Listening to my body

Do you ever have one of those days where your body says, “Whoa whoa whoa, slow down! You’d better rest up or you’ll have to pay for it!”

I’m having one of those days. Yesterday I was very “productive,” in the sense that I made a lot of food and then cleaned up the kitchen. (Healthy and delicious food, I might add.) I think I would have been okay if I hadn’t made the spicy olive oil bread dip, or maybe if I hadn’t gone out afterwards to pick some friends up at the airport from their 10:30 pm flight.

Either way, my body is saying, “Rest.”

So I’m going to listen, otherwise it will get much more insistent. It’s like fibromyalgia is a voice for my mind, body, and spirit. Enough stress on any one of them, and fibromyalgia gets a wee bit louder.

“Pssst, hey, you might want to lift with your knees next time.” (back gives a twinge.)

“Okay, if you’re going to walk around a lot at least wear those inserts the doctor gave you.” (slight foot pain added to the chorus)

“Do we have to stand by the kitchen pot the entire time it’s steaming? Can’t we set a timer and go sit down?” (fatigue)

“Wait, you’re going to cook something else? Okay, but we better get to eat it once you’re done. We’re hungry.” (hunger, fatigue, and pain)

“Dishes? Okay, there are a lot of dishes. But you had better sit down and rest after the dishes, young lady, or you will be sorry.” (pain and more fatigue)

“You want to extend your curfew so you can go out tonight? Well, if you do that you have to rest tomorrow. I mean it. No going out to the museum like you wanted to.” (really, really tired, on the edge of a headache)

Every time, my body ratchets up the pain and fatigue just a notch – trying to get me to notice my limits. If I really, really don’t pay attention, it screams at me. (Or as a friend says, I have to “pay the piper.”) That’s when it takes the stern-parent-you-are-SO-grounded approach by incapacitating me for several days – or more. “You will rest, because I said so.”

Honestly, I think all people have these kind of limits. If you are “able-bodied” and you run on little sleep for a long time, your start getting cranky, have trouble driving, etc. It just takes longer for your body to scream at you. With fibro, it’s like my body is a little trigger-happy, and is VERY insistent that I know my limits.

It’s that balancing act I was talking about the other day, although maybe I’m personifying my fibromyalgia a little bit.

Winston Churchill had severe depression, which he described as his “black dog” that followed him everywhere. I suppose fibromyalgia is a little bit like that, although I picture it more as a little gremlin on my shoulder that starts gnawing on me if I don’t listen. Or maybe it’s more like my own body rebelling, and us a time-out. After all, why create this artifical divide between “my body” and “me”? That’s a subject for a different post.

Signing off now, so I can go rest.

Body as a processing tool

If I ever needed a reminder that the mind-body connection is a real and vital part of life, I’ve gotten it recently. There have been a lot of new changes and new beginnings (no need to go into it here).

The thing with change – it’s hard, it’s difficult, and it’s absolutely essential to growth and development. (Just google “death and rebirth” if you want more examples.) That’s really a topic for another post, which will come at some point. But back to mind-body connection.

I went through a whole wealth of emotions recently – fear, anger, compassion, elation, frustration, and so on. I ended on a high note, and was really feeling proud of what I’ve accomplished.

As for my body – there was a delay of about 2-3 days, and then it started processing all that change physically. I’ve been dealing with a fibro flare – pain, fatigue, and fibro fog. This morning my stomach started acting up at about 6 am.

The thing is – it’s not a bad thing that my body is going through all these changes so rapidly. It’s only natural that with so much change going on, my body needs to process it too. When I go through emotional changes, I expect to cry. Why shouldn’t my body cry, too?

I know it’s going to get better. I just have to be with it for awhile, and let the changes happen. I don’t think burning up is a particularly pleasant experience for a metaphorical pheonix. But being reborn – that must be something.

Weekend extra: Blog post on values and balancing mind-body wellness

Bronnie Thompson has written a wonderful blog post about Balance, control & passion. It echoes a lot of what I’ve been pondering (to myself and friends) lately about the meaning of work and values when one has a chronic medical condition/disability.

“Yesterday a couple of colleagues were talking about balance in life, and making it plain that they think people who spend a lot of time and energy on their work are sad.  Their opinion? Work is the means to pay for your ‘real’ life, to spend more on working means less on what is really important to them…

One way of looking at the distress and disability associated with chronic pain might be to think of it as a result of conflict between what can be done (resources) and both values (what is important) and goals (how I want to express my values). An ongoing problem with life itself is the limited resource we have to do what we want!  The whole of life is really about this balancing act.  And I suspect that one of the major sources of distress for people with chronic pain is that they carry on using the same strategies to express values but with limited resources to achieve it.

I’m not the only one to think of it this way – several authors have talked about the concept of ‘psychological flexibility’ (McCracken & Vowles, 2007).  Psychological flexibility involves several processes such as acceptance, mindfulness, values, and cognitive defusion.  This is a bit of jargon from ACT (Acceptance & Commitment Therapy) and basically means being able to allow oneself to experience all that life brings, while at the same time choosing to act according to what is important and valuable to you – and being prepared to alter the way in which this is achieved, depending on the situation.

So one way of looking at people with disability from their chronic pain is that they are stuck.  Stuck using old and unhelpful ways to achieve what is important to them.” [emphasis mine]

What wonderful insight. In my introduction, I talk a lot about my pre-bipolar-and-fibromyalgia self and preconceptions about what it means to be successful.

A lot of people talk about finding a balance, often finding a balance between mind, body, and spirit. How does having fewer resources to do so affect this balance? What happens when you don’t have as much energy, or you’re dealing with chronic pain? Bronnie discusses some different treatment modalities, such as Cognitive Behavioral Therapy (CBT) and ACT (Acceptance & Commitment Therapy).

“One problem I have with CBT is that when my own resources are low (I’m really tired, maybe I’m a bit depressed) the energy it takes to process and evaluate my automatic thoughts can be really hard to find.  It takes a lot less energy to simply allow the thoughts to be there but not act on them and remain focused on achieving things that are important to me.”

I actually hadn’t heard of ACT before, so that’s something for me to look into. I have to echo thoughts on the energy it takes to use CBT. If you’re already in the midst of some emotional or physical pain/fatigue/distress, it’s very hard to kick-start yourself into using those CBT coping skills. When I’ve dealt with some negative thought patterns due to mental illness, I found that it was very important to use my coping skills as soon as I noticed a problem. If I waited until it was a bigger problem, it snowballed out of control. Physical pain can sometimes come on very suddenly. You don’t always get some head notice that you’re going to have a flare-up. That’s why I prefer mindfulness meditation to CBT when I’m having a fibro flare.

“What we are trying to achieve in pain management is living according to what is important (valued) and being flexible enough to find ways to achieve this despite pain…

What this means is that there are times when I choose to act according to what is important to me, despite my own thoughts (which might be automatic, and wanting affirmation from people that I’m OK and not ’sad’), and despite my own energy levels.  To be able to choose whether I persist with some things and drop others, knowing that I’m living out my important values gives me that freedom that we call ‘being in control of my own life’.”

Well said.

Wiggle your big toe

This post is the first of a three-part series on exercising with physical limitations.

When I was first diagnosed with fibromyalgia, I froze. Everything hurt, and I was convinced that moving would hurt even more. (In the short term, it can.) I would “over exercise,” and then end up hurting for several days. The less I exercised, the harder it became to do anything.

It didn’t help that my view of exercise to that point was “something that you do to stay in shape but no one actually enjoys.” In general, gyms seemed like giant fishbowls where people watched you torture yourself from the street. Gym clothes were utterly intimidating. Why would I want to do that?

I’ve found – with a lot of help and encouragement from professionals and some loved ones – that exercise can be fun and enjoyable. There are a wealth of reasons to exercise:

• Feeling able to exercise can boost confidence.
• Exercising is a great way of getting in touch with your body, which is essential if you’re trying to get into the whole “mind-body” way of life.
• The more you exercise, the more you find you can do. It’s an “upward spiral” rather than a “downward spiral.”
• It can be fun to “discover” new things to do as exercise. I recently started swimming again, which is both fun and low impact.
• One day you will probably be showering and realize that you have new, sleek, firm muscles.

Notice that I’m not even getting into the weight-loss issue here. I’ve found that “exercising for weight loss” is the quickest way for me to lose interest. If I don’t lose weight right away, then it’s disappointing. However, if I’m exercising so that my body will feel better, then I’m likely to see immediate results.

The trick is to take baby steps, as with all things. If I were to try to go for a five mile run, I’d end up sore and swollen and tired and in bed for a few days.

When I first started exercising again after a long period of inactivity, I would go very gradually. Maybe I’d walk to the stop sign near my house and back (about 1 block total, if that). I’d gradually add more and more. It’s the same with any exercises my physical therapist has given me.

Even now, I’m having to re-establish my exercise routine. There was a really bad cold snap, which tends to make walking outside challenging. I’m still trying to find a good “back up plan” for when the weather outside is frightful. Then I got a really bad stomach flu, and was too sick to exercise. Now it’s back to exercising. The good thing is that since I’ve built up those muscles and health routines before, it won’t take me as long to get back to where I was.

Any amount of movement is good. Slowly increasing your activity with something you enjoy is a step towards a healthier lifestyle.

Here are some sample ways to begin: walk, swim, bike, drum, do laundry, vacuum, stretch, canoe, sail, garden, hike, dance, build a table/bookshelf/etc., do yoga, shop, play fetch with your dog, spend any amount of time with a toddler…

Pick something that you enjoy. That is key.

Note: Check with your medical professional before beginning any exercise routine.

“Skillful” Reactions to Pain

I had my first “topic request” for a post. (Please pass on more requests in the comments section, or as an @ request on the Twitter feed.) A friend asked me to write more about my reaction to pain mentioned in the previous post. She described my reaction of “Oh, I’m in pain…it will pass” as being potentially very alien to people.

I’ve drawn a lot of inspiration and methodology from mindfulness meditation, so a lot of what I’m about to say is my interpretation of wise things I’ve been told. I learned a lot of this from Insight Meditation Community of Washington (IMCW) meditations I’ve attended. One of the people who leads discussion after the meditation is Jonathan Foust. He actually has a 30 minute (or so) podcast about “Working with Pain” on his website. If you’ve got the time, it’s a wonderful talk. There’s also a guided meditation mp3 on the same page.

I could talk about a lot of pain theory and techniques, but instead I think I’ll describe one of my first IMCW meditation experiences. This was the experience that made me really “get” mindfulness meditation, and totally convinced me how wonderful it is. It was also a – pardon the pun – insightful experience.

Mind-body connection

I read an article, “Is it All in My Head?”, from Psychology Today recently, and I really feel like it has a lot of good content about the role of the mind-body connection in chronic pain syndromes.

“Capping her frustration, Howard cannot be sure to this day why she became ill. But her best guess is that the self-imposed stress of her ambitious lifestyle played a role….Howard’s suspicions are confirmed by many researchers, who are coming to believe that psychological factors play a crucial role in perpetuating many physical illnesses, particularly a subset of chronic ailments that defy logic, diagnosis or a cure. It seems that the way you think about your illness can actually affect how sick you get.

These “multi-symptom illnesses”—which include chronic fatigue syndrome, fibromyalgia and potentially others such as Gulf War syndrome, irritable bowel syndrome and the condition known as multiple chemical sensitivity—have provoked intense controversy. Because they have no obvious biological cause, some doctors and researchers dismissed them in the past as hysteria or the “yuppie flu.”

Many patients, in response, became equally determined to prove that their disease was just as real and as biologically legitimate as heart disease or breast cancer….

However, the war between doubters and advocates has waned. The consensus is that these illnesses are truly mind-body diseases, in which biological and psychological causes and dysfunctions are inseparably intertwined. The mind seems to play a key role in kick-starting and perpetuating illness—but it’s not that sufferers are simply malingerers. Their bodies are sick, and their reaction to the illness often makes it worse.” [emphasis mine]

I definitely would have had a hard time hearing this when I was first diagnosed. I was in the “camp” trying so hard to justify my pain to people who didn’t seem to understand. Heck, I even had a “Fibromyalgia is Real” awareness bracelet.

That mindset didn’t help me get better. I just stayed trapped in what Buddhists would call dukkha, or suffering.

Allowing myself to feel pain – but not dwell in pain – is probably the single most important lesson I have learned from my experiences with fibromyalgia, if not my life.