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.

Food scales

Lighten Up to Limber Up

Many people with chronic health conditions are told by their doctor to “lose weight”. Having a chronic condition can mean the weight creeps on, often prior to diagnosis when we don’t know what is wrong, just that we aren’t well. This may continue after we are diagnosed, while we wait for treatment decisions to be made or for treatment to kick in. We may be on a steroid for a while (as I was) which despite the best intentions in the world can result in patients gaining unwanted kilos. Lots of stuff going on that disrupts our normal patterns, can effect our ability to see we are gaining a kilo or two.

How many times do any of us get home from work too tired to cook a proper meal, so we have a toasted cheese sandwich? With Vegemite, of course! Or grab take-away on the way home? Maybe even Vita-wheat, Vegemite and cheese. That’s 232 calories, but not really nutritionally balanced. Doesn’t look too appealing either, to be honest.

Vita-Wheat Vegemite Cheese

In addition, because we don’t feel well, we aren’t exercising enough to compensate for our often less than optimal food choices. We are defeating ourselves from both aspects: too much in, not enough out. We are NOT necessarily able to just ramp up our weights or cardio and burn that cheese sandwich right off. In fact, walking from the car to the lift at work may be as much as we can manage some days. Adjusting to our new activity levels means adjusting to new fuel levels as well.

I can see some readers rolling their eyes already: “I knew she’d get to the weight loss eventually, but I want a coach who isn’t all about the scales“.  Hear me out. Let me assure you I am not all about the scales (actually, I am all about food scales), but I mostly certainly AM about helping my clients attain and maintain a weight that supports their efforts to manage their condition – or conditions. Take a good honest look at my picture below – do I really look like Vogue are going to invite me to appear on their cover next month? Of course not – I am no Australian size 6 – nor do I aspire to be. That photo is 12 months old – taken shortly after my medication change but before I was able to ramp up my own weights, but I have used it deliberately to illustrate the challenge we face.limberation-small-15

What I aspire to is being pain free and in control of my conditions. I’ve achieved that as far as my autoimmune conditions are concerned, but I can still improve my back support (detail later in this article). I am not going to complain if I lose a few more kilograms, but neither am I going to obsess about it. While the lighter I am the less stress there is on my joints, where I am right now now I’m more interested in building strength (to support my joints and increase my metabolism (in turn encouraging those kilos to drop off as a nice side benefit).

Make no mistake, when it comes to your health, the risk of developing a range of conditions is dramatically increased if you are overweight or obese (comorbidities associated with obesity are conditions such as diabetes, heart disease and cancer to name just three) . The risk of negative long term health outcomes are higher if you remain overweight or obese. The medical and scientific evidence is overwhelming.

Being overweight increases the load on joints for conditions such as the arthritis family. The heart has to work harder to pump blood around. If you find doing stuff an effort, imagine how hard your internal organs are working. My lumbar spine is not a lumbar spine I would recommend either – as we get older, lots of bits and pieces tend to show wear and tear, irrespective of any conditions we may have. In my case my lumbar spine is a bit unhappy. So core and glute strength is important for me.

At L3/L4 I have “marked facet joint hypertrophy” and a disc bulge. At L4/L5 I have a broad-based disc herniation and facet joint arthropathy. The complete findings run a full page, that’s just a sample. I don’t need or want to place any more stress on my back by making it carry around extra kilograms or not supporting it with good muscle tone. I still have some intermittent pain we suspect may be the result of this wear and tear, but it is improving.

To give your body the best chance of serving you well for the next 20, 30 or 40 years, you need to take care of it. Especially now a medical condition/(s) is making a darn fine effort at undermining your plans. Reduce the strain on the joints, give your heart and lungs a lighter workload, give your body the right fuel in the right amounts.

Speaking of fuel, when you take your car to fill up the tank with petrol or diesel, the fuel tank has a finite capacity. My car has a 60 litre tank. I can’t put 70 litres in the car. Our bodies are a little more flexible. My body will use an estimated 1,388 calories a day to stay alive: breath, pump blood around, blink (refer BMR Calculator below this article). I’m 62, so my metabolism is already slowed just by the fact I’m not longer 20. If I eat more than 1,388 plus whatever my activity calorie burn is but don’t use it, I’ll just expand. Unlike the car’s fuel tank, my body has no capacity limitations. Nor does yours.

Example: 1,388 + 100 for steps for day + 380 for a strength workout = Total 1,868

If I eat 2,200 calories, guess where the excess over 1,868 is going? Fat stores. That puts more stress on my joints, internal organs have to work harder.

Many of the learned articles on overweight/obesity talk in financial terms of the costs to the community and the country. I’m concerned about the personal non-financial costs to YOU, the individual.

I won’t lie to you. Getting into the groove of eating less calories BECAUSE you are burning less calories is a bit tough initially. As I mentioned in my opening paragraph, it may be a while before you even realise your activity levels have dropped or your metabolism may have slowed as a result of your new friend, your condition. We have to adjust to not burning as much as we used to: it requires us to develop new habits, change behaviours: that is hard. But only for the first few weeks. What bothers you more? A difficult few weeks –  or a tough (possibly shortened) rest of your life? The sooner you take positive action, the shorter the road will be.

Am I saying I never have a Murray River Salted Caramel with Macadamia ice cream (my nemesis)?

Connoisseur Murray River Salted Caramel

No, I’m not saying that. I like to have the things I really enjoy every now and then. I am also well aware that “little” indulgence is worth 339 calories. In other words, worth a whole meal (for my calorie levels, you may be able to have more). If I’ve burnt off 400 calories through activity that day, I can indulge and still hit my calorie deficit target. If I’m having a day where for whatever reason I’ve done very little activity, I make sure I am strict with myself. Keep on top of it, because we no longer have the luxury of going for a 40 kilometre bike ride to pull back a couple of naughty days.

All that discussion was without even looking at ensuring we are getting balanced nutrition. Our body is fighting an internal battle for us now – we need to give it the right nutrients (micro and macro) to put up the best fight it can. That’s a whole different topic for another day!

This article should be read as an introduction and conversation starter only. The concepts discussed are general and not tailored for any individual circumstances. Limberation can provide healthy eating support and guidance.

Additional resources:

PwC report, Weighing the Cost of Obesity

BMR Calculator mydr.com.au

BMI Calculator mydr.com.au

Australian Guide to Healthy Eating

Also check the references on the Science Stuff page.