It was exactly a year ago when everything changed for me. On May 10, 2011 I logged on to check my bloodwork results. I scrolled down, and stared at the screen. And the floor dropped out from under me.
I had a positive result. Which, in the medical world, is a very big negative. I had a positive ANA. Which is a screening test for lupus.
But let’s back up a little. It all started a few weeks prior, with a little aching in my right elbow. I didn’t think much of it. Too much time on my laptop, maybe. And then, a few days later, I started to feel a little soreness in my right knee. Then my left knee.
Things were not trending in the right direction.
More joints became involved, until I could ignore it no longer. I had distinct pain, and stiffness, in both elbows and wrists, both ankles, knees, and hips. Then, a little redness about my elbows and ankles. And definite, visible swelling.
It was time to see my doctor. I booked an appointment for three days’ time. And during those three days, my symptoms became even worse. I was trying not to freak out. Trying very hard, but not particularly succeeding.
The problem, of course, with having a career in medicine is the knowledge. All the scary possibilities reared up in my imagination. Rheumatoid arthritis. MS. Lupus. Various other connective tissue disorders…
When I finally saw her, my doctor shared my concern. Which was both relieving and worrisome at the same time. I wasn’t imagining it. Also? I wasn’t imagining it.
So we did some tests. X-rays and bloodwork. The x-rays came back normal. Good. The initial bloodwork results came trickling in. Thyroid somewhat off, thyroid antibodies elevated. Low iron. Low vitamin D. It was strange to see my own bloodwork coming back abnormal, I’d always been generally healthy. But none of that stuff was alarming. None of it was stuff I couldn’t deal with.
A few days later I got the result I most definitely could not deal with.
That positive ANA.
I remember staring at the screen. My husband and my dad were making lunch and chatting in the kitchen. My dad was visiting to help us out because I was, at that point, entirely unable to do anything for myself or my children.
I started to cry. The crying got worse, and louder, as that result began to sink in. Me? Lupus? Suddenly, everything I knew about life had changed. My whole life would now be measured in two segments, before lupus, and with lupus. Nothing would ever be the same.
Again, I was simultaneously thankful for, and cursing, my knowledge base. I’d seen people with lupus, watched them deteriorate before my eyes. Lupus was a nasty disease, I knew that. It was a forever diagnosis, but unpredictably waxing and waning. It could affect every aspect of life and function. Cause end-organ damage at a whim. Force the use of potent medication that caused side effects almost as bad as the disease.
It was a terrifying moment.
But shortly after that initial terror, a few things crystallized for me. Life was going to take on a new shape. First, I was not going to do shit I did not want to do anymore. Also? I was going to do shit I did want to do.
Over the subsequent weeks, I saw two rheumatologists and an endocrinologist. There were few answers forthcoming. But one thing they hesitantly agreed on? This was not, in fact, lupus. They weren’t impressed at my antibody numbers. Said my results weren’t specific enough.
A huge relief. For the time being. Because then I entered a different world…the world in which I embraced the unknown.
I had more x-rays taken. Much more bloodwork. My doctor (bless her) called me regularly to check on me. For a while, things continued to worsen for me, physically. My joints became enormous, swollen and painful. Sleeping was very difficult. And the red welt-like lumps grew over my ankles, legs, and elbows. Erythema Nodosum, I thought, looking at the welts and nodding. I went to see my doctor. Erythema Nodosum, she said, on sight, also nodding. Not a diagnosis, per se, just a symptom that was all part of my nonspecific inflammatory flare.
I developed an annoying cough. A dry, irritating cough that seemed to correlate with worsening joint pain. I lived on anti-inflammatories. And, like the bad patient that all good doctors are, I resisted taking the prescribed prednisone. It was a line I was not ready to cross.
My mother wanted answers. “If we could just get a diagnosis, find out what it is…then we’ll know how to treat it.”
I nodded, but I knew the naiveté of this statement. Autoimmune diseases are multitude. There are endless categories and labels, and lots of ‘not otherwise specified’ tags on the ends of otherwise specified names. I knew that many people go years without a firm diagnosis. “I was misdiagnosed for a long time,” they say, clenching their teeth at the conspiracy.
But I know that “misdiagnosis” is really only a relevant term when you’re talking about stuff that’s black and white. And that medicine, the human body, is the exact opposite of black and white. Stuff evolves. Stuff changes. Stuff becomes more obvious, and then we’re in a position to pin down a diagnosis. There are no perfect tests, rarely any textbook cases. Often, the only time we know for sure what happened in someone’s body is when we cut it open at autopsy. And even then, there’s a whole lot of deductive work that goes on. This is all especially true when it comes to autoimmune disease, which shapeshifts to its heart’s desire.
So I prepared for a long period of not exactly “knowing”. But, just because I didn’t have an exact name for the maelstrom that had taken over my body, didn’t mean there was nothing I could do.
I knew that my immune system was freaking out. I knew that my body was going on inflammatory overdrive. And I knew I could do something about that.
So I started taking care of myself, I mean really taking care of myself. I knew about the physical stuff I could do. I needed to get more sleep. I needed to start eating more veggies, more fruit, more whole grains, more superfoods. I started taking vitamin D, and omega-3. And selenium. Incidentally, I suddenly understood the desperate patient’s plight oh-so-well, in a way I’d never experienced before. The urge to take supplements. The urge to do something—anything—to grasp on and hope that I’d discovered the thing that would make me better. I was grappling for the reins of control. Just as I’d seen so many patients do, sitting across from me, sitting in the cheap examination room chair while I sat in the comfy, expensive desk chair. And now I was in that cheap chair.
I couldn’t exercise. I was getting passed by the octogenarians who live in my neighborhood as we walked the snail’s race to the village. I’m not kidding. Literally, I was lapped by seniors with walkers. But I started doing yoga. I could barely do any of the poses at first, could barely move, really, but I still managed to spend a couple of minutes doing deep breathing, meditating, and very gentle stretches.
Significantly, I started exploring the less tangible aspects of health. Mostly, stress. I had been under a lot of stress. New baby, living through major house renovations, putting tons of pressure on myself to work and be a great mom and wife…plus my own writing aspirations. It was too much.
I started reading a lot about stress, which led me to reading about happiness. And that has revolutionized my life.
And then…as the weeks went by, things peaked and began, ever so gradually, to improve. About three months after things started, I was mostly back to normal. Physically, anyway. Psychologically, I would never be the same. In a good way.
I don’t know what improved things for me. Was it the omega-3? Was it the yoga? Or was it just the natural course of things; would I have gotten better on my own?
The rheumatologists, at last, agreed on a diagnosis. Most likely, I’d been battling a thing called Lofgren’s Syndrome. A rare form of a rare disease called sarcoidosis. Which is classified as an idiopathic autoimmune disorder. Idiopathic, here, meaning: no identifiable cause. Read: we have no freaking idea why it happens.
In me, maybe stress triggered it. Maybe not. You know what? It doesn’t matter. I knew I was too stressed. And whether the stress caused it, contributed to it, or was merely an innocent bystander…I knew I had to do something about it.
One year later, is everything exactly as I want it? Nope. I’ve been symptom free since everything settled in the summer. Am I stress free? Not exactly. Am I blissfully happy? Ummm, not quite. But you know what? It’s pretty damn close. Do I have a perfect lifestyle?
Well…it’s getting there. And that’s okay, because it’s a work in progress. A healthy lifestyle isn’t something you just turn on overnight. You work at it. I’m working at it.
A big milestone for me? I started running. At first I wasn’t sure this was a good idea. My husband was nervous for me, didn’t want me to do anything that would stress my joints, for fear of things coming back. But…so far, so awesome.
And I embrace the uncertainty every day. Because although the rheumatologists believe Lofgren’s syndrome to be the most likely diagnosis, there’s still a chance it could have been—could be—something else. Something that could come back. Like lupus. See, I read their consultation letters. There was lots of room for reassessment should my symptoms recur.
To be honest, it’s hard not to freak out every time I get a little twang in a joint, now and then. But, in a way, it’s a good thing. It certainly keeps me from taking my health for granted. Those little twangs serve as momentary reminders.
Health can be snatched away, even one evening while you’re sitting there on Twitter and your elbow starts to ache a little. Taking your health for granted is a mistake we all make. But I’m working on correcting that, and enjoying my good health every day.
Just the other day I jogged swiftly past a pair of seniors ambling along with their walkers. And my heart soared. Of course, I know I’ll be just like them one day.
But not yet. Not just yet.
Wait a sec.
I do have a nickel for everyone who says that. And that’s because it’s one of the top reasons people visit their doctor.
Fatigue is ubiquitous, you guys. If I could bottle energy, I could retire right now and go live in some sun-soaked villa in Tuscany. Sipping wine, strolling through olive groves, reading novels, shopping for Italian shoes…
Um, what were we talking about?
Right–back to the issue at hand. We could all use a little more energy, couldn’t we? I’ve written about this before. In two previous posts (here and here), I recommend various ways to step it up a little.
But there are more.
Here you go:
1.Light it up.
Our circadian rhythms (otherwise known as our sleep-wake cycles) are hugely dependent on light cues. Give your brain a big hint that it’s bright-eyed/bushy-tailed time by sitting beside a sunny window, going for a walk outside, or even just turning on more lights inside.
2.Stretch it out.
In a pinch, a few stretches at your desk can give you a boost. But studies are increasingly showing the benefits of regular yoga practice–and one of those benefits is improving depression, stress, and anxiety–big-time energy zappers.
3.Take a cold shower.
A downward temperature change has been shown to give an energy jolt, in general. But in particular, a 3-minute cold shower has been shown to improve symptoms of chronic fatigue.
4.Try a little music medicine.
There’s a growing body of research to show the physical & mental benefits of music. Relaxing music has been shown to alleviate stress, but you can tailor it to your mood–more upbeat music can improve alertness.
This is one of my favorite research findings lately. Quite a number of studies have shown that chewing gum can improve mood, cognitive function, and alertness. Plus, calorie-free, and easy, right?
North Americans may be many things, but one thing we’re not? Svelte. Not on average, anyway. And certainly not compared to the rest of the world. Are there things we could learn from our friends in other countries around the globe? Why, yes. Yes there are. Join me on a little tour.
In Okinawa, Japan, they eat using this principle: hara hachi bu. Roughly translated, it’s an instruction to eat until you’re 80% full. And it’s an excellent practice to live by. There’s no reason to eat until you’re stuffed. Also, there’s a delay in the message from your stomach to your brain that signals “full”. By the time you register that you’ve had enough…you’ve already overdone it.
This is the birthplace of yoga, of course. I’m a big fan of yoga; there are a multitude of health benefits for taking up the practice. And a slimmer physique happens to be one of them. A recent study showed that long-term yoga participants have lower BMIs than other exercisers. Perhaps it’s the mindfulness training that does the trick. Because here’s what happens when you engage in Mindless Eating.
Well, you know what they say: French women don’t get fat. I’m not sure anyone has fully figured out this (highly irritating) mystery…but I have some thoughts. I imagine it has to do with portion control, taking pleasure in food, and long leisurely meals together with friends & family. Oh, and chocolate for breakfast.
It’s not entirely unique to the sun-soaked people of Greece, but the Mediterranean Diet is one we can all embrace, to improve our heart health, our waistlines, and our pleasure in food. Olives? Wine? Garlic? Yes please.
To understand why it makes sense to eat like a Brazilian, think Gisele. Think thong bikinis on the beaches of Rio. A staple on the Brazilian table is rice-and-beans. It’s a low-fat, high-protein, high-fiber choice, which helps stabilize blood sugar. A study in Obesity Research examined the Brazilian diet in detail and found that a traditional diet mainly consisting of rice and beans lowers the risk of being overweight by about 14%.
All over Italy, in cities and small villages alike, la passegiata is an enduring tradition. It’s an informal stroll around town each evening before, or after, the family dinner. Italians promenade the streets, socializing, getting fresh air and a little exercise before settling in for an evening. To my mind, it certainly beats plopping on the couch to break open a bag of chips and stare at another episode of The Bachelor.
All that spicy stuff in Thai curries and noodle dishes means there’s plenty of capsaicin in the Thai diet. That’s the substance that makes food hot…and it not only boosts metabolism, but also: you simply can’t gobble down spicy food at the same rate you can a cheeseburger. Fiery food means slower eating. And that’s a good thing for weight loss.
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How many of us start the day running before our feet hit the floor? Are your mornings a frazzled mess? Instead of lurching into your waking hours and figuring things out as you go, maybe you need to consider a more…intentional approach.
Starting the day on the right foot has psychic repercussions that carry through the day. And by psychic I don’t mean palm-reading. I’m talking about what it does to your brain/soul/emotional center to begin your day the “right” way.
Now–to clarify–“right” will mean a different thing to everyone. The perfect a.m. routine, for you, honors your priorities for health and happiness. You want to initiate rituals that send a cue to your inner self that you are taking care of yourself. Nourishing yourself. You’ve rested, and now you’re beginning the day by turning on the lights in your brain, firing up the furnace, priming the pump. Even if it’s been a crappy night (the early years with a newborn spring to mind) you can still start each day fresh.
Your routine does not need to be lengthy. Few of us can devote a big chunk of time to drawn-out morning rituals (as much as we might like to!). But even a few minutes can make a big difference.
To get you thinking, some examples of things you might include in your morning routine:
You couldn’t include all these things, and they’re not all going to be your thing anyway. Which is okay. Choose your favorite 2-3 activities, then start crafting your own perfect morning ritual. Of course, you’re probably not always going to make them happen. Also okay.
So I’m wondering…what would you include in your perfect morning?
Have I mentioned how much I love yoga? I recommend yoga so often to patients, I’m almost getting tired of hearing myself gush about it. But really, if you’re looking to improve your health–physical, mental, or emotional–it’s hard to go wrong with yoga. Here’s my roundup of all the beautiful ways yoga can help you:
1. Chronic Back Pain. Studies have shown the benefits of yoga when it comes to the bothersome, and often debilitating, problem of chronic low back pain. A randomized study done recently in the Annals of Internal Medicine showed that yoga was superior to regular care for treating chronic back pain. Hello, cat pose.
2. Depression. In 2010 The Journal of Psychiatric Practice published a review of all the research examining yoga as a treatment for depression. Here’s what they said:
Yoga may be an attractive alternative to or a good way to augment current depression treatment strategies. Second, aspects of yoga-including mindfulness promotion and exercise-are thought to be “active ingredients” of other successful treatments for depression. Third, there are plausible biological, psychological, and behavioral mechanisms by which yoga may have an impact on depression.
There are many reasons yoga is a wonderful adjunctive treatment to conventional treatment for depression, by helping with stress, insomnia, physical pain, etc. We’re only scratching the surface in terms of using yoga to treat depression, and I suspect many more studies will come.
3. Heart Health. Yoga has been shown to lower blood pressure and slow the heart rate. It’s helpful for stress. It just may reduce cholesterol. And there may be other physiologic benefits, like anti-oxidant activity and anti-inflammatory properties, that we’re starting to understand to be major factors in preventing heart disease. And who’s not interested in a healthier ticker?
4. Rheumatoid Arthritis. If you happen to suffer this autoimmune type of arthritis, yoga could be especially good for you, too. There have been some (typically small, early) studies (like this one, and this one) that have shown improvement in symptoms when patients participate in a yoga program. Psychological benefits (decreased stress and depression) as well as physical benefits (decreased pain and disability) were some of the outcomes.
5. Insomnia. Can’t sleep? Several studies have shown yoga to be beneficial in improving sleep–even for people with insomnia-ridden conditions like menopause and osteoarthritis. How yoga works, exactly, to improve sleep is not fully known, but it probably has a whole lot to do with the body’s stress reaction. Chronic stress and sleep are not good, um, bedfellows.
6. Menopause. Yoga appears to help with a whole bunch of the symptoms associated with menopause: insomnia, mood changes, and maybe even hot flashes. Nice, since hormone therapy is such a hornet’s nest of potential trouble these days, to have non-medication alternatives to these vexing symptoms.
7. Stress. This is probably the biggest reason I regularly “prescribe” yoga. There is plenty of evidence, both research-based and anecdotal, for the stress-fighting benefits of yoga. The meditative aspects of yoga, the fact that it incorporates breathing exercises, the relaxation and the physical movement…it all helps to explain why yoga is the bomb for stress.
So get your butt down to that yoga studio. A little downward dog, a few sun salutations…voila, you’ve worked your body and your psyche. Now that’s multitasking.
There are so many reasons yoga is good for you. And it’s interesting that physicians are increasingly “prescribing” it as a therapeutic intervention for their patients. Count me as one of those physicians! Yoga has been shown to be beneficial for a wide variety of health concerns. Not to mention the somewhat less tangible benefits of improved stress and a better sense of well-being.
I’ve dabbled in yoga from time to time over the years. With my first pregnancy I attended a prenatal yoga class that was the highlight of my week. I loved it, and was convinced that it was a reason why my pregnancy went so well and was such a pleasure.
But then life intervened and in recent years I’ve found it very challenging to get my butt down to a yoga studio. Who, exactly, has the time (on any sort of regular basis to make it meaningful) to travel to a studio, change, do a 90-min class, change back, travel back…hello, 3 hours later!) Not to mention the cost.
But after a recent health crisis, of sorts (…that I will talk about soon. But not yet.) I turned to yoga again. This time, I knew I needed to get creative. I had to squeeze it in somehow, but in my life right now (with 2 young boys, plus work and everything else), free time is pretty scarce. And I’d rather not spend $15 per class! I tried reading books and magazines with diagrams and explanations of poses…but this is just not the same. I love the class atmosphere: the music, the guidance from a teacher, all that. There’s the DVD option, of course. But I’ve done yoga videos in the past, and doing the same video workout over and over and over…well, it gets a bit dull.
I found an awesome solution. Online yoga.
Now I can do brief yoga tidbits (12-15 minutes, if that’s all I’ve got!) or a longer class if I find myself with a larger chunk of time. And I can do it at home, whenever I can fit it in. They’re real guided classes, including Savasana at the end (the delicious meditating bit where you lie on your back in corpse pose). The instructors are fab, and there’s tons of variety. And they’re always posting new workouts. So forget about the boredom factor. And it’s only $10 per month! You can’t even do one real-life yoga class for that. (And in case I sound like I’m selling this a bit hard, I have no connection whatsoever with myyogaonline.com and am not being compensated in any way for this post. I’m just a fan.)
But as much as I love yoga, I’m gonna play devil’s advocate a little, here: yoga is not a magic bullet. It’s absolutely fantastic, make no mistake, but it is merely part of a healthy lifestyle. If it were the only thing you needed to do to stay healthy and happy, there would be no unwell or stressed-out yoga teachers, right? Well let me tell you, in my line of work I’ve encountered many a yoga teacher who’s struggling with stress and illness just as much as the rest of us.
So what do you think? Are you a yoga fan? How do you get your yoga in? Has it made a difference in your life?
How Much Protein Should I Eat? (from Fit Sugar). This one’s for my vegetarian sister who has asked me this exact question. Great tool.
Train Your Brain To Crave Healthy Foods (from CNN Health). Interesting! I doubt I could re-wire myself, like they describe in this article, to the degree that chocolate would make me feel nauseated (nor would I want this to happen!). But a little of these strategies could be beneficial, I think.
How Chocolate Can Help Your Workout (from New York Times Health) I am always interested whenever they discover new benefits to eating chocolate. Always.
Can Chewing More Help You Eat Less? (from Reuters Health) Another case of science backing up what your mama always told you. Chew your food!
Yes, Miranda Kerr Does Yoga, But It’s Not Why She’s Modeling 7 Months After Giving Birth (from Blisstree) A wonderful, and very balanced, take on post-baby weight loss, celeb mommies and their workouts, body image, and realistic expectations.