Adjusting Our Goals

When we use Movement As Medicine, we need to set goals: SMART goals. If you are new to the concept of SMART goals, click on this link “Make 2018 Your Year for SMART Goals” and catch up!

My current general goals are:

  • 7,500 steps a day, including active rest days
  • Weight training Tuesday, Thursday & Saturday
  • Swimming Wednesday & Sunday

I say general goals because within each of those, there are more specific goals, e.g. improve my walking pace to 10 minutes per kilometre, increase my leg press weight to 110 kilograms, swim 1,000 metres in a session.

Today is Sunday. I did not swim today. I adjusted my goals due to my condition requirements. Or, to put it another way, I was happy decided to miss that swim goal today. Sometimes we have to. Everything has been going swimmingly (pun intended) however on Friday I did something unusual: unusual for my body, that is. I scrubbed dirt off a window cavity frame well above my head. In fact I was on a stepladder. Yes, I do shoulder presses at the gym, but that is a very controlled action. Scrubbing stuff is not such a controlled action. Oh, I inherited the dirt, I didn’t create it! Just in case you wondered.

As is typical for my joints, two days later (today) the joint I may have overloaded while living life is complaining. The same two day lead time happened with my wrist recently when I used a manual screwdriver to screw 48 screws while building two bedside drawer units.

Lots of screws!

In that particular case, Friday being an active rest day, my grumpy wrist didn’t upset my walking – however on the Saturday I did drop my bicep curl weight. My wrist has to hold the weight. Often we can adjust activity to ensure we are operating in a pain-free range. We can walk for less time or at a slower speed, but do more walks on the day, for example if it is knees, hips, feet or back that is grumpy. I can temporarily lower a weight, as I did with the bicep curl, to ensure I don’t aggravate any inflammation. In that case, inflammation I had caused by doing too much twisting of the wrist.

Swimming is not such an adjustable activity. I can’t do half a stroke. I can’t reduce the range of motion of my arm to swim within a pain-free range. I’d sink and that is not a good look.

I pulled out my hydrotherapy equipment and did 30 minutes of exercise in the hydrotherapy pool. The top picture is my carefully rinsed equipment drying. From the left:

  • Push bells which I also use as dumbbells. I got these instead of aqua dumbbells as I don’t have to grip them, they strap onto my hand.
  • Pillow. I use this in the corner of the pool when I do certain leg exercises. Purely for comfort.
  • The bag I carry the equipment in.
  • Aqua cuffs for the ankles – this particular type is no longer available, it seems.

I bought these from theraquatics.com.au some time ago if you are interested in getting any equipment yourself. Theraquatics are a registered NDIS provider.

The ankle cuffs have extension pieces, therefore the two can be joined to make (for example) a waist “cuff”.

Setting goals is important. Just as important, when we are managing chronic conditions, is the ability to say to one’s self, “It is OK to adapt today”. That can be difficult for some of us. For example, I find it VERY difficult, let’s say impossible, to end a planned 2 kilometre walk at 1.93 kilometres. I’ll walk to the clothesline and back to get that final 70 meters! I like round numbers, I’m an accountant! What can I say?

Yet I knew when I was making my breakfast this morning that my right shoulder was not happy. I knew that swimming would quite likely exacerbate the situation. Then I’d need to take Prednisolone to settle it down. So I did the sensible thing. Gritted my teeth and let my swimming goal slide for the day. I replaced it with an alternative activity. One where I could easily control my range of motion.

Am I annoyed? Yes. Of course I am. At the same time I am also pleased with myself for being sensible!

Goals are good. Adjusting goals is sometimes necessary and also good. Even for stubborn people!

Incommunicado Quads and Walking Sticks

I know I’ve been incommunicado – unfortunately the quads in my right leg also went silent – so silent I couldn’t move my right leg. At 1 am on a Friday morning, not knowing what was wrong, I’ll admit to being a little panicked.

This was a few days after I’d had some very minor, completely unrelated surgery, so it was a bit of a busy time. My knee was already playing up then, as the hospital had helped me into a wheelchair from the taxi on arrival for admission.

Initially I thought I’d just been lying funny and my leg had “gone to sleep” and would recover in a few minutes. When it didn’t, I was a little more concerned. I couldn’t actually make it out of the bedroom – every time I tried, using the windowsill as a walking stick, then swapping to the bed frame – I’d get halfway across the end of the bed and feel SO nauseous I’d have to lie down again. Took me three or four attempts to actually get out of the bedroom. The doctor later told me this would have been due to pain, yet I do not recall any pain, I just could not use my leg. Well, yes, it was very painful if I put any weight on it, but I was studiously avoiding doing that – or so I thought!

To cut a very long story short, I dragged my poor daughter out of her bed, a 40 minute drive away, to take me to the emergency department. By 10 am I could lift my leg about 1.5 centimetres off the bed in ED. By noon I could bend it 90 degrees! Yay! I did not want to be admitted because the following week I was starting a clinical drug trial and intervention at this point might very well have excluded me. More on the drug trial in my next article – it is FANTASTIC.

So I was allowed home with a prescription of rest and elevation. The knee was rather swollen. Something else I didn’t need. It was the swelling in the knee that cut off my ability to use my quads. I should have known: earlier in the week I’d used an ice pack. I remember thinking “This ice pack isn’t very cold” then popping in on my left knee for a moment and thinking “This ice pack is FREEZING”. Clearly there was already a bigger problem brewing than just a sore knee.

My quads shutting down had nothing to do with my psoriatic arthritis. This was just a new problem arriving with very bad timing.

An MRI later and the results were in: “significant osteoarthritis, particularly behind the patella”. Oh, great – just what I need – not.

I got one of those awfully boring grey hospital sets of crutches so I could get around. Of course I thought I’d only need them for a day or two. Umm nah. I did manage to get down to one crutch, but I hated the grey, the cuff didn’t fit properly over my denim jacket and I was about to go to a conference in Sydney (more on that in a later article too). So I bought a very pretty walking stick (see above). If I had to use one, I was going to at least be semi-stylish!

Second problem was how to rehabilitate this knee. My rheumatologist advised (just as well, really) exercise to build my muscle strength back up. With the challenges I’ve had since January with medication changes and the resultant psoriatic arthritis flare, my exercise had taken a temporary back seat. It doesn’t take long to lose strength, especially as we age! I am reasonably sure this contributed to the osteoarthritis letting me know it was not at all happy with me. In order to make 110% sure I was doing the right thing, I enlisted the help of an exercise physiologist, Jack. Yes, I’m a personal trainer, but in this specific case I wanted to triple check my approach was correct. Jack has higher qualifications than I do and I do not hesitate to call in the big(ger) guns if necessary. He did get me to start a little slower than I might otherwise have done (a good thing), but by the second appointment he essentially let me loose. I did pick up some nice new very specific rehab exercises from him and am very grateful for his guidance and expertise.

I retired my walking stick on August 29th after six weeks. Yesterday I was back on the leg press, high reps, low weights. VERY low weights. I did one set at 40 kgs and two sets at 60 kgs. I was doing 160 kgs last year! This picture won’t mean much to readers, but to me it was getting my mobility back!

I’ve also been doing hydrotherapy. I’m “allowed” to do as much hydrotherapy as I like. Jack was thrilled I was doing squats in the hydrotherapy pool, I was thrilled he was thrilled with my adaptation! I do them out of the pool as well, but in the pool is good, especially with this darn knee.

Back in 2014 I’d had a Synvisc shot in my left knee (which was great) but of course that strongly indicates that left knee is not all that wonderful. It also indicates (although I didn’t have an MRI of the right knee back then) that perhaps both knees were a little under the weather back then. I had an arthroscopy on this right knee many years ago and until now had no further issues. Well, now I know I have two knees requiring a little extra care and attention. With the extra load the left took while my right was on strike, by the time I retired the walking stick, my left knee was reminding me it is no longer a perfect 20 year-old knee. I threw my hands in the air and applied the rehab exercises to both knees.

I’m lucky – I have been able to retire the walking stick. Using one is like driving, it takes a long time before it becomes second nature. I felt I was on “L” plates the whole time. I’d drop it when trying to juggle bag, stick and anything else I happened to have – such as a morning coffee. Getting on and off trams was a challenge but at least I was no longer one of the invisibly ill and people jumped up to give me the special needs seats. I now had a badge. I never seemed to be able to lean it anywhere without it falling over – poor Cleo (my cat) nearly got whacked by the flying walking stick several times as it fell to the floor. I felt I just could not get it right. I also felt SO SLOW.

I have a new appreciation and understanding of those who use mobility aids permanently or semi-permanently. In the last week, I carried it with me, but used it less and less as my knee recovered – however then people look at you in very odd ways as you are carrying but not actually using a walking stick. I never thought of getting a folding walking stick – lesson learnt!

That particular situation is much better addressed by Kristen Waldbieser, who does not need her wheelchair 100% of the time.

Between minor surgery and the above, I hope you forgive me for being very quiet. I’m going to make up for that in the coming days. I have a drug trial and a conference to write about! Stay tuned!