I caught a virus about two weeks after moving day. I try to avoid catching bugs, but I think the body was ripe for invasion given the aforementioned circumstances! I was out for the count for several days!

Other life events that can be physically challenging include weddings (our own, or a family member), family holidays, community events we may be involved in organising, school fetes; the list is endless.

If it is a wedding and you are mother or father of either of the happy couple, the lead up is full of additional activities and you want to be in the best shape possible on the day.

Here are my tips for keeping our body healthy when we face a complete disruption to our physical routine that has the potential to cause us pain or a condition flare.

  1. Plan, start preparations early. Stop what you are doing if pain starts. Build rest periods into your plan.
  2. Accept help! My daughter and son-in-law helped me pack. A friend helped me unpack at the other end. If you are involved in the organisational stages as well as “on the day” or post-event clean up, make sure you do not say, “Oh, no I can manage”.
  3. Take annual leave if possible. I took a week.
  4. DO NOT be tempted to “help” the removalists on the day (if you are moving, otherwise adapt this tip to suit your situation). You organised help for a reason: whether they are paid experts or volunteers, resist the urge to throw yourself into the physical fray.
  5. Maintain your daily stretching regime. It can be easy to let such things slip when faced with exciting things going on. Your stretches are even more important now to counteract the pressure you are putting on your body.
  6. You may also have prescribed remedial exercises to do – maintain those too, for the same reasons.
  7. Ensure you get adequate sleep.
  8. Pay attention to your posture. With all the bending I was doing, I was diligent about hinging at the hip to ensure I minimised pressure on my spine.
  9. Do something appropriate to support your body during this time. For example, I booked a massage the second day after the move to iron out the niggles.
  10. Eat well, ensure you consume enough protein. Stay hydrated.
  11. If this is a big social event (rather than moving home), I strongly recommend continuing to wear your usual shoes on the day (in my case kyBoot shoes). While you might get away with “pretty” shoes or heels for an hour or so, any longer could well result in pain which could be very unpleasant on the day.

Every person is different, every person’s objectives and capabilities are different. If you are father of one of the bridal couple, your one burning desire for the day may be to walk your child down the aisle and maybe walking is your personal challenge. Plan ahead, practice, seek advice from your allied health providers well in advance. If necessary, consider adaptations: for example, at the recent royal wedding Prince Charles didn’t walk the full length of the aisle with Meghan.

Yes, I did resort to Panadol and a heat pack on my back the actual day of the move, but I have even impressed myself with how well my body coped (apart from the darn virus). The annual leave certainly helped, as I was not under pressure to rush. I could work unpacking for an hour, rest for an hour, do my stretches, get my exercises done; all without feeling as if I needed to hurry or as if I should be somewhere else.

Get back to your normal exercise routine as soon as possible. I took a day off from organising the new place to have that massage and go for a long walk.

My main objective, aside from a successful move, was to ensure I did not undo all the good work I have done to date. I did not want a rheumatoid arthritis flare. I was confident if I made sure I took my physical limitations into account, accepted or asked for help as necessary and took my time, I would be fine. Was my back a little stiff? Yes, a little, but at no time was I in excruciating pain or taking strong pain medication. I didn’t expect to come through it without my back grumbling a little, given the degenerative damage.

I have boxes that need lifting to the top shelf in the wardrobes: they are not hurting anyone sitting on the floor and that is where they are staying until someone better able to do it visits! Yes, it is tempting, but I’m NOT doing that to myself! Stick to your rules! Some of us are all too susceptible to striving to be “normal” and do what we used to be able to do. That is not a good idea! My study looked like this for several days (don’t tell anyone, but it still looks very similar) but it isn’t hurting anyone and I stay in one piece physically.

I ventured, for the first time EVER to Ikea and bought a small dining table and chairs that I assembled all by myself! This is a terrible photo, but I am proud I survived the move well enough to do this! It is an extension table, ideal for apartment living, so was more complicated than a straight table.

While unpacking, I came across this poem. Some days, like moving day itself, stuff just has to be done. But afterwards? Keep this in mind!

“Dust if You Must” ~ Rose Milligan

I painted my nails instead of dusting!

Last thought – amazing the things you find when you unpack stuff.

Here is me in a Melbourne publication in 1998.

Doctors and Exercise

I last wrote about incidental exercise, but what about a more structured approach to exercise? Many of us with chronic conditions would benefit from exercise. Most of us also probably have doctors in our lives, either general practitioners or specialists (called consultants in some countries) such as a rheumatologist.

Over the Easter weekend an interesting report appeared in the Medical Journal of Australia, “Exercise: an essential evidence-based medicine”. Naturally, I was excited to see exercise receiving coverage in the medical media!

Regular physical activity is highly beneficial for the primary, secondary and tertiary management of many common chronic conditions. There is considerable evidence for the benefits of physical activity for cardiovascular disease, diabetes, obesity, musculoskeletal conditions, some cancers, mental health and dementia. Yet there remains a large evidence–practice gap between physicians’ knowledge of the contribution of physical inactivity to chronic disease and routine effective assessment and prescription of physical activity.

There was a similar report last year out of the UK, “GPs in England ‘unconfident’ discussing physical activity with patients – report”.

Now a nationwide study has revealed that 80% of GPs in England say they are unfamiliar with the national guidelines, and more than one in seven doctors say they are not confident raising the issue of physical activity with their patients.

“Many people have described [physical activity] as the most cost-effective drug we have, yet we are not implementing it properly,” said Justin Varney, co-author of the research from Public Health England (PHE). “This is as appropriate as having a conversation about smoking,” he added.

The medical advice I was given when I became sick was, literally, “Get some exercise.” Not how, what, when, frequency, intensity – just “Get some exercise”. As we know, I did better than that, I went and got an exercise qualification. After that, I asked my rheumatologist what weight he thought it would be safe for me to lift on the leg press, without negatively impacting my condition. His response? “I have confidence in you, you’ll work it out”. Which, in my case given my qualifications and experience, is fair enough. To a patient that is an exercise novice, I know my doctor would not have said that particular phrase. He and I have known each other quite some time now and have a very good patient/doctor relationship. I wouldn’t be writing this article if he had not set me on the exercise path in the first place. I share these conversations to provide real world examples of the above two articles.

Exercise is not a discipline many doctors are trained in, which is fair enough – they can’t be experts in everything and I need my rheumatologist to be an expert in rheumatology! Apart from anything else, a medical specialist would be a very expensive personal trainer. I really do not want to pay his medical charge rate for exercise advice. Look at it this way: a specialist or general practitioner may also send you to a physiotherapist, but do you expect that doctor to BE a physiotherapist? No, you don’t. So we should not expect our doctors to be able to write us a tailored exercise program either.

A member of a chronic illness support group today shared a similar experience, having essentially been told to “figure it out” by one of her doctors.

I recently wrote an article titled “Preventing Tomorrow’s Pain”. I didn’t really write it – I recorded a video. NOW, some time later, when I look back at that video, I can clearly see the improvement in my demeanour/attitude before I walk (after sitting in a conference all day) and while I am walking. Yes, I was pain free the next day and I swam 1,000 metres.

If your doctors don’t mention exercise, raise the topic with them. Really, your doctors don’t need to be exercise trainers, they just need to reassure you and encourage you that exercise will help you manage your conditions. They need to give you a medical clearance to undertake exercise. People like me can do the rest.

The above two articles, from opposite sides of the world, provide clear evidence that just because your doctor may not have mentioned exercise does not mean exercise should be ignored. Exercise may be the best medicine for you, just not mentioned by your doctor. Another contact told me when she offered to do exercise, her doctor was so surprised and said “You’re prepared to do that?” giving my contact the impression maybe he’d just given up over time trying to get patients to exercise. Doctor was very excited, patient exercises and her body does not “turn to concrete”. On a side note, I love that phrase, as it explains so well how many of us can feel if we don’t MOVE!

I use this graphic often: this is what happens if you don’t move. No, you don’t have to be lifting weights, start with simple stretches. Just MOVE it!

de-conditioning

Patients can be reluctant to try exercise as medicine. After all, instinctively we know pain is a warning signal and we believe rest will make it better even though science shows the opposite is true more often than not. We may fear those first few painful steps. A friend said the other day, “the cave you fear to enter holds the treasure you seek”. This, I feel, applies to exercise for so many people. We want the treasure: minimal pain, to be free of opioids, regain functional movement and retain quality of life. The cave is exercise and movement.

You may be reading this because you are searching for a solution. You are researching, perhaps. Do not be afraid to enter the cave. Ask your doctors, raise the topic of exercise with them. If they raise it with you, listen to them. Bear in mind the “how to” of exercise is not their specialty.

If you are ready and willing to try movement as medicine, call me or send me an email.

This article constitutes general advice only and may not be suitable in all situations. You should always seek a medical clearance to undertake exercise if you have medical conditions. Always apply the pain management principles of pacing when starting an exercise program.

Incidental Exercise

Never underestimate the value of incidental exercise. For many years 10,000 steps a day has been considered a desirable minimal level of daily activity for health. I’ve shared the video below in other articles, about the dramatic drop in activity from our active past to our now relatively passive present. Here it is again as a reminder!

I love that video because it illustrates so well the change in how we live. Our bodies were designed for the active past lifestyle but too many of us live the passive present depicted.

Back in 2014 I participated in the Global Challenge. Looking at the website for the 2018 event, I see it has changed since 2014, but the objectives remain the same. This is an annual event to encourage office workers particularly to get out and about and moving. I am proud to say I won all the trophies available, despite some challenges such as ending up on crutches due to a very, very grumpy knee.

2014 was the year I found out I was sick. Looking back, what I find interesting was my actual steps per day in early 2014, compared to that recommended steps a day number of 10,000. We received our pedometers well before the event started and several of us started wearing them to see how much of an improvement was needed. I found I was walking approximately 2,500 steps a day. I was shocked, as I had a history of being active, but, as they say, “life happened” and I had found myself in a very inactive phase.

To paint the picture of my life at the time, I was a senior manager with a company car. In the morning, I would walk out my back door, jump in my car, drive to work, park in the basement, take the elevator up to my floor, sit in my office or meeting rooms all day, at the end of the day repeat the journey in reverse. At home I was helping children with homework, cooking dinner – there was little time for me to take care of myself. I should have made the time!

Now I deliberately use every opportunity to clock up a few extra steps: my kyBoot shoes definitely help. Without the heels I can decide, weather permitting, to walk an extra 1,000 steps down the road from my office before catching the tram.

The photo at the top of this page was taken on just such a day recently. It was a beautifully sunny end of the day, not too hot, the trees provided such a pretty filtered sunlight effect and the evening birdsong was a lovely musical accompaniment: I really enjoyed just de-stressing from the office by stretching my legs.

I am extremely lucky in that the tram line goes directly from my work location to my home location with many stops along the way. I can easily walk part way, tram part way. Not everyone has such a convenient transport situation.

If you drive to work, is it possible to park a little further away from work? That isn’t possible for me, on the days I do drive to work my only parking option is the staff car park. This is one of the reasons I prefer to take the tram as it gives me more options for incidental exercise.

Cycling to work is great exercise already: my knees don’t like cycling, so it is not an option for me. Luckily my body doesn’t object to walking in any way, which is one of the reasons incidental exercise is so important to my welfare and the management of my rheumatoid arthritis and damage in my lumbar spine.

How many of us travel to the gym or the pool, to diligently undertake exercise, in our car? My swimming pool is only 1.5 kms from my home. I have reached the point now where walking 1.5 kms is easy. One issue I have to be careful of is exposure to the sun, so I can only do that walk weather permitting. I also need to be careful not to overdo it. I am well aware that a three kilometre walk and a swim may send me into the #spoonie Boom/Bust cycle if I am not careful. Pacing is paramount. My gym is located at work: I do the same incidental steps as on a normal work day.

I walk to my general practitioner’s clinic rather than drive.

As I am a person with chronic health conditions, I don’t get to 10,000 steps on a daily basis due to the energy/lethargy issues that go with my conditions. Yet. I am slowly building up and each month I am more active that the previous month.

Look at your daily routine and determine what adjustments you might be able to make to increase your level of daily activity. I am a firm believer that frequent movement is better for our bodies and our health than being stationary all of most days then working out like mad in the gym for 45 minutes maybe three days a week. I was very happy to have my belief confirmed when I did the Pain Management Program! The reality was brough home to me more recently when I spent a day in the Emergency Department (why is a story for another day) – my body almost turned to concrete through not moving. I was very stiff after lying on a hospital bed all day.

Yes, I certainly do work out in the gym because resistance training is very important, especially as we mature, but moving as much as possible is perhaps even more important, yet so difficult for many of us to achieve.

I know from my own experience with my conditions, the days I am not working in the office and move a lot more I get to the end of the day with no stiffness or little niggles anywhere. Days when I am more stationary I will end the day in discomfort. Not pain, but discomfort. Move more. Movement is medicine has become my mantra.

This is an edited version of an article I first wrote for Kybun.