A Pacing-Up-date

We’ve decided that it’s really time to upset the apple cart. The last few months have helped us figure out that we want to do something really different for the next few years. We know that it doesn’t include owning a house. It may be sizing down to an apartment and looking for jobs that better fit our new life plans or really going wild and buying an RV. It all depends on how God leads us.

So the press is on. We’ve listed the house and now we have to get it ready. There are so many projects and I have a pacing plan. I know it doesn’t make sense but I have troubles with pacing up and down at the same time.

This morning we started off well with breakfast, stretching and ice. Then I mowed. Since it only takes 40 or 45 minutes I used that as a substitution for my 30 minute walk. After lunch I started on cleaning 8 sets of combination windows and the aluminum storms. Half way through my back was on fire so I iced. When I finished up I drew a warm Epsom salt bath.

Since I pushed it so hard on the chores, I skipped the stairs today. I feel pretty good about the balance of my activities. I had 3 really good periods of activity where I didn’t let the pain control me. Using the desensitization techniques proved very effective at controlling it. I have 8 more sets of windows, 2 picture windows and 2 doors to do tomorrow. Hopefully I’ll get it all done before the house gets showed in the evening.

s

Pacing My Projects

The planter and steps on our front porch has been suffering from water damage. A couple of weeks ago I worked on the steps and got them looking better but this planter was still needing some attention.

I got out a little 5 pound hammer and starting whacking away at it. Soon figuring out that I was going to need something bigger. So out came the sledge hammer. Denise had come out to help me. She loaded bricks and shoveled dirt while I broke it up and carried the bricks to the truck.

I was working on my new pacing for pain management techniques and thought I was on a roll. We had dirt and bricks everywhere. I was busy busting it up and Denise was telling me it was time to start cleaning up. As you can see we had only made a little progress. But I was planning on getting at least half of it done in the couple of hours that I had allocated for the activity.

So listening to my wife’s advice (as I always do). I finished loading up the bricks and cleaned up the mess. We took a little break and then hauled the cement and bricks out to a place we could dump them.

It wasn’t until this morning that I realized how much I was going to pay for my 45 minutes of work. WOW! I guess this is going to be a project over the next few days. Am I ever thankful for my new skills of stretching and icing to desensitize my nerves! So to say the least I wasn’t a ball of fire at church this morning. Afterwards, we went on a 30 minute walk and I think I’m pretty recovered. I think tomorrow, I’ll not try to do quite so much!

s

Target Heart Rates for Aerobic Exercise

Before you start exercising, consult with your physician to determine your appropriate heart rates and whether there are any physical limitations that you need to consider.

We were having a discussion the other day about what our Maximum heart rate was and at what level should we push our hearts to get good Aerobic exercise. The first thing we have to find out is what our Maximum Heart Rate is. This is simply a calculation of 220 minus our age. So as you can see below. At age 55 our Maximum Heart Rate is 220 – 55 = 165. From this number we can start coming up with some plans.

For someone who has not been exercising, I would suggest that they target the 50 percent level of their maximum heart rate. While doing this you should be starting with a lower duration of exercise. Let’s say if our long term goal is to walk 30 minutes, you may want to start out at 5 or 10 minutes twice a day at an easy gate. Once you have created a reasonable baseline you can start increasing by a minute a day. After a week you should be ready to start kicking it up.

The next step would be to pick up the pace of your walking to simulate how you would walk if you were going ‘to get somewhere’. Monitor your heart rate so you know how each change that is made affects it. The goal would be to get up to the 75 percent range. You may need to add some hills into your route if your heart rate doesn’t want to come up. This is a good range to be at for the average person who is just wanting to stay healthy.

If you decide you are going to train for a more arduous event you could work yourself up to the 85 percent range. I’d say at that point you should be working closely with a trainer and physician to make sure everything is okay and monitored properly. The only other note for the average person is that it doesn’t hurt to push from 75 towards 85 percent on a once or twice a week basis just to keep the edge on.

Age 

Maximum HR

50 percent

75 percent

85 percent

20

200

100

150

170

25

195

98

146

166

30

190

95

142

161

35

185

93

138

157

40

180

90

135

153

45

175

88

131

149

50

170

85

127

144

55

165

83

123

140

60

160

80

120

136

65

155

78

116

132

70

150

75

113

127

75

145

72

108

123

80

140

70

104

119

85

135

68

101

115

 

Pain Management Program – Graduation

To Be Continued…

This is a milestone in a journey where there is no destination. It’s about enjoying, learning and growing through each moment. There are no failures only tomorrows.

The Pain Management Program at University of Nebraska is complete for me. Now starts the journey of managing chronic pain for ‘maybe’ the rest of my life. Many thanks to the PMP team for all of their hard work and compassion. And thanks to my pal Amy for showing me courage and giving me friendship. This series of blog entries is complete. I have ideas for future updates and some tools that I want to share when I have them more fully developed. I hope to share them in the next few weeks.

s

Pain Management Program day 24

Learn to appreciate your pain

What! Are you crazy? Not as much as I used to be!
We were challenged today to consider ways that our life has been made better because of our pain. Actually this isn’t a new concept to me. I knew for some time that I was addicted to high stress and demanding work environments. I knew it wasn’t healthy for me but I couldn’t get out of it myself. That is where I am thankful for the pain. It wasn’t a pleasant experience. It was like ripping my heart out. But as time went by and I started unwinding this overwound body, I appreciated the path I am on and the pain that made it possible.
The other aspect that we learned about is the attachment we have to our pain. During a lesson on Thai Chi we were practicing focusing on our breathing. The focus was supposed to be solely on our breathing. We shouldn’t let our mind wander but when it did we should simply return our attention to the breathing. After the exercise we were asked about the thing that we were thinking about when we lost our focus. Mine was the pain in my shoulder. The goal is to set the object that would take your attention away and set it aside so you could focus on the breathing. This act of returning focus on the desired object is the goal of the exercise and it can be a way for us to learn to divert our attention away from pain and toward other activities that are more desired. I think it goes along very well with mindfulness where we keep our focus on the moment.
Today we set our non-physical therapy goals for the next month. I’m excited that the program is about over and I’ll get to start applying the techniques that I have learned in broader areas of my life. I have already started having discussion with Denise about what some of our mutual goals are and how I will pace myself on a day to day basis. I think she is going to be a great teammate as I get accustomed to my new life plan.
s

https://www.the-jacobsens.com/2013/09/pain-management-program-graduation.html

Pain Management Program day 23

Living well with pain.

The theme for the last couple of days is the idea of preparing us to manage our own pain program after we leave the four week program. Today one of our classes was “Living Well with Pain”. We looked at how all aspects of our lives are involved in successfully managing pain. As always exercise was the main course but we also looked at diet, nature, relationships, recreation, relaxation and stress management, religious and spiritual involvement, and contribution and service. All of these make up therapeutic lifestyle choices. Having a well-balanced life is an important part of managing pain.

This brought to my mind a thought that I have been working on for a couple of weeks. I have been trying to picture what my life will be like as I pick the amount of each of the categories above to balance my life. Of course for me a main consideration is making a living but as I look at the other categories I want to make sure that I include an appropriate amount of each of these.

There are some rules that I want to try to follow.

  • Meals should happen at regular times.
  • Go to sleep and get up at the same time every day.
  • Limit the total chore and work activity
  • Include free time with no purpose
  • Include categories that I don’t readily understand

I had a picture in my head of a weekly schedule with tasks planned for the whole week and they would be color coded with the type of activity they were. I could schedule things like stretching, walking and stairs throughout the day and maybe give them a color of green for exercise. I could do similar things for chores and work, and maybe put fun and social activities together. Then the complete project should have the effect of a rainbow with no one color getting priority. Having a good balance across the week and on each day.

Today was another milestone in exercise for me as I reached my maximum for walking. So where I had got up to 28 minutes twice a day, tomorrow it will be 30 minutes once a day. The way I see this is that I can move the saved time to another “active” category like chores or work. It could be recreation. Either way it would be something other than relaxation. I have gained a level of activity that I don’t want to lose.

s

https://www.the-jacobsens.com/2013/09/pain-management-program-day-24.html

Pain Management Program day 22

A big day.

Today was a really full day for me. My schedule was completely full plus I still had to get my exercises done. My walk is up to 26 minutes and I’m up to 5 flights of stairs. Both twice a day. Then I also have 20 minutes on the bike. By the end of the day I was beat. I came back to my room and basically collapsed. This is the type of day I don’t want to have in the next few weeks so I’ll plan so that I’ll only do the activities that will also give adequate time to do exercise and relaxation.

I had a session with my PT today. It amazes me how she starts the evaluation with very soft touch at the top of the head, on the shoulders and down the sides of the chest. It’s as if she was hardly touching me. For the life of me I don’t get how she can tell anything. But I know she can. I can tell by the way my body has responded in the last 3 weeks. I have flexibility in the hips and lower back and my shoulders slide back and forth easily. I am still having problems with raising my arms over my head. She says it’s due to chronic stiffness around my sternum and ribs. She has given me more stretches to specifically work that area but indicated that these may be areas that will always be tough for me to get moving.

Later in the day we had a lesson on exercising at home. We discussed the different types of people that are available to help us with exercise, their expertise/certification and what some of the deficiencies there may be in their knowledge or experience. Especially around the area of chronic pain and activity pacing. It is far more likely that medical doctors are trained to use intervening methods such as medicines or surgery. Personal trainers may know muscles and how to work them or they can teach us how to use the equipment. Both of these professions have their place but people with chronic pain need different types of support. The thing we need to focus on is that we now have the tools to make our life better. First we look at exercising for flexibility, then endurance, coordination and finally strength. The elasticity and length of our muscles is the first best defense against our pain. Then follows the rest. We will be our own best advocate, we can get input from our physical therapist and others who are in our life but in the end it will be our responsibility.

At the start of the four weeks we completed a video tape session that took us through a series of activities including walking around a mat, sitting in a chair, standing on one leg and stretching exercises. I know from the graduation of the last class that this video is compared to one at the end of the program to show and make a record of our progress. So we finished our day today with our discharge video. One of the things I laughed at myself on today was the standing on one leg. Over the last three weeks I’ve actually become very bad at it. I think with all my joints getting loosened up, my body doesn’t quite know how to handle it.

So there’s three more days to go. I’ve really enjoyed this but I’m ready to go.

s

https://www.the-jacobsens.com/2013/09/pain-management-program-day-23.html

Pain Management Program day 21

Just because it’s such a big part of pain management, I want to reflect a bit more on pacing.

Saturday morning when I got up, we had the pressure of the garage sale starting so I skipped breakfast. That threw my day off right from the start. Even though my activity and rest was alternated fairly well. Missing breakfast, messed up my stomach and then lunch was delayed. Consistency is important especially in the daily meals.

I really felt bad that I was setting myself up for a poor Monday.

Then Sunday night, I wasn’t paying attention and forgot to take my Ambien and Cymbalta. I had a fitful night of sleep. I woke about 2:00 and ate a small breakfast, watched a little TV and started feeling like I could sleep at about 3:00. That’s when it hit me about the medicine. No wonder I couldn’t sleep. It was too late to take the Ambien but I took the Cymbalta. Then I had four more hours of restlessness. I really felt bad that I was setting myself up for a poor Monday. So the moral of the story is that there is more than exercise and relaxation to consider in pacing.

Today, we had a good lesson on Exercise and the brain. There was a lot of good information about how exercise creates chemicals that make you think and feel better. The most compelling information was that compared to Cognitive Behavior Therapy or Medicine, exercise is equal in its results. With no side effects!

I’ll have to be careful to not fall into the same patterns of workaholic-ism that exacerbates the pain, fatigue and all of the other symptoms of fibromyalgia

The second lesson for the day was about affecting change and resisting relapse. One of the issues I’ve been dealing with is that I am addicted to stress. Working my way back into the workforce, I’ll have to be careful to not fall into the same patterns of workaholic-ism that exacerbates the pain, fatigue and all of the other symptoms of fibromyalgia. I’m hoping that by the end of the week I have a much more clear plan on what I’ll be doing for the next few weeks as I take the plan into life.

Monday’s end up with a session in the Therapy pool and relaxation. I was really happy that today I completed a stretch where I stand against the side of the pool and lift one leg toward the opposite hand. I was able to make my foot touch my hands on both sides fairly easily. I’m not sure how that happened. I had felt stiff and sore all day from the poor night of sleep. I need to remember that pain is not equal to flexibility.

s

https://www.the-jacobsens.com/2013/09/pain-management-program-day-22.html

Pain Management Program days 19 and 20

Practicing Pacing!

This weekend went pretty well. Denise had been setting up for a city wide garage sell for the last few weeks. She had it mostly set up and all I needed to do was show up.

Saturday morning we were up at 7:00 and had the doors open before 8:00. I helped get things set out and took a couple of breaks through the morning to exercise and stretch. We shut down around 2:00 in the afternoon. I found time to ice and then mowed most of the yard later in the day. After dinner we had an ice cream date downtown.

Today we had church. It was a more relaxed morning than last week because I had fewer responsibilities. This afternoon we had time for some relaxation (Football), walking and getting ready for coming back to the Med Center. All in all I felt pretty good about the weekend. I had pain but worked through it with exercise and ice. I think my one downfall is that I really didn’t do well at relaxation (focusing on relaxing the mind and body). I need to get that into the plan. Oh Yeah, I need a plan too! Denise wasn’t sure what I was going to try to get done while I was home and I didn’t plan for my different needs.

So tonight, I’m settled in at the Med Center. I’m anxious for tomorrow and to get through the week. Looking forward to finding out what the team will help me develop for a plan as I get on my own.

s

https://www.the-jacobsens.com/2013/09/pain-management-program-day-21.html

Pain Management Program day 18

The pain management program is attended by two sets of people. Both can be attending for a period of 4 weeks but one class is 2 weeks ahead of the next. They refer to these classes as Seniors and Juniors. I think this is one of the most helpful aspects of the program. As new students come into the class they see the seniors, who after two weeks are walking and cycling good distances. They seem happy. They are optimistic. The list goes on. This encourages the juniors who the seniors see on their first day and wonder if they looked so forlorn and crippled. They come in shuffling their feet and exhibiting all sorts of pain behavior and talk.

You see tears because of the realization of the things they have lost and now they have hope in regaining them.

At the end of week 1 for the Juniors, week 3 for the seniors we have a group session and it’s the students who do the talking. Each person gets a chance to say what the week was like for them and then the others get to respond. It’s a very powerful time to see the courage and hope in each persons walk through this program. We get to hear about activities that an individual gave up long ago because of the pain and fatigue, and their plans to start back at it this weekend because they are already feeling better. You see tears because of the realization of the things they have lost and now they have hope in regaining them.

The staff told a story of an earlier time in the program when they had fewer students. In one 4 week period they only had one individual going through the program. While he was getting lots of attention from the staff, he missed a great deal in the encouragement and challenge that he would have received if attending with other people. Especially other people who were at different stages of the program.

Today we completed the endurance testing and set goals for next week. I’ll max out on the walk by Wednesday but will only increment by two flights on the stairs. Still a slow go with my heart rate. At least I get to move up this time. I have just one more week before they are done with me. I’ll be able to manage my pain on my own. Well, almost. I will need the support of my wife. I can go back to the PMP for refresher classes and to use the gym. But the goal is that I will be on my own. No longer depending on others to fix me. I’m anxious for that. I won’t be cured. I may not have the life that I had before but I’ll have a much healthier and fulfilling life than I was living in pain.

s

https://www.the-jacobsens.com/2013/09/pain-management-program-days-19-and-20.html