Let’s Stretch

Stretching helps us get our movement back. We don’t have to do Olympic level stretches: to start, do what you feel comfortable with. Day by day you will improve. Your aim is to increase your flexibility and functional range, not run the marathon or climb Mount Everest. It can be discouraging when we see “everyone else” able to do things we can’t. It isn’t everyone else, though – there are plenty of people in a very similar situation to ourselves. We need to let go of the “everyone else” comparison because it does us no good at all.

Range of motion can even lead us to not buying clothes we like. I tried on a dress I loved. BIG problem: it had a full length zip up the back. I no longer have the range of motion in my shoulder joint to be able to zip that dress up by myself. So I had to buy a different dress. Still bugs me every time I think about it!

David Tom MD, an Arizona-based chronic pain specialist, says patients who are successful in managing their conditions see movement as medicine. I love that phrase. Movement is the one of the best drugs we can use.

What stretches should you do? This is will depend on your particular situation, but a good set to start is listed below. Hold each for three calm breathes, do each stretch twice. That is, twice each side where the stretch is a side-to-side stretch. Do stretches in a controlled slow manner, paying heed to your body. This is a not a race, the only aim here is to getting our body moving.

  1. Neck stretch 1 – simply tuck your chin to your chest.
  2. Neck stretch 2 – tilt your head to the side, turning your chin towards your armpit and your ear to your shoulder. Be careful not to lift your shoulder to your ear! If you are tilting to the right, you can place your right hand on your head to gently add some additional “pull” to the stretch.
  3. Shoulder rolls – rotate your shoulders in a circle backwards, with your arms at your sides. In gyms you may see people doing full arm rotations, forwards and backwards. This is not necessary to achieve your short-term objective. Do not rotate shoulders forwards, the body prefers backwards and we want to give the body what it prefers at this stage.
  4. Shoulders, chest, biceps – stretch your arms straight behind you. You can retract your shoulder blades if you are able, and clasp your hands behind your back but this is not necessary. Again, watch those shoulders – make sure you aren’t lifting your shoulders. Take you arms back only as far as you can comfortably.
  5. Side bend – sitting or standing is fine, depending on your current ability. I won’t describe this one in words as I demonstrate it in the video above.
  6. Back rotation – this can be done lying down or sitting. I prefer lying down. Lay on the floor arms outstretched, knees bent. Roll your knees to one side as close to the floor as you can, hold. Return your knees to the centre, roll to the other side. This may be too challenging, so the seated version is to hug yourself and rotate your upper body to one side, hold. Return to the centre and repeat the other side.
  7. Hamstring stretch – the hamstrings are the big muscles that run down the back of your legs. These can get very tight, especially if you haven’t discarded those high heels yet! That was a not-so-subtle reminder to check out my KyBoot recommendation. There are many ways to do a hamstring stretch, here are two.  You can sit on the edge of a chair and place one leg out in front of you, heel only on the floor, toe pointing towards you, straighten the knee and bend slightly forward at the waist. A second option is to lay on the floor and raise one leg at right angles to your body, your hands behind your thigh to gently encourage your leg towards a 90 degree angle to your body, knee as straight as possible.
  8. Quad stretch – quads are the muscles at the front of your thighs. My favourite place to do these is in the warm water gentle exercise pool with ankle floats. On land, stand behind a chair or beside something you can hold on to for support. Lift you foot up behind you towards your bottom. If you are able, you can catch hold of your ankle and lift the foot higher. You will feel the stretch in the front of your leg above the knee.
  9. Calf stretch – another stretch with options. Option 1 is to stand facing the wall, hands about head head height against the wall, one knee bent, the other leg stretched out behind you, heel to the ground. Press your heel into the floor and bend the other knee. Option 2 is to stand on a step on your toes and drop your heels below the step. The is my preferred version. You will need something to hold onto.
  10. Glute (the muscles in your buttocks) stretch – sitting in a chair, lift one your left foot up and place it on your right knee. You can push down on the left knee to increase the stretch if you wish, providing that is comfortable. Repeat for the other side. If this is too much, simply lift your left knee up and point it towards your right side. A more advanced version is to lay on the floor, bend your knees with your feet close to your buttocks, place your left ankle on your right knee then place your hands either side of the right left and pull your right knee towards your chest just until you feel the stretch in your left buttock.
  11. Thoracic Stretch/Snowangels – our upper back can get quite stiff when we are not as active as we should be or we spend too much time at a keyboard. You will need a long foam roller for this one. The pictures illustrate, I hope! Just laying on the foam roller is a good start. Snowangels add arm movements: start with your arms positioned at your sides, palms facing the floor, then take you arms in a wide arc to stretch out behind your head, palms facing the ceiling. This needs a bit of floor space as you may be surprised just how far your reach is when your arms are at a right angles to your body! This is not a “three calm breaths” one – stay on the roller as long as you feel comfortable. Perhaps start with 30 seconds if you’ve never done it before.

In the first image I have moved my arm so you can see the roller. In the second you can see my head is totally supported – hence the need for the long roller.

This is not the easiest to do and may be too advanced for beginners. Some readers will have difficulty getting on the roller and will need to build up flexibility and strength. The aim is not to hurt ourselves, so BE CAREFUL! I still prefer to hold onto something while lowering myself onto the roller. I love the way my upper back feels when I get off the roller.

Stretching daily is a very good thing. Build the time into your daily schedule and stick to it, even on the “bad” days. Design a simple spreadsheet and place it on the fridge, mark each day off as you go. Stretching isn’t the only activity we need, but it is a good place to start.

If you would like some help, Contact Limberation.

This article constitutes general advise only and the stretches outlined above may not be suitable in all situations. You should always seek a medical clearance to undertake exercise if you have medical conditions.

 

Pacing For Beginners

Pacing in the context of managing our pain relates to our rate of activity or our performance progress. In this article I am using walking (that’s why the feet!) as an illustration, but the same logic can be applied to sitting, standing, resistance (weight) training or whatever activity it is that we are having trouble doing to the level we want to.

As I have shared previously, when I was first started on this journey, I walked five minutes at a time, four times a day. Five minutes was how long I could manage before I experienced pain. Slowly, by pacing, we can build up.

Please be aware pacing is only one component of condition management, it is not THE solution. This is a general introduction only, each person requires specific planning tailored to their circumstances.

Warning: Maths Ahead

Let’s assume for the maths part of the exercise that like me, you can also walk five minutes before you experience pain.

  1. Take that five minutes as your Test 1 measurement.
  2. After a suitable rest, do a second Test. The Test 2 result might be four minutes.
  3. Add 5 + 4 = 9. To find the average of your two trials: 9/2 = 4.5 minutes.
  4. Now you need your baseline, your official starting point. This is 80% of your average. 4.5 * 0.8 = 3.6 minutes, or 3 minutes 36 seconds.
  5. Increase at a rate of 10% from your baseline. 3.6 * 1.1 = 3.96 minutes. Let’s just call it 4 minutes!

Each day you increase by 10%. JUST 10%.

Putting Pacing into Practice

How does this work in practice? I did some timings on a stroll the other day. It took me 217 steps and 1 minute 48 seconds to walk from one tram stop to the next.

What is a tram, you ask? I’m glad you asked! This is a Melbourne tram. Terrific mode of city transport.

If you don’t have trams in your area, do you have an alternative?

Why was I doing the timings? Because we can use local infrastructure to our advantage. After a while you will get very bored with your backyard or walking around the same block. Tram lines are fantastic because we can walk, hop on a tram for a rest, get off further down the line preferably within one or two metres of a nice cafe, finish our rest over a nice coffee and then repeat the exercise back.

As we build up, we can use the distance between trams stops as stepping stones. Looking at my 1 minute 48 second walk between stops cited above, that is way more than a 10% increase from a 4 minute baseline. That would be closer to 50%, WAY too much. But later on it will be possible. You are not stuck on 4 minutes for long! As you build up you can walk just past a tram stop then back and still catch a tram to reward yourself with coffee. Over time you will be reaching the next tram stop.

A little reconnaissance may be necessary. This is the tram stop I was passing. In the middle of a busy main road, there are lots of steps up from the pavement, an over-bridge and then more steps down. This may not be ideal for those pacing up slowly! This is one of the tram stops you might want to zoom straight past – as a passenger!

Of course there are many alternatives: drive to a favourite park or beach, then walk. I don’t suggest the shopping centre, as it could take 20 minutes to walk from the car park to your store of choice!

The Rules

Rule #1: stick to the times. DO NOT be tempted to do more than you should, despite how great you might feel right that minute. You risk undoing all your hard work to date if you do that.

Rule #2: do it every day. Even if you don’t feel the best today, do your allotted time. Every day.

Rule #3: Wear appropriate footwear. If it is sitting you are working on, ensure you have an appropriate chair.

Other Thoughts

I also apply pacing strategies to manage the fatigue, along the lines of how much I do on any given day. I’ve mentioned before I don’t do grocery shopping on days I do a strength workout. I don’t do strength workouts the days I work eight hours in the office. We work out rules for our individual circumstances.

Christine Miserandino (lupus and fibromyalgia) has written The Spoon Theory which is a great way to visualise the energy/fatigue situation. I found it very early on in my journey and it certainly helped me adjust to my new life. I do have many more spoons these days than I used to, but that didn’t happen overnight.

Challenges of Living Alone with Chronic Conditions

If you have newly discovered you have a chronic illness/condition/disease AND you live alone, there are challenges patients living with family don’t face to the same degree. Some of the items below I have mentioned before, but today I am looking at the specific circumstances of living alone, which can complicate matters. While we may not have children or a partner to care for (in some ways making life a little easier perhaps), the flip side of living alone means no-one to make us a nice cuppa, to help us make the bed (or let us off the hook entirely), or to just snuggle up to for comfort.

Even if we have a nice neighbour to call on for help (as I have done from time to time), we may need to plan our activities very carefully. It is easy to fall back into the boom-bust cycle, both physically (pain) and psychologically (the stress), especially in the early days. We aren’t used to the “new me” at all, we tend to think of it a bit like having the ‘flu, we’ll just get over it. No, sorry, this is here to stay (unless we go into remission, which is possible in some cases). We can learn to manage it, yes. In time and with practice.

Today I’m asking you to carefully consider the physical and practical aspects of managing day-to-day tasks. It WILL get easier as your treatment starts to work and you build up your resilience over time, learn to pace and build up (or build back) your strength, but today we are talking about the beginning, when we are adjusting to living this new life. These are some of the things I wish I’d known in the early days.

Grocery Shopping

Grocery shopping can be a challenge. Yes, I could order on-line and have my groceries delivered, but that costs money: if we live alone we don’t usually buy enough to qualify for free delivery! It is OK to carry the bags in from the car one at a time if necessary – or even half a bag at a time. Take the frozen stuff first, in case you need a rest between loads. Once you get stronger this will improve – but don’t try to do what you used to do before, not until your body is ready. If we struggle to carry in all the bags at once, where do we go? Yep, back into that pain boom-bust cycle.

Shop more frequently if possible and necessary.

Showering

I remember standing in the bathroom in tears when my shoulders were playing up badly. I could not dry my back after my shower. It wasn’t just the pain, it was the inhibited range of motion. Also, this was out of the blue, completely unexpected. Situations like that can make fears of the future rise up and cause anxiety, anger and frustration. Living alone means we have no-one to talk to about those fears right there and then, no-one to comfort us in our time of stress. Also, no-one to dry our back. Mindfulness exercises will help. Relax our mind and relax our muscles – often times that is just enough so we can complete the task at hand. That alone makes us feel better.

Bath sheets instead of bath towels are very useful. Being larger, not so much shoulder movement is needed to dry one’s back. While there is a lot of technology out there to assist people, I haven’t found anything yet that helps dry one’s back. I admit I haven’t looked very hard because the problem was not ongoing for me.

The unexpected can happen. Negotiating our ablutions, unexpected events or not, can be a challenge. Putting prescribed skin cream on areas you can’t see, for example, can be a bother to say the least.

Changing the Bed Linen

I’ve mentioned before that changing the bed linen used to wipe me out. But there is no-one else to do it, so it is either manage it somehow or sleep in dirty sheets – not the best option. Break it down over the day. Get the linen off the bed (I find that not too difficult) early, then do the rest spaced out over the day if necessary. Put on the bottom sheet, go away and do something else or rest. An hour later tackle the top sheet. If putting on the new doona cover is too hard to do in one hit, break that down too. It is OK, you are the only one seeing your messy bedroom! You have all day to get the bed back together! If we give in to the “I must do it now” story to do our bed in one hit, where do we go? Yep, back into that pain boom-bust cycle.

Above is Cleo, very comfy in her little fluffy igloo. She feels safe and warm and protected. We need to feel the same, we just don’t need to cause ourselves a flare getting there.

Our Hair

For anyone with long hair, this can be a challenge, especially if our shoulders are involved in our condition, or if standing causes pain (a chair in front of the mirror would solve the standing issue). Blow drying long hair can take twenty minutes or so, our arms raised for much of that time. On a bad day just don’t do it – letting your hair dry naturally is not a crime, the fashion police will not issue a citation. Actually, no, the fashion police might very well issue a citation, but WHO CARES! Our path to regaining our functional movement and managing our pain is WAY more important than someone caring about our hairstyle. If we force ourselves to do our hair to meet social expectations, where do we go? Yep, back into that pain boom-bust cycle.

Dishes and Ironing

Ironing is easy – I’ve talked about that before – just don’t do it. One item when you need it, that’s enough. Although sitting may be a solution, I find I don’t get enough pressure happening so the clothes don’t look “done”.

A fellow patient I know says it takes her three tries to get the dishes done, with rests in between. Standing is a major source of pain for her at this time. It is what it is – if you have to wash a plate at a time, so be it. Build up to two plates. In time you should be back to being able to do all the dishes at once, but feeling guilty because you can’t now is not going to help. Wash anything you use as soon as you use it is a strategy I adopt most of the time. Living alone we tend not to generate a dinner wash of six plates and cups, which is a good thing. If you have a dishwasher, I hate you already (I don’t).

Cooking

Cooking is a little different. We need to ensure we are eating healthy, nutritious food: the two main reasons are to enable our body to fight this battle the best it can and to minimise or reverse any weight gains due to medications and our reduced activity levels, thereby protecting our joints and internal organs. Unfortunately, cooking is not necessarily as easy to spread over the day as other tasks can be.

We need to plan our food preparation so we don’t do more than we should at any given time. We may simply have to give up some of our favourite dishes – for a while – if they require lengthy preparation. There is NO point in spending a painful hour preparing something only to be too exhausted or in too much pain to actually enjoy the fruits of our labour. Don’t put yourself through it. Console yourself with the knowledge that a dish requiring less preparation is probably a healthier dish anyway!

This is where living alone can actually be a plus, as we aren’t faced with anyone complaining about the “plain” food. Then again, someone else could be cooking for us! It is what it is, just please eat healthy, nutritionally balanced meals!

If you can afford it (many of us, having reduced our working hours due to our conditions, can not) delivered meals such as Lite n’ Easy can be a great solution, at least to have some in the freezer as a standby. I use my slow cooker to cook six meals at a time and freeze five. My freezer is bulging with pork, beef and lamb meals which take seven minutes to defrost and three minutes to heat in the microwave. Lifesavers if I have a tiring day at work. I’ve been known to boil two eggs and have them with a steam fresh bag of vegetables if all else fails.

I never peel potatoes or carrots, the skins are good for us anyway. I’m not allowed green beans or onions, so I avoid a lot of slicing and dicing. There are great kitchen appliances available to make these things quick and easy. Make Christmas present requests. I know two people who are stroke survivors, both need to manage with one hand and have quite a few utensils that are very useful. Look at what is available that will make food preparation easier for you.

General Housework

One thing to avoid is the temptation to clean up like a whirling dervish if visitors are coming. Try to spread out doing tasks over the week and have a room you can just chuck stuff in if need be and close the door! “OMG, Jane’s coming over, I must have a pristine home” is a recipe for disaster, especially in the early days when you are learning your new life. Most of us who have worked all our lives are very much into the routine of spending a good part of our weekend doing everything: clean the bathroom, dusting, vacuuming, clean the oven, maybe mow the lawns, wash the floors, change the linen, do the laundry, ironing for the week ahead, grocery shopping and THEN we used to add some socialising on top of all that.

socialising is important
I do get to socialise! It is important.

Ummmm – not a good plan any more. It doesn’t matter what your major symptom is; pain, lethargy or other. Trying to do it all is not going to help. Stop. Don’t be tempted. We have no-one to delegate tasks to and can be so tempted to do it all at once, to feel we HAVE to at least try to appear “normal”. No we don’t. We have a new normal now. If Jane is a really good friend, she is not going to care if your place doesn’t look like Martha Stewart’s been your housekeeping consultant, Jane is going to care how you are feeling, how your health is.

Summary

Look, all that and I haven’t mentioned exercise once! I am now. No, I don’t write template exercise routines and publish them because that, I believe, is inappropriate for my client base. Every single one of us is different. Different conditions, different stages, different trouble spots in our bodies. It is important we make sure we have time to build our physical condition though, in ways appropriate for us as individuals. This is NOT a luxury any more so we can look good on the beach come Christmas holidays, this is now a necessity.

Living alone can make exercise harder. No-one to motivate us or support us. No-one to take that first short walk with us. It can be easier to just turn on the TV and hide from the world.

All the above careful planning of our activities will be for naught if we don’t build conditioning into our routine. Even before I did any formal exercise or pain management studies, I learnt very early on if I moved, my stiffness and pain receded. That’s what led me to learn more. Why was it so? How much better could I get?

Have I had bad patches? Of course I have. I remember the shower incident mentioned above, another day I was woken up by pain in my right arm that was excruciating, a day I lay down for fifteen minutes and then couldn’t get off the bed. Overall am I better now than I was in late 2014? Definitely. So. Much. Better.

For Melbournites, yesterday I walked from the corner of Nicholson St and Victoria Parade to Federation Square. Stopped, had a coffee (very nice Bailey’s Latte it was too), then walked to the Arts Centre.

Bailey's Latte
This was SO delicious.

Three years ago I was on crutches.

recurring appointments

Yes, Brain Fog IS a Thing

Brain Fog is definitely a thing. Not a thing we want, like, enjoy or get used to. It sucks: BIGTIME.

There can be many causes. Brain Fog can be a symptom of menopause. It can be simply a sign of aging. It can be a side effect of medications. It can be due to lack of adequate nutrition. It also seems to go hand-in-hand with many medical conditions, including autoimmune conditions and chemotherapy.

Before we can deal with brain fog in our day-to-day lives, we have to actually come to grips with the fact it is a thing. That’s tough. I had a memory like an elephant – once upon a time. At first you think maybe you are going nuts: at one stage I asked my GP if I could be tested for early onset dementia, I found it so scary, so “un-me”. It gets less scary as you develop strategies for dealing with it.

Check With Your Doctor

If you feel you are being affected, the first thing to do is check with your doctor (or doctors as the case may be). If you are female and of the right age, it may be menopause related and you may be able to consider Hormone Replacement Therapy which may solve the problem. If it might be a side effect of your medications, there may be alternative medications that may reduce the problem. Don’t just suffer in silence without finding out if there could be a different cause or a possible solution.

My personal example is around sense of direction. I would be driving in the right direction to get from point A to point B but my emotions would be telling me I was driving the wrong way. It wasn’t just driving. I’d park in the supermarket car park and when I came out I’d have no idea how to get back to my car. Admittedly, that was in a complex of shocking design, but it was distressing. I was almost thinking maybe I was going to have to give up driving, it was so bad. My daughter drove me to a medical appointment and I was convinced she was going the wrong way. It was stressful.

For completely unrelated reasons (several side effects I won’t list) I discussed a change of medication with the appropriate specialist. Within five days of ceasing the drug my sense of direction was back. I was ecstatic! Now, I can’t prove my sense of direction issue was due to the medication in question, however the co-incidence suggests it may have been. No, correlation does not equal causation, but in this particular case I’m fairly convinced.

Write Everything Down

Makes sense, doesn’t it? Write EVERY appointment or thing you have to do down. No, it doesn’t have to be on a piece of paper in a diary. I have calendar apps on my smartphone that will display several calendars at once, in different colours. This highlights any clashes between different aspects of my life. I have my office calendar, my Limberation calendar and my personal calendar.

Flag emails for follow-up! You’ll forget you said you’d respond tomorrow!

However you choose to do it, do it religiously! Unfortunately, this alone does not solve the problem.

Look at Your Calendar

Make it a religious part of your daily routine to look at the calendar. Allow me to illustrate. Last week I had a major change to my routine. While usually I work three days a week in an office, Wednesday to Friday, Last week I changed to working Monday, Wednesday, Friday because on Tuesdays and Thursdays I am going to Pain Management School (my name for it, not theirs). This change is temporary, but it is a disruption foggy brains find …… challenging.

I had an appointment on Thursday morning. As I lay snuggled under the doona I ran my day through my head. No, I convinced myself, I have this morning free. I made plans to have a late-ish breakfast and then wash and curl my hair. I was sitting waiting for the heated rollers to cool when my allied health professional rang and asked was I all right. “I’m fine”, I replied, thinking isn’t this a truly lovely gesture on her part.

“Well, I wanted to make sure because you are always so prompt.”

O.M.G I was SO SO SO embarrassed. I’ve always been the punctuality police. Being LATE gives me the horrors. Missing an appointment altogether because I FORGOT? O.M.G.

So make checking the calendar a part of your daily routine NO MATTER WHAT your foggy brain may suggest to you. Also check for flagged emails at the same time!

Medications Too!

Medications to be taken every morning or every night may not be so bad: I find that becomes just part of my normal brush-the-teeth-comb-the-hair routine. Anything that is not daily? Make an appointment in that calendar. The Repeat function in your calendar is great for that (see picture above). The classic example (sorry guys, this is a female example) is Hormone Replacement Therapy patches. Change twice a week, Wednesday morning and Saturday evening. If my phone doesn’t beep at me, it will be Friday morning before I think to myself “Did I?”

Even this morning (another Thursday, must be something about Thursdays) I again had a late breakfast (but DID check my calendar) then took a phone call, then sat on the edge of the bed to check social media and then thought “Have I taken my medication?” I decided I was pretty sure I hadn’t, so I took it. But the change in routine nearly bit me again.

Yes, the pill organisers from the pharmacy can certainly help because you can look and see if Thursday’s pills are gone.

Don’t Feel Guilty

This is about taking care of yourself. If you stuff up, as I did last Thursday, accept this is now part of life. You will forget things. All feeling guilty will do is add stress to your day and we’ve already talked about stress. Most of your medical team will understand if you miss an appointment – they’ve seen it many times before. WE each think we are the only one, but we aren’t. Friends and family should care enough about you to understand. Work, I agree, is slightly different. If employed, we are getting paid to do a job and we should do our utmost to not forget, but if it happens, it happens. Apologise, reschedule, move on.

Shopping Lists

I’d happily been through my whole life rarely if ever writing a shopping list. Now? I write shopping lists. I can’t stand getting home from the grocery shopping to find the one thing I REALLY REALLY needed is not in that pile of shopping bags.

Variations on the Theme

Brain fog is a thing. It can also be different for different people. One thing I haven’t yet found a solution for is retention of new information. For example, I’ll read something on a web site, let’s say a price of an item. As soon as I’ve gone from that page, I can’t remember the price. While studying I found rote learning of anatomy hard to retain – I still struggle with the names of some of the muscle origin and insertion points, although I know where they are! Concentration may suffer, your mind will wander during conversations. The brain may “freeze” – finding a perfectly common word just escapes you (very difficult in business meetings, also very menopause-typical that one).

Some days, the brain just doesn’t want to be taxed.

Sleep, Exercise and Nutrition

Poor sleep, inadequate exercise and less than optimal nutrition can all contribute to brain fog, over and above any medical issues. Do the best you can to ensure you keep these aspects of your life in tip-top shape.

I’m relatively lucky. I’m not suffering from brain fog much at all and I have strategies to mitigate the difficulties. The first step was accepting there was a change and I had to manage it. The second step was learning to work with it, rather than fighting it. Fighting it is stressful and then we get back on the wheel of exacerbating our condition by fighting the condition. Completely self-defeating.

What are your experiences of brain fog? What are your managing tips? Please share!

Beat the Boom Bust Cycle

BOOM! You feel great! You do all the things you’ve had to put off. What a sense of achievement!

BUST…… Can’t move, feel totally wiped out, no energy……

And so the cycle goes.

While the boom/bust cycle is certainly applicable to pain, today I am looking at another symptom of many chronic conditions, fatigue. Lethargy can be a better description.

If you google “fatigue and rheumatoid arthritis” you will get about 579,000 results. Similar with other conditions. “Fatigue and lupus” will find about 705,000 results.

While fatigue can be, often is, linked to pain levels, I have found it can also not be: I can be fatigued without pain. Thankfully, not nearly as much now because I’ve adopted strategies to manage the fatigue much better than I did in the early days. As will be the case with many people, there may be more than one condition involved. In my particular case, hyperthyroid, a condition that may cause sleep disruption/lack of sleep quality – not something that helps a person suffering fatigue.

I still remember one particular day early in my journey. I woke up feeling FANTASTIC! Off to the gym I went, did a great workout, did the grocery shopping on the way home, changed the linen on the bed: and then collapsed. I had no energy for three days. Not how I want to life my life.

In an earlier article on removing stress from our lives, I spoke of certain practical changes I made. Not all were for stress alone.

The following should be read as ideas. This is some of the things I’ve done: all, some or none may work for any other individual, or may simply prompt thoughts about what might be applicable in your own situation.

Depending on how aggressive your condition or conditions are you may not need to be this drastic. Lifestyle changes such as exercise, eating well, ensuring adequate hydration and good sleep hygiene may be sufficient. The Arthritis Foundation has a short introductory article on beating fatigue with lifestyle changes. I certainly incorporate all those (especially the exercise, of course) in my life!

Don’t Overdo It!

Rule Number 1 is the same as Rule Number 1 for pain management. On the “BOOM! I feel so good today” days DO NOT rush around madly doing a list of things a mile long (shopping, go to the gym, vacuum etc etc). Especially in the early days (battling the guilt of not getting things done) we can go completely overboard on the BOOM days. Guess what? The next few days are awful. BUSTed. Then we feel awful again because we aren’t doing what we feel we should be doing…… around and around it goes.

Even now, I never do my grocery shopping the same day as I do a strength workout. I don’t do a strength workout the days I go to my day job. I do not check my work emails on the days I am not in the office (that took discipline, developing and sticking to that rule). I plan ahead and I PACE myself carefully.

RELOCATION

When I was appointed to my current role, I lived a considerable distance from my new work location. I love driving, but spending an hour in peak-hour traffic in the morning and up to two and a half hours getting home after eight hours in the office was NOT a happening thing. Not only did I find driving on the freeway in second gear extremely stressful, an eleven and a half hour day was just way too much. The best solution for me was to relocate closer to work.

I can now drive door to door in ten minutes, or I can take a tram and be there in twenty minutes. No stressful driving conditions and a much shorter day.

Reduce Working Hours

This is a tough one. Again this is an aspect of life that can relate to both stress and fatigue. If you are fatigued, you are less likely to perform as well at work and that creates stress (and in some cases, guilt). If your work is being a mother and a wife, the same feelings can apply.

In either situation, reducing working hours can be difficult. There are financial implications of reducing paid hours of employment. For a mother, who is going to do the work?

I have been extremely fortunate and am extremely grateful for my situation. The reduced hours I work allow me to feel I am professional and effective when I am in the office, yet I get enough time to ensure my exercise regime is followed, I can prep meals on a day off for the days I work and I get adequate rest. I can also schedule medical appointments on my days off without feeling guilty for taking time off work.

No, financially it is not as beneficial as working full-time. But I am a lot healthier.

Exercise

Yes, well, it goes without saying that would be high on my list of recommendations! Limberation would not exist if I did not believe so strongly in the benefits of exercise. I won’t repeat my How Tough is it to Get Moving article here, I’ll just repeat, when I say exercise, I’m not suggesting you rush out and start running 10 km a day!

The days I do strength workouts I ALWAYS sleep well that night. Exercise has definitely helped alleviate my fatigue.

Healthy Eating & Hydration

Particularly, I have found, a problem if you live alone. When you are so tired you can hardly keep your eyes open (but of course you can’t sleep either), perhaps also in pain, maybe also stressed because you missed that important deadline at work or missing the school concert: guess what, taking the TIME to eat properly, or even enough, just seems to fall by the wayside.

Once I started making sure I ate enough protein and stopped depending on “easy” solutions such as toasted cheese sandwiches, I did indeed feel a lot better. The meal prep mentioned above is not just about time, it is also about ensuring I have nutritionally balanced meals right there when I am too tired to cook.

Drinking enough is also crucial. I find I am good on the intake when I am at work or the gym. I am slack when I am home – the water bottle always seems to be where I am not and I forget. I certainly know about not drinking enough later on though.

Don’t Worry About the Ironing

Or the vacuuming. Or polishing the furniture (a quick dust will do). Yes, you must feed the cat, dog, fish or bird if you have one. Vacuum one room a day. If you are in a family environment, delegate the ironing if possible: if living alone a) buy clothes that don’t need ironing or, b) iron one thing the night before. Hide the ironing basket in a cupboard out of sight, not only of visitors, but out of sight of yourself so you won’t be tempted to overdo it!

Sleep Hygiene

There are lots of different sleep hygiene strategies/techniques you can try, from breathing techniques to relaxation music, yes, even counting sheep will work for some. Temperature of the bedroom is important, put the screens (iPad, phone, TV) away well before bed-time. Talk to a professional about strategies that might work for you.

This one is an ongoing challenge for me, so I have no brilliant suggestions of my own to share. I know it is important and I’m working on it!

Why the Cat?

Why is my cat the photo? Because Cleo is doing what we must all do. Learn new things, within our restrictions. I don’t have an area I can let her experience the great outdoors freely. Learning to adjust to a harness and lead allows her experiences she would otherwise not be able to have.

Our harness is learning to PACE ourselves, so we can still have adventures.

Additional Resources:

A very interesting media release from 2007 by Arthritis Australia is worth reading, Women’s Insights into Rheumatoid Arthritis.

How tough is it to get moving?

You may be asking yourself “How tough is it really, to get moving?” This may be moving again or starting from scratch. I’ll be honest, it may be tough-ish. How tough (or easy) will depend on many aspects: your specific condition, were you diagnosed early and therefore received appropriate medical care early, your pre-diagnosis level of activity, the medications you are on, the symptoms you specifically experience, do you have a chronic condition or are you in recovery from treatments such as chemotherapy.

The aim  of moving is to prevent de-conditioning, which I spoke about in Launching Limberation. Specifically here I am referring to pain management, but the benefits extend beyond this.

My Journey

I’ll share some of my own journey but as you read please be aware your situation may be entirely different. I do use time, distance and weight in this article to provide a sense of progress. Different people, different situations, different numbers, different timelines. What applies to me may not apply to anyone else at all.

Thankfully, I wasn’t completely starting from scratch – while I’d had an activity hiatus for roughly four years, I did have a gym junkie background to leverage. Or so I thought. In the beginning it certainly didn’t feel like I was leveraging anything!

Because I was diagnosed with two different autoimmune conditions at once, my medical team advised we stabilise one condition (hyperthyroid) before attempting to treat the other (autoimmune arthritis). Fatigue was a major problem for me in the beginning. Coping with getting to and from work, work itself and home life was draining what energy I did have. There was basically nothing left in the tank in the early days.

At the Starting Line

When I did start, I started very slowly. I did five minute walks four times a day. It didn’t take me long to realise I felt better when I moved. Pain and stiffness receded very quickly once I was actually MOVING. I increased to ten minute walks, three times a day. Finally I got to twenty minute walks, twice a day. I also moved as much as I could during the working day: sitting was hell. Even now, writing this in my home office where I do not have a sit-stand desk, I will not sit for long. No amount of activity is too small to start.

I didn’t do any strength (resistance) work at all in the beginning. I added some swimming: gone were my 2.5 km sessions: my physio was advising I swim 250 metres. I mumbled and grumbled that 10 laps wasn’t worth getting in the pool for, but I did stick to her advice the first time. The inflammation was also in my shoulders, meaning I had to strengthen my shoulders: be able to do 20 prone shoulder rotations (each side) daily with a 2 kg weight before I was allowed back in the pool.

Resistance Work

I wasn’t until late 2015/early 2016 I got back on the weights. I’d always liked the leg press, but had no idea what I should try to start with. Prior to the autoimmune arthritis and the hyperthyroid diagnosis, I’d been diagnosed (by MRI) with meniscus tears in my left knee, not a lot of cartilage to speak of and I’d had a Synvisc shot. I was understandably cautious, but knew I was continuing to lose muscle strength which wasn’t going to help me long term at all. I needed strength to support my joints, especially the damaged ones.

I loaded 10 kg weights on either side of the leg press and felt SO frail. I was in my school gym – most (not all) fellow fitness students were athletic and I felt like I didn’t deserve to be there. 20 kg was perhaps overly cautious. I upped the weight to a total of 60 kg quite quickly. From 60 kg to 100 kg took quite a bit longer. If I recall correctly, I got stuck around the 80/90 kg mark for quite some time. One of the issues was not actually physical by then – it was not knowing what was safe for me to aim for and no-one I asked was quite sure either. Will I ever get back to 200 kg? Right now, I doubt it – and you what? I’m OK with that. I know I have achieved what I set out to do – stay off pain medication. I’ll let the healthy people worry about 200 kg leg presses.

Climbing back up

Ultimately I asked my rheumatologist, who is very supportive of what I am doing, “How far is it safe for me to go? I don’t want to damage anything”. He is well aware I am using my own body as a research subject. He smiled and said “You’ll be fine. You’re sensible. Back off if it hurts.” After that I was more confident to push myself. I am careful. I don’t subscribe to the “no pain, no gain” philosophy – after all, pain is what I am working to manage, I don’t need to have more of it. Pace, incremental gains, no lifting to failure. My definition of “push myself” is not the general fitness industry definition – for very good reason.

I have just, this month, August 2017, managed to do a dumbbell bench press with 12.5 kg dumbbells (25 kg). I started back at 5 kg (10 kg total): it has taken me over 12 months to get to this far.

Other Considerations

Sometimes progress stalls. I find I lose gains very quickly if I miss a strength workout. Whether this is due to medications, the conditions themselves, my age (yes, I do have to consider that these days) or a combination of all three, I’m not sure. I’ve searched for research around such questions but have yet to find anything specific.

In late July 2016 I had a change of medication. I found this helped dramatically with the fatigue and therefore it has helped all the other aspects of my re-conditioning.

I don’t run. My knees are pain free and I want to keep them that way so I just don’t risk putting them through jogging or running. I walk a lot. I walk to my Pilates classes, I walk to or home from the gym, I walk to the next tram stop. While I’d love to get back to 10,000 steps a day, I’ll settle for 8,000 plus my other activities. I do indoor rowing, great whole body exercise.

In 2014 I could swim a 2.5 km session. In 2016 I was finally allowed by the physiotherapist to swim 250 metres. Now I’m back to 1.2 km sessions. Sometimes I only swim 800 – it depends on how I feel and how my shoulders feel. The message here is listen to your body at all times. Don’t use that as excuse to not do anything – but listen to your body. On Saturday I did my usual strength workout: I had every intention of increasing that leg press again, hopefully by 10 kg – I was aiming for 140 kg. As soon as I did my warm-up set I knew for whatever reason today was not the day. My strength was just not there. I suspect it was lack of dietary protein the day before – I’m currently monitoring how I feel against my dietary protein levels as mentioned on the Science Stuff page. So I simply did not try any increase. Next week will do, there is no rush, I’m not competing with anyone. I didn’t go backwards and that is my focus.

I’ve added Pilates to the mix at the suggestion of my physiotherapist. While this may look easy (looks like I’m doing absolutely nothing, doesn’t it?), trust me, after ten of these retracting the scapulae and opening the chest, I don’t want to do any more until the next day!

Objective Achieved!

As you can see, it isn’t achieved overnight. I’ve worked at it. Slowly, but surely, I’ve achieved my original goal: to stay off pain medications. Now on to the next goal, which is to help others in similar situations.

Will you give movement a try? Contact me for a preliminary chat. Limber Up to Live Life.

Disclaimer: This article is based in part on personal experience and is of a general nature, not tailored for any individual circumstances. Where appropriate, readers should seek medical clearance before embarking on an exercise program.