tag:blogger.com,1999:blog-55352535919733770312024-02-18T22:19:12.579-08:00M.E RecoveryI know people who have recovered from ME and I know that I will recover sooner rather later. This blog is about sharing what does and doesn't help, what you should and shouldn't waste your money on.M.E recoveryhttp://www.blogger.com/profile/01015059601098075577noreply@blogger.comBlogger17125tag:blogger.com,1999:blog-5535253591973377031.post-24387159822655550632017-05-15T09:12:00.000-07:002017-05-15T09:12:36.191-07:005 things to say and not to say to a friend with M.E/CFS<span style="font-size: large;"><span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;">I am now into my seventh year of having M.E/CFS and am beginning to face the reality that I am unlikely to recover before my daughter grows up. With the years spent predominantly within one room my invisibility and isolation from society deepens. Having a chronic illness is a very lonely place to be and I am lucky enough to be living within a family, imagine how alone I would be without them? In my experience most family and friends do their best to ignore the fact I have M.E in a way that they would be unlikely to ignore cancer if I were unfortunate enough to have that. If they ever do mention my health what they say is often offensive, along the lines of 'you really should try to get better/ do gardening/ pull yourself together' like recovery hasn't been my sole focus for the past 6 years!</span></span><br />
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<span style="font-size: large;"><span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;">I wanted to give a little advice to those of you out there who may know one of the 250,000 people in the UK with this illness, who may not know what it is okay to do or say, in order to encourage you to break down the barriers between the internal world of being imprisoned by a chronic illness and the outside world. Here goes....</span></span><br />
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<span style="font-size: large;"><span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><b>1. Don't assume you know how a person with M.E/CFS is feeling.</b></span></span><br />
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<span style="font-size: large;"><span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;">Most people assume the key issue is 'chronic tiredness' because of the unfortunate name the NHS has given our condition. Chronic tiredness is something you experience as a first time parent, and you can push through it, you have to for the first few years of parenthood in order to avoid having your children taken into care! (See I've still got a sense of humour, even after all these years) Not only does the type of tiredness we with M.E/CFS experience bear no resemblance to any tiredness ever encountered in an ordinary or even ill life - it feels cellular as if each molecule of your being is wading through treacle - you can not push through it, you can not ride the wave, you can not ignore it and do a little more, often because you simply can not physically make the energy you need but even when you feel you can push a little further there are DIRE CONSEQUENCES, so if you are not an idiot you learn not to outstrip your capacity even if you really, really want to.</span></span><br />
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<span style="font-size: large;"><span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><b>2. Don't assume you know what symptoms your friend is experiencing.</b> </span></span><br />
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<span style="font-size: large;"><span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;">To be honest exhaustion is often the least of my worries, it is all the other symptoms that my body cycles through either because I have tried to do something vaguely enjoyable - such as leave house-arrest for two hours and venture out for a coffee with my partner - or simply because that's what my body happens to be inflicting on me at the moment and I have no idea why, now, this minute.</span></span><br />
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<span style="font-size: large;"><span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><b>3. Do ask your friend about their illness, about the symptoms they personally struggle with and what their life is like. </b></span></span><br />
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<span style="font-size: large;"><span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;">Yes we all know how boring other people's illness is, but simply ignoring it is not going to keep your friendship going for long. Would you just ignore or show no interest in what a friend was experiencing if they had cancer, when they had to crawl back to bed after an hour, or you knew they had chemo, would you just roll up at their house and never mention it? Yes, I know some people will disappear completely from the scene, as with all illness, but if you do stick around would you ignore your friends cancer? I somehow doubt it. The thing is we have sympathy, empathy for people we know with cancer and one of the reasons for that is we are scared of getting it ourselves and that fear makes us think about what it would be like to have it, which immediately makes us more open and therefore a tiny bit more sensitive to what they must be going through. We don't imagine we will ever contract M.E/CFS, we never imagine what it is like to have that, until we wake up one day and ... </span></span><br />
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<span style="font-size: large;"><span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;">People with M.E/CFS are as bored as anyone with the grinding, relentlessness of their illness but if you take the time to actually ask them how the illness operates for them and listen to the answer you will make that person feel like somebody actually cares about them and now has a sliver of insight into what they are experiencing, and this will make them feel less aloneand probably not need to keep trying to draw attention to their symptoms. In my experience when someone has taken the trouble to gain insight into what is actually going on for me (that has only happened with one person outside of my immediate family) I have found that person less draining to be with. Perhaps its because there isn't this constant mismatch between what is going on in the room, what is seen and shared, and what is going on in my body, what is invisible and ignored.</span></span><br />
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<span style="font-size: large;"><span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><b>4. Do not tell someone with M.E/CFS they look well, or not so bad. How we look on the outside rarely reflects what is going on on the inside.</b></span></span><br />
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<span style="font-size: large;"><span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;">Someone may even appear alert but inside they may be feeling like they are slowly drowning in symptoms. So take the time to really notice how your friend seems, rather than making 'reassuring' comments. If you feel you are being crushed by symptoms being told 'yur looke good!' makes you feel worse, not better! Strangely enough there is nothing more reassuring for me than when a person says you look awful, tired or simply picks up the cue that the end of my tether is being reached energy/symptom wise and voices that observation. Once again it comes back to being seen, to being heard and to not feeling like you are invisible because no one mentions or appears to have noticed that your life does not resemble an ordinary life. </span></span><br />
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<span style="font-size: large;"><span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><b>5. Be aware that engaging with human beings is probably the most energy draining thing a person with M.E/CFS can do short of actually being daft enough to try to exercise.</b></span></span><br />
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<span style="font-size: large;"><span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;">Most of us are not antisocial recluses by nature, it is just that we have discovered something we never realised before getting ill and that is that talking, thinking and listening - processing all that information - is one of the most energy consuming things we can do. Yet most of us miss people, miss the life we once led, miss our old friendships, and lament the fact we can not make new friendships because we have so few opportunities to do so and so little to give. But just being aware of this fact, being tuned into your friend by doing the things I have already outlined, talking calmly and listening carefully when you are with your friend and not having unrealistic expectations of what they can manage socially, will keep your friendship going and minimise the loneliness and isolation of living with this condition. Trying to encourage an open and honest dialogue between you and your friend about when things are too much for them will minimise how much their time with you drains their battery. Don't take it personally, it's not personal and please don't stop being in touch, texting, emailing, making arrangements to call round because your friend does need your friendship and is probably feeling like she doesn't have much to offer in return. So if you value your friendship make sure she knows it and just take a few minutes to think about the restrictions of her life and imagine how you would feel if your life and all your relationships were restricted in the same way.</span></span><br />
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<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;"><span style="font-size: large;"><span style="font-family: "Helvetica Neue",Arial,Helvetica,sans-serif;"><b>Doing all of the above will make you an even more valued friend.</b></span></span></span></span><br />
<br />M.E recoveryhttp://www.blogger.com/profile/01015059601098075577noreply@blogger.com3tag:blogger.com,1999:blog-5535253591973377031.post-75093095909713395262014-11-19T08:39:00.003-08:002014-11-19T08:39:56.875-08:00
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" width="320" /><br />
<br />
<div class="western" style="margin-bottom: 0cm;">
T4 with four Iodine
molecules (I) attached, Remove Top Right to convert to T3</div>
<div class="western" style="margin-bottom: 0cm;">
<br />
</div>
<div class="western" style="margin-bottom: 0cm;">
<u><b>The Science of
Thyroid Function - Reverse T3 And All That Jazz</b></u></div>
<div class="western" style="margin-bottom: 0cm;">
<br />
</div>
<div class="western" style="margin-bottom: 0cm;">
Despite being
hypothyroid for 20 years and having a body that makes too little
thyroxine, I had never really appreciated exactly how thyroxine works
in the body. The thyroid gland makes T4 and T3. T4 has four iodine
molecules attached, and is stored in the body ready to be converted
to T3 by removing one of those iodine molecules. It is only T3 that
works in the cells of the body to produce energy. I did not
appreciate that every cell in my body needs thyroxine, more
specifically needs T3. I had this general idea that the symptoms I
had had 20 years ago which led to me being diagnosed as hypothyroid
were produced because my body was having to work harder to make T4
and T3. I did not realise that in fact it is the reduced amount of T3
in the cells that leads to those cells not functioning properly.
</div>
<div class="western" style="margin-bottom: 0cm;">
<br />
</div>
<div class="western" style="margin-bottom: 0cm;">
This means in effect
that if you have a severe shortage of T3 in your cells every part of
your body can be affected, that means from your heart, to your liver,
your brain, all your organs will struggle to function effectively
without the thyroxine they need. It can also affect how your whole
adrenal system works, if you don't have enough T3 your adrenal system
will also struggle to function effectively, and if your adrenal
system is struggling this can also affect how your body is able to
use the thyroxine, how your body is able to take up T3 in the cells.
When I realised just how fundamental the need for thyroxine and
specifically T3 is in the body I began to see how a chronic lack of
it would, if nothing else, have a massive impact on my M.E, even
raising the possibility that perhaps some problem with my thyroid was
at the root of all of my symptoms. Because if all my organs were in
some way compromised by lack of T3 then all those organs would
struggle to function. Perhaps this is why my heartbeats so slowly and
blood has a tendency to pool in my feet, perhaps this is why my
adrenals aren't functioning properly and I have a body that can not
respond effectively to the slightest stress, perhaps this is why my
liver is not processing sugars properly or my insulin is not working
consistently, resulting in reactive hypoglycaemia and symptom of
sugar crashing Perhaps this would explain why I could only go so far
in gradually increasing my exercise before I would reach my limit and
my recovery would progress no further.</div>
<div class="western" style="margin-bottom: 0cm;">
<br />
</div>
<div class="western" style="margin-bottom: 0cm;">
But how could this be
true? How could it be that my body had suddenly stopped being okay on
the dose of thyroxine I was on and how could it be that my blood
results did not indicate a lack of thyroxine?<br /><br />Let's deal with
the blood results first. When you have your blood tested to see how
your thyroid is functioning you have to realise that the reference
ranges used by the laboratory to indicate normal, are actually an
average or median of all the results that that laboratory gets from
the people it tests. Then you have to ask yourself what kind of
people have thyroid function tests, perfectly healthy ones, or people
who are tired, ill, or have chronic fatigue? Of course the proportion
of people who have this test are ill in some way that is why they are
being tested. My local laboratory sets its TSH range – TSH is a
measure of how hard your body is working to produce thyroxine – at
somewhere between 2 and 4, below 2 hyperthyroidism is a possibility
and above 4 hypothyroidism is a possibility. However, there is a
piece of research which actively recruited healthy individuals, with
no known family histories of thyroid problems and tested their TSH
levels. Guess what? The average for this group of people was not
between 2 and 4 it was just under 1, demonstrating that in fact the
optimal level for a healthy individual is to have a TSH level of
around 1. If you are on thyroxine and your level comes in at just
under 1 it is probable that your doctor would reduce your thyroxine
in the belief that you are on so much it is suppressing your thyroid
function.
</div>
<div class="western" style="margin-bottom: 0cm;">
<br />
</div>
<div class="western" style="margin-bottom: 0cm;">
The other part of the
equation is how much free T4 and free T3 is in your blood, rarely do
doctors test for this as a matter of course, but one can also assume
that the levels being seen as normal as set by the laboratory for T4
and T3 are as distorted as the levels set by the laboratory for TSH.
By this you can see that you could potentially get thyroid function
results which are not optimal but which are considered within the
normal range by a doctor. In addition to this, I was on a combination
of T4 and T3, taking synthetic T3 is known to suppress your TSH
levels, so my levels when tested were always around 0.01, which in
itself could have masked what was going on in my body.</div>
<div class="western" style="margin-bottom: 0cm;">
<br />
</div>
<div class="western" style="margin-bottom: 0cm;">
The second part of the
equation is something called Reverse T3. (RT3) If you imagine four
iodine atoms in each corner of the molecule of a molecule of T4, and
that in order to convert this to T3 the body takes away one the top
right hand side iodine atom, reverse T3 is where the body has taken
away, for example, a iodine atom on the bottom right hand side,
rendering the molecule unable to be used by the cells of the body to
make energy. There is not a great deal of information and research on
RT3, the body naturally makes a certain level of T4 into RT3, it is
perhaps a checking system whereby the body can ensure that there is
not too much active T3. But it is also known that the body produces
more RT3 when it is stressed, physically or emotionally or starved,
because at these times it is likely that it needs to preserve energy
and function in a minimal way. It is possible to have your RT3
measured privately and there are people who have enormous levels of
it in their bloodstream and one can only assume that this hinders the
body in accessing the active T3. I can only consider that it is
possible that the stress to my body caused by three major abdominal
operations, not to mention a long history of eating disorders, has
produced too much RT3 and thereby blocked my body's access to T3. It
is also possible that with a suppressed TSH perhaps my body sensing
enough T3 converted the T4 I was taking into reverse T3 in a
disproportionate way. There is also the possibility that as a result
of the stress to my body that my body no longer converts T4 as well
as it used to, or other possibilities are that my body for some
reason, again perhaps the stress, no longer finds synthetic T4 agrees
with me, my body does not work well with it any more.</div>
<div class="western" style="margin-bottom: 0cm;">
<br />
</div>
<div class="western" style="margin-bottom: 0cm;">
This is all very
scientific, and admittedly a lot of hypothesis on my part, not to
mention that not many endocrinologists let alone GPs have the
faintest idea about RT3, and if they do, do not accept that there may
be times when the body no longer works the way they understand it
does. Because as with M.E there is very little research in the UK
taking place in order to further understanding of these issues.
However I have come across many, many people who were diagnosed with
M.E only to find that when they took thyroxine, or changed to natural
desiccated thyroxine (NDT), or even in extreme cases have taken only
T3 in large enough amounts, that they have made a full recovery from
their diagnosis of M.E.
</div>
<div class="western" style="margin-bottom: 0cm;">
<br />
</div>
<div class="western" style="margin-bottom: 0cm;">
It seems to me logical
to deduct that if people have experienced a dramatic improvement in
their health as a result of changing their thyroid medication that
something complicated and little understood is going on with these
people's thyroid function. However, a well-known endocrinologist has
stated that his research shows there is no improvement in people's
symptoms if they take NDT for example, and therefore if people do
improve on NDT it is evidence that their condition is psychosomatic.
It seems to me an outrageous manipulation of science to draw such a
conclusion without any actual psychological or physiological evidence
to back it up. To my mind the natural conclusion is not that the
people who get better must to all intents and purposes be mad, but
that there is something unknown, undiscovered and misunderstood about
these people's health conditions.</div>
<div class="western" style="margin-bottom: 0cm;">
<br />
</div>
<div class="western" style="margin-bottom: 0cm;">
I have tried to explain
to you why you can have a so called normal thyroid function test and
yet have a thyroid system that is not functioning normally, and also
how reverse T3 may be an invisible influence on a persons thyroid
function, but I am not claiming that all M.E, or even my M.E, is
caused by abnormal thyroid function. In my next post I will tell you
how I have been trying to address the possibility that my thyroid is
at the root of my condition.</div>
M.E recoveryhttp://www.blogger.com/profile/01015059601098075577noreply@blogger.com0tag:blogger.com,1999:blog-5535253591973377031.post-35693956786265341822014-11-06T11:42:00.000-08:002014-11-06T11:43:06.803-08:00<div class="western" style="margin-bottom: 0cm; text-align: center;">
<u><b>Is This The Key to
recovering from my M.E?</b></u></div>
<div class="western" style="margin-bottom: 0cm;">
<br /></div>
<div class="western" style="margin-bottom: 0cm;">
Unfortunately I haven't
been absent from my blog because I made a miraculous recovery! I have
had a couple of setbacks. An old friend of mine, who'd had chronic
fatigue had found Chinese herbs very helpful in her recovery so,
desperate as ever, I thought it's one of the few things I haven't
tried. £100 or so lighter I found myself getting iller, slipping
back, and realised it was the herbs. So disappointed as ever I
knocked that one on the head and went back to what I had been doing
before. By about June this year I was back where I had been before
the herbs, able to tolerate being upright for about 1 to 2 hours,
needing to rest afterwards for one and half hours, being a bit more
human when upright, my symptoms were quite calm, mainly the
exhaustion and my adrenaline keeping me pinned to my bed. However my
new GP did something that set me back about three years.</div>
<div class="western" style="margin-bottom: 0cm;">
<br /></div>
<div class="western" style="margin-bottom: 0cm;">
Now I have been
diagnosed hypothyroid since 1994. Over the years like a lot of
hypothyroid patients my need for thyroxine had increased and by the
time I hit the m.e wall I was on 175 MCG of thyroxine and 20 MCG of
something called liothyronine sodium. I had had a very supportive GP
before I moved to Wales and she had put me on liothyronine sodium at
my request. The thyroid gland is a very complex part of the body that
produces thyroxine otherwise known as T4 and liothyronine otherwise
known as T3 along with T2 and T1, and who knows what else! Now the T3
part of that is the active bio-available form that your body is meant
to turn T4 into in order to use the thyroxine you are given by the
doctor. My new GP in Wales looked at my blood test results and in her
infinite wisdom, despite my arguments, despite what an
endocrinologist in England had said, despite the fact that changes to
thyroid medicine <span style="font-weight: normal;">are </span>usually
ramped up and down in small steps, she decided to take away all of my
T3, and cut my T4 down to only 100 MCG. In effect she had more than
halved my dose overnight.</div>
<div class="western" style="margin-bottom: 0cm;">
<br /></div>
<div class="western" style="margin-bottom: 0cm;">
Now all hypothyroid
patients don't like their medication being reduced because we never
feel like we've ever gone back to the person we were before we were
diagnosed, however having M.E I was particularly concerned about this
drastic change. Now I expected a re-occurrence of the symptoms I had
had when first diagnosed in 1994, basically I thought I'd get fatter,
balder, have drier skin and obviously be more tired. I did not for
one minute expect what happened.
</div>
<div class="western" style="margin-bottom: 0cm;">
<br /></div>
<div class="western" style="margin-bottom: 0cm;">
After a couple of weeks
on my new dose I felt an improvement, my adrenaline reduced I was
managing to do more, however that only lasted a week. After that week
I began to go drastically downhill, symptoms I had not seen for at
least a year came back full force, in fact after about six weeks I
was almost as ill as I had been when I first hit the wall. Desperate
to get my dose increased I went onto the Health Unlocked website to
get some advice from other sufferers of hypothyroidism about how to
challenge my GP . Many people told me I did not have M.E just badly
treated hypothyroidism. To be honest with you I thought they were
evangelical nutters, who did not accept the existence of M.E. why did
I think this? Because I knew that relatively speaking when I first
got M.E I was on high-dose of thyroxine, and I knew that the array
of symptoms my M.E produced far exceeded anything I had ever heard of
someone suffering when they have an underactive thyroid, lastly, I
knew that M.E does exist and is not caused by hypothyroidism because
my partner had had M.E for 16 years and had recovered without taking
any thyroxine.</div>
<div class="western" style="margin-bottom: 0cm;">
<br /></div>
<div class="western" style="margin-bottom: 0cm;">
Despite my conviction
that my M.E was not caused by hypothyroidism I had to admit as my
symptoms increased I struggled to understand how this drop in
medication could be reproducing my experience of the first year or so
of having ME. Symptoms I had even forgotten about returned, so for
example my brain fog became so bad I could barely speak; I was
freezing cold then boiling hot; my headaches increased and I felt
nauseous; my eyes were so tired and itchy it felt like I'd been at an
all night party and hadn't been to bed for 24 hours; and my sugar
crashing, thrumming and tingling went through the roof. I became
increasingly curious about the endocrine system, in particular the
thyroid gland and its role in the production of energy in every cell
of the human body. The more I opened my mind, the more I read, the
more I discovered that people with hypothyroidism shared many of my
symptoms, the more convinced I became that even if my hypothyroidism
was not the total cause of my M.E I would never make a recovery
unless I addressed what was staring me in the face: that either my
body could no longer convert T4 to the active T3, or else something
was blocking the take up of T3 by the cells of my body. It could not
be a coincidence that all my M.E symptoms went through the roof when
my medication had been so severely cut, there had to be some sort of
correlation!</div>
<div class="western" style="margin-bottom: 0cm;">
<br /></div>
<div class="western" style="margin-bottom: 0cm;">
In my next post I will
elaborate on exactly what I have discovered about the relationship
between my M.E and hypothyroidism.</div>
M.E recoveryhttp://www.blogger.com/profile/01015059601098075577noreply@blogger.com0tag:blogger.com,1999:blog-5535253591973377031.post-48453740854251905032013-12-01T05:08:00.000-08:002013-12-01T05:09:37.167-08:00Stringing the days together<!--[if gte mso 9]><xml>
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<br />
<div class="MsoNoSpacing">
<span style="font-family: Georgia,"Times New Roman",serif;">When I started on my rigid up and down schedule and
walking in water for 5 mins three time a week about<span style="mso-spacerun: yes;"> </span>a year ago I felt sick as a dog most of the
time, exhausted, adrenalin pressing on my chest, the drive to get flat
dominating my time upright and generally unable to function. I could see no
cause and effect in how I was feeling and be unable to predict bad and worse
days. I would spend the time I had to be up longing for it to pass so I could
crawl back to bed and, whilst loving my daughter, simply wishing she, and all
other human beings who made any demands on me, were elsewhere! So where am I a
year on?</span></div>
<span style="font-family: Georgia,"Times New Roman",serif;">
</span><br />
<div class="MsoNoSpacing">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgdLnTb2ZcEjaU4beM5p7VUQn5BUsLtAVzu9C5slskInFXf1f-jomjFmpdI_XLx_N-PQ8fn7gQa1pD9xGMjBkDLOTBAeFq49djbCjCOLU4a04IZ_SrfLmZtVAL2phdmzlrJipDbIY3HWCxg/s1600/necklace+2.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="289" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgdLnTb2ZcEjaU4beM5p7VUQn5BUsLtAVzu9C5slskInFXf1f-jomjFmpdI_XLx_N-PQ8fn7gQa1pD9xGMjBkDLOTBAeFq49djbCjCOLU4a04IZ_SrfLmZtVAL2phdmzlrJipDbIY3HWCxg/s320/necklace+2.jpg" width="320" /></a></div>
<div class="MsoNoSpacing">
<br /></div>
<span style="font-family: Georgia,"Times New Roman",serif;">
</span><br />
<div class="MsoNoSpacing">
<span style="font-family: Georgia,"Times New Roman",serif;">I remember the South African physio who has been advising
me through the past year told me that what would hopefully happen is I would
get a better day, then bad days, then another better day and slowly the better
days would get closer together and all going well eventually more and more
better days would get strung together like a necklace. It was very difficult to
believe this and it felt very very far away at the time. I have struggled
sometimes to hold onto hope and struggled sometimes to stick to my schedule –
remember me going up the Mountain in a distressed moment last summer? But now I
feel a year has made a big difference, it is easier to look back over the past
twelve months and see the progress I have made. And I know it isn’t just time,
I know this progress is a result of the disciplined approach I have taken to my
illness and to the healing effect of getting in that water 3 times a week
regardless of how I feel.</span></div>
<span style="font-family: Georgia,"Times New Roman",serif;">
</span><br />
<div class="MsoNoSpacing">
<br /></div>
<span style="font-family: Georgia,"Times New Roman",serif;">
</span><br />
<div class="MsoNoSpacing">
<span style="font-family: Georgia,"Times New Roman",serif;"><u>20 minutes in the Pool Now</u></span></div>
<span style="font-family: Georgia,"Times New Roman",serif;">
</span><br />
<div class="MsoNoSpacing">
<span style="font-family: Georgia,"Times New Roman",serif;">Last week I got to 20 minutes in the pool. I swim lengths
for 3 mins and then walk in water for 2 mins. I can drive myself to the pool
fine, I can shower and dress without feeling like I am close to dying. I can
swim a length of breast stroke and a length and half scullying on my back
before putting my feet back down again for 2 mins. I wear my heart monitor and
not only stick to my time to the second regardless of how good or bad I feel,
but I also keep an eye on my heart rate and if it is going silly as it
sometimes does for no reason, like hitting 130 bpm rather than the average 106
when I swim, I swim very very slowly and glide as much as possible. </span></div>
<span style="font-family: Georgia,"Times New Roman",serif;">
</span><br />
<div class="MsoNoSpacing">
<br /></div>
<span style="font-family: Georgia,"Times New Roman",serif;">
</span><br />
<div class="MsoNoSpacing">
<span style="font-family: Georgia,"Times New Roman",serif;"><u>Walking</u></span></div>
<span style="font-family: Georgia,"Times New Roman",serif;">
</span><br />
<div class="MsoNoSpacing">
<span style="font-family: Georgia,"Times New Roman",serif;">A few months ago I also started very slowly to walk on
the days I am not swimming. I employed the technique used for swimming, ramping
up the time once I had stabilised for 3-4 weeks. So in this way I started by
going to the first gate and back, then the field beyond the gate and back, then
the next gate and back and now I can get over that gate and walk a few hundred
yards out on the mountain. It is wonderful!</span></div>
<span style="font-family: Georgia,"Times New Roman",serif;">
</span><br />
<div class="MsoNoSpacing">
<br /></div>
<span style="font-family: Georgia,"Times New Roman",serif;">
</span><br />
<div class="MsoNoSpacing">
<span style="font-family: Georgia,"Times New Roman",serif;"><u>Extending my rigid schedule</u></span></div>
<span style="font-family: Georgia,"Times New Roman",serif;">
</span><br />
<div class="MsoNoSpacing">
<span style="font-family: Georgia,"Times New Roman",serif;">And last week I re-jiggled my schedule so that now I am more
or less up for 1.5 hrs and down for 1.5 hrs so I’m not staying in bed for 2 hrs
at a time in the afternoon. </span></div>
<span style="font-family: Georgia,"Times New Roman",serif;">
</span><br />
<div class="MsoNoSpacing">
<br /></div>
<span style="font-family: Georgia,"Times New Roman",serif;">
</span><br />
<div class="MsoNoSpacing">
<span style="font-family: Georgia,"Times New Roman",serif;">Since reaching 20 mins in the pool and spending less time
in bed I have taken another leap forward in how well I feel when up. For the
past few weeks I have had NO SUGAR CRASHING and less and less adrenalin. These
are the last two symptoms, apart from the inevitable ‘tiredness’ , that I have
been getting for the past few months. When I am up I can cook and teach my daughter,<span style="mso-spacerun: yes;"> </span>do my self -employed work and act quite like
a normal person to the outsider, so long as I go back to bed when I’m meant to.
I even coped with visitors the other day, cooking dinner for them and talking
to them - the most exhausting thing I find - <span style="mso-spacerun: yes;"> </span>but of course after 1.5 hrs I went to bed,
then got up and saw them after my stint in bed.</span></div>
<span style="font-family: Georgia,"Times New Roman",serif;">
</span><br />
<div class="MsoNoSpacing">
<br /></div>
<span style="font-family: Georgia,"Times New Roman",serif;">
</span><br />
<div class="MsoNoSpacing">
<span style="font-family: Georgia,"Times New Roman",serif;">This all indicates to me the importance of keeping the
pressure on pushing just a little at the edges of what I can do, so long as I
have been stable for a few weeks at that point. Being stable doesn’t mean I
feel brilliant all the time, doesn’t mean<span style="mso-spacerun: yes;">
</span>I am symptom free before moving on, it just means I haven’t gone
crashing backwards before I push at the edges once more. The additional
movement and exercise must be helping my body function better so having a
positive knock on effect and I have been using Gupta to chase away any fearful
or negative thoughts about potential recovery or focusing on symptoms.</span></div>
<span style="font-family: Georgia,"Times New Roman",serif;">
</span><br />
<div class="MsoNoSpacing">
<br /></div>
<span style="font-family: Georgia,"Times New Roman",serif;">
</span><br />
<div class="MsoNoSpacing">
<span style="font-family: Georgia,"Times New Roman",serif;">Sometimes a year feels like a very long time to have
worked so hard and have come a small way, sometimes it feels I’ve come miles
and miles and can truly believe that if I keep this discipline up I will make a
full recovery before my daughter’s childhood vanishes before my eyes!</span></div>
<span style="font-family: Georgia,"Times New Roman",serif;">
</span><br />
<div class="MsoNoSpacing">
<br /></div>
<span style="font-family: Georgia,"Times New Roman",serif;">
</span><br />
<div class="MsoNoSpacing">
<span style="font-family: Georgia,"Times New Roman",serif;">Any questions feel free to comment or share what’s been
helping you recently!</span></div>
M.E recoveryhttp://www.blogger.com/profile/01015059601098075577noreply@blogger.com0tag:blogger.com,1999:blog-5535253591973377031.post-53648796538513520642013-11-15T12:10:00.002-08:002013-12-01T05:09:54.046-08:00ARE YOU an M.E US and THEM-ER???<!--[if gte mso 9]><xml>
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<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><b>Are
you an M.E us and them-er?</b></span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;">Some
people seem to take the attitude that there is a difference between ME and CFS,
and that if someone has ME they can NEVER recover and if they have CFS it is
not the same as ME. People also have the idea that if someone does recover,
then whatever their symptoms whilst ill, they can’t have had ME, their illness
must be something different BECAUSE: people with ME can NEVER get better. </span></span><br />
<br /></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;">I
think this is a load of old twaddle!</span></span><br />
<br /></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;">Sometimes
this involves people who identify as ME sufferers back stabbing others and
trying to argue against them. I myself have had nasty comments from the us and
them-ers about the use of CFS as part of
my twitter tag, the argument being that
if I don’t agree with the term CFS I
shouldn’t use it. I do loathe the term CFS as it appears to identify ‘chronic
fatigue’ as the predominant symptom, demonstrating no insight into the
particular and peculiar nature of the exhaustion experienced in ME, nor in anyway acknowledging the wide array
of other symptoms that - for me
personally - have become the nemesis that dominates my disability. However, I
recognise that this is the term the medical profession use in the UK and that
as such many people will only have this term to identify their illness with. I
used it on twitter in order to ensure I was communicating with as many
sufferers as possible and not just the ones who use the term ME.</span></span><br />
<br /></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;">The
thing I hate the most about all this is that to use your precious energy
criticising other ill people on the grounds that YOU have the CORRECT
definition of the illness and everybody else is WRONG is not only
counterproductive and spurious but a really really good way to distract and
detract from working out what is going on with this wretched illness and how to
recover from it. Oh yeah but that’s because I forget it is IMPOSSIBLE to
recover from ME, because, catch twenty two, if you do you obviously never had
it! Well what a load of old tosh!</span></span><br />
<br /></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;">Yes
there are times when I talk to people who have recovered, or people who currently
identify as having MECFS and I do wonder if they have had or have the same
thing as me. How can they own and ride a horse regularly if it’s taken me 11 months to build up from 5
minutes in a pool to 15 minutes? How can people go out and about so much? How
can they have traveled to India whilst saying they still have MECFS??? On bad
days I think "HOW? I want what you have because you can do so much more!!!" But
then I think about all the ignorant people who see me going to the swimming
pool 3 times a week and haven’t a clue
that I am ill, or the friends who just don’t ask or understand if I try to
explain how I can sit and talk to them for 15 minutes like a normal person, but
as I talk the poison is rising and I will pay for it later or tomorrow!</span></span><br />
<br /></div>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;">I
do personally believe that you have to be more than chronically tired to have
ME, you have to have an array of additional neurological symptoms, but I do
believe people get better – I live with one of them – and I do believe that as
recovery progresses we can lose the other symptoms and be predominantly left
with tiredness, but more than anything I do believe that judging and bitching
about other people is a huge waste of precious energy, and the best way to ensure
you NEVER recover! </span></span><br />
<br />
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;">Do please subscribe to get up to date Posts! </span></span></div>
M.E recoveryhttp://www.blogger.com/profile/01015059601098075577noreply@blogger.com11tag:blogger.com,1999:blog-5535253591973377031.post-37261026318214078562013-10-01T11:44:00.000-07:002013-11-17T10:34:45.966-08:00<br />
<span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><b>The Glass Cage</b><br /><br />You cannot see the walls of my glass cage<br />You think: She walks, she talks, what can the problem be?<br />You cannot see the energy that drains from every cell just to sit and speak<br />The rope strung tight that every sound sets jangling<br />The Tsunami of poison rising ready to sweep<br /><br />The closing of the window<br /><br />You cannot see the umbilical cord that tethers me to my bed<br />Nor how like an embryo I am flayed and unable to survive for long in the outside world</span></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><br />
Y</span><span style="font-size: small;">ou cannot see the Death’s-head moth that hovers over me<br />Fluttering its wings against my breast<br />Before coming to settle its massive furry head upon my chest<br /><br />I cannot see electrons circling a nucleus<br />I cannot see the thoughts forming in your head<br />I have no evidence of your feelings beyond your words<br />No one yet has precisely defined what the difference is between alive and dead</span></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><br /></span></span>
<span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;">Because of that are all these things mere phantasies?<br /><br />I hear the footsteps of my daughter<br />Her laughter echoes like the ghost of a family I once lived amongst<br /><br />Gone is my agency<br />Gone my lived-full-life</span></span><br />
<span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><br />
</span><span style="font-size: small;">I wait and wait for the ink licked fingers that press me down to one day let me go</span></span>M.E recoveryhttp://www.blogger.com/profile/01015059601098075577noreply@blogger.com0tag:blogger.com,1999:blog-5535253591973377031.post-1553480697970190782013-09-05T11:56:00.001-07:002013-09-05T11:58:44.303-07:00Pain and the Brain - what can we learn to help ME recovery?<br />
In Lorimer Mosely's book 'Painful Yarns' he demonstrates his experiences of people's pain and how the brain relays pain to the body. He is an Australian physio therapist who has specialised in back pain. His many stories are entertaining and amazing, but the key information they demonstrate is that pain is something the brain uses to tell a person there is something wrong, it is a construct of the brain. People can no longer have something wrong with them - for example an amputated limb - but their brain can still be telling their bodies to feel pain. Or conversely people may have something wrong with them, but because of the context or their personality their brain doesn't tell their bodies to feel pain - for example a man with a nail through his foot walking two miles barefoot to the hospital and being absolutely fine, then banging his knee on a bench and screaming out in agony! One example from his book.<br />
<br />
Mosely is not saying these people don't feel pain, he's not saying they are not in pain, what he's doing is holding up a mirror to the fact that pain is something in essence created by the brain, and that the brain can also choose or be taught not to tell us about that pain. This is very different from saying a person with an amputated leg doesn't feel pain it is in their head. It isn't in their head, their brains are creating that pain in the same way as your brain will create pain if you stick a knife in your leg, both are real, both are valid. But if people's brains can also, for whatever reason, not inform someone they are in pain what can we learn from that, and how can that information be used to help people who experience chronic rather than acute pain? <br />
<br />
How could this knowledge be applied to ME? Could it be something has switched our brains on to pain, symptoms etc and is it possible to switch that information off? I don't have the answer to that last one, I don't think there is a magic bullet, but I do think it's possible that by unavoidably being aware of our illnesses we are reinforcing the message from our brain that there is something wrong and we need to experience it. Again, like Mosely, this is not in anyway the same as saying it is in our minds, it is as real as putting the knife in your leg, it's just that perhaps we don't actually need to be told we have a knife in our leg anymore, perhaps we need to find a way of convincing our brains to tell us different things. Perhaps this is how we can get stuck and need help to get unstuck. We are ill, it is real, but how we think can affect how we experience our illness and we need to find the most useful ways to think to aid recovery.<br />
<br />
This fits with something I heard on Radio 4 recently about surgery to electrically stimulate the brain to help various conditions, including enduring untreatable depression and Parkinsons. One man has chronic and constant pain in his arm, so bad that he has considered chopping his own arm off, only the doctor told him it wouldn't make any difference, the pain is not in his arm, it would still be there because the pain is a message to the brain that has gone wrong. By stimulating the right part of the brain they can change his experience of this pain. It's not that the pain isn't real, it's not that the doctors don't believe his experience - they do enough to do an expensive operation - it's that his brain or the neural pathways are stuck on the PAIN ON mode and by stimulating the brain they can either turn these off, or as one patient put it 'It's not that the pain has gone, it's that the pain doesn't matter anymore!' <br />
<br />
All Food for Thought.M.E recoveryhttp://www.blogger.com/profile/01015059601098075577noreply@blogger.com0tag:blogger.com,1999:blog-5535253591973377031.post-17186685978326497022013-08-19T12:22:00.000-07:002013-08-19T12:22:34.475-07:00How to use walking in water to recover from ME<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjK5FvP94WDYen_-cLutOKnorgPEtqTBlAUNLnNsoBt9W5mEhUIBbCD-ixMdfkkQ-IyTF1s-dLJoosFwr0bLFKkeFYyLivP76A9wSTm3CbokLdPSU8C9OMHlWkM_mCmFpFLcUqPOCzZAUEE/s1600/swimming+on+back.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="232" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjK5FvP94WDYen_-cLutOKnorgPEtqTBlAUNLnNsoBt9W5mEhUIBbCD-ixMdfkkQ-IyTF1s-dLJoosFwr0bLFKkeFYyLivP76A9wSTm3CbokLdPSU8C9OMHlWkM_mCmFpFLcUqPOCzZAUEE/s320/swimming+on+back.jpg" width="320" /></a></div>
So finally, here is how to use water to help recover. My aunt had severe ME, and I think had to be carried into the water at the beginning, but she has put water down as the biggest contributor to her amazing recovery in only 2 years!!! The shortest I have ever heard of. I have worked via e-mail with her physio in South Africa and this is how she advised me:<br />
<br />
I started by being in the learner pool (which is so much warmer) 3 times a week for 5 minutes only. It is important to have a day between paddles and not to swim. I simply walk I in the water up to shoulder height using my arms to part the water ahead of me. Like I said before when I first started it took a lot out of me, I had to be driven there, I felt very shivery when I got out and getting dressed felt like a huge mountain to climb. I think my aunt was so ill she was only in the water for 2 mins to begin with. So I did 5 mins Mon, Weds and Fri however ill I felt and after about four weeks I felt stable at that amount of time so then I increased it by only 2 minutes more. You do this every time, keep at the new time, keep being steady with it, allow yourself the day off to recover, keep to your fixed schedule the rest of the time and when you feel you are stabilising at that amount of time up it by 2 minutes. It is important not to push it, not to try and ramp it up too quickly, and if something goes wrong, you get an infection or over do it like me, then rein it back a bit by 2 or 4 mins depending on how ill you are. I have had to drop back down three times now - which is always very disappointing - but each time I have found it takes less time to get back to where I was.<br />
<br />
When I got to 11 mins for the first time I suddenly realised I was feeling very much more robust. Unfortunately I got an infection and was very sad to drop back to 7 mins after having a couple of weeks off, but I got back to 11 mins in about a month, rather than the two it had taken me to get there. The exciting bit is finally getting to 15minutes as then you can start to swim a little. You swim for 2 mins, then walk for 3, swim for 2, walk for 3, swim for 2 and walk for 3. <br />
<br />
It all sounds like graded exercise, but I have to say it is more than that. As I have said I wear a heart monitor in the water and as soon as I get in the water my heart rate starts to drop. Getting in the water feels really healing there is something lovely about it even when I was struggling either side of the getting in the pool. But recently where I pushed myself up the silly mountain and had just reached 15 mins and had to drop back to 13 mins, getting in the water just calms everything down, all the weird body symptoms, the autonomic nervous system stuff just seems to be soothed by being in the water. And this time it has only taken me 2 weeks to feel stable enough to get back to 15 mins and 2 min swims. When I think back to last December and how much better I am, how much more robust, I feel really hopeful that given another year or so I will get back on my feet properly. It's important to be realistic and take it steady. My aunt thinks the most important thing is to make steady progress and avoid crashes as they damage the body further. It is of course all about mental toughness - if only those idiots who think it's all in our heads would realise how tough you have to be mentally to live with this awful condition!<br />
<br />
Where I lived before was too far from a pool for me to use even though my aunt told me it was the best thing I could do and I couldn't quite believe her, but here I am lucky to be a 10 min drive away and have a leisure centre where I have paid £150 for a years unlimited swimming, so I'm only paying £1 a swim in essence. It is the best bit of money I have chucked at this illness and believe me from mitochondria cell function tests to injecting myself with B12 and magnesium its the best £150 I have spent.<br />
<br />
I urge anyone with ME, however ill, to try it. To beg someone to take you and stick to a tight schedule and try it. I know my aunt isn't the only person who has recovered this way, although she is the fastest the physio has known. If you want any advice let me know, and of course if you sign up to e-mail reminders you will automatically keep up with how my recovery is going!<br />
<br />M.E recoveryhttp://www.blogger.com/profile/01015059601098075577noreply@blogger.com0tag:blogger.com,1999:blog-5535253591973377031.post-82683291864914889742013-08-07T08:42:00.000-07:002013-08-07T09:05:17.120-07:00So Cross with myself!!As anyone who cares will have noticed I have not managed to post about how to do water therapy yet. Why? Because I have shot myself in the foot so to speak and have been too ill to write much until today.<br />
<br />
Last Friday I was upset about something and it all just served to emphasise how powerless and trapped I feel by my illness. I got myself in such a state about it and how I can't do anything to change this, I can't just apply my mind and my will power and BOOM it's all gone that I wanted to do something that made me feel less trapped and powerless. So what did this silly cow do? Well, we live two thirds of the way up a small Welsh mountain, so I in my hysteria dragged myself up the last third of it! I had to stop every hundred yards or so to sit down and rest and cry and the dog kept giving me concerned looks, but with no one else to talk any sense into me I just kept going. I got to the top eventually and I lay on the ground and looked at the clouds and the sky and began to feel a bit better. After a while I even managed to stand up and walk slowly back down feeling much better than I had on my ascent. I even managed to kid myself it was okay, there I could do it. Ha! Ha! Ha! <br />
<br />
Well if I haven't learnt before I have now. Just feel like I've been unplugged again, my heart's been going random, sugar crashing again and generally feeling really rotten. The problem is even I had stopped appreciating how much progress I'd made. I felt like because I was doing so well when up and about and not feeling rotten that others who don't know me so well would think, 'what's her problem, see she walks, she talks'. I let this get to me, I let my own imaginings get to me, I forgot to remember that the only reason I was so good at walking and talking was because I had worked so hard at sticking to my schedule and building up my water therapy time. Well I will remember next time, however distressed and angry I am at living in this glass cage, I will appreciate that the walls had extended a little further, how easily they can fall back in on me.<br />
<br />
This post is not about me moaning about how I feel, I want it to serve a purpose for others. I felt sharing this foolishness on my part may help others not make the same mistake.<br />
<br />
Lets see how long it takes to gain back my ground, I feel I have gone back several months, it will be interesting to see if it takes less time than that to stabilise again and get back to where I was a week ago. Wish me luck.<br />
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I will blog about water next, soon. If you want to know when I've blogged next please do sign up for e-mail reminders. That's all your e-mail will be used for, nothing else.M.E recoveryhttp://www.blogger.com/profile/01015059601098075577noreply@blogger.com2tag:blogger.com,1999:blog-5535253591973377031.post-35219956501813415962013-07-29T07:59:00.001-07:002013-07-31T08:35:47.972-07:00Walking in water - what a huge difference it's made to my health!<div class="separator" style="clear: both; text-align: center;">
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I started doing water therapy because my aunt said she believed it was the main thing that had enabled her to make a full recovery from total disablement within only two years! With the help of her physio via e-mail I have implemented a regime that is giving me real hope of a full recovery!<br />
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When I first started the water therapy in December 2012 I was too ill to drive the 10 mins to the pool and back and when I got out after being in for only 5 mins, getting dressed felt like climbing a mountain! After maybe 4-5 weeks I was able to start driving myself on good days and after about 8 weeks I was driving myself all the time and getting dry & dressed got easier and easier. Despite having a couple of dips during the past 7 months - one because of a chest infection - I am now so much more robust all the time. I easily get myself to the pool and back, I can shower and wash my hair, and get dry and dressed easy as anything and I am getting stronger and stronger and apart from my fatigue and adrenalin symptoms <u>all</u> my other symptoms are gone!<br />
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I know that part of this improvement is due to my pacing schedule (see previous post), but I believe a huge part of it is down to walking in water. During my 6 week chest infection where I had to give in and stop going to the pool for a couple of weeks my nasty symptoms started increasing and I was sugar crashing, feeling really sick in every cell of my body and my adrenalin was getting difficult to bear. I e-mailed the physio in South Africa in despair, but she reassured me that once I got back in the water these symptoms would abate again. I couldn't quite believe this - despite having observed what a positive affect the water had on my symptoms previously - but she was right! Immediately after the first session they started improving again and after a couple of sessions those nasty symptoms, that make me feel like lying down and dying, had gone! <br />
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I wear a heart rate monitor in the pool and I had noticed right from the start that my heart rate could be 140 bpm, but as soon as I got in the water I could just watch it start dropping to somewhere between 60 - 80 bpm. I also noticed that despite feeling really rotten going to the pool, after a visit those symptoms were normally much improved following the visit. Why?<br />
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Well<em> </em>I think two things are going on: 1) the weight of the water pressure around the body is helping counter orthostatic intolerance (see my previous post) helping to close the blood vessels and push blood back up toward the brain, and 2) the sensation on my skin as I move through the water is giving the nerves and neural pathways something else to communicate to the brain other than symptoms. Kind of confusing the brain somewhat and interrupting the sick messages going between brain and body. In addition, it also has the effect of graded type exercise that gives the brain a rib cage that it can acclimatise to, but it is certainly a lot more than a graded exercise regime!<br />
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My next post will teach you precisely how to do water therapy so you can try it for yourself! <br />
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If you find my blog helpful, please share it with others! Thank you.M.E recoveryhttp://www.blogger.com/profile/01015059601098075577noreply@blogger.com0tag:blogger.com,1999:blog-5535253591973377031.post-62888441773987445072013-07-21T12:50:00.001-07:002013-07-31T08:36:39.833-07:00 Walking The Tight Rope - mind v matter!<div class="separator" style="clear: both; text-align: center;">
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There are two tight ropes in ME. One is strung through my body and it overreacts to ordinary stresses so that rather than setting off a mild ripple it sends a reverberation like a jump jet just went past rather than a challenging phone call with British Gas! And the other is the tight rope I walk each day between mind and matter.<br />
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I have no doubt that ME is a physical illness, there are tangible and - if the medical profession can be bothered - measurable physical symptoms, however how we feel and think can also interact with the illness and hinder recovery. I have observed this in myself and others. I think the reason some people find lightening process (LP) ; reverse therapy; stone age diets; Gupta and whatever else 'cures' them is a combination of things. Firstly, the nebulous nature of the disease is frightening, frustrating and unpredictable, in order not to over do it we have to be aware of our bodies and our symptoms and keep checking we aren't pushing ourselves too far, but unfortunately this understandably results in us thinking and worrying about what our illness is up to and how our bodies are most of the time. This reinforces the neural pathways carrying messages from our brain reinforcing all the horrid symptoms. On top of this we can learn that movement and activity makes us feel worse and start to fear movement and activity and shy away from it. This is what I mean by walking the tight rope, trying to find the balance between pushing oneself physically and mentally just a little, just enough not to sink into the awfulness of the illness and not pushing just that bit too much and falling off the wire.<br />
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I think that what you need to do when you first hit the wall and what you need to do as the illness progresses are different things. When you first hit the wall you need to stop, you need to rest, you need not to push at your body and try to force it on, but if you rest, remove stressors etc your body will start to recover. The problem is that the physical thing, whatever it is, can start to heal, very slowly over years, but the problem is if you don't start to challenge yourself just a little you will get stuck. Stuck and maybe even spiral backwards. Many many people seem to improve hugely after a few years but then can't quite make a full recovery. And many people will say they were 'cured' by doing x or y. But with most of these people when you start to talk to them you see that they had made huge leaps forward in recovery before doing x or y or they had been ill for 10 - 20 years before doing x or y. Well what if what had happened was their bodies had healed, but the mind was now stuck, stuck in the ME loop, not quite able to take that last step forward and then they go and do something like LP and hey they are 'cured' what they perceive is that LP cured them, but what they have forgotten is how very ill they were 5, 6, 7, 8 20 years earlier, how far they have already come and this last push was just what they needed to push the mind over the finish line and start thinking they can get 100% better. <br />
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I was recently talking to someone who put their recovery down to Reverse Therapy and LP, but once I started asking about it it became clear she had already made huge progress, and these tools helped her put the last pieces of the jigsaw in place to make a full recovery. It made me appreciate that when I tried Gupta after only being ill 6 months and it moved me forward hugely, but didn't 'cure' me, perhaps it couldn't because not enough time had gone by for my body to have healed. It has made me think that perhaps I need to revisit my Gupta methodology and start implementing it again now that my body has had a further 18 months to heal itself in. That maybe I need to give it another push, whilst keeping to my schedule and using water therapy, but within that framework start challenging the thoughts about the body and illness once more.M.E recoveryhttp://www.blogger.com/profile/01015059601098075577noreply@blogger.com0tag:blogger.com,1999:blog-5535253591973377031.post-54640507649042472272013-07-07T12:51:00.003-07:002013-08-07T08:43:18.908-07:00PACING - the hardest thing to get right - Tricks and Tips!<div class="separator" style="clear: both; text-align: center;">
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<span style="font-family: Arial, Helvetica, sans-serif;">Living with someone who was finally recovered from ME just as I met her I thought I knew what pacing was, until I got ME and had to try to put the theory into practice. At the ME clinic the physio said, 'Hey you know what you're doing, in fact you probably know more than me!' Yep, I did know more than her, but more than very little is still not a lot!</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">I don't know about you but I tried listening to my body, trying to look for patterns, trying to tell when was the moment when it was time to stop. My partner said she'd learned that when she was thinking 'Hey it's time to stop' she'd probably already gone over the edge. I would be up and as I felt the Tsunami of ME building I would try to cram that last thing in, finish that small task (talking to my daughter for example) try batting off that feeling of impending doom that I wasn't going to make it to bed in time. It was a nightmare and of course involves lots of thinking about the body, tuning into my symptoms, analysing my health. NOT USEFUL!</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Then I read Lorimer Moseley's book 'Painful Yarns' which gave me a fanastic insight into the brains methodology for communicating pain and helped me understand why my aunt's physio in South Africa had suggested trying a rigid schedule. A rigid schedule is like a rib cage, it holds you in place, means you can plan your day and don't have to spend time thinking about when you should be resting, should it be now, in 10 minutes or two hours ago!</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">So right now my schedule looks something like this:</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">8am-8.30am up for breakfast.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">8.30am-9.30am quiet bed rest.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">9.30am - 11am Up</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">11am- 12.30 quiet bed rest</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">12.30 - 2pm Up</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">2pm- 4pm quiet bed rest</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">4-6pm Up for dinner etc.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">6-7pm quiet bed rest.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">7pm -10pm put daughter to bed and be UP, but on sofa watching some TV if I'm lucky.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">This schedule does move some if I need it to, but essentially I aim to have 12 half hour slots of rest paced throughout the day.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">I found out this was what I needed as my baseline by making a chart for myself where I divided the day into half hour slots and spent a week or so trying out different patterns, times up and finally settled on no more than 2 hrs up at one time and no more than 2hrs resting.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Now the key to my schedule is that I get up and lie down as laid out above whether I feel good or bad. To begin with I was often getting up when I felt sick as a dog, getting through the 1.5hrs longing for bed, but staying up until the allotted time to go back. The same for being in bed, if I'm feeling okay I go to bed regardless. This is my bottom line, this is where I am building from, and the thing is it goes against all known ME wisdom to be up even though your feel crap. ME wisdom says you will crash. Similarly getting out of bed when feeling crap: YOU WILL CRASH! NO, this isn't true. Often I have noticed that past a certain time in bed feeling rubbish it doesn't get any better, in fact it starts to feel worse. I've also many many times since implementing this regime observed how staying UP despite feeling rubbish (but only for the allotted time) does not lead to a crash.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">After the first few weeks of doing this I noticed that I started to have less UP and feeling really awful, I began to feel I could do things when I was UP and not just hang around downstairs tolerating my family wondering why time goes so slow when you feel so ill!</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">I've been using this methodology for the last 5 months and I can honestly say that apart from a couple of dips, one caused by a chest infection, my life has become more stable, my health is more stable. I don't feel that how I will feel is as unpredictable as it once was. Sure I can dip for no apparent reason - hey I've got ME - but on the whole from one week to the next how I feel is far more stable. In my UP times I am far more productive and my rest times I don't spend as much time feeling RUBBISH and wishing I was dead. </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">The thing now is to build on it. That's what the hydrotherapy is all about....</span><br />
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<span style="font-family: Arial;">Hey is there anybody out there? Am I blogging into space? Ask me a question - go on....</span>M.E recoveryhttp://www.blogger.com/profile/01015059601098075577noreply@blogger.com0tag:blogger.com,1999:blog-5535253591973377031.post-26657493747004609432013-07-05T12:36:00.001-07:002013-07-31T08:37:15.699-07:00To Gupta or not to Gupta that is the questionI wrote a lot about Gupta a year or so ago on an ME/CFS forum, I tracked my progressed using it. <br />
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What is it? Well, you may have heard of the lightening process (LP), it's a bit like that, only it doesn't requiring you re-mortgaging your house to do it, nor does it tell you 'Stand and Walk, a miracle has been cured because ME doesn't exist It's All in Your Mind!' Like the LP however, it uses Coaching and Neurolinguistic Programming methods (NLP), but it takes a more humane approach than LP, it is slower and the most important thing from my point of view is YOU CAN GET A REFUND if it doesn't work.<br />
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I know when I first got ill and heard about LP it was very difficult not to consider trying it. Lets face it we are all desperate to get better and we think, what is that works for me? What if I waste the next X years being ill and it could have worked for me? Hey it may be £700 for 3 days workshop, but what if.... I think that's what I hate about LP the way it exploits that fear and hope. I used to do coaching and training in the voluntary sector and I know that I would never charge more than £200-300 a day for running a workshop, that's for all the participants, so divide that by even 5 people and it shouldn't cost each person more than £200. <br />
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Anyway I digress into my loathing for LP, back to Gupta. I don't think Gupta is ripping people off, or trying to tell them it's all in their minds. He was ill, he has recovered, and he is sharing what he learnt and developed whilst making a good living from it. It costs about £100 for a set of dvds that take you through the whole process. If you are not satisfied after trying the method for 6 months you can get a full refund! That's what I did. I did find it immensely helpful, it took me from walking slower than my 74 year old mother, and getting no further than 200 yrds on a good day to being able to walk for 10 mins or so a day. It was hard work, it took a leap of faith to overcome my fear that I might be damaging myself in some way, but it was really worth trying. So why did I get a refund? Because it didn't completely cure me in 6 months and hasn't since and I know I gave it a really good shot, but it promised a full recovery and there was no quibble with getting my money back. So on balance I would urge anyone to try it, it could make a big difference to your health and you never know you could be at the stage where your body has recovered enough that it actually does help you make a full recovery. What have you got to lose? Only your time and hey you've probably got plenty of that on your hands as you lie around in bed. And if it doesn't help enough? Get a refund. Don't be too British about it, just send the dvds back and know you only wasted the postage.<br />
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If you want to know more about what it entails let me know and I'll tell you more!M.E recoveryhttp://www.blogger.com/profile/01015059601098075577noreply@blogger.com0tag:blogger.com,1999:blog-5535253591973377031.post-16087840467725120452013-06-24T12:18:00.001-07:002013-08-07T08:43:42.616-07:00Orthostatic Intolerance<div class="separator" style="clear: both; text-align: center;">
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Some doctors - the ones that believe in ME obviously! - think that at least 80% of sufferers experience orthostatic intolerance. It means the inability to tolerate being upright, in particular standing. Standing or being upright causes you to feel increasingly worse and in me creates that driving panicky feeling that I must lie down, I must get flat asap. Recognise it?<br />
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My understanding of what is happening is that for some reason the body's blood is pooling in the lower half of the body. Our hearts are constantly pumping against gravity to distribute blood as evenly as possible throughout the body, if that isn't happening efficiently gravity pulls the blood downwards into your feet. So the brain is lacking blood producing an array of nasty symptoms. As you can imagine not enough blood to the brain could be why you experience brain fog, but it could also mean that your brain tells your body to release adrenalin, in order to make the heart pump faster in an attempt to correct the imbalance, making your heart race for no apparent reason, and giving you that horrible feeling of pressure in the chest and wired feeling. It can also be responsible for the malaise you may feel. <br />
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At it's most extreme a person will not be able to tolerate being upright and will actually faint and many ME sufferers when given the tilt test will momentarily pass out. The tilt test is where a doctor straps you to a table and tilts it suddenly backwards. Orthostatic intolerance is a recognised condition hence the existence of the tilt test, however it is not commonly recognised by GP's etc as making up the landscape of ME.<br />
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For me finding out about orthostatic intolerance has been enlightening as it makes sense of so much of what I suffer from and gives me the knowledge that the drive to lie down that builds after I've been up and about for 1-2 hours is not my imagination but something tangibly wrong with the function of my body. When things are bad with me I will feel the need to lie down sooner, when I've had some really good days - one or two so far - I don't get that sensation at all. For me I identify it as starting with a feeling of pressure in my chest that I associate with a release of adrenalin. I call this feeling adreanliny, but the longer I am upright the more symptoms build like a Tsunami that only I can sense building and building with that feeling that drowning is inevitable if I don't get flat and quiet soon.<br />
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Hope this helps some of you. M.E recoveryhttp://www.blogger.com/profile/01015059601098075577noreply@blogger.com0Wales51.711780729016212 -3.164062530.942085729016213 -44.4726565 72.481475729016211 38.1445315tag:blogger.com,1999:blog-5535253591973377031.post-357716399313044402013-06-19T12:04:00.002-07:002013-06-19T12:04:27.631-07:00MY Aunt has fully recoveredMy aunt is an oncologist in South Africa. She became ill several years ago. She was so ill she had to have a chair lift fitted and my uncle once commented that if she were an animal we'd be merciful and put her out of her misery. Luckily he didn't because she made a full recovery in only two years!<br />
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She worked with a physio in SA. She started by making herself walk one metre a day. She maintained this and then when stable increased it. She did this until she could walk up her own hallway. But the thing that she thinks made the biggest difference was the water therapy. This was what the physio really helped her with. She started by spending 1 min in a warm pool three times a week. When she had maintained that for a month with out getting worse she upped it by a minute. Sometimes she maintained that time for a month, sometimes she maintained it for a week depending on what she and her physio felt was right. She says that when she started this it made the biggest difference. She would walk in the water until she got to being able to stay in the water for 15 minutes. Then she started to swim alternate visits. In this way she has made a full recovery. She is the fastest recovery the physio knows of but she has seen a few other people fully recover using this approach.<br />
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I think the water does two things. If you are experiencing Orthostatic Intolerance where your blood is pooling in your feet and the lower part of the body - and some doctors think 80% of us will experience it with all its other symptoms - the pressure, the weight of the water is helping to close the blood vessels down etc and push the blood up into the rest of the body. Secondly, I think that because the brain, the nervous system, etc is in freefall the sensation of the water on the skin, combined with the pressure confuses the brain. It means the skin is sending different signals to the brain about what it is sensing, distracting it from sending messages like tingle, thrum, adrenalin release, heart rate speed etc. I will blog again about my experiences of water therapy. I am finding it very helpful.<br />
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M.E recoveryhttp://www.blogger.com/profile/01015059601098075577noreply@blogger.com0tag:blogger.com,1999:blog-5535253591973377031.post-91513083014130426302013-06-12T08:30:00.003-07:002013-06-12T08:30:30.644-07:00Subjects coming up<strong><span style="font-size: large;">Let me know what you want to hear about...</span></strong><br />
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<span style="font-size: large;">Gupta Amygdala retraining - is it worth trying? I tell you my experiences</span><br />
<span style="font-size: large;"></span><br />
<span style="font-size: large;">My partner had M.E for 16 years, now she's 100%, but my aunt made a full recovery after two years - how?</span><br />
<span style="font-size: large;"></span><br />
<span style="font-size: large;">Pacing - how do you do it effectively?</span><br />
<span style="font-size: large;"></span><br />
<span style="font-size: large;">Hydrotherapy - what is it? How to do it? And what a big difference it makes?</span><br />
<span style="font-size: large;"></span><br />
<span style="font-size: large;">Does diet make any difference?</span><br />
<span style="font-size: large;"></span><br />
<span style="font-size: large;">Orthostatic intolerance - never heard of it? Up to 80% of us are affected by it!</span><br />
<span style="font-size: large;"></span><br />
<span style="font-size: large;">Are you and us and them-er?</span><br />
<span style="font-size: large;"></span><br />
<span style="font-size: large;">What does the success of the cancer drug indicate about M.E?</span><br />
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M.E recoveryhttp://www.blogger.com/profile/01015059601098075577noreply@blogger.com0tag:blogger.com,1999:blog-5535253591973377031.post-12597117151703591132013-06-11T12:19:00.000-07:002013-06-11T12:19:33.006-07:00Welcome to M.E<br />
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Firstly, I hate the term chronic fatigue syndrome. I was a parent for four years prior to hitting the M.E wall. Being a parent is to be chronically fatigued - having M.E is very different. If only my single symptom was fatigue. If only the fatigue I experience as a baseline of my illness were like any tiredness I have ever experienced. As you will know if you are reading this because you have M.E it isn't like that.<br />
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In the run up to hitting the M.E wall I was experiencing periodic symptoms, days when I felt like I was wadding through treacle, days when I couldn't understand what was going on and felt scared. I had had three major abdominal operations and never quite recovered from the last. I kept pushing through the treacle, but one day I hit the wall. I couldn't get out of bed. To move felt like every cell in my body could not work, it was very challenging to even get to the bathroom, my body felt alien and over taken with weird and strange sensations. Over time I began to unpick what was going on and differentiate between symptoms and what was going wrong, but not why.<br />
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I have observed my body and my illness for over two years now and I am convinced that what is going wrong is in the brain. The brain controls everything, it controls whether adrenalin, sugar levels crashing, pain pathways, nerve sensations are switched on or off. There is no pathology in the organs involved in these symptoms, my blood sugar levels are recorded as on the floor some days but the endocrinologist can't replicate this and there is nothing wrong with my pancreas. My blood pressure is high/low for no reason, and my heart can race, jump do very strange things, but there is no pathology in the cardiac system of my body. My body can tingle and thrum as if every single cell is vibrating, yet there is no nerve damage or problems like with MS. So for these symptoms to randomly come and go means by brain is instructing the organs to behave in this way. There is something wrong with the brain not the rest of the body.M.E recoveryhttp://www.blogger.com/profile/01015059601098075577noreply@blogger.com0