Meeting Another One in (Almost) a Million

In the 35 years since my first terrifying medical incident, a rare and often deadly disease, I have never met someone else who survived what I had. That’s unsurprising since it only affects only one or two children in every 100,000, and there is a 10-20% mortality rate. In fact, of the three children with bacterial streptococcal meningitis that year, I was the only one who survived.

But a couple of weeks ago, I was in the elevator of my apartment building (yes, I am the kind of person who starts conversations in elevators), and I found one! Oddly, we were talking about the switch from hard copy bulletin board to digital bulletin board in our garage elevator lobbies. Someone mentioned that it really helped the elderly residents who had vision problems, and I piped up that I appreciated it because of my steroid-induced cataracts. The other meningitis survivor asked why I was on steroids, and *boom* there we were, two meningitis survivors on one elevator.

I suspect she was about 10-15 years older than I, and she was 16 when she got sick which is a little more dangerous than six, but it also means that we had it within a couple of years of each other. Weird, right?

We got off the elevator and had some time to compare notes. We were both in a coma. Hers was longer, but my fever was higher. We had similar experiences coming out of our comas (too personal to share here), and we both had major, lasting side effects. She lost 10 years of memory, going from new driver to first grader in the space of her coma. She had to relearn everything she’d lost in those 10 years. I didn’t have 10 years to lose, but I lost some motor skills and the use of the left side of my body (temporarily) through paralysis.

That meant that both of us had to relearn how to go to the bathroom, how to write, how to feed ourselves. She recovered faster than I did, but it left is both with some . . . things. She still has muscle spasms and I have back issues from muscle atrophy and occasional shooting pains from the base of my skull into my left shoulder, occasional reminders that will never go away completely.

As we stood there in the lobby, it was weird to have so much in common. Have you ever had the feeling of being happy to see someone you had never met before? And that you very likely will never see again? I live in a building with over three thousand other people. In over 10 years, I had never seen this woman. I gave her my card, but if she hasn’t reached out in the last month, she probably won’t.

And that’s ok. When you have a rare condition, sometimes it’s enough to know there’s someone else out there just like there. However, instead of waiting to find support in random elevator conversations, you might want to find an actual support group, either online or in person. There’s nothing quite like finding the people who know your condition as well as you do. For all the ups and downs you weather every day, you will never have to explain it to them.

Beyond the Prescription: Tips to Manage Chronic Pain

Guest Post

Jackie Waters was diagnosed with rheumatoid arthritis in her mid-20s. She soon began making the lifestyle changes needed in order to minimize the number of medications she would need to take, and was kind enough to reach out to The Patient Advocate’s Chronicle to share her insight. She is a mother of four boys, and lives on a farm in Oregon. She is passionate about providing a healthy and happy home for her family, and aims to provide advice for others on how to do the same with her website Hyper-Tidy.com.

If you’ve recently been diagnosed with a condition that causes chronic pain, you might be envisioning a medicine cabinet filled with pricey prescriptions and a calendar packed with time-consuming doctors’ appointments. Regular check-ins with your medical team are important, but it’s also important to know there are some things you can do on your own to help minimize and manage your chronic pain -- and your reliance on medical interventions.

Facts and Misperceptions About Prescription Drugs

Although prescription drugs are an essential part of the arsenal in many people’s fight against chronic pain, it’s important to understand the risks that come with them. Some people perceive prescription drugs as inherently safe because they’ve been prescribed by a doctor. But drugs come with warnings about side effects for a reason, and their unintended effects can be even more pronounced if they aren’t used properly. People often begin abusing prescription drugs without even realizing they’ve done so. They start increasing the dosage themselves a little at a time, maybe one pill more once a week. Then twice a week, then once a day. Some increase their intake because they’ve developed a tolerance through repeated usage or because they’re struggling to cope with their chronic pain or other issues.

In fact, prescription drugs are among America’s most commonly abused substances, coming in behind only alcohol and marijuana. According to a 2014 report cited by the Substance Abuse and Mental Health Services Administration, 15 million Americans ages 12 and up had used prescription drugs non-medically in the past year. All too often, prescription drugs act as a gateway to illicit drugs, with 12.7% of newly reported illicit drug users starting first with prescription pain relievers. So it’s important to use prescriptions only as intended and not to rely on them as your only defense against chronic pain if there are other avenues open to you.

Diet and Exercise

Chronic pain is sometimes caused by inflammation, which is the body’s immune response to toxins it’s working to clean out. Over time, inflammation can also trigger conditions including heart disease, strokes, diabetes, Alzheimer’s disease, and even depression, according to information from the Cleveland Clinic.

Experts at that institution recommend adopting an anti-inflammatory diet to defend against chronic pain. Rather than focusing on certain superfoods, these eating plans recommend consuming eight or nine servings of vegetables -- perhaps substituting a couple of servings of fruit -- each day, eating dairy products in limited quantities, opting for whole grains over simple carbohydrates, and avoiding red meat on all but the most special occasions. As an example, a Mediterranean or vegan diet follows many of these guidelines.

Additionally, exercise can enhance the positive effects of an anti-inflammatory diet. An appropriate exercise regimen might include a daily walk or bike ride, and also helps control weight and alleviate stress. Medical professionals recommend maintaining an ideal weight you decide upon with your doctor, as well as actively managing stress levels.

The Importance of Pacing

Making some simple changes to your daily routine can also help keep chronic pain in check. Experts suggest starting by keeping a symptom diary to track your pain levels for a few weeks. Make notes about your activities and rate your pain level on a scale of 0 to 10. Then, look for patterns and make modifications where you can. For example, if extended periods sitting behind a desk aggravate your pain, request a standing desk at work or at least break up sitting sessions with activities that get you up and moving. For example, maybe you can stand, stretch, and stroll while taking calls. Even without chronic pain, doctors recommend walking five minutes for every hour you sit.

You can also use your pain record to time how long you can comfortably do activities before pain flares. For example, if standing in the same spot to do dishes puts you in pain after 15 minutes, break up dishwashing into shorter sessions rather than pushing through until the last glass is sparkling.

Controlling chronic pain takes a multi-faceted approach that may include medications and other conventional interventions. But implementing some of this advice can help make you an active and effective member of your own pain management team. 

2017 -- En Fin (The End)

The holiday season is approaching its end. In a few days, hundreds of millions of people will stay up too late with a bunch of strangers celebrating . . . what? That they survived the year? The beginning of a new one, where we may or may not stick to idealized, nearly impossible resolutions? Why do we need to wait for a whole new year to set goals for ourselves?

I’m sure you can tell that I am not much of a celebrant. (Although, to be fair, perhaps surviving THIS year is celebration-worthy.) However, that has not kept me from developing a New Year’s tradition.

Lame Year’s Eve

It’s exactly what it sounds like. Three of us who grew up together 500 miles away from here plus one husband gather at Moose and Squirrel’s house. (They’re the only ones who have a house.) We catch up while playing cards or watching movies until we fall asleep on the couch. Then we wake up just in time to watch the ball drop in Times Square and go home. Lately, we have even taken to adopting a country with an earlier midnight and celebrating around 9:00 p.m. our time. We’ll make that country’s food and try to track down some shots of their midnight. This year, it’s Brazil, specifically Rio de Janeiro. Who wouldn’t want to celebrate New Year’s with Rio? (Notice I did not say “in.”) I am making risotto cakes with tomato coconut sauce this year. A good time is had by all and we don’t lose New Year’s Day to the recovery.

The funniest thing about it is how many people seem to prefer something like that to their bigger, more formal plans. The best thing about it is that I get to spend some no-pressure, quality time with part of my support system. These are the people who knew me before autoimmune conditions. I mean, how many friends do you have that you’re ok falling asleep in front of?

This year was hard, and I am glad to see the back of it. I hesitate to say that 2018 can’t possibly be as bad, since Murphy has a way of proving me wrong. So, whatever happened this year, and whatever’s coming this year, I’m glad I’ll be spending the end and the beginning with Moose and Squirrel.

If I Must

If I must make a New Year’s Resolution, I resolve to laugh more. Sometimes we get so bogged down in our chronic lives, we don’t realize what we are missing. But there is a reason “Laughter is the best medicine.” has survived a generation or two, and now the saying is borne out by science.

I’m sure you can feel the stress drain from your body with a good belly laugh. Or you’ve suddenly started laughing in the middle of a fight about something that seemed serious at the time. But did you know there are biochemical benefits as well? It strengthens your immune system, releases endorphins, which relieve pain, and it increases blood flow, which is good for your heart.

Robert Frost said, “If we couldn’t laugh, we would all go insane.” So, in the interest of collective sanity, I invite you to share my resolution to laugh more in 2018.

What are your traditions and resolutions for this year?

Not ok

Do you remember Successories, those posters (and so many other products) that had “motivational” sayings on them? Fifteen or twenty years ago, they were everywhere – offices, dorm rooms, and gyms across the country. [Full disclosure: I had a desk calendar. Our office manager chose it.] I suppose the idea was that if you were struggling with Gratitude, Collaboration, Excellence, Integrity, Perseverance, (all those things you’re already bringing to the table), you could just look at one of those posters and muster the strength to be all you could be, to borrow an Army slogan from roughly the same timeframe.

I have seen a lot of articles mimicking that sentiment directed toward patients struggling with difficult conditions. The main theme is, “Everything is going to be ok. You’re going to be ok.” That’s good some of the time. Not all of the time. The fact is, these conditions are scary. Sometimes you’re not going to be ok. And that’s ok.

When I was diagnosed with kidney disease, I had a very kind doctor who let me sit in her office and cry for an hour while I called my dad and my boyfriend. I was really scared then. It didn’t feel like I was going to be ok. And that was fine. It was a normal, if overwhelming, reaction to a serious condition. It didn’t help that most people diagnosed with that condition were decades older than my 29 years old. It made me feel that I was that much closer to the possible death that came with it. (The most common causes of death in diabetics are heart disease and kidney failure.)

At that time, I probably would have punched someone who told me everything was going to be ok. I needed time to process, to adjust, and to prove to myself that maybe that was true. I’m not saying that we should allow ourselves to develop a victim’s mentality, but there are more dimensions to the psychological impact of chronic and autoimmune conditions than can be addressed by, “It’s going to be ok” or any other simple motivational saying (I’m looking at you, Nike’s Just Do It).

I wonder how those of you with chronic pain feel about that? Or multiple sclerosis? Or cancer? Or any of the other conditions that challenge you every day or come with the possibility of a long, slow degeneration? I imagine that, like me, you’re ok in waves – up for a while, then down, then up. Hopefully the ups last longer than the downs, but sometimes they don’t.

So, yes, it will probably be ok, but it’s perfectly acceptable to feel like it might not, as long as you don’t let that feeling interfere with getting there. And if you do start to feel like not ok is taking over, make a call.

Does your Chrismukkah suitcase sound like you’re carrying a pharmacy?

Love ‘em or hate ‘em, the holidays are here. When I travel home, we don’t have any more tension than the average dysfunctional family. There’s no yelling or alienating political discussion (we all know what to expect from the others). There are small celebrations to suit a small family. Sometimes I even forget to light Hanukkah candles. Because I forget it’s Hanukkah for all eight days. But, I do enjoy the time with my family, usually at Thanksgiving.

It’s complicated, though. My monster is best behaved when I follow a routine. The holidays are anything but. My brother has four kids and my dad is in his 70s, so that means I’m travelling to make it easiest for everyone. I have to leave my comfort zone, the place where I know who to call and where to go in case of emergency. Even my immune system seems less challenged in my own place, even if all six of my brother’s family pile into my one-bedroom condo.

If your body works anything like mine, the only way to get through holiday visits is to plan as if you were going to another planet.

1. Plan for prevention. Bring bottles of medication instead of separating out what you need for the time you will be gone. If you use consumable medical equipment, make sure you have several of whatever you need and check at least twice. Maybe once more before you leave. The last thing you want is to be held up on the way home by weather, traffic, or overbooking and be short.

Start taking vitamin C a few days before you leave (There are tons of immune system boosters that work to varying degrees, but I prefer the classic.). If you don’t get sick, you can stop taking it a couple of days after you get home. If there is anyone in the household you are visiting who is already sick, take as much as you can. You will know when you’ve taken too much vitamin C if you start feeling nauseated.

2. Plan for every possible sickness. I have a whole separate bag to transport my traveling pharmacy. It consists of every over-the-counter and as-needed prescription I have. With suppressed immune systems, fevers, colds, sore throats, and coughs are all significant possibilities from a quick trip home for the holidays.  

3. Know what your challenges are likely to be and have a strategy to deal with them. Whether it’s suspending your ‘rules” for the time you’re away, looking for the closest gym to your in-laws’ house to maintain your workout routine, or asking your host for detailed menu plans to help you, make sure you have a plan for every challenge you can think of.

4. Only you know what you can handle, but often doing something that makes you stand out from the rest of the family is difficult, and can seem silly for just a few days. But falling out of your routine for those few days can knock you off track for longer (I’m speaking from experience, like when I let playing with kids replace exercise and not picking it up again even though there aren’t kids to play with in my apartment), so enlist help. Find someone you trust for backup or announce your plan to the whole group. You don’t have to give a reason, just state your desire to accomplish your goal for the time you are there. Sometimes just talking to that person(s) is enough to keep you on track.

I instituted these plans for myself after my first couple of visits with multiple kids. For whatever reason, if a kid has a light cold, I get it 10 times worse. More than a few times I’ve driven home thinking I was fine only to realize I had a fever of 102+ when I got up to my apartment. At this point, I always expect to get sick, and it’s a family joke/congratulations if I don’t (I didn’t this year – yay!). Even if I do get sick now, it’s not nearly as bad as it was. I’ll take that.

We at The Patient Advocate’s Chronicle wish you a happy, healthy, and well-planned holiday!

Still Sleepy?

A couple of weeks ago, I posted about the importance of sleep. It would have been better if I had written about the importance of lack of exhaustion. As I began to catch up on sleep, I still couldn’t shake the feeling of being tired all the time. It was better, but still present enough to be a stumbling block. So I began to consider other possible causes. Sometimes exhaustion has nothing to do with how much sleep you get. Chronic and autoimmune conditions that affect hormones or metabolism can be just as guilty. Turned out adjusting my blood pressure medication did wonders, so let’s start with that one:

Hypertension (high blood pressure): Tiredness is a common symptom of hypertension. It causes the constriction of tiny arteries called arterioles. Your heart has to work harder to pump blood throughout your body, which makes you tired and out of breath. Risk factors for high blood pressure include diabetes, being overweight, lack of exercise, race, gender, smoking, and drinking.

Anemia (iron deficiency): Your red blood cells come equipped with hemoglobin, an iron-rich protein that bonds to oxygen molecules and distributes the oxygen to the rest of your body. When there isn’t enough iron in your red blood cells, your tissues don’t get the oxygen they need (including your brain). Lack of oxygen makes you tired, too. Many things can cause anemia, even something as simple as an iron-deficient diet or a heavy period. Chronic conditions like cancer, HIV/AIDS, rheumatoid arthritis, kidney disease, Crohn's disease, and other chronic inflammatory diseases can also cause anemia. (Please note that there are multiple types of anemia, but here I am talking about simple iron deficiency.)

Hypothyroidism (Thyroid imbalance): Hypothyroidism is when your body doesn’t produce enough T3 and T4, the hormones that regulate your body’s internal temperature, metabolism, and heart rate. It is not uncommon for hypothyroidism to go undiagnosed. As with other types of hormone deficiency, your body has to work harder to function properly, which makes you tired. But with hypothyroidism, exhaustion can come from too many directions to list here. Read this for an explanation of most of them.

Sleep apnea: Sleep apnea is when you don’t breathe properly while you are asleep. Instead of breathing evenly, you briefly stop breathing and/or breathe shallowly. Disrupted sleep causes exhaustion during the day just like hypothyroidism. Symptoms like exhaustion and snoring are commonly accepted as “just life,” so sleep apnea can go undiagnosed for a long time.

Undiagnosed condition. There are a lot of conditions that cause exhaustion even when they are being treated properly. Before they are diagnosed, or if they are misdiagnosed, it can get extreme. For example, before I was diagnosed with diabetes, I was sleeping 14 hours a night and still falling asleep in second period. No one bothered to mention that to my mother, so I continued misdiagnosed for several months. In fact, it was when I told my mother that I was too tired to school, she had me tested. (After responding, “Not in my house, you’re not.”) And if your condition is one that can cause dramatic weight loss, that’s like a double whammy – all you systems slow down and you enter starvation conditions, even if you are eating normally.

Drug interactions: I bring this up because of a particular incident I had at work about 10 years ago. I was a newly diagnosed chronic kidney disease patient, and one of the most common treatments for CKD is a class of blood pressure medication called beta blockers. If you have ever had asthma, even if you have grown out of it, you are not supposed to take beta blockers. Well, I forgot to tell my doctor because I hadn’t had it for years. As we adjusted my meds up to properly treat the hypertension, I began to feel tired and breathless, especially when I walked up the stairs. Basically, the beta blocker was working on both my blood vessels (which it was supposed to do) and on respiratory passages (which it wasn’t supposed to do). After just a couple of months, I went to an ER because I wasn’t getting enough oxygen. We knew because my lips had turned blue.

Exhaustion is common. Maybe you can never get to bed on time, or maybe you have young kids who keep you up at night. Or maybe it’s a common problem with a not so common cause – an autoimmune condition. Take stock. If you suspect your tiredness is due to causes other than everyday circumstances, schedule an appointment with your primary care physician and discuss it with them. If there is something medically wrong, better to treat it earlier than later.

NOTE: This post addresses physical, not psychological causes of exhaustion.

A Plea From The Susceptible

Today’s post is brought to you by my Monday morning, when I sat down at my desk and immediately heard three obviously unmuffled sneezes followed by a loud “oh, my god, my throat.” Only a thin cube partition separated me from all that contagion.

I just got home from four days with my family, and it appears that I may have gotten away with a clean bill of health even though one of the kids was sick. She was very careful and I washed my hands enough to crack the skin on my knuckles. With four little ones, someone usually has some kind of sniffle, so I only come home healthy about 10% of the time. The last thing I need is to pick up whatever a colleague caught from his family over the holidays. So, if this sounds like you, even a little, please stay home.

Let me explain.

A healthy immune system’s job is to be able to distinguish the difference between its own tissues (you) and invaders like bacteria or viruses. Autoimmune patients have overactive immune systems that identify parts of your body as invaders, which damages previously healthy tissue. For me, around sixth grade, my body decided to attack my pancreas until the part that produces a hormone vital to my ability to process food, was dead. Not just dysfunctional, but dead. As a doornail. (Type 1 diabetics have no insulin production, as opposed to Type 2s, who have faulty insulin production.)

After developing their conditions, some autoimmune patients also develop a suppressed immune system due to the medications they take, like immunosuppressants for transplant patients, chemotherapy for cancer patients, steroids for lots of things, and glucocorticoids for allergies, asthma, or conditions caused by overactive immune systems. Other times it’s the condition itself -- arthritis, certain types of anemia, scleroderma, Type 1 diabetes, etc.

I actually fall into both the medication and condition categories, which makes me vulnerable to every cough, cold, or flu that comes my way. It’s one of the reasons I don’t take public transportation. And when I do get sick, it takes forever to fight it off. The flu might take you out for three days. I once had to struggle through a fever and sore throat for a month.

But what about my family? I chose to visit even though I knew someone was sick. That’s right. I chose. I have to go to work, so it is not my choice to work in an environment contaminated by your cold, flu, or on this particular Monday morning, bronchitis.

I guarantee you have colleagues on some of the medications listed above or who have some of the conditions that suppress their immune systems. Starting a conversation with “Stay away, I’m sick” or “I feel better than I look” isn’t good enough.

So, I’m asking, no, pleading with you to stay home when you are sick. Please. It would better for both of us. You can heal more quickly by sleeping when your body demands and I can let my immune system putter on as usual, imperfect, inefficient, but good enough for the daily grind.

Words Matter

Yes, I am going to do that cheesy Thanksgiving thing where I talk about something I’m grateful for this year.

Twenty years ago, an ophthalmologist at the Joslin Clinic said something that changed the course of my condition. It was during a pre-surgical appointment, probably an offhand comment. I was a scared, noncompliant diabetic facing eye surgery decades earlier than the average patient. I don’t remember the exact context, and the statement was not intended to have an impact, I think. But it did, because he said it at exactly the time I needed to hear it.

“MD does not stand for medical deity.”

With seven simple words, my ophthalmologist, Dr. Timothy Murtha, dropped control of my life into my lap. I had been governed by doctors and parents for the six years previous, a girl who’d been through the medical wringer and ended up knowing way too much to be completely cut out of treatment discussions. Without a voice, fear was amplified, as was rebellion. Funny how they misbehaved hand in hand back then.

From that day forward, I was allowed to actually say no, not just nod my head and accept what others decided for me. I could tell my providers what I wanted, and we could work it out together. It’s how I’ve built such a strong team of providers.

Recently, I returned to the Joslin Clinic, the global gold standard for diabetes care, for the first time since I was in college. I’d volunteered for a study that would track the development of serious complications. Just before I went, I realized that there was every possibility that Dr. Murtha would be there that day.

When I arrived for my appointment, I explained what I wanted to do. My contact told me that the doctor was in the office that day and didn’t start seeing patients until 1:00, so there was a chance I could steal a few minutes of his busy schedule.

As my appointment wore on, it became clear that it would take much longer that I originally thought. I began to get impatient and nervous. I wasn’t sure why. After all, if I didn’t get to talk to him face-to-face, I could always send an email. But then, why hadn’t I done that in the intervening decades?

In the end, the doctor agreed to see me during his lunch hour. As soon as I sat down, I got that unexpected lump in my throat that sometimes happens when you feel more than you want to. I thought it was just going to be a simple thank you, but I think instead the lump was a subconscious acknowledgement of how different things could have been if he hadn’t created that verbal fork in my road, which had allowed me to take a better path.

We chatted for about 10 minutes. He did not remember the words that had so changed me. (Of course he didn’t. He must have seen thousands of patients in the 20 years since I’d been there.) It didn’t matter. I got to tell him how much those forgotten words had meant to me, and he was glad to see how far I had come. At a place like Joslin, so many of his patients drift off into their lives after treatment, he rarely gets to find out how they are doing.

It’s hard to remember what we do have sometimes when we struggle with our own bodies, especially if you’ve been up twice in the middle of the night to deal with faulty medical equipment and you still have to be at work by 7:00. Or when your body decides to take a random vacation from any semblance of normal functionality. But the ups and downs will settle eventually, and you will return to your pain-in-the-butt routine, beleaguered, but grateful for the life you have.

Not Like a Baby

Ah, sleep. The domino by which all the rest fall. You’ve been told a thousand times that lack of sleep is bad for you. It makes you, well, sleepy. Your mental acuity drops, you feel sluggish, your muscles don’t do what you tell them. If all this happens to a healthy person, can you imagine how much harder a chronic patient’s body has to work to get them through a day without the right amount of sleep? There is considerable evidence that lack of sleep can increase both blood pressure and insulin resistance, as well as cause other health issues that can exacerbate chronic and autoimmune conditions.

And the worst part is, you can’t just sleep more to make up a sleep deficit. it might take a month of an extra hour of sleep every day to catch up.

A sleep deficit is a primary tool in my self-sabotage campaign, the excuse I use to overeat and skip exercise. I tell myself sleep is more important. If only I were caught up on sleep, being too tired to exercise wouldn’t factor in. Neither would eating sugar to give me an energy a boost.

But why? Why do we need so much? As long as you get some, isn’t all sleep the same?

You know it’s not. If you want to resolve a (non-clinical) sleep issue, first understand how sleep works. Everyone has an internal 24-hour clock that governs the hormones that put you to sleep and wake you up. It’s called your circadian rhythm. It still takes its cues primarily from light and darkness. When it’s light outside, it’s time to be awake. When it gets dark, it’s time to sleep. However, our society no longer operates in conjunction with sunrise and sunset. We use electric lights to dictate our own schedules, often without realizing how counterintuitive it is to our natural functionality.

Second, understand how we use light and how it affects sleep. Turns out light is complicated. There is a price to pay for that incredibly clear, vivid device screen because of the type of light it uses to project images. No matter what size it is, that screen emits “short-wavelength-enriched light”, which has a higher concentration of blue light than natural light does. Blue light suppresses melatonin -- the hormone that tells you it’s time to sleep -- more than any other type of light on the spectrum. So if you’re one of those people who reads on a tablet before bed or uses the TV to cure insomnia (guilty), you might be making it worse instead.

Sleeping with screens on or just after you turn them off can affect both length and quality of sleep. Ideally, adults should get somewhere between seven and nine hours of sleep, enough to spend the right amount of time in each of the five sleep cycles.  The stimulant effect of our screens make it hard to fall asleep when we intend to and upset the balance of light, heavy, and REM sleep. That kind of imbalance can affect how you feel as much as not enough time asleep.

Third, find a solution that works for you. Everyone’s will be different. I am going back to my childhood. When I was little, my parents used to read me to sleep. So, tonight, I am going to set the TV timer and turn on a podcast that comes close to the kinds of stories my parents used to read. In fact, some are exactly the same stories, just a little more grown up. I’ve tried this when I can’t sleep and I’m always out in minutes when I do that (I listen to the whole podcast another time – thanks, Myths and Legends!).

Just as sleep is the domino that brings all the others down, it is also a strong foundation to build upon. There is a reason I use it as my favorite excuse. If I don’t feel tired, it eliminates one of the biggest roadblocks to reaching my goals. If this works, I’ll be well on my way.

Struggling in the Red Zone

In American football, if a team isn’t performing to expectations, the commentators sometimes start talking about “struggling in the red zone.” That’s when the team gets close to scoring -- they’re battling in the “red zone,” the yards closest to their end of the field -- but they just can’t get the ball over the line.

Well, I’m struggling. In my head I shouldn’t be. The stress of a job change (after 11 years) is almost over. I’ve even allowed myself a week’s vacation and have already gone through the new company’s health insurance summary plan description, or SPD. The new company is an unknown, but all signs point to a new, exciting opportunity with intelligent colleagues and hands-off management. All good, right?

So why do I continue to stand in my own way?

After a year of not following a meal plan or regular exercise plan, and sometimes not even taking my meds properly, my brain is rewired with new habits. These habits were a lot easier to make than the old ones. No effort is involved in doing nothing, whereas, a lot of effort is needed to exercise every day and stick to a meal plan. At least I am back on a tight medication schedule again.

Another reason might be that when I initially started the push to lose weight and adjust to a healthier lifestyle, I had a catalyst, something external that drove my initial efforts until it was a habit. I am not entirely happy to admit it was a guy I had known years ago. I didn’t want him to see me at the size I had gotten to. He lived out of state and knew I wasn’t crazy about having my picture taken, so I had a little time to start a new routine. After a while we faded again, but even when I didn’t have him as a catalyst, I was able to stick to my plan for years. Now, I have no catalyst to get me over the inertia of a new start. It has to be a slower, more gradual, and sustainable plan.

Last week I listened to a podcast that may help me figure out how to get out of my own way. There was a small section where Daniel Khaneman (Nobel laureate who specializes in how we think about thinking) spoke about a college class 60 years ago, when a man named Kurt Lewin theorized that behavior was a balance of driving factors, which push you toward a decision or goal, and restraining factors, which keep you from getting there. In order to induce behavior change that sticks, you have to diminish the restraining factors as opposed to increasing the driving factors.

Turns out this is pretty counterintuitive. The podcast points out that most times when trying to change your behavior, whether self-motivated or externally motivated -- say a doctor or spouse is concerned and wants you to start walking 30 minutes a day -- the process starts with a combination of arguments, incentives, and threats: it’s only a half hour, the benefits far outweigh the effort, you will live longer, you’ll feel better, you will die if you don’t start moving more, etc.

They tried this on me when I was a non-compliant 16-year-old diabetic, and after logical arguments and incentives failed, they told me I was going to die of a stroke in a few years anyway if I didn’t change. It didn’t work. Perhaps they should have asked why I wasn’t following a regimen already and how I could have alleviated those restraining forces – fear, apathy, self-destruction?

That was 20 years ago. Now it’s on me. I have all the external tools, including a flexible work schedule. Now it’s time to take a good look at the inside of my own skull and figure out what I need from myself to finally get myself past the red zone and into the end zone.