Category: Health and treatment experiences

Move More: How I Actually Started Exercising with a Chronic Condition

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Move More: How I Actually Started Exercising with a Chronic Condition

Does just seeing another article about exercise make you want to turn the page? It often makes me want to. When I got diagnosed with my chronic condition all the information about exercise seemed so out of touch with the reality of my life. If I’m already tired, sore and busy then I’m not going to be able to go to the gym. I can’t afford a personal trainer. With my back pain there is no way I can participate in the group yoga classes I used to take in university. Even more frustrating was the fact that all the research I came across proved how beneficial exercise is to health. I knew that I should exercise but I felt like I couldn’t.

 

But what if I could?

One day I came across an(other) article reporting on research that showed yoga could improve fibromyalgia, my chronic condition (OHSU, 2010). The results were impressive – pain was reduced by 24%, fatigued by 30% and depression by 42%. Great, I thought, another thing I can’t do that would help. But in this case I also found that two of the researchers were part of a nonprofit organization that produces exercise DVDs for fibromyalgia, including one on yoga and Pilates (link below). I ordered the DVD and skeptically waited for it to be delivered. I was surprised and excited to find that I was able to do the routine – which was shown at three different intensity levels so I could modify the poses as needed. I found that the at-home instructional DVD format was affordable, convenient and accessible – I could do it when I was able, for as long as I could and without wasting energy traveling somewhere and back.

Woman stretching arms behind back

Photo by Steven Depolo

During my health coach training I learned that yoga, tai chi, qi gong, and stretching are all range-of-motion or flexibility exercises. These types of exercise can also build strength and promote balance, but primarily focus on lengthening tight muscles and moving joints through the full span of movement they are intended to achieve. “Limited flexibility can cause pain, lead to injury, and make muscles work harder and tire more quickly (p. 92, Lorig et al., 2013).

My positive experience with the yoga/pilates DVD encouraged me to find other programs with a similar format. One of my favorites is the Tai Chi for Health series by Dr. Paul Lam (link here), especially the Tai chi for Arthritis program that was designed in conjunction with the Arthritis Foundation. This instructional video that takes you step-by-step through 12 lessons until you have the movement sequence memorized.  I enjoyed learning an entirely new way of moving and began to feel more confident that I could include exercise in my weekly routine.

I also started seeing a physiotherapist who put together a thorough stretching routine for me to do daily. Without doubt, this is the single most effective thing I tried to improve my health and well-being. My pain has decreased and my daily functioning has improved, along with my quality of life.

Many flexibility/range-of-motion exercises programs also share a second common feature as mind-body movement practices. For example, “Yoga is a set of theories and practices with origins in ancient India. Literally, the word yoga comes from a Sanskrit work meaning “to yoke” or “to unite”. It focuses on unifying the mind, body, and spirit, and fostering a greater feeling connection between the individual and his/her surroundings” (Moonaz, 2015). Greater body awareness, stress reduction, emotional balance, and improved energy are all benefits of mind-body exercise programs (Moonaz, 2015).

Flexibility/range of motion exercise programs are a great starting point for anyone who has not exercised for awhile, or who has a health condition that makes movement challenging. They are easy to do at home or you can find many classes offered in your community. Gradually incorporating these routines 2-3 x/week and practicing daily stretching is how I was able to actually begin to  move more. Below is a quick primer on what these kinds of activities are so you can pick the right one for you and a link to programs that I have tried:

Yoga: “Yoga involves directing your attention and breath as you assume a series of poses, or stretches” (Gaiamlife, n.d.).

Qi Gong and Tai chi: “The term qi gong (or chi kung) describes the complete tradition of spiritual, martial and health exercises developed in China. Tai chi is one of the most common of these. Practicing qi gong involves performing a series of movements while paying attention to the body and staying aware of the breath. The exercises are especially effective for developing balance, focus, coordination and graceful, centered movement” (Gaiamlife, n.d.).

Stretching: Poses to lengthen muscles and increase range of motion in joints

 

References:

OHSU. (2010). OHSU Research Suggests Yoga can Counteract Fibromyalgia. http://www.ohsu.edu/xd/about/news_events/news/2010/2010-10-14-ohsu-research-sugge.cfm

Moonaz, S. et al. (2015). Yoga for Arthritis. Johns Hopkins Arthritis Center. http://www.hopkinsarthritis.org/patient-corner/disease-management/yoga-for-arthritis/

Gaiam Life. (n.d.) How to Choose a Mind Body Exercise. http://life.gaiam.com/article/how-choose-mind-body-exercise

 

 

 

Exercise at home: Tai Chi for Arthritis

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tai chi

My husband and  I decided this week that we need to focus on regularly doing stress relieving exercise. We came to this conclusion after one of those pointless arguments that you have in the middle of a stressful week, when you aren’t really dealing with what is actually bothering you. One problem with having chronic pain is that every week can seem like an especially stressful one – flareups can interrupt like mini crises, causing a flurry of last-minute adjustments to make sure all the necessary things get done. Life can start to seem like a giant game of whack – a – mole (that carnival game where the ‘moles’ pop their heads up faster than you can hit them with the hammer). We realized that if we just keep trying to react to all those inevitable stressors faster and faster, from forgotten pill refills to unexpected financial costs to family demands on our time, the only result will be that we are burned out, not that our to-do list will ever stop growing.

I think we need to try to get a little bit of control by managing our stress better, not doing our chores faster. I have an upcoming mindfulness-based stress reduction (MBSR) course happening at my hospital later this fall, which I think will be really helpful. However, another important thing to include is exercise. This is difficult for chronic pain and fatigue patients, for obvious reasons. It can also be hard for our spouses and caregivers because they often don’t have time between working and doing the household chores to fit in some exercise. I’m very lucky to have a man in my life who is willing to do so much for me – but he sometimes forgets to take care of himself in the process.

I think that it is very convenient to have an at-home option for your exercise. Walking and aqua fit are great, but if the weather is bad or you don’t have the energy to trek out to a pool somewhere, it can often mean no exercise at all. I think a really good resource are at-home DVDs.

I was excited to find a resource called Tai Chi for Arthritis by Dr. Paul Lam . I had never done tai chi before I got this DVD and I have to admit that I generally associated it as an exercise that was most appropriate for elderly people. Like a lot of other things that I’ve had to revise, I’ve learned that this stereotype is just not true. This is a really good instructional video that takes you step-by-step through 12 lessons until you have a movement sequence memorized.

I particularly like tai chi because the entire program involves standing, not transitioning from lying to sitting to standing which other exercise forms like yoga tend to do. There is also a seated tai chi DVD available on his website if that is easier for you. It is entirely possible to take rest breaks if needed between lessons. The DVD also includes warm-up and cool down segments. It’s nice to be learning an entirely new way of moving – it feels like a new skill rather than a simplified exercise protocol. Although it is very gentle, I can feel afterwards in my shoulders and mid back that I have been exercising. Dr. Paul Lam is also a very Zen individual, and watching him is just in itself calming!

This program was specifically designed by the Arthritis Foundation in the US and Dr. Paul Lam, who is a medical doctor and tai chi instructor. Some of the health benefits discussed on the Tai Chi for Health Institute website include:

  • Muscle strength is important for supporting and protecting joints. It is essential for normal physical function.
  • Flexibility exercises enable people to move more easily. Flexibility also facilitates the circulation of body fluid and blood, which enhances healing. Many arthritic conditions such as fibromyalgia, scleroderma and spondylitis are characterized by joint stiffness and impaired physical function. Tai chi gently frees up stiff joints and muscles.
  • Fitness is important for overall health and proper functioning of the heart, lungs and muscles. Tai Chi for Arthritis can improve all of these components.

Several studies of the program were completed and they demonstrated pain relief and improved balance for patients with arthritis. I’m going to focus on trying to do this program two to three times a week. Hopefully I will begin to feel more of the physical benefits, but especially the stress lowering effects of exercise in general and tai chi in particular!

My partner (who does not have chronic pain) is going to be doing a beginner yoga DVD by Rodney Yee which looks really good. It focuses on learning each posture correctly and then gives you a couple of routines to learn. It’s good to remind the people that we love and who take care of us to look after themselves once in a while!

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It’s 3am, I’m wide awake, and feeling guilty about it

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This morning, I woke up tired. I know, big surprise for someone living with a chronic condition. Whether it’s painsomnia, stress induced insomnia or regular old insomnia, it’s all too common.

I take a prescription sleep aid every night. I’ve stayed away from more effective but more addictive sleeping pills and currently take a low dose tricyclic. I also take several supplements. I have found that melatonin, 5-HTP and l-theanine are an effective combo. However I still get those nights where I wake up every couple of hours or can’t get back to sleep. Sometimes I give up in frustration and take an over-the-counter sleep aid as well. Other nights, like last night, I feel guilty about taking anything extra and just try to get back to sleep.
Now I’m exhausted. Or maybe I should say extra exhausted, since I feel fatigued most of the time. I’m wondering, what is that guilt about?

I always feel like I should take the least amount of anything that I need. I worry about what everything I already do take is doing to my body. I feel like I need to justify all of my prescriptions. I wonder if I failed somehow because meditating and yoga don’t make me sleep.

But, I have a bonafide diagnosis for a debilitating condition. According to my sleep study I come out of deep sleep into light sleep 14 times an hour. If I need to take extra supplements in the middle of the night then so be it, right?

I think this comes down to a sort of internalised stigma about being sick. The assumption that you must have done something wrong to get sick in the first place. Or if you do the right thing you’ll get better. Or maybe it’s the assumption that if you try harder, or get tougher, you’ll get over it. Acceptance of my condition has come in stages. Recognizing my own internalized ableism is another stage. I think it’s good that I want to take the least amount of medication possible, and try to see where supplements can work instead of prescriptions. But that attitude is only ‘good’ to the extent it helps me manage my condition, not when it becomes a means of self-criticism for being sick. I already have enough fatigue without adding extra sleepless nights because I wouldn’t let myself accept that I need help to sleep.

Vulva Monologues: Topical Gabapentin and Vulvodynia

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November 2010

I shudder when I remember that summer. I was so frustrated with my body. I couldn’t understand what was happening. Newly engaged, and we couldn’t be intimate. Every time we tried, it ended in tears. My partner tried to be strong for us, to be positive, but I wanted him to be vulnerable, to show me he hurt too. I tried crazy things, like inserting yogurt and even garlic in an attempt to get rid of what I guessed might be a horrible yeast infection gone wrong. That ended up with me going to an emergency room with cramps and irritation, and a look from the doctor like I was going to be one of her stories (“I had this crazy patient who…”).  Vulvodynia isn’t just a yeast infection, and don’t put garlic anywhere near your vulva – they aren’t friends!

After months of waiting, I finally saw an OB-GYN with expertise in vulvodynia. She confirmed my diagnosis of provoked vulvodynia (also called vulvar vestibulitis). Her first course of treatment was a topical compound cream of lidocaine and gabapentin.

A 2008 study of 35 women with local and general vulvodynia women treated with topical gabapentin found that 80% had a 50% reduction in vulvar pain (Boardman et al., 2008). The benefit of topical application is that you avoid the body-wide side effects of taking a pill. If you are interested in a topical treatment, another option is topical amitriptyline and baclofen (an anti-depressant and muscle relaxant, respectively). A small retrospective study  that investigated this treatment found :  29% patients reported no or little (<30%) improvement, 18% reported moderate (30-60%) improvement, and 53% reported much (>60%) improvement (Nyirjesy, 2009).

Unfortunately for me, after 3 months there was no change in my pain (and no sex either). I also felt that the base cream was even causing some irritation around the outer labia. So, the journey to find an effective treatment continued…

Topical gabapentin in the treatment of localized and generalized vulvodynia.
Obstet Gynecol. 2008 Sep;112(3):579-85.
Boardman LA, Cooper AS, Blais LR, Raker CA.

Topical Amitriptyline-Baclofen Cream for the Treatment of Provoked Vestibulodynia

Journal of Lower Genital Tract Disease:

October 2009 – Volume 13 – Issue 4 – pp 230-236

Nyirjesy, Paul MD1; Lev-Sagie, Ahinoam MD2; Mathew, Leny MS1; Culhane, Jennifer F. PhD1

Open Letter to All Health Professionals Treating Clients with Fibromyalgia

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Open Letter to Health Providers

I usually never write a letter of complaint after I have a(nother) bad experience with a health provider. I just want to move on. In some cases I am afraid commenting will affect my treatment. In others I just feel disillusioned that it will make any difference.

I am coming up on my four year anniversary since diagnosis and I feel a sense of responsibility, that after all my experiences I should raise awareness about the basics of safe, competent, patient centered care. So I am posting a letter I wrote to an acupuncture clinic I tried last week, which was an epic failure, in the hope that a health provider out there reads it and learns a thing or two!

Good afternoon,

I would like to cancel my appointment next week. Treating chronic pain patients requires specific skills and I would like to pass on a few suggestions for improving your clients’ experience:

– after the acupuncture needles are put in place, inform the client how they can call for assistance if they need to. I was in significant pain because of the lying position I was in and could not get help during the last 10 min of waiting.

– inform the patient about each procedure beforehand, what it will be like and what the possible consequences might be. Sarah (name changed) asked if I would like to try cupping and after I agreed she began the treatment before explaining what it entailed. Furthermore, instead of testing one or two times she did it all over my back. Since then, I have had chronic headache, a pain flare and deep bruising. The definition of my condition is increased pain sensitivity so an experienced practitioner should have trialed the treatment on the first visit. I have had to see my physiotherapist to undo the muscle spasms caused by this treatment.

–  I was given a herbal remedy but the ingredients were not explained, nor were the benefits or possible side effects described. This is the equivalent of my doctor saying ‘here is a prescription’ without telling me what it is, why, or what it should do! I have a lot of sensitivities to drugs and supplements, and often need a  lower dose than normal but was not given an opportunity to discuss this in private.

All of these examples are ultimately a failure of patient-centred care – making the client feel like a person rather than a diagnosis –  and therefore,  I will not be returning to your clinic.

Sincerely…

Digestively Challenged: Overcoming G.I. Tract Problems when you have a Chronic Illness

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Digestively Challenged: Overcoming G.I. Tract Problems when you have a Chronic IllnessIs eating well with chronic illness a luxury? When I first got diagnosed, I thought so. The significant pain I was experiencing in the muscles around my shoulder blades made it impossible for me to chop, stir, or sauté a whole meal – basically, to cook. My partner was more than happy to help (as long as I showed him how!), but it felt unfair. After all, he was now supporting me financially and doing the majority of the housework – since laundry, vacuuming, scrubbing and dusting were similarly impossible for me. We tried to eat the healthiest convenient foods we could. Unfortunately, convenience isn’t healthy, at least when it comes to eating. In a previous post, I wrote about how my processed diet failed me, even though I was making supposedly healthy choices. In one year, I gained about 20 pounds, ate four times the daily recommended allowance for sugar, was woefully short on fruits and vegetables, ate too many servings of grain and too few servings of protein.

I also had hypoglycemic attacks if I did not eat on time. I remember that panicky feeling of being on transit, far away from a convenience store, and starting to feel shaky and sweaty.  I also developed a number of food intolerances.  I felt anxious about eating out or trying a new recipe for fear of having an ‘episode’.  Not only did I have unpleasant digestive symptoms but also strange neurological ones – sweating, pulse racing, excessive salivation, skin crawling, restless legs, and others.  It was these two problems that made me feel like I needed to understand what was going on in my body and to regain control over my eating. It’s important to begin with a good understanding of digestive problems that affect spoonies (people living with chronic illness).

Firstly, we need to avoid food intolerances (also known as food sensitivities). Food intolerances are defined as a physical reaction to eating certain foods, such as digestive symptoms like bloating, gas, diarrhea or constipation, or stomach cramps.[i] These reactions do not occur because of an immune response to a particular food – that would be defined as a food allergy. In the case of a food intolerance, some people may be able to eat a small amount of the trigger food without having a physical reaction, up until they reach a threshold level. Food intolerances may occur because of the absence of a necessary enzyme (such as lactase to break down lactose sugar in dairy), having irritable bowel syndrome, having a sensitivity to food additives, having a problem digesting certain carbohydrates (acronym FODMAPS), or for no known reason. Food sensitivities may be more common among people living with fibromyalgia and CFS/ME because of the overall sensitization of the central nervous system associated with these conditions. Research indicates that at least half of people with FM or CFS/ME experience significant relief by eliminating certain foods.

How can you figure out what foods you are sensitive to? Naturopathic doctors, integrative doctors and nutritionists can offer tests that pinpoint sensitivities. However, the least expensive way is to do an elimnation diet. You begin by cutting out the most common foods that cause intolerances and any foods that you are suspicious of for a period of time, usually 2 to 4 weeks. These foods may include: dairy, gluten, eggs, soy, corn, sugar, citrus, peanuts, shellfish, and coffee. Then you gradually reintroduce one food type at a time to notice your physical reaction. If your symptoms reappear, then you know you are sensitive to that type of food. In my case, I am intolerant of eggs, red meat, and to a lesser extent, wheat. I am also sensitive to high concentrations of fiber or resistant starch. The elimination diet is best done with the guidance of your healthcare professional.

A second problem associated with the digestive system and chronic illness is the development of Leaky Gut Syndrome. Essentially, leaky gut occurs when the lining of the intestines becomes more permeable, which allows particles of partially digested food or waste to leak into the bloodstream.[ii] Increased permeability occurs because of damage to the tight junctions between intestinal cells. When the immune system encounters foreign particles in the bloodstream, it launches a response, including inflammation. Symptoms of leaky gut syndrome include digestive symptoms, gas, bloating, diarrhea, fatigue, joint pain and rashes. In addition to chronic inflammation, leaky gut syndrome affects the ability to digest food and to absorb nutrients. Furthermore, it compromises the immune system by tying it up responding to foreign particles in the blood, which leaves it less able to respond to actual pathogens. The intestinal lining actually is a significant site of immune activity, but when it is damaged, overall immune function is impaired. How does the intestinal lining become damaged? Through food intolerance, stress, medication, flora imbalance and autoimmune disease. Emerging research shows that several autoimmune diseases share increased intestinal permeability as a characteristic[iii].

In terms of diet, the usual recommendations include treating Leaky Gut Syndrome through clean eating; in other words, avoiding commonly allergenic/intolerant foods, inflammatory foods, pesticides, herbicides, additives, or sugar and rebalancing intestinal flora by consuming probiotics. For autoimmune diseases in particular, some experts recommend the paleo diet, which emphasizes protein and vegetables, while cutting out grains and legumes. For example, Dr. Terry Wahls has written a book on how she reversed her MS through a nutrient dense paleo diet. Supplements that can help to repair the damaged intestinal lining and reduce inflammation include l-glutamine and DGL.

When it comes to diet recommendations, I think the most important thing to remember is that we are all genetically diverse. We will all have unique responses to different foods and there is no one-size-fits-all diet. For example, I feel terrible after eating eggs or after eating a large portion of cruciferous veggies (broccoli, cauliflower, etc) because I have a food intolerance to eggs and  am sensitive to large portions of insoluble fiber. The paleo diet isn’t for me. However, a high-protein vegetarian diet keeps my digestion happy, hypoglycemia at bay, and generally gives me more energy. The only universal truth when it comes to nutrition is that nobody benefits from eating a diet high in processed foods, sugar, sodium or fat. We all feel better on a whole foods diet. It can seem overwhelming to change your diet when you are dealing with the multiple, uncertain symptoms of chronic illness. The potential to improve your quality of life is worth the effort in experimenting to find what works. Here are a few resources to help you get started:

  • 100 Days of Real Food is a resource for transitioning to a diet free from processed foods (includes blog, meal plans, challenge, cookbook) http://www.100daysofrealfood.com/

Read other great blog posts by writers with FMS on the Fibro Blogger Directory http://www.fibrobloggerdirectory.com/

[i] http://www.mayoclinic.org/diseases-conditions/food-allergy/expert-answers/food-allergy/faq-20058538

[ii] https://www.womentowomen.com/digestive-health/healing-leaky-gut-syndrome-open-the-door-to-good-health-2/

[iii] http://www.todaysdietitian.com/newarchives/021313p38.shtml

Convenience Isn’t Healthy: Chronic Illness and Diet

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When I was diagnosed with fibromyalgia three years ago, my diet was all about convenience. I came to the conclusion that eating healthily was just a luxury that I could no longer have. I tried to generally to choose healthier convenience food options. For example, a whole-grain cereal instead of refined grain, or a low-fat frozen lasagna instead of full-fat. A typical day looked like this:

Breakfast: Multigrain Cheerios with a banana (251 Calories)

Snack: Yogurt (115 Calories)

Lunch: sandwich with deli meat, granola bar, carrot sticks (348 Calories)

Snack: Trail mix (352 Calories)

Dinner: Spaghetti (store bought pasta sauce) (344 Calories)

Snack: Slice of Toast (69)

Total: 1538 Calories (Calculated at Super Tracker www.supertracker.usda.gov)

So, calorie-wise not so bad. However, as any nutritionist can tell you, calories are only a small part of the nutrition story. If I ate 1500 calories in chocolate, it would only be delicious, not healthful.

What was wrong with my diet?

  • Grain heavy: I had a total of 240 g of grains, which is over the USDA recommendation of 170g or 6 oz for a woman my age. While grains provide benefits like fiber, eating too much of this food group can lead to weight gain.
  • Protein policy: in total, 16% of my food intake was protein. While this is within the acceptable range set by the USDA, dieticians recommend your protein daily allowance should be calculated using this formula: 0.8 x weight in kg (easily converted using any online converter). For me, this comes to 52 g per day. Protein should be distributed between all meals to help sustain energy. In my case, breakfast and dinner were primarily carb based. http://www.livestrong.com/article/343966-how-to-calculate-protein-rda/
  • Sugar high: in total, I had over 90 g of sugar! The World Health Organization recommends that less than 10% of your daily energy consumption should come from sugar, with added health benefits coming from less than 5%, or approximately 25 g. My sugar total was almost 4 times that much! This is bad news for my blood sugar levels and weight management, never mind long-term health consequences. http://www.who.int/mediacentre/news/releases/2015/sugar-guideline/en/
  • Nutrition deficient: I had less than four servings of fruits and vegetables (banana, carrots, raisins, tomato sauce). This means I was getting an inadequate amount of micronutrients (vitamins and minerals), and losing out on the many other benefits of these healthy foods such as antioxidants and fiber. Furthermore, the servings I did have were primarily starchy vegetables or high glycemic fruits, which only added to my blood sugar concerns and weight gain.

Overall, I gained 20 pounds in a year and went up a dress size. I was also permanently fatigued. For anyone coping with chronic illness, sustained energy is a significant challenge. Balancing macronutrients – carbs, protein and fat – along with factors such as fiber and sugar, is important for preventing spikes in blood sugar that inevitably lead to energy crashes. According to the Mayo Clinic, based on a 2000 calorie/day diet, the total daily allowances should be:

 

Nutrient Percentage Grams
Carbohydrates (vegetables, fruits, grains) 45-65% 225-325
Fiber   Female: 22-28; Male 28-34
Sugar   Female: 24g; Male: 36
Protein 10-35% 50-175
Fat 20-35% 44-78
Saturated Fat 7-10% 16-22

http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/how-to-eat-healthy/art-20046590?pg=1

Maximizing micronutrients (vitamins and minerals) is also key healthy eating. Adequate intake of nutrients like Iron and B vitamins have been linked to improved energy levels, while others like Vitamin D and Magnesium help reduce chronic pain. In addition, chronic illnesses like fibromyalgia have been linked to high rates of oxidation, so eating antioxidants is important to counteract these effects.

The USDA recommends at least 2 ½ cups of vegetables per day for women and 3 cups for men, and 1 ½ cups of fruit per day for women and 2 cups for men. The USDA recommendations have been critiqued, which is another post altogether, but provide guidelines that are much healthier than the Standard American Diet www.choosemyplate.gov.

Is Your Disability Your Personal Problem, a Social Problem, or Both?

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So you have a chronic illness. Is that a disability? If it means significant restrictions to your daily activities, then, according to medical and government guidelines, yes, you have a disability. This may challenge the abilist stereotypes you might have absorbed from the media, where disability is usually linked to the need to use a wheelchair because of a spinal cord injury or limb impairment.

This might get you wondering about what exactly the definition of disability is, how do we usually understand it and what does that mean for how we value ability/disability. Mainstream medical models say the problem lies within individual bodies. Disability advocates say the problem lies in our inaccessible and abelist society. I wanted to post an excerpt from my instructor on disability studies to clarify these models and meanings:

 The medical model of disability positions disability as an individual physical problem.

The charity model sees disability as an individual personal tragedy that should elicit our sympathy. Dossa (2005) refers to this as the “personal tragedy model” of disability. The “supercrip” model positions disability as an individual challenge over which someone can triumph by dint of hard work and elicits our admiration. In the moral model, the inherently negative stereotype of disabled people, which as Kumari Campbell (2008) points out links to self‐hatred, is something to be borne solely by disabled individuals. What all these models have in common is that they individualize disability, problematize disability and locate disability in individual bodies that are defined as wrong (Wendell, 1996, p. 360). These all serve to “other” disabled people.

Wendell believes that none of these models serve disabled people. She explores and explains the social model of disability as a more useful alternative. This model, which came out of the disability rights movement turns the focus away from disabled people and disability and onto the able‐bodied and ableism. Framing disability as a social justice issue means that the difficulties that face disabled people are located within disabling social structures and attitudes.

The social model arose through the disability movement’s critique of responses to the care needs of disabled individuals. Through rejecting the medicalised or therapeutic model of disability in which power lies with professionals and disability is pathologised and individualized, the category ‘disabled’ was transformed into a collective political identity. Disability is understood as being constructed not through physical or mental impairment but through social, cultural and environmental barriers such as inaccessible education, housing, public spaces and employment environments; discriminatory health and social service systems; absent or inadequate benefits; and negative cultural representations. The social model requires us to engage with the marginalization and exclusion that disabled people are forced to face in disabling environments and challenge medical and social responses that enforce dependency.

What does it mean for our practice and for us as people, if we understand disability as individual rather than social? How is our practice impacted if we see most disabilities as resulting from individual failure to properly manage one’s life and avoid risks – including the relatively new requirement that parents/ mothers use genetic testing or amniocentesis to avoid having a disabled child? Alternatively, if we work from the social disability model and “value the differences of people with disabilities…what implications does that have” (Wendell, 1996, p.8) for our practice?

Most commonly, doctors are given the right and the authority to decide whether or not someone is disabled and to define the nature of the disability. What a doctor decides can and does determine access to benefits and entitlements. As Wendell points out, defining disability serves a larger political purpose. It reinforces the idea that disability is located in individual bodies (or brains); it makes disability into a problem of the disabled person; and it reinforces the power of doctors to pronounce on disability. But what then happens for people with unrecognized, undiagnosed or undefined problems? Where does illness, especially chronic illness, fit into disability definitions?

 Macias, Teresa. (2015). Unit 3: Disability theories and models. Accessed online Jan 26, 2015.

The Magic Bullet of Nutrition?

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Do you remember the part in the Father of the Bride when the marriage is almost cancelled over a blender? The groom-to-be gifts his fiancee with a blender and she is furious because she takes it to mean he expects her to be a 1950s housewife!
My significant other remembers this and so it was with great reluctance that he bought me the birthday present that I asked for – a Nutribullet blender. But he wrote me a very romantic letter to make up for it!
I’m actually kind of a nutrition nerd so it’s a great gift from my point of view. I also have high hopes that it’s going to make me feel better.
First of all, what is a Nutribullet blender? It is a high powered blender that makes “a nutrient extracted drink designed to feed your system as many servings of easily absorbable fruits and vegetables as possible”.
I got the Nutribullet Pro blender. It comes with four BPA free plastic containers so you can choose the size of smoothie you want to make. The containers have lids for storage so you can take your smoothie with you. The blender has a powerful 900w motor so the smoothie is ready in seconds. The idea is to make the nutrients as bioavailable as possible by fully breaking down the veggies and fruits – and taking stress off the digestive system. Unlike juicing you get all the fibre in addition to the nutrients. The maker claims the Nutribullet doesn’t oxidize the smoothie as much as other blenders because of its speed and cyclonic action … But you have to drink it right away.
The blender comes with smoothie recipes, called Nutriblasts. The basic formula involved 2 cups of leafy greens, 2 cups of fruit, and a ‘boost’ of nuts or seeds, like chia seeds or almonds. It also comes with a recipe book that includes recipes for FM! It’s pretty affordable at around $115.
The best thing about the Nutribullet is the convenience. When I first got fibromyalgia I gave up on eating healthily because of all the work involved in cooking whole foods from scratch. As time has passed I have learned that the only way to manage this condition effectively is through lifestyle choices – making time for gentle exercise (walking, yoga, qi gong, tai chi), taking supplements, going for body work appointments (massage, physio, osteopath) … and eating well, most importantly. But my healthy eating choices have to be quick and easy to be viable. Throwing a cup of leaves, a banana and frozen berries into a plastic cup meets these criteria! I used to try to use my giant blender but it’s hard to clean, heavy and made more dishes. Most of the time it ended up in the fridge for a week with quickly separating smoothie servings left in it.
Although this particular product works for me, I think whether you use an old Oster work horse blender, a juicer or a vitamix, green smoothies are one if the best things you can incorporate day to day if you have chronic pain and fatigue.

The Sleep Supplement Trio That Finally Worked

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The never ending search for a good night’s sleep…If you have fibromyalgia, you know what I’m talking about. I have blogged before about different supplements that can help you get the rest that you need. Dr. Teitelbaum’s recommendations have been my starting place for finding effective sleep supplements.
After a lot of trial and error, I found a concoction that seemed to work: 50 mg 5htp, 100 mg L-theanine, and 3 mg melatonin. This seems to help me fall asleep, stay asleep and get back to sleep if something wakes me up. Interestingly, I found an article that recommends this exact trio because of the synergistic effects between them.
L-theanine reduces stress chemical messengers (cortisol and epinephrine) to induce calm and help you stay asleep.
Melatonin is a hormone that tells your body that it’s time to go to sleep. It also provides pain relief to FM patients when taken at higher doses (a recent study demonstrated that 10mg per night is effective). Melatonin is also a potent antioxidant.
5htp is a precursor to melatonin and serotonin. One interesting thing I learned from this article is that night time serotonin helps repair the wear and tear that day time activity causes. 5htp helps provide the building blocks for both of these important chemical messengers.
http://www.betternutrition.com/supplements-for-sleep/ sleep supplements
Huzzah! I hope this helps someone else out there sleep well tonight!