Namaste, and all that…

rageyoga.jpg

A couple of weeks ago, I made the somewhat premature, and possibly ill-advised, decision to book myself onto a yoga class, and I have to admit that, all things considered, it was quite an odd thing to do taking into account that I am currently unable to even manage the most basic of asanas well.  I remain puzzled about what on earth was going through my mind at this particular point in time, but as with the majority of my ‘decisions’ of late, I had a fair level of reassurance that I would most likely bail at the last minute anyway – ‘unreliable’ has become my middle name over the past few years.  I’d even gone as far as to phone the teacher beforehand to warn her of my various physical limitations, perhaps in the hope that she would refuse her consent to me attending because I could turn out to be the biggest liability she’d ever had to deal with; however, no joy there either, and she suggested I came along to give it a whirl.  Meanwhile, my head was busy reassuring itself that I still had numerous reasons for not showing up: waking up and getting up on time is still quite a major achievement for me, swiftly followed by the level of pain and stiffness first thing, whether the pills kick in on time, and when they do whether I’ll be too wasted to do anything much at all.  And even if I managed all of the above, I would presumably have raging anxiety levels which would make it impossible for me to go somewhere I’d never been before and be surrounded by complete strangers.  So, I slept well that night, safe in the knowledge that I had numerous genuine reasons and lame excuses already in place, and assumed I simply wouldn’t manage it which would probably be the best outcome for all involved.

Yoga is interesting stuff, and I’ve practised it intermittently for many years.  I should, perhaps, add here that I’ve never felt the physical / psychological / spiritual/ transformational uplift which many yogis / yoginis apparently do experience, but in the past my relatively brief periods of doing yoga regularly have produced positive physical and psychological results.  I first tried it during late pregnancy, and found it helped with respiration, relaxation and flexibility.  I tried it again a few years later, having discovered that I would need to wait many years before my knee replacement surgery could be performed so to try to retain as much flexion within my leg as possible in the meantime, and then again a respectable period of time after surgery.  And finally, I drifted back into it a few years ago, during a more frantic search for some level of reassurance that my body wasn’t escalating wildly out of control, before having to admit that actually it was and I needed more surgery.  It seems that there has always been some benefit in my practising yoga on a regular basis, so why do I never stick at it?  If memory serves correctly, it is a combination of things – firstly, and perhaps inevitably, the changing levels of mobility and pain due to my arthritic condition; secondly, my psychological issues with depression and the accompanying lethargy, lack of motivation and decreased energy levels are hardly conducive to such practices; and finally, dare I say that perhaps it’s my personality which is at odds with it, my impatience and my lifelong inability to stick at anything for very long before flitting off and diving into my next fad?

Anyone who has ever tried yoga will probably tell you that it’s hard work – really bloody hard work.  Yes, it all looks very lovely and a bit freaky, but just because no-one ever leaves a class with a scarlet sweating face and gasping for breath doesn’t mean that it isn’t a major body work-out.  Again, this is what puzzled me about why I booked myself onto a class – surely, after all the aches and pains of the past few months, why would I want to put my body through something like this?!  I guess the answer lies in the fact that I am so totally sick of doctors, surgeons, hospitals, physios, and all things clinical.  I think the answer is that I realised that I needed to do more to get my body working better, to build more stamina, to strengthen core muscles etc but also that what I wanted was something which was interesting, nurturing, and was more holistic than the traditional post-surgery recuperation strategies.  One of the purposes of this blog has always been to consider a more humane perception of the physical and psychological impact of arthritic conditions and treatments, and how clinical approaches to recuperation are limited simply to physiological expertise rather than a more supportive and holistic approach.

So, did I actually get myself to the class?  Yes!  Much to my amazement, I did manage to get myself there, and have attended a further two since then, although it would be fair to say that one was far more suitable than the other.  I even managed to complete some of the asanas with varying degrees of success, and am now trying out various local classes to find something which works best for me at the present time and with my current physical limitations.  It’s tough and I feel absolutely battered for a couple of days afterwards, but I have learnt a lot about the current condition of my body and its limitations.  I have also learnt something rather curious about my psychological state of mind.  As often happens with me, my anticipation of how I will respond to any given circumstance or situation is not necessarily correct, and this is precisely what happened with the first yoga class; I expected to be too shy / nervous / anxious to attend, but actually the opposite happened.  As I have said previously, I don’t really do ‘anxiety’ or if I do it’s usually a specific situation, most often if I have to go somewhere I don’t know and where I don’t know anyone.  The first yoga class had all the elements I avoid like the plague whenever possible, however, I did manage this with relative ease, most likely because the state of my depression is, at present, in the “couldn’t care less about anything” phase; it was by exploiting this which enabled me to get there and do that thing.  I’ve figured that this is actually something really useful to be aware of, and if I genuinely don’t care, whatever happens or if something goes badly pear-shaped, it won’t bother me because it doesn’t actually matter.  It’s empowering, although for all the wrong reasons, but is progress of sorts I think.

My habitual hunt for interesting images today produced the pic above – yes, it’s unusual for a yoga photo, and thankfully, no effortless flexibility or smugness here.  The image in itself spoke volumes to me about my own shortcomings regarding yoga practice, but the article is also worth a read.  Rage Yoga, if you haven’t heard of it before, is the complete antithesis of the usual practice of yoga, and I’m both ashamed and possibly proud to say that maybe this is a type of yoga that I should consider and start tweaking my practice to accommodate a lot more swearing and regular beer breaks?

So, tomorrow I will be back again at my local, very calm and polite class – forcing my body to do stuff it really would rather not given the choice, channelling my anger and frustration into asanas, and trying not to swear out loud.  To any yogis and yoginis out there who might be reading this, “Namaste”.  And to anyone else who happens to practise Rage Yoga, “Namaste, Motherfu*kers!”

 

 

You are not alone!

aloneI don’t know about anyone else, but I find the world to be an incessantly noisy place.  And it isn’t just the usual suspects such as the internet, social media, mobile phones and generic media, but people too seem to have become extremely noisy over the past decade or so, almost like they are no longer capable of dealing with stillness or, worse still, silence.  I really enjoy both stillness and silence, I enjoy being alone, I am entirely comfortable in my own space, and can easily spend long periods of time alone, quite comfortable in my own company, so much so that I actually prefer it a lot of the time.  However, I am not immune to everything and there is one area of my life where I feel a desperate lack of interaction and a need for something to change.

One of the problems which I, and many others, experience as the result of having a long-term health condition is one of feeling alone, and I suspect that this feeling is common to many other problematic health issues; the feeling of isolation, the unfair assumption that those closest to us will probably have no idea how we really feel because we always try to make it sound less of a problem than it really is, and the realisation that no matter how sensible, logical and practical their responses and reassurances intended to counteract our negative mindsets may be, we can never quite accept what they are saying because it feels like they “just don’t get” the extent of the tedium and frustration of dealing with chronic conditions.

Feeling alone with a challenging health condition is an uncomfortable place to be, and in previous posts I have written briefly about this, and the reasons behind why I feel this way.  The fact that, statistically, 8.75 million people in the UK sought treatment for osteoarthritis last year reveals how alarmingly common the condition actually is, and there will be many others who have either not sought medical help or are perhaps yet to realise that the source of their pain is actually an arthritic condition.  So bearing these statistics in mind, how and why could I possibly feel a sense of isolation when, I am most likely surrounded by people with the same condition?

In the vast majority of cases, osteoarthritis is an age-related condition; put bluntly, the older you are, the more likely you are to develop it because as your body ages, your joints become worn and consequently osteoarthritis sets in.  Anyone and everyone can develop the condition, and as we age most people will experience arthritic symptoms to a greater or lesser degree.  That being said, herein lies my first problem regarding the isolation which the condition brings.  I developed osteoarthritis in my mid-teens, and throughout the many years of dealing with it, I have not been surrounded by people who have any experience of the condition or have needed to have surgery.  In fact, until very recently, I had never met anyone else even remotely around my age who had first hand experience of it. I would imagine that by the time most of us reach retirement age, a common topic of conversation is dealing with various aches and pains, some of which could be the result of arthritis developing in the joints, and I would anticipate that having even one friend who shares similar health issues to yourself can help not only with reassurance, but also reduce the levels of psychological isolation which can occur.  Over the years, I have come to realise that I would really appreciate knowing someone else who has some personal knowledge and experience of the condition and/or surgery, and feel that this situation could have the potential to reduce the feeling of isolation which I experience on a regular basis, which is most often triggered by a symptom of the condition reappearing or suddenly becoming a new and noticeable problem.

More recently, this situation changed when, a couple of weeks ago, I was at the hospital for a physio appointment.  This particular hospital is a private provider who relieve the NHS of the huge demand for joint replacements for NHS patients, a demand which the NHS cannot meet due to lack of funding, beds, staffing, etc.  Although it is a small hospital, it is a significant local provider for many joint replacement surgical procedures, and as such, it would be fair to say that their average punter is in their golden years.  In fact, during this particular visit, I was reminded of this before I’d even reached the building by overhearing an elderly couple in the car park saying “Oh yes, this is where Mavis got her shoulder done!”  The Waiting Room is usually filled with patients of retirement age, but on this particular day there was a woman who looked about my age, and didn’t hesitate to introduce herself and talk to me, which was something which was extremely welcome for both of us I think.  This rather lovely lady told me that she was in her mid-fifties and had just had a knee replacement.  She was slim, intelligent, with an athletic physique, looked extremely fit and healthy, and was clearly as delighted as I was to find someone of a similar age in the Waiting Room, so it was impossible to resist chatting to one another; in fact, I would have loved to have had more time with her.  Also, I have recently heard about a ‘friend of a friend’, who I don’t know personally, who had a knee replacement a couple of years ago.  So, rather strangely, in recent weeks I have discovered that there are other people of my age around – I always knew there would be, it was just odd that I never came across them before.  Rather disappointingly, my chat with the lady in the waiting room was very brief since we both got shuffled off into different areas for our respective appointments, and the ‘friend of a friend’ is just someone I hear about rather than have any contact with.  But, the fact remains that these people are around, which makes me feel slightly less freaky, but I still have the isolation issue to deal with.

My other grouch relates to the widely acclaimed ‘success rates’ of these surgical procedures, which I have always found to be extremely unhelpful.  It is invariably more difficult to be the voice of the supposed minority and openly disagree with something which is greatly lauded publicly by saying “I’m sorry, but that hasn’t been my experience of this.”  As I have stated in previous posts, I greatly appreciate that these surgical procedures have resulted in my having improved mobility, less pain and a much improved quality of life, however, they are not a perfect solution and some problems do persist.  Interestingly, I have also been told by medical professionals that there are more problems with this type of surgery with ‘younger’ patients, ‘younger’ being a term applied to anyone below around 60 years old; the issue which is most evident is that ‘younger’ patients experience more pain, simply because their nervous systems are ‘healthier’, being more sensitive and responsive than those in patients who are of the anticipated age for this type of surgery.  More interesting still is the fact that the individuals mentioned above, who are both in their mid-fifties, are currently experiencing problems with their new joint.  The lady who I spoke to in the hospital waiting room was experiencing oedema within her knee joint and had limited flexion which was a cause for concern some weeks post-surgery.  She had also been informed that there are more problems undertaking these procedures with ‘younger patients’ and she, understandably, felt very disappointed with the current outcome of her surgery.  The ‘friend of a friend’ is also experiencing difficulties some two years after surgery, is possibly experiencing nerve pain within the joint, and has recently been back to see the consultant again to try to resolve this.  Rather ironically, and disappointingly perhaps, he had decided to go ahead with the surgery after hearing how successful his friend’s knee replacement procedure had been.  What I do find interesting in the midst of all this is what happens when you start to voice your own concerns, niggles or even general dissatisfaction with the outcome, and it is certainly enlightening when people who previously claim that the procedure solved all and every problem start to consider whether this is really the case.

Knee replacement surgery in particular is notorious for being painful and a difficult procedure to perform; more to the point, the joint will NEVER function like a natural knee because it is beyond the capabilities of the mechanical joint to do so, so any claim that it is ‘as good as’ is frankly deluded.  Knee replacement procedures are considered to be a success when the joint can be bent with ease to 90 degrees – any additional flexion is a bonus, but is not anticipated as a surgical outcome.  Additionally, it is accepted by patients and professionals alike that it is extremely painful to kneel on a knee joint replacement – it feels not dissimilar to what you would expect from kneeling on knife blades, so is highly avoidable.  However, as time goes on, the pain dissipates slowly, and I noticed that after about 6 years I could actually kneel on the joint again, presumably because the soft tissue had grown back and the joint was bedded in fully.  Furthermore, some level of nerve damage is anticipated during most types of surgery – personally I have a couple of numb spots within my knee joint, presumably the result of very minor nerve damage, but this is not a problem to me.  However, significant nerve damage can also occur, is extremely painful, is difficult to diagnose where the problem is coming from with much accuracy, and although steroid injections can help to ease this type of pain, they cannot be used where metalwork is present, and therefore are inappropriate for use within the same area as a joint replacement.

It’s complex and frustrating stuff indeed, and I would even dare to suggest that people who wax lyrical in wonderment at their new joint replacement are deluding themselves a little.  I’ve had three joint replacements over the past decade, with vastly differing results.  The first, a rare type of knee replacement, brought with it an extremely protracted recovery period alongside a host of relatively minor setbacks, before finally being what I would describe as ‘ok, but not brilliant’.  The second, a hip replacement and therefore a much simpler joint, procedure and faster recovery period, was relatively straightforward, and ‘it’s pretty good’, is certainly a vast improvement on the knee experience and the joint itself is a whole lot more co-operative.  And finally, the second hip replacement, which is ‘totally amazing’; yes, I’m slightly ashamed to say that I gush about this one because it’s been a transformative experience.  Maybe I got lucky third time round, but I suspect it was more the case of it being on the side of my body which has less arthritic deterioration and greater muscular strength, and also that this surgery seems to have resolved a lot of pain and mobility issues by actually realigning my skeleton correctly, something which the previous surgeries failed to achieve.  But in spite of all this, I remain aware that it is a mechanical joint and that is how it feels.

So, I guess it’s fair to say that I’ve experienced a range of outcomes from these procedures, and even the outcome of the most successful cannot honestly be compared to how my body felt before the onset of arthritis and joint deterioration.  When I confessed to the nice-lady-in-the-waiting-room that sometimes I felt I could cheerfully punch people when they harped on about how bloody marvellous their new joint replacement was, I wasn’t joking.  I fully expected her to end our conversation abruptly, disown me and sit elsewhere, but she didn’t, and really took me by surprise by quietly confessing that she felt exactly the same.  So could it be the case that despite our apparently genteel outward appearances, lurking beneath lie two angry and aggressive women who just want to floor anyone who doesn’t share their own experience of this?  Or is it more a case of feeling hugely frustrated with problematic surgical outcomes and the subsequent incumbent responses, which appear to be nothing more than a people-pleasing exercise which meets the required  expectations regarding purported miraculous surgical procedures?  Surely it would be more beneficial to patients and professionals alike to obtain honest feedback post-surgery, and dispense with the culture of guilt-tripping or challenging anyone who dares to suggest that these procedures cannot yet provide a perfect solution for everyone?

Certainly by talking with this lady and sharing our experiences reassured us both that we were neither hypochondriacs nor attention seekers, and that because we were below the anticipated age for this type of surgery, additional problems were likely to and did arise.  However, what felt most important for myself was that I no longer felt I was  floating about feeling isolated and a bit of a freak in all this.  That sounds horribly selfish so perhaps I should try to clarify the relevance of all this:  No, I’m not pleased that either she or the ‘friend of a friend’ have needed to have this type of surgery at a relatively young age, and I’m certainly not pleased to hear that they are both experiencing different problems as a result of those procedures.  What I am pleased about is that I have finally met someone of a similar age who has experienced this herself, and that in itself is the much-needed evidence for me that I am not alone.  And that, in itself, is massive!

 

 

“What did you learn during today’s session?”

Q: “So, what did you learn from today’s session?”

A: Nothing, absolutely nothing.  Zilch.  Nada.  Rien.  Nic.  An almighty nowt.  Sorry.

apathy

I really wish the answer was different.  I’ve been thinking about it for a few days now, and I have an official Homework Sheet where I am expected to share my newly gleaned & hopefully positive response(s), which is to be returned by tomorrow.  I can’t quite bring myself to answer truthfully so I am struggling to find an acceptable answer which isn’t a downright lie but also not something which might upset or insult the poor bastard who’s delivering this stuff.  I see absolutely no point in lying and consequently falling into the trap of people-pleasing, appearing receptive, optimistic, grateful even, but isn’t the whole point to be honest, both with myself and others, and hopefully this is how to pave the way for ‘progress’ of sorts?

Accessing Mental Health Services in the UK is a tricky and lengthy business, and I can only assume that funding (or the shameful lack of it) is the reason for this.  Demand is extremely high, at an educated guess I’d say that the need for Mental Health support is probably at epidemic levels these days, and yet it remains elusive, extremely difficult to access, and the process is protracted in the extreme.  I have been trying to access Mental Health support for many years now, and after recognising that I’m not coping and my issues aren’t just going to go away if I try ignore them, it has required a relentless and determined effort over the past three years to get this far.  I have just been accepted for a seven-week course of ‘group therapy’ relating to living with a Long Term Health Condition, and attended the first session last week.

I can only talk about my own experiences of trying to access NHS Mental Health Services, and have concluded that it is, like many other NHS services, a matter of jumping through hoops and hoping that you don’t get spat out somewhere along the way and find yourself back at the starting line again.  I have spent the past few years playing this very unentertaining game, and each time it has gone something like this.  It starts with seeing a GP, who expresses concern about, in my case, my relentless low mood.  We complete a questionnaire which concludes that I have severe depression, and I am advised to contact the local NHS provider for Mental Health Services.  They complete the same questionnaire with me over the phone, conclude that according to the questionnaire I have severe depression so they cannot offer me any support (the service is designed to support individuals with mild to moderate depression) so send me back to my GP.  My GP offers anti-depressants, which I refuse.  I explain my reasons for being unwilling to take anti-depressants and request some kind of talking therapy or CBT, but am told that these services can only be authorised by the Mental Health Service, who have just spat me out.  So I am cut loose and left to my own devices yet again until the next time.

During a more recent trip to my GP we discussed this problem yet again, and I was advised that in order to access these services, I would need to lie.  We figured that if I could produce a score which defined me as having mild or moderate depression, presumably I would then be able to access the Service.  The trick would be to score as highly as possible but try to get it within the range of ‘moderate depression’ without spilling over into ‘severe’, but try not to lie so much that the score came up as ‘mild’ since I would be treated as less of a priority than a ‘moderate’ score.  Bizarre stuff indeed.  In my own humble opinion, this was hardly the best starting point for accessing a service, but had to admit that it seemed to be the only way.  I dislike lying and deceit of any kind, I am not a good liar and find it hard to provide or maintain describing a situation which really isn’t true.  So, when the Service contacted me to complete the damned questionnaire yet again, I quickly decided that being brutally honest would be the best way forward.  I confessed to my conversation with my GP about lying in order to access the Service, my reasons for not wanting to do that, and also explained that I felt the scoring on the questionnaire didn’t take enough into consideration – for example, physical conditions.  I made clear that because I have a painful, long-term physical condition, this hugely impacts on what I am able to do or any activities which I choose to do, and at that time I would most often choose to do nothing, not because of my mental health but because it was either too painful or physically impossible.  However, the scoring on the questionnaire would flag this level of inactivity and hermit-like existence as a symptom of depression rather than an issue relating to physical disability.  I also have a long-term and complex history of mental health issues, which were discussed during this phone call and, as usual, was flagged as being of concern – partly because of the duration of my problems, but also because previous interventions had not provided an acceptable outcome.  I also felt it important to mention that I did not agree with the outcome of the questionnaire, that it would most likely classify me as ‘severe’, and having experienced severe depression I am absolutely convinced that I am not experiencing that level at present, and have not experienced that for many years.  So, having got all that out of the way, we completed the questionnaire and, as anticipated, the score came up as ‘severe’.  However, the nurse I spoke to was amazing and did accept the ideas and concerns which I had put to her, and accepted that other factors were providing a distorted score – in fact, we were both very aware that if I did have severe depression, I wouldn’t have even been able to manage such a long and complex conversation with her.  So, rather than shoot myself in the foot again, it seemed that being honest had paid off and I was accepted into accessing the Service – huzzah!

A couple of weeks later, I received a letter inviting me to join a group therapy course aimed at supporting people with long-term health conditions.  The blurb sounded good, I was excited, but had to decline due to up-coming surgery but asked that I be put on the next course of this kind.  The course started last week, and I was excited – at last I’d managed to access the Service, had high hopes that it would be a beneficial thing to do, and was interested in meeting other people who were experiencing similar issues and hoping to exchange a few ideas about coping mechanisms.  The reality was that I found it disappointing, but perhaps this is always the case when you finally manage to access something which has previously been denied to you?

So, returning to the original question: “What did you learn in today’s session?”

  1. That the Mental Health provider need to urgently up their game regarding accessibility for individuals with physical health conditions.  The session was provided for 12 people in a small room.  Half of the room had four tables which were not used, except to provide a space for a small projector (which could have easily been place on one table, and the others moved out of the way or stacked in a corner to make more space for the attendees).  The other half of the room contained three rows of chairs, with four chairs in each row, with little space to manoeuvre between; roughly six of the attendees used walking aids (sticks, wheel walkers etc) and a few others had mobility issues, so a little elementary arithmetic will tell you that only four chairs had ease of access.  There was NO consideration taken regarding accessibility for people with mobility issues, which is ironic considering who the session was aimed at and that the provider had information regarding our various health issues and accessibility needs in advance.
  2. There were three staff members in the room – the main presenter, a student who assisted with the presentation, and another student who was observing.  Was this really necessary considering the space constraints?
  3. There was no opportunity provided to ‘meet’ other participants.  The main presenter, a CBT therapist, introduced himself and the students, and the rest of us sat in rows next to complete strangers for the duration of the session.  I only got to see the faces of the people sitting on either side of me, the backs of the heads of the people in the row in front, and I have absolutely no idea who was sitting behind me.  The presenter seemed a little disconcerted that everyone was reluctant to speak or contribute, but why would we considering that we were in a room full of strangers?  I totally get the ‘but people have depression and anxiety issues so wouldn’t want to introduce themselves in front of everyone’ argument, but in my previous life as a teacher, I am very aware that introductions and ice-breakers are really beneficial thing to do and create a positive ambiance in the room, which then facilitates a better learning environment.  Activities like this are priceless, and there are loads of options which even the shyest person can participate in.
  4. The ‘presenter’ had absolutely no idea how to provide an engaging presentation.  The content of the session was a Powerpoint presentation – the slides were dull, the content was obvious, and it all felt rather patronising.  It seemed to be a case of ‘stating the bloody obvious’.  There was certainly scope to add our own ideas and contributions but either no-one had much to say, or felt too intimidated to speak.  Again, with my teacher’s head attached, there were a couple of opportunities to get us to do some of the work, maybe working in pairs or as a small group, or maybe scribbling ideas on post-it notes – instead of putting it all on a slide and read it out to us, why not ask us what we thought or felt or had experienced?  This would provide the added bonus of getting us to communicate with each other and breaking the ice a bit.  I wasn’t the only one who felt the presentation element was poor.  At the break, I did actually manage to speak to someone!  A nice lady who said she thought that the presentation was poor, as was the room layout – she had done presentations professionally too, so we had a bit of a winge about it between us.
  5. That the provider urgently needs more money!  The projector needed a new bulb – apparently their other projector did too.  Ours was producing a pink screen, so it was difficult to read the mundane content.  The other projector, somewhere else in the building, was producing blue light.  I thought this to be pretty embarrassing – to be unprepared in this way is bad enough, but for neither machine to be working correctly is pretty piss poor.  Also, of course, light and contrast of light with text is extremely important for many health conditions, not just eye complaints but for other conditions such as dyslexia too.  Again, no consideration for accessibility for participants.
  6. You provided a really sloppy presentation and set up.  In addition to all of the above, I should add that the projector (despite the surplus to requirements four tables) was shining on a wall and part way across the frame of a whiteboard – couldn’t it have been moved to be either on the wall or on the whiteboard, not somewhere vaguely in between where the text distorted?  or could you not manage to use the Smartboard which was on the other wall, which could have solved all the problems listed above?  Your two students would know how to use one, even if you don’t…

All this is curious stuff indeed.  I have heard many and varied tales about this particular provider, some good, some not so good, so I guess my first experience of them is in the ‘not so good’ category so far, which is a shame because there is no other NHS alternative and I don’t have the money to pay for private services.  Listing the above short-comings might seem petty, but the fact that there so many of them did contribute considerably to  my thoughts following the session, and clearly for several days afterwards; if I’m brutally honest, I really don’t want to go back for even one more session, let alone another six!  As with most things in life, if part of it is good or positive, it enables you to overlook the lesser quality stuff and, to some extent, major cock-ups too.  But having had poor presentation skills, poor room set-up, lack of accessibility, mundane patronising content, and even the damned projector light bulb being on its way out, I’m finding it hard to find anything good to say about it all.  I know for sure that if, as a teacher, I’d been observed doing a presentation like that and committing even one of the deadly sins listed above, I’d be out on my arse before lunchtime.  Ok, this guy isn’t a teacher, he’s a therapist, but clearly the ability to provide effective presentations has become part of his job, and therefore he really needs to up his game.  Accessibility isn’t rocket science, and requires nothing more than common sense, a bit of foresight, and some empathy – it costs nothing to set up a room for people with accessibility difficulties, just a few minutes of your time, and your audience will recognise this instantly and appreciate your efforts.

Apparently, this provider has been rolling out this course nationally across the UK, and it will be reviewed some time in the near future based on the opinions of the participants and the impact it has had on our lives.  In order to assess this with regard to quality, impact and the inevitable ‘value for money’, we will also being given questionnaires to complete each week so our responses can be assessed, analysed, etc and a decision will be made regarding whether the financial cost justifies the outcomes.  Right now, I’d say probably not, but then again, I may change my mind as the course progresses, if I can persuade myself to keep attending.

It’s a difficult one.  The accompanying blurb sounded very good, and it seemed that it might be a good option to try and a step in the right direction, but the reality is that this session was horribly disappointing, stress-inducing, and uncomfortable, physically and socially.  In the meantime, I guess I have to keep attending, I need to complete their paperwork each week, and try desperately to find something positive to say about it to keep the funding coming in, so that the service can be provided for others in the future.  However, I’m still stuck with my homework:

Q: “What did you learn in today’s session?”

A: That I really don’t want to come back here again.  Sorry.

 

The Big Bruiser

It’s now just over a week since surgery, and I need to prepare myself psychologically for my first meeting with The Big Bruiser.  BruisesTomorrow is the first day that I can avoid this no longer; tomorrow my bandage will be taken off, sutures removed and there it will be, in all its hideous glory, The Big Bruiser #2.  This time last year was the first of these wounds that I’d seen, so I’m assuming and hoping it won’t be as much of a shock this time around.  It was bigger than I expected, as well as lumpier, uglier and more bruised, but what really stuck in my mind was how like a lump of raw battered meat it looked.  My daughter came along to photograph it – yes, we’re close like that, we enjoy sharing gory stuff – and even now those first photos of it fill me with a feeling of extreme nausea.  But, then again, as I keep telling myself, it’ll be much easier this time round because not only have I done this before, it was also very recent.  Which begs the question, why aren’t I handling the whole situation better?

Orthopaedic surgery inevitably means bruising, not the genteel constrained type as in the picture above, but mega-bruising which can cover significantly large areas of your body.  Bruising occurs following some kind of injury and your blood capillaries leak into the surrounding soft tissue thus creating discolouration on the skin’s surface.  I’ve spent the past few days trying to deal with both the physical and psychological impact of post-surgical bruising, and have to confess to struggling a bit.  For the first couple of days after surgery, there was some swelling and a bit of nasty bruising around the wound but nothing unexpected, but this swiftly morphed into the bruising bonanza of the past few days.  Rather stupidly, I didn’t recognise it as such at first, what I saw was massive swelling in my leg and a lot of new pain which took me spiralling into panic mode, phoning the NHS out-of-hours services, and then feeling very foolish and selfish for wasting their time on something which is part and parcel of the process.  Bank Holiday weekends are never helpful – when you’re panicking, everything seems a whole lot more urgent than it really is, and the fact that I had to wait around 12 hours before I could see a medic meant I was almost at hysteria level by the time they arrived and provided some desperately-needed reassurance.  Since then, I’ve calmed down a bit – the next day, bruises emerged in the swollen areas and this reassured me about what was happening and continues to happen.

At the time of writing, I’m having another night of not much sleep.  It’s the early hours of the morning, I’ve been up for a few hours already and have an ice pack slapped on my leg in an attempt to tame the swelling a bit.  I suspect it’s a lost cause, but I’m trying because although I’ve now aware that I’ve hit ‘bruising phase’, I’d really like to reduce the swelling somehow in order to reduce the pain and enable a better level of mobility – ie. one where I can actually bend my leg and use it properly, rather than having to drag it around with me like an inflatable child’s toy.  Bruising and swelling is difficult stuff, especially post-surgery because there is very little you can do to contain it.  At present, I need to take anti-coagulant medication for a further 5 weeks – they thin my blood in an attempt to reduce the risk of blood clots – but in doing so, I am not able to take NSAIDs (anti-inflammatory medication) alongside these.  Attempts at reducing swelling and managing bruising are limited to the simple things in life – keep the limb elevated, and keep slapping on those ice packs.  Hardly the stuff of rocket science, but I’m hoping that if I keep at it, it might reduce the pain a little.

The other thing which has interested (and shocked) me about all this is how little I remember about this last time.  I would’ve expected that it would be indelibly engraved on my memory forever, but apparently not.  My other hip was replaced around a year ago, and I’m surprised at how much I’ve forgotten about the healing process, and how easily I slide back into trauma mode.  I think the lack of mobility is partly to blame for this, because at present I really don’t have much flexibility – all I have is an awareness of varying degrees of pain in various areas of my hip or leg, but I can’t bend or reach down or touch to see what is happening.  The inability to collect visual information about pain or a physical restriction is frustrating and a bit scary – I can’t see it to make a rational decision, but it feels bad so I’ll panic in my blindness instead and assume that something terrible is going on.  I can conclude, then, that what are described as ‘the delayed symptoms of massive physical trauma’ (swelling, bruising) are now coming out to play, and alongside that are the symptoms of the psychological trauma I always seem to experience in this scenario.  I’m generally not a weepy or panicky kind of person, but this stuff reduces me to a total coward and a gibbering wreck, and I really wish there was more post-operative support alongside these procedures.  I mean, yes, there is – if I’m worried, I can call the hospital or get an ambulance to take me to A&E, but that’s not what I’m talking about here and not something I feel is an appropriate thing to do, unless I’m dying.  What I want and need is more psychological support alongside the healing process.  No, I’m not ill, but yes, I’m in pain, have all sorts of strong drugs racing through my body 24 hours a day, and my body is going through huge and varying degrees of change and healing which I don’t understand, and my head is, quite simply, fucked up.  Meanwhile, my scheduled (read as ‘necessary’) appointments are as follows:

  • 10 days after surgery, appointment with Practice Nurse to check wound, remove bandages and sutures
  • 2 weeks after surgery, option of attending face-to-face physiotherapy appointments on weekly basis
  • 6 weeks after surgery, appointment with Consultant surgeon to check progress of wound and mobility

I’m sorry, but for me, that’s not enough; I suspect that I’m not alone in feeling that I need some level of support with the psychological impact of this procedure, and that many more people would benefit from a more personal, caring and holistic approach to post-operative care.  I’ve said it before and it seems that I need to keep saying this until perhaps one day someone will either listen or hear me: I AM MORE THAN JUST MY BLOODY BONES!!  You’ve fixed my bones, now I need help dealing with the trauma in my head…

 

 

Last day of freedom

Today is my last day of freedom, at least for a while.  mans-dirty-arms-grabbing-at-the-air-through-metal-bars-from-dark-interior_hzpmfrh8g_thumbnail-small07By freedom, I mean being able to be independent, to drive wherever I want whenever I want, to do stuff alone without having to have someone with me to help me do the most basic and mundane of tasks, to have some semblance of control over what goes on and what is possible, and to not be housebound and needing someone else’s co-operation, permission or approval to venture out.  For me, this is the stuff of nightmares.  I hate being dependent on anyone, really hate it; it embarrasses me, humiliates me, frustrates and angers me.  I’ve never been especially good at asking for help, which is probably why I find this so difficult, but there’s a big difference between the normal scenario of asking for help with tasks which no mere mortal could manage alone, and asking for help to get up or down from a chair, to support you as you attempt to go up or downstairs at snail’s pace, and to ask for help getting on shoes, socks and even knickers.  The latter situation will be my joyless existence for the next few weeks, and I feel massively irritated at the prospect already.

Bearing all this in mind, I was determined to make the most of today, my last bid for freedom if you like, my last day before surgery; to assert my independence as much as possible (within my current physical limitations at any rate) and ‘do stuff’ – nothing exciting, just walk the dog and deal with the domestic joys of cleaning / washing / gardening in order to minimise my need to ask anyone for any help over the coming weeks, when I’m officially incapable of doing anything more than shuffling around very slowly.  But despite having my ‘positive head’ attached when I woke up, it all seems to have been a bit of a miserable sort of day, and I’ve really struggled to complete much at all.  I thought I was really looking forward to walking the dog; the sun was shining, there was hardly anyone around, the landscape was spacious and stunning, but somehow my head was somewhere else so I didn’t stay out as long as I’d planned (which was a real shame because I won’t have another chance to do that again for a while yet).  The domestic bliss of a clean and organised house never really materialised either, all the tasks I’d set myself seemed extremely arduous, physically exhausting, and didn’t bring with them the satisfaction I’d hoped for.  It took me until mid-afternoon to realise that my heart just wasn’t in anything today, that I was most likely more than a bit twittery about tomorrow’s surgery, that whatever I tried to achieve today would probably feel disappointing, and that all I really knew for sure was that I felt exhausted and rather weepy.

Tomorrow, I will be undergoing surgery for a hip replacement in my right hip; my mobility will decrease immediately and massively, as will any attempts I make at asserting my independence.  It is now almost a year since I had a replacement in my left hip, and in view of this I have decided that I should perhaps redefine my arthritic condition, since these days it seems less of a condition and more of a career than anything else; if only my condition had enabled me to have a decent vocational career alongside it, it might feel less of a burden, but alas, no.  My arthritic career seems to be going from strength to strength, whilst my vocational prospects seem to be ever diminishing.  I’d really like to be able to have a break from all this; undergoing two replacement surgeries within the space of a year really is too much, but I don’t seem to be able to make the necessary progress towards having a body that functions correctly by any other means.  Perhaps tomorrow’s surgery will be a further stepping stone towards that, and then, maybe just maybe, I can get a bit of distance away from all this seemingly endless miserable stuff?

Hippie Stuff

This post is for those who may be considering having a Total Hip Replacement (THR) and to share my own experiences of that in the hope that it could be helpful to you.  I will also write about the similarities and differences between having hip or knee replacement surgery because I think it’s inevitable that I would compare the two.

healthy hipThis image shows a healthy, normal hip joint, and if you have been diagnosed with arthritis in your hip(s), the clinician will have noted that rather than there being a nice healthy space in the ball-and-socket joint such as in this image, there will be a narrowing, or if you’re really unlucky, no space left at all and bone-on-bone contact.  The arthritis in my left hip was discovered late, too late really, and was immediately classified as ‘severe’ so I’m afraid I haven’t seen any images of the gradual deterioration and intermediate phases which occur; however, what I have seen is an image of my hip from a few years earlier which has been incredibly useful for comparisons of ‘then’ and ‘now’.  In my case, my hip changed from something similar to the image above, to something akin to the image below in approximately 5 years.  Without wishing to alarm anyone or to incite some kind of arthritic hysteria, I can assure you that this is not the normal rate at which the disease progresses, and the majority of OA sufferers experience a much slower deterioration over a period of a decade or much longer before surgery becomes necessary.  It appears that my OA is aggressive, and judging by the flustered responses of specialist clinicians to my test results, I suspect that it is unusual in its enthusiasm and pace.  hiprplcmt

If you are an NHS patient in the UK and your x-ray result is of concern, you will most likely be referred to a MusculoSkeletal specialist, who is the stepping stone to getting a referral to a consultant-surgeon.  I was annoyed at recently having to go through this process (having managed to be referred directly to a surgeon only the year before) but actually the MSK specialist I saw was amazing – incredibly thorough and helpful in her diagnosis and subsequent medical report.  One of the tests which she undertook was called FABER (an acronym for Flexion, Abduction and External Rotation), which the above source describes as “a passive screening tool for musculoskeletal pathologies, such as hip, lumbar spine, or sacroiliac joint dysfunction, or an iliopsoas spasm.”  Put simply, a ‘positive’ FABER result means that you have musculo-skeletal problems within one or more of those regions  – it’s all about measurements of movement, in my case the test clarified that I had only 90 degree flexion and no medial or lateral rotation.  If you are experiencing pain and suspect that your hip could be the problem, the Oxford Hip Score test may be a useful tool to try at home; I only discovered this very recently and have never been asked to complete it at any orthopaedic appointments, so I am not sure how valid the professionals consider it to be.  Obviously, the problem with such tests is that all responses are entirely subjective, so it’s best to be brutally honest with yourself about your difficulties and levels of pain.  But it is something which you can complete in a few minutes, and I think it could be helpful in either alleviating your fears or confirming that perhaps you should make an appointment to get your hip(s) checked out.

So what exactly is a hip replacement?

Click this link for an NHS video about hip replacement surgery.

And what about the patient perspective?

One of the purposes of this blog is to look at my own experiences of osteoarthritis and the surgery which this has so far entailed, yet something I find extremely irritating is that the focus seems to be placed solely on my physical condition – identifying where the physical problems are, the condition of my joints, is there any cartilage? etc.  I always feel cheated somehow that the ‘human perspective’ is at best overlooked, and at worst completely ignored.  So, listed below is information relating to my own experiences of these procedures, as a UK NHS patient.

Do I have a choice of surgeon and where the surgery will take place?

Yes.  You should receive a letter which gives you online access to book a consultant appointment with the care provider of your choosing.

NHS or private care providers?

Although I am an NHS patient, both my procedures have been undertaken at private hospitals.  If you are an NHS patient, no additional cost is incurred.  I can only assume that the demand for joint replacements is so high that the NHS can neither meet the demand nor have the number of necessary beds available.

How long will I be in hospital for?

You will be discharged asap after your procedure.  You will be encouraged to mobilise asap, prove that your new joint is weight-bearing, that you can walk with sticks, manage stairs, have some level of mobility no matter how minimal, and that you can manage toileting needs before you can be discharged.  The discharge rate for hip replacements is fast – for my procedure last year, I was in hospital for around 36 hours.  Knee replacements are more complex so your hospital stay could be longer – I was in hospital for 4 days for mine, but this was almost a decade ago so this could now have changed.

What about physio?

I was given a sheet of exercises, to be completed 4 or 5 times a day.  The more you practise these exercises, the better the final outcome of your procedure.  However, I really struggled with this, the pain was too great due to problems elsewhere within my leg, and after about a month of trying then being nagged or told off because I’d failed again, I felt very depressed about it all and just gave up.  Even if you can’t manage the physio exercises, it’s important to keep moving and NOT give in to the massive temptation to bomb out on opioids, lounge around watching TV and eating mountains of chocolate during the long slow weeks that follow surgery.  Although I failed gloriously at managing my hip physio exercises, I did try to keep as mobile as possible doing other really basic ‘activities’, such as extremely short-in-distance-but-took-an-absolute-age dog walks, short trips to local shops, practising walking up and down the stairs.  The more mobile you are, the quicker you will heal and the better the final outcome.  Curiously, I managed the physio much better following my knee replacement – I worked really hard at it, like a really crazy obsessed person and finally achieved an excellent outcome.  If you can manage it, the effort really does pay off.

What about driving?

You will not be allowed to drive for about 6 weeks after surgery.  Both knee and hip replacement surgeries render your limb too weak to be able to drive safely at this time, and (I think) that your driving insurance is invalid during this period.  You will need to find yourself a willing driver to help you with this stuff, and also the joys of getting in and out of a car…

Managing transport / travelling

After both my procedures, understandably, my world shrank.  For the initial few weeks, my mobility was extremely limited, I was unstable on my legs, extremely tired, and felt very vulnerable so I only ventured out of the house as an absolute necessity.  After my knee surgery, when I was legally allowed to drive again, I bought an automatic car in the hopes that it would make things easier, which it did to some extent; what I didn’t foresee, were the problems I would have actually getting in and out of any car – the car door had to be wide open, and because of the swelling and limited flexion in my knee, I had to kind of slide myself into the seat after putting my surgery leg in first.  If you have a Blue Badge and therefore are able to use allocated Disabled parking spaces, this makes life much easier simply because you have the space to open the door fully.  Following my hip procedure, travelling was far more difficult, but for a very different reason.  Getting in and out of the car was easier than it had been after knee surgery, but I found it extremely painful when the car was moving; I assume that g-force is to blame, and this meant that not only was I very aware of how fragile my body was during these first few weeks, but also it felt as if my whole body was being rattled around in a liquidiser when the car was moving – every turn or bump in the road feels extremely painful and it’s  stressful stuff.  Although this improves slowly alongside your body healing, it still takes time before it is more manageable, and with me, I think it was around 3 months later that I could cope with it without wanting to cry.  As for public transport, there was no amount of money you could pay me to use buses or trains at this time.

How independent will I be?

Not especially, for the first few weeks.  When you are discharged from hospital, you will probably have minimal mobility; shuffling around nice wide hospital corridors and user-friendly staircases to prove you are sufficiently mobile is not the same as being at home, and you will need on-going support from family or friends to ensure that you are safe, don’t fall and can manage personal care needs.  My main problem both times were stairs and steps – I was surprised to find that my low doorstep was just a bit too high to step over, and the stairs were much steeper than I remembered.  Again, knee and hip surgery bring with them different issues – I fell several times at home after my knee procedure, but didn’t fall at all after hip surgery.  Personal care issues such as getting dressed can be difficult, and following hip surgery you should not bend more than 90 degrees for the first few months – it’s an interesting exercise to try this out before surgery, so you will realise how much you will need to adapt your movements to manage everyday tasks independently.  You will probably also need help in managing your medication; there will be a lot of it at first and it’s strong stuff, it’s a good idea to take it as advised, and also get help from someone to make sure you write down what you have taken and when.  The hospital provided me with a few day’s worth of meds, so it’s also a good idea to get organised and have sufficient medication to come home to after you have been discharged; I, rather foolishly, didn’t think about this, so had to spend several hours one day shortly after being discharged, trying to get hold of some more morphine because the hospital only gave me enough for the first 3 days.

The worst day?

The worst time for pain and stiffness depends on which procedure you have.  For hip surgery it is definitely the day after you have been discharged.  I’m not sure why this is – perhaps the realisation that you are no longer in the safe and protective atmosphere of the hospital, perhaps because all those strong meds they gave you during surgery have worn off, or perhaps that’s just because that’s how it is?  After waking from hip surgery, I felt sore but ok and this feeling of “Phew!  that wasn’t as bad as I expected!” lasted the next day too, the day that I was discharged.  However, the first morning I woke up at home was definitely the worst day, and I felt absolutely battered.  Hospital staff are aware of this and it is acknowledged that most people really struggle during their first full day at home.  For knee surgery, it was different – the worst day was immediately upon waking from surgery, I’d never experienced such pain before, I didn’t know what to do or how to cope with it, and even though I was still in hospital and on very strong painkillers I just found it so hard to deal with.  This was almost a decade ago, and I would expect that things would be different now and much improved.

Hip replacement vs knee replacement

The general consensus of opinion is that hip replacements are a much easier ride than knee replacements, and this is something I would wholeheartedly agree with.  The hip surgery seems a simpler procedure, the immediate pain I experienced was much less than with my knee replacement, I mobilised quicker, and was able to do more things independently sooner than after my knee surgery.  Knee replacement surgery was (at the time I had mine) a notoriously difficult and painful procedure.  I had never experienced any pain like it or since, but I would assume that practices are now much improved since it was around a decade ago.  Also, the knee replacement I had was an unusual one (lateral partial) which is apparently a more complex and challenging surgical procedure than the other partials and full replacements, so it could be that the relative rarity of my surgery could account for the difficulties I experienced.  Post-surgery knee pain is very specific and localised, it starts immediately after surgery and is more intense than hip surgery pain, but it slowly eases off over a period of weeks or months.  I think some of the problems I experienced with the knee surgery was that I wasn’t sufficiently informed about the procedure, recuperation time and levels of pain so I was a bit shocked by how difficult it was to manage.

What about mental health and orthopaedic surgery?

Orthopaedic surgery is statistically notorious for issues relating to trauma, not simply the physical trauma which your body experiences, but also for psychological ‘trauma’ which can occur with surgery.  This should come as no surprise to anyone since many people with on-going chronic pain also experience poor mental health and depression, so how would anyone expect us to respond when invasive surgery is performed?  For some reason, and I have no idea why this should be, but I do experience some kind of psychological issue with this type of surgery.  I feel quite ashamed of myself and I don’t understand what is going on here within my head about this – after all, my knee replacement was long-awaited and much needed, my hip replacement was also essential, both procedures were intended to improve the quality of my life, both physically and psychologically, so what’s not to like?  What is there to get psychologically messed up about?  This is clearly a big topic for me, I think it best to save it for a separate post.

Scars

The scars are pretty minimal if you consider what the surgery entails.  My knee scar is around 5″ long, and my hip scar is around 10″.  They are quite neat, and they do fade with time.

Is it all worth it?

In my case, the answer to this is absolutely YES!  Without these surgeries, my quality of life would have been very low, and I would most likely be unable to walk by now if I hadn’t had joint replacements.  However, they are not like a normal healthy joint and can feel a bit clunky at times, but hey, this is your life and mobility we’re talking about here and if you want any semblance to a normal healthy life, this is the route to take.  I would also cautiously add that if you are asking yourself whether to bother having a joint replaced, it is probably too soon to make that decision – put bluntly, if you are struggling to mobilise and the pain is bad enough, you would not even be asking the question, you’d be begging to have the surgery.  I would also advise that if you are at all unsure, that you get on the conveyor belt for an MSK appointment asap; NHS waiting times are long in the UK and it can take a while before you get a consultant appointment, unless you are an urgent case.  A consultant appointment is simply that – you get the chance to discuss your x-rays, you will be examined for mobility and pain issues and advised accordingly, and the decision to take things further or not is entirely up to you.

The Yarn Whore

For the past six months, I’ve been knitting socks.  I had heard from various reliable woolly sources that knitting socks was “very difficult” and it was necessary to juggle more than two needles at a time, so despite being an extremely obsessive and socks1experienced knitter, I convinced myself that I wasn’t good enough, or lacked the necessary discipline, or wouldn’t have the patience to manage to make even the most humble of socks – or worse still, manage to end up with a single sock and not be able to persuade myself to make an actual pair.

I was first taught to knit by my mother when I was very young, I think I was about 4 years old, and I’ve always suspected that her intention was to give me something to do which would keep me quiet and distracted.  I used to knit up balls of string, then when the ball came to an end, I’d unravel it and start again.  My mother wasn’t a particularly talented knitter, she knew the basics of knit, purl, cast on and cast off, so as a child I was limited to making dishcloths as presents for grandparents.  But there was something about the process which really appealed, something elusive and intangible.  By the time I hit my teens, I dived fearlessly into designing and making jumpers – huge, baggy affairs which often went down to my knees, were too big across the shoulders and had sleeves which were too short; the jumpers available in the shops were truly hideous, clingy affairs so it seemed the perfect way to resolve that problem and improve my knitting skills as well.  There was also some kind of knitting revival going on at the time, and for the first time ever, beautiful crazy yarns were available, including fluffy mohair in a range of sumptuous colours.  I was hooked, and have knitted obsessively ever since.

Medically, there has been a lot of discussion about knitting and its mental health benefits, and most recently, there has been a lot of debate and consideration into the concept of Social Prescription, rather than the more traditional approach of sending you away with a few bottles of pills.  Social Prescription is the idea of recommending an activity, preferably one with social interaction, to improve not only mental health issues but also physical health issues such as lowering blood pressure, etc.  Social Prescription activities are many and varied, and could include knitting, fishing, walking, sewing, painting, pottery, or basically any creative activity which has the potential to distract from current or ongoing health issues and increase social interaction, and in the UK, GPs are being actively encouraged to prescribe, for example, knitting rather than more pills.

So what exactly is it about knitting which works for me?  As a self-confessed Yarn Whore with an obsessive compulsion to click away, what is clear is that knitting is a multi-sensory experience.  With the exception of taste, knitting brings a feel-good factor to all the other senses: visually, the yarn is beautiful both prior to and after knitting, and the range of colours and textures available now is incredible; the gentle clicking sound of the needles and the subtle smooth sound of yarn sliding off the needles is very calming; the textures of different yarns as they slide through your fingers are curious and varied, as is the way that the different yarns respond to the knitting process; and the different scents of the yarns reflect their various compositions and fibres, from the relatively strong smell of natural wool yarns to silks and cottons (yes, they all have a different scent!).  But the sensory response to the process is arguably not what makes knitting a really positive activity to get in to.  Yes, any creative process will benefit your mental well-being, but the knitting experience brings with it a rather hypnotic, meditative state which I haven’t experienced with other creative processes.  When I knit, my body starts to physically move very slightly, responding to the movements of my hands and arms; in passing the yarn around the needles or when slipping stitches off the needles, my body begins to sway slightly, rhythmically, gently, my breathing follows these rhythms, and it is this range of movements which makes knitting such a meditative, relaxing process.  Furthermore, most knitting demands some level of concentration (I’m thinking aran or socks here!) which forces you to focus, not get distracted, and so you will inevitably focus less on your health issues.

So, back to the decision to suddenly man-up and try to make socks.  Actually, I bought my first-ever sock yarn last summer, deliberately prior to going into hospital for surgery – for some bizarre reason, I thought this would be an excellent idea.  I took it with me, looked at it a few times, then wimped out and put it away again; it seemed that it was a really stupid idea to try to improve my existing skills by learning something new at such a time and was just too much to deal with.  However, after a couple of weeks at home, when my physical symptoms were a bit easier to manage, I decided that I needed some serious distraction so started on the much-avoided sock challenge – and I loved it!  I learnt to knit on five needles, began to understand why socks need to be knitted in a certain way, and had (very sensibly) bought some self-striping yarn so I wouldn’t get bored, and I have obsessively knitted socks ever since.  I have written three different patterns so I can knit socks in different yarn weights, and as soon as I finish one pair I start another, I just can’t stop!  What was most apparent in all this was the soothing, meditative effect of knitting on my body and my mind at this difficult time, and I would have really struggled to cope without the distraction of the knitting process alongside the satisfaction of making something beautiful.

I now have far too many socks and need a bigger sock drawer.  I probably should give some away as gifts but they all feel special to me and I don’t really want to part with them, not yet anyway.

For more information about the benefits of knitting, click here

 

Mind over matter – the power of the depressive voice

painyinyanI no longer believe that I will ever get better.  The possibility of this becoming my reality entered my mind a couple of years ago, but this the first time I’ve written it down and I guess that in  doing so, it entails an  ‘official acceptance’ of it in some way.  I’m very aware of how potentially damaging this mindset can be, and am also conscious that this is the product of my ‘depressive voice’.

So what does this apparently simple statement actually mean, to me?  It means that I fully expect to be in pain for the rest of my life; it means that no matter what procedures the surgeons perform, the arthritis will always be one step ahead of them and continue to spread to other parts of my body; it means that my mobility will continue to deteriorate and I will become increasingly dependent on other people; it means that I will continue to be potentially unemployable; it means that I will be increasingly marginalised and disenfranchised; it means that I will continue to withdraw from life and isolate myself.  It means that despite all of the above being wholly unacceptable to me, the depressive voice has won.

There is general medical consensus that there is a link between chronic pain and depression.  It’s hardly rocket science – my body hurts so I feel depressed.  But this is depression we’re talking about here, a nasty bastard of a disease, an entire entity in itself, and managing it is a whole different ball game to feeling a bit fed up because part of your body is a little sore.  Some medical opinions go further: individuals who experience chronic pain commonly experience anxiety and depression; anxiety and depression disorders in themselves can cause chronic pain; anti-inflammatory medications and opioid analgesics can cause additional pain; as the pain worsens, so does the depressive condition; and orthopaedic trauma, either through injury or surgery, triggers PTSD in 20%-51% of patients.  A Canadian study from 2017 recognises this and is calling for a more holistic approach for orthopaedic patients by supporting their mental health both during and post-treatment, not only for the purposes of monitoring their well-being during a period of psychological distress, but also to facilitate a better recovery and improved outcome.  In the UK however, the focus remains on degenerative bones and crumbling joints.  Despite being asked to complete orthopaedic questionnaires which include a couple of ticky box questions about mental health and depression, no additional support or guidance on managing depression was forthcoming, so I can only assume this information was collected purely for statistical purposes.  It remains abundantly clear that a more holistic approach is needed here, a human perspective if you like; I am more than my crumbly crappy skeleton, and my psychological issues over the past couple of years have impacted massively on my ability to manage both my physical condition and life in general.  Below is an image depicting areas where I experienced pain yesterday, and rather interestingly, my arthritic problems are only present in my lower body; this is a fairly typical day, so I think it is only to be expected that my mood is currently very low.

pain7.jpg

It remains disturbing to me that the psychological impact of orthopaedic conditions is briefly acknowledged then so readily dismissed.  I firmly believe that the power of the mind far exceeds that of the body, so it is both logical and absolutely vital that psychological issues be dealt with alongside the management of chronic pain.  Recently I experienced several ‘meltdown days’, days when I could barely function due to the level of my depression.  I found it curious that on one particular day, as the depression deepened, my levels of pain were reduced.  I have no idea what other people experience when they have a depressive episode, but in my case it is a complete absence of thought – my head seems empty, it is a numb, dark, empty void, and I stare at blank walls for hours without any awareness of time or whether a single thought might have been created or processed.  I see it as my brain going into emergency shutdown, a filtering mode in an attempt to protect me from myself, sifting out anything which might rattle me or upset me, leaving only what is necessary for my physiological survival.  Perhaps on this particular day, my brain decided that the endless pain needed to be filtered out, even just for a short time?

As for the depressive voice, I need to find a way of getting it to work for me in a positive way, to help rather than hinder me, and to convince me that some level of recovery is possible, I want my mind to actually support me and be on my side for once.  What I need from it are constructive thoughts and patterns of behaviour, some positive input to change my way of thinking and rid myself of the defeatism which consistently takes over my mind.  As time goes on, more physical problems continue to emerge; the depressive voice needs to go, or I fear that I will never achieve anything more than a temporary superficial recovery and an increasingly self-imposed isolated existence.

 

 

 

“The feral pile”

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Dogs.  I’ve owned them all my life and can’t even begin to imagine how desolate I would feel without one.  Owning dogs, or spending time with them, has been scientifically proven time and again to have huge benefits for your physical well-being and an even greater impact on your mental health.  So how and why does spending time with dogs (or other furry companions) improve your overall health?

  • Companionship

Dogs are especially loyal and loving creatures, so offer their owners comfort, reassurance, companionship, emotional and physical security, and unconditional love.

  • Responsibility and Motivation

Owning a dog brings with it responsibility and motivation – the responsibility for feeding and caring for your pet, and the motivation to exercise it regularly and sufficiently.    In fulfilling these responsibilities, you should notice some improvements in your physical and mental health, even if the changes are small at first.

  • Depression

Walking a dog can increase your physical level of fitness, but also give your mood a boost.  Here’s why:

  1. walking releases endorphins, which reduce physical pain and improve your mood.
  2. walking has a calming effect – it can reduce adrenaline levels which, in turn, lessen levels of anxiety and stress.
  3. walking increases levels of seratonin, the ‘happy chemical’ or mood elevator.
  4. walking enables more efficient use of dopamine, a neurotransmitter which signals responses of pleasure and motivational reward.
  5. walking increases your levels of Vitamin D3, which is absorbed directly from the sun; this enables increased seratonin and dopamine release to the brain, and subsequently can elevate a low mood.
  6. walking increases oxygen levels in the body and brain, enabling dopamine receptors to function more efficiently and lift a low mood.

Click here for an article about the benefits of walking and mental health.

  • Socialising

Walking dogs inevitably leads to meeting other dog owners, and sometimes chatting – usually about dogs! – and occasionally these chance encounters can lead to lasting friendships.  Social isolation can be a key ingredient of depression, and it is believed that people who are socially connected are more likely to be mentally healthy.  Socialising with other dogs is also good for your canine companion – dogs need doggie friends too!

Click here for a wonderful article, How getting a dog saved my life

  • “The Feral Pile”

The Feral Pile is not a phrase that you will find in any study about human and canine relationships or behaviour, but it is the way which I describe the most important behavioural aspect to my relationships with my dogs, and why they are so important to me.  I think the simplest way to describe it is ‘mutual bonding’ and the behaviours which bring that about.  The picture at the top of this post is of my current dog, a golden labrador, who was 5 months old at the time.  She had had an unpromising start to her life, and this picture was taken the day I brought her home; she was clearly needy, anxious, in desperate need of reassurance, and we spent our first week together snuggled up in a feral pile on the sofa.  She is now a strapping 3-year-old who weighs in at 30 kilos, but we have continued our tradition of spending several hours each day in the feral pile together; she loves the reassurance and attention, and I love everything about it: her scent, her soft velvet fur, her warmth, her rhythmic breathing, even her snoring in my ear, her reassurance, her devotion, and her beautifully gentle personality.  Being in the feral pile immediately reduces my levels of stress and I feel much more relaxed, the warmth and softness of snuggling up to her relaxes my muscles and my physical pain seems less, and her gentle breathing has a soporific effect usually resulting in the best quality sleep I’m likely to have that day.  Every day, I smile at her behaviour or her expressions and she lifts my mood considerably, which is hugely important since my mental health has been poor for a while now.  Yet, despite the obvious mismatch of having a large energetic dog alongside my current mobility problems, she brings with her enormous reassurance, affection and a whole host of other intangible, wonderful things which far outweigh the challenges.  If we can’t manage to do something or if it all gets too messy, we stay calm and simply revert to the feral pile until all is well again, and then we try again another day.

Osteoarthritis and Mental Health

This post is a continuation of the static post which can be found on the Mental Health page where I was undertaking an experiment to examine the potential relationship between arthritis and psychological well-being, using a word cloud programme to create an image using text.  A week has now gone by, I have recorded 12 words or phrases each day relating to the question ‘How do I feel today?’, and this is the resulting image:

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This image is what I would describe as a ‘generic’ image to reveal the symptoms and emotions I have experienced over the past week.  Word cloud programmes, by default, recognise text as individual words rather than as a complete phrase, and the larger the text, the more frequently a specific word appeared in my lists – for example, the largest words, such as ‘pain’, ‘back’, ‘stiff’, ‘sore’, etc appeared in my list several times, and in various combinations or phrases.  Conversely, the smallest words appeared once only.  This is all well and good, and provides an overall generic view of what I was trying to capture by doing this experiment.  Evidently, the physical symptoms of my arthritic condition dominate in this image, but it is also interesting that several words relating to mood appear in moderately-sized text.

In this second image, I have tweaked the word cloud programme so that phrases are ‘read’ by the programme as complete words – in other words, ‘lower back pain’ will be read as one complete word.  This provides a much more specific image:

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Interestingly, the words ‘low mood’, ‘sore back’ and ‘cold’ are now the most frequently occurring words and therefore appear in the largest text.  Although the word ‘pain’ no longer dominates the image, it occurs several times in medium and smaller text, but this time specifically relating to the type of pain I experienced: ‘back pain’, burning pain’, ‘hip pain’, ‘sharp pain’, etc.  What this image also reveals is the extent to which symptoms of low mood and depression appear and how they seem to be as prevalent an issue as the physical symptoms themselves.  Additionally, I believe that these images provide a valuable insight into how exhausting it is, both physically and mentally, to experience an arthritic condition.

A couple of additional thoughts relating to this experiment and the resulting images.

Firstly, at the time of writing, it is a typically cold and damp January, and as arthritis sufferers are well aware, this is the absolutely worst time of year for us regarding our experiences of pain and is also the most problematic with regard to managing our pain and symptoms adequately.

Secondly, although I am firmly of the belief that osteoarthritis and reduced levels of mental well-being are intrinsically connected, I would also argue that low mood and symptoms of depression cannot be solely attributed to arthritic conditions, and that there are many other factors at play in our lives which influence our moods and well-being.  Having said that, however, I have been extremely pleased to discover that during my medical appointments over the past couple of years, arthritis sufferers are now routinely asked to complete mental health questionnaires.  I am assuming that this is an extremely positive step forward in better managing arthritic diseases – after all, how can individuals experience chronic pain on a regular basis, without also experiencing low mood and symptoms of depression?