Let's Talk About Grief, Baby

I'm pretty sure when Salt-N-Pepa wrote this memorable song "Let's Talk About Sex" in 1990, they didn't think it would be parodied by a tiny blog discussing grief.  Have you ever seen this music video? The lyrics begin with "Yo, I don't think we should talk about this. People might misunderstand what we're trying to say, you know?...  Ya, but that's a part of life..." I think we need to talk more about "all the good things AND the bad things," which includes death, dying, and grief. The idea of "not talking about something" makes it scarier and allows for stigmatization.  There should be no guilt or shame when it comes to grief, but for that to happen, we need to talk about it.

The Fam <3

If you happen to know me IRL, follow me on social media, or you've read my previous blog post here, you know that both of my parents died from complications from Covid-19, fourteen days apart, in December 2020 and January 2021. (Get vaccinated already, for heaven's sake!)  In the same year, my family also said goodbye to my Uncle Pete (November 2020), and my Aunt Marilyn (my mom's sister, November 2021), not related to Covid-19, but terribly sad just the same. They're the four seated in the front row of this photo from our family reunion a few summers ago, all too young and too special to be gone. In the year this was all occurring, there has been incredible love and kindness towards my family and to me, including gifts of several books about grief. Now that I've read them, this post shares a little about each one, hopefully helping you if you're grieving, or if you're wanting to show you care to someone who has recently experienced loss.  

Source.

First, a definition.  There are many- but what stuck out to me was the third bullet on this one: Grief is "a NORMAL, natural, necessary, and adaptive response to a loss."  I initially felt entirely crazy in my grief. I was a different person and couldn't recognize myself.  Nothing about the grief experience feels normal. I started running late and losing track of time when I'm typically way too early for everything.  I forgot about commitments, getting texts asking where I was, only to realize that I totally spaced it. I said no, when I typically would say yes. I didn't want to help other people, and that's what I do for a career, and typically love. I was angry, I cried hysterically in the middle of Target, I had to pull over on the side of the road because I couldn't see through tears to drive, I couldn't sleep - when normally I'm the ultimate sleeper, I couldn't get out of bed, I stopped cooking, and I went into isolation. I'm about as extroverted as it gets and I didn't want people around me. These behaviors were far from my normal, so for someone to say it was a "normal" response was helpful. 

If you're also grieving, it is likely that your experience will differ from mine.  My brother, sister, and I were going through it together, but we each had (and still have) different responses to our losses. It doesn't do ANY good for us to compare to each other, because the person you're grieving held a personal meaning to you, and the family members I'm missing held personal meaning to me.  I talked to my mom on my drive home from work 3-4 times per week for seven years.  The drive home form work is one of the worst times ever for me... my brother doesn't have that same experience.  Fortunately he'll answer if I call him at that time, knowing what's going on.  Even for the family members grieving over the same people, the hole in your heart and soul doesn't feel the same for each of you. For me, grief has been fear and anger and frustration and sadness and confusion and loneliness all rolled into a ball. And pain. So much pain. I've written many blog posts about pain in the past, but grief is the first time I've experienced so much pain that was 100% connected to my psycho-social experience. There was nothing wrong with the anatomical structure or physiological function of my heart, but there was SO much pain and it was very real. (Come to find out, about 3 months after my mom died, I was diagnosed with pulmonary emboli - so it's possible that there was something going on anatomically, then, too, but that's a story for a different day.) None of my learning about pain prepared me for the pain of heartache.

All the pain and emotions came with gratitude, appreciation, reflection, and love for the people we lost and those who cared about our family. I hope that in your grief, you can find these positives - but they don't shine through every day. At the beginning, almost all of the days felt very dark, with very little time for light. As time has passed, there has been more time for light, and the dark has been less frequent and less intense. Perhaps you'll find one of these books or an idea in this post to be helpful for navigating this unmarked territory. Or at the very least, maybe you'll laugh at something in the music videos and have a brief period of light to disrupt your dark. 

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Book #1; "Healing After Loss" by Martha Hickman was the first grief book I started reading about two weeks after my mom's funeral. A good friend from high school who experienced heartbreaking loss sent it to me with the sweetest note. "Abs - people sent lots of stuff after what happened. This book was the only one I could handle. Short and simple. One page a day. If it helps, great. If not, use it as kindling.  Love ya." <3 My sister actually received it as a gift from one of her friends, too.

I have so much gratitude that I was able to take a leave of absence from work because I could not have been a functional physical therapist - or human - during that early time.  At the beginning, I know I was breathing, but I wasn't really alive.  I would see my therapist and she would ask me how eating, showering, and sleeping were going, and would ask if I had done any body movement at all.  We decided focusing on those basics initially was the best way to go, and beyond those, I set the goal to read a single page each day.  Accomplishing that goal was the first step to a long pathway back to returning to life. This book is set up like a calendar, one page per day of the year with a quote and a meditation related to grief and loss. In the beginning, I didn't have the ability to focus. For someone who reads about 40 books per year, it shocked me that I couldn't read a full sentence, let alone pages or chapters. My mind would wander or I'd just end up staring off into space. I spent a lot of time in the fetal position and, at the recommendation of my cousin, watched the entire series of Lost to occupy time and distract me between phone calls with my family. A book where I could read a single page was ideal - and honestly sometimes I had to re-read the same page several times to get through it and retain anything. Some of the quotes felt applicable and helpful.  Suggestions to move my body to get me out of my head - even if it meant getting up to get a drink of water and then curling back up buried under a pile of blankets. Acknowledgements and appreciation for the people who've been lost, knowing that early on, that's really hard, but that as time passes, the memories won't be as sad and there will be happiness and joy recalling time we spent together.  Recognizing that grief is hard and heavy but that there is life to live if you can manage to move through it is a common theme.  I liked this book, but also read it a page at a time, and once I returned to work, I sometimes would miss a few days, so I still have some left to get through, but I'll finish it eventually.

Book #2:

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My therapist gave me "It's OK That You're Not OK" by Megan Devine. She recommended I purchase this book a few times, but I couldn’t put myself together enough to order it or get it from the library. I was still having all my meals delivered and not leaving my house except to see her every week. Beyond basic survival, I didn't do anything except watch Lost and talk to my family with occasional friend visits, still incredibly fearful of the stupid Coronavirus. So when I arrived at a therapy session, about two months into my grieving, and she handed me a copy of this book, I finally understood how much she thought I'd benefit from reading it and by then, I was capable of reading for longer stretches.

This book was really good because it presents a first-hand experience from the author, who is a therapist, who suddenly lost her husband. She shares her grief and lets you find places where it matches your own. She shares many of the things commonly said to someone who is grieving and explains why some are helpful - and others are painful.

What I'm writing here is what I experienced, but the book explains similar situations, why they're painful, and what to do instead. For example, at the beginning, nobody else could understand what my siblings and I were experiencing. Tons of people said "I can't imagine what you're going through." I have a shoebox full of condolence cards that say that sentence. It's probably an accurate statement, said with good intentions, but instead of saying this, people could have asked what I was experiencing, helped me to process in some small way, and share in my grief. This is semantics... but as I preach in healthcare, the words we use matter, and these circumstances cemented that belief in me. Another common case of good intentions but hurtful words in our situation was "at least they're together." Remember, my dad died, and then fourteen days later my mom did, too.  I don't know about my brother and sister, but initially, I tried to find solace in knowing that they were together, but that never made me feel better. They didn't both need to die. Why couldn't my family at least have one of them, still? 

From "It's OK that you're not OK."

A few people told me they didn't know what to say to me, but they planned to keep showing up hoping that it was good enough. Trust me... it was. It is. The random text messages of my friends' kids on their back yard swing set, late night phone calls, invitations to get together even though I would likely decline, just dropping by to say hello, bringing over homemade dinners, offering to pick up Dairy Queen since you're going with your kids and they'll be quiet eating it in the minivan long enough for you to give me a quick hug? Asking how I was and not accepting "fine" as an answer, making me truly share how I was, and telling me that it was OK to cry, despite my embarrassment... that mattered. Those were really thoughtful and helped me feel like I wasn't forgotten while I wasn't able to live my own life. Friends took care of my house and made sure my mail was picked up, plants didn't die, and had a house cleaner come in while I was traveling for funerals. Showing up, however you do it tells the grieving person that you know they're hurting, and that you're willing to sit with their pain. You're not trying to take it away. You're keeping us company while we try to find air in our lungs. It's proof that we're not alone. Asking about memories so we can feel our loved one with us is even better. A grieving person is thinking about their loved one non-stop anyways... you bringing it up might be hard, but it provides for an outlet.

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The end of this book contains a short essay "How to Help a Grieving Friend."  My favorites: "4. Be willing to witness searing, unbearable pain." "5... Your friend cannot show up for their part of your relationship very well.  Please don't take it personally, and please don't take it out on them."  and "6... Do not say 'Call me if you need anything,' because your friend will not call.  Not because they do not need, but because identifying a need, figuring out who might fill that need, and then making a call to ask is light years beyond their energy levels, capacity or interest." Saying "What can I do" to someone who has a gaping hole in their heart doesn't work. They want their loved one back - nothing you can do will achieve that. Want to bring over a meal?  Offer it on a specific date and time. Want to sit with your friend while they cry? Tell them when you plan to show up. Send a note, a drawn picture from your kids, a text message just saying you're thinking about them. Recognize that your life is continuing with little change, but theirs is frozen in time.  

Book #3: 

Another friend send me this book, a favorite in her family, that is an illustrated story about, "The Boy, the Mole, the Fox, and the Horse." It's a sweet story about kindness and friendship with beautiful drawings.  Though it's the shortest book of the group, it took me a while to be ready to read it because the cover felt like it would be sad, and I was already sad! This one can be read as a book or you can just open up to a page and enjoy the individual messages - it's designed to be read either way. It probably would be a good choice early on, particularly if you're not capable of concentrating very much. And then I sent it to a friend who experienced loss of a special pet, and she seemed to really appreciate it, too. 

Book #4: Last but not least, "Finding Meaning." arrived with a note recommending I wait a bit before diving in and reminding me how many people cared about me. Ten months into life without my parents, I decided I was ready to read it.  I sat in my therapist's office telling her that we were nearing a year of grieving, that I thought it was time for me to decrease the frequency of our sessions after getting through the anniversaries, and that I was going to read my final book about grief before moving on. And then I read Chapter 2 of this book which shares that grief doesn't end at a year or any arbitrary length of time. When asked "how long should someone grieve," the answer is "as long as I'm alive without the person I loved."  It may not hurt as much or as frequently, but that emptiness and sadness exists and can be triggered forever.  The book uses this as part of it's main theme - that Kubler Ross' 5 Stages of Grief end in Acceptance, but that she missed the 6th stage: Meaning. Meaning in the life (lives) that have been lost and in your own life moving forward without them.  Meaning helps make sense of grief.  It can look like gratitude, commemoration, honoring, shifting behaviors after the realization that life is short, or something else entirely.

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Finding Meaning shares the benefits of expressing your grief.  I've written about my grief once before, and spoken about it quite a lot, including discussions with my family about my preference to continue including my parents in our future life experiences, even though they're not here. Some people lose loved ones and they keep their emotions inside and private.  That could be ok for them, but it isn't what feels right for me.  I wouldn't be who I am if it hadn't been for the way my parent's raised me. They'll always get a little bit of the credit for whoever I become, and I will intentionally acknowledge that. This book seemed to examine death more than the others. How our society looks at death as a failure - despite the fact that 100% of people die. It explains that grief is inevitable where there was love, but that suffering is ultimately a choice that we can individually control, though that seems impossible at the beginning of this road. I know I still experience moments of suffering, when the pain overtakes me as I accidentally go to call my mom on my drive home from work, or I want to ask my dad a question, and forget for a moment that I can't. I don't suffer as much as I did before, and I think it's important to share that for anyone who might be grieving and comes upon my post.  Yes - I miss my parents - every single day, but I can continue living and keep them part of my life even though they're gone.

Honorable mentions: I also read Michael Rosen’s “Sad Book,” a book about grief appropriate for little kids written about the loss of his son, and Tom Hart's “Rosalie Lightning,” a graphic novel with incredible artwork depicting the loss of his young daughter. While all of these books helped me in different ways, I didn’t read any specific to loss of a parent, and definitely not two of them fourteen days apart with the added loss of two more close family members, and for certain not during a global pandemic where it was impossible to mourn with the rest of our family.  I would think more people lose parents than spouses or children, but maybe they're not usually as traumatic and they're more expected that less books are written about that?  Above all, I’m so grateful for these gifts, particularly the notes that accompanied each of them, and I can appreciate that others, including many in my family, have felt loss in a deep way this past year.

Added June 9, 2022: At the suggestion of a friend who was also experiencing grief, I read "Welcome to the Grief Club: Because you don't have to go through it alone" by Janine Kwoh.  New in 2021, I was already a year into my grief process when I read it, and liked it.  This book was different than the others and deserves inclusion in my post because it was helpful, supportive, validating, and used multiple mechanisms such as a short page or two of text, questions with answers, characters with speech bubbles, and even graphic representations to help process thoughts and emotions.  I think I would purchase this one to send to someone experiencing grief because it was easily digestible in small chunks, and, considering the topic, it was the easiest to relate to. 

Typical of me, this post has gone on far longer than I intended.  Music often enhances situations, but the anthem of this post can't be "Let's Talk About Sex."  At my Aunt's funeral, my cousins chose to play "You Are My Sunshine," which my Aunt sang to them - and my Mom sang to my sister, brother, and me. I couldn't believe the snow that started falling while a song about sunshine was playing. For me, I tend to cling to a song during emotional times, particularly if the lyrics seem to fit the situation.  Later on, if I happen to hear that song, I flash back to that time and appreciate the memory having a theme song to accompany it. Since my parents died, I've been cherishing the comfort from my family and my oldest friends, and so for many months, I've been playing Ben Rector's "Old Friends" on repeat. Those friends who are more like family, like my cousins who also feel like friends, all of which knew my parents. People who were sad about what was happening for their own reasons and grieving alongside me. I think people who are sad need to find what feels most comfortable, and for me this was what felt right. "Cuz no one knows you like they know you and no one probably ever will, you can grow up, make new ones, but the truth is, there's nothing like old friends... I've got some good friends now, but I've never seen their parents' back porch. Wouldn't change how things turned out, but there's no one in this time zone who knows what in-line skates I wore..." Some awesome lyrics on repeat for many months filled with sweatpants, blankets, tea and LOTS of tissues and FaceTime.  So why not post two different songs with entirely different tones and messages to round out the same blog post? 

If you're grieving, I'll keep it real and tell you this sucks. So much. And it hurts, right where your heart is beating in your chest. But it's normal to feel this way if you've had love in your life. You're not alone. And while you'll continue missing your people, there is life worth living even without them, and you can bring your memories of them along with you.  Take photos with your loved ones when you see them next... you'll be glad later.  And tell people you love that you love them. 

If you need help, here's the Crisis Grief Text Line for you to get help right now.

Sending love to Aunt Marilyn, Uncle Pete, Mom, and Dad. Always. TTHAS. 

Science of Social Isolation

A few weeks ago, during the insanely stressful period of the United States Presidential election on top of a global pandemic, I wrote this post on Facebook:

Since that time, things have gotten progressively worse.  Last night I got into my car after work and burst into tears in the parking garage.  Instead of driving home, my car (not a self-driving vehicle, but somehow able to drive without my brain functioning) drove to my dear friend's house, still in the beginning of her post-Thanksgiving quarantine, and I melted on her front doorstep.  As my mask collected my tears, I crumpled.  I definitely didn't see it coming, and for certain I'm not ashamed to admit that I had hit a complete and total breakdown.  I'm not sure if sharing this helps others to realize they're not alone right now in whatever deep, dark place they might feel like they're existing in.  Maybe this makes people more sad.  But I've now reached the portion of the pandemic where spontaneous crying is occurring, and I know that I'm not the only one in Struggle City.

Why now?  Maybe it's the new restrictions from the Washington State Government shutting down the gym which was the only place I was really going (besides work, the grocery store, and Home Depot).  Maybe it's the winter in Seattle where the days are gray and cold and the sun rises late and sets early so you feel like you're in a Stephen King novel all the time.  Maybe it's the holiday season without being able to see family or friends, none of the usual festive parties and seeing everyone's trees and menorah's all brightly lit.  Thanksgiving with a close friend was really great - but we didn't shy away from acknowledging that the world is weird and so heavy right now.  Or maybe it's the fact that I attended two virtual weddings and a funeral in the past few weeks, all of which would have been supremely better experiences if I had been there with my family and friends.  The list of possibilities for why this hit me now goes on... but those seem like enough.  I'm sure you can come up with your own.

The reality is that I was not built for social isolation. Early in the pandemic, I felt like going to work was enough social interaction for me to keep on thriving. It isn't anymore. You can sense the weight of the Coronavirus in every corner at work, on every coworker, at every socially distanced lunch break, and with every single patient/family.  As a 100% extrovert, I feel like a battery that has been running on empty for so many months. Drained. Nothing left to give. My usual options for battery recharging are not available... dinner with friends, eating out, traveling to see my family, traveling to escape the Seattle weather and find sunshine, hugs, the gym, occasional visits with my friends' pets, sitting at a bar, sporting events, movies... another list... I'm rambling.  It doesn't energize me to work out at home or go for a walk alone.  Isolation in a different place doesn't change my feeling of being alone.  Skype calls - though they definitely help - are just not the same as dinners and happy hours or brunch.  Remember brunch?!  I don't bother with take-out meals on my own.. seems silly when I can just make something at home and save money. Why take a day off from work to do absolutely nothing? Amazing that bathroom renovation and painting my whole house boosted me up for a while.  If this is making you sad or depressed, I'm truly sorry.  I'm not depressed... I'm just insanely aware of being alone, emotionally exhausted, and feeling like the world is too heavy.  How did Atlas do it? If this is how I feel, I can't imagine how my superiors or those who actually work on the front lines are doing it... cuz I'm not even treating patients suffering from COVID!

So what's a person to do when realizing that social isolation is kicking them in the face?  The options are pretty limited right now.  Today I started looking up research about the science of social isolation.  With patients having chronic pain, we teach them how pain works to try to help alleviate it... maybe learning about social isolation will help me cope?  I used ResearchGate to look at this 1988 paper "Social Relationships and Health" by James S. House. Interestingly, I also came across a monthy by month list of citations for this paper's abstract and, not surprisingly, it has been cited an average of 2,000 times per month in 2020 where it would only have gotten a few hundred citations before the pandemic

Here's what I learned:

1: Prospective studies have found an increased risk of death in people who have low quantity and sometimes low quality social relationships.

2: There has been longstanding curiosity with regard to which comes first: do people who are less integrated into society have bad health or do people with bad health integrate into society less?  Gotta love a good chicken or egg conundrum.

3: The connection between mental health and physical health has not been studied with nearly enough depth or breadth.  Before I started learning about mental health - and giving any thought to my own - I'm not sure I even believed they were so intricately related.  Now, I don't want to go more than a week or two without seeing one of my mental health providers.   

4: My favorite quote: "...what was consequential for health about social relationships was their supportive quality, especially their capacity to buffer or moderate the deleterious effects of stress or other health hazards."  

5: A 1965 study looking at 4775 people between ages 30-65 examined four types of social ties: marriage, contacts with extended friends and family, church membership, other types of group memberships and the impact on mortality.  It was at this point that I realized the articles I had skimmed - and this one - don't fit the problem I'm experiencing.  I have really, really, really wonderful relationships.  About 90% of the time I'm at grossly unaware of fact that I'm not married... sure underneath and when brought to the surface, that's missing, but I don't sit around thinking about it on the regular.  But truly I have so many great family and friendships... and right now I can't be around any of them!  Does their absence have the same meaning?  

So I searched for more papers and read more abstracts.  Because I'm a science nerd and... seriously what else do I have to do?  I'm going to be here sitting on my couch either way - I could do this, read a book, or continue binge watching Friends.  At least this is a little bit different, and I can share it with you.  I scanned abstracts that look at the neurobiology of loneliness, the relationship between social isolation and cardiovascular illness, saw lots of information on social isolation for the elderly population, psych papers looking at depression, and then:

"How the  Covid-19 Pandemic is focusing attention on loneliness and isolation," a June 2020 paper from Australia.  Here's what I learned:

1) Social isolation (absence of social connections) is not the same as loneliness (subjective dissatisfaction with relationships).  I feel loneliness when I find myself single at a wedding... I feel social isolation when I haven't seen my parents in a year and my friends in several weeks as we are responsibly distancing ourselves to prevent COVID spreading.  Both social isolation and loneliness have been shown to predict premature mortality, depression, cardiovascular disease, and cognitive decline.  (Hello brain fog!)

2) I'll give you a hint at the recommendations for how to improve the negative feelings: exercise and social interaction.  

And so, I'll end with this.  Check out this image and find out where you're at.  If you're in the green and yellow - maybe you have the capacity to check in on your friends to see where they are.  Yesterday I was in the red.  Thankfully, today I'm more yellow/orange and had the ability to check on someone else.  But yesterday I needed someone to check on me.  Know that it's ok to tell someone you need help.  Tell me!  Tell your neighbor.  Tell your family.  Tell someone.  Just saying the words "I really need help right now" made all the difference in letting some of the weight go.  No shame in tears... I know mine will come again.  In the end, we're all going to be ok.  We're all going through this together.  It sucks for everyone.  It sucks for parents who are schooling their kids at home and can't get a moment of quiet alone time - and it sucks for those of us who are alone.  It sucks for healthcare providers, teachers, grocery store workers, real estate agents, business owners, and delivery people.  Honestly, it's pretty hard to find someone who hasn't been impacted by the pandemic at this point... and it took every ounce of strength not to lose my mind on the parents I saw congregating at the playground today, maskless, and too close together, when I dragged myself out of the house to go on a physically distanced and masked up walk.  We all have an obligation to help keep each other safe, now.  We all have an obligation to care for our friends and family.  Let's hope the vaccine is near and that we can go on airplanes again in 2021!  Good thing I'll have some vacation time saved up. 

Life in the Time of Quarantine

Hi Everyone -

Hope you're all hanging in there, enjoying being at home as much as you can, staying safe, washing your hands and faces.  Is your mental health ok?  Have you gotten any fresh air?  I know that might be hard for some people.  It has been over a month since my last blog post, but that was certainly not for lack of trying.  I've started to write several times in the past few weeks but the Coronavirus Pandemic has actually left me speechless. (Shocking, I know.)  I can't go to my usual coffee shop where I like to write and life has been turned upside-down, just like I'm sure it has been for anyone reading this.  I'm not a scientist and won't pretend to know anything about the virus itself.  I've never been more aware of how much I touch my own face - and even still I probably don't notice it more than half of the time. I'm not on the front lines fighting this, so don't let the masked image later in this post fool you.  I'm spending most of my time in isolation at home when I'm not in the clinic with occasional stops at the grocery store as needed.  Writing a blog post hasn't been on my priority list because I couldn't decide what to write about in the shadow of a global pandemic. As a writer friend recently told me, sometimes you just need to sit and write, let it flow, and see what happens.

Writing is an outlet for me.  I use it to help organize my thoughts and relieve stresses.  It offers an opportunity to be creative, use different areas of my brain, share ideas, highlight things I'm learning, and to show support for causes that matter to me.  At a time when I'm also not seeing my usual collection of mental health providers and also not going to the gym, the sudden and total removal of so many outlets has been a big deal. It helps to know that everyone else is in the same boat.  Nobody else is going to the gym.  We're all working out in our laundry rooms with whatever we have at home or going for walks in the neighborhood.  I've heard of people doing lots of different crafts, trying out meditation apps, yoga in the home, new types of exercise, and some people are buying pets in order to find novel coping methods. You're not alone...we're in this together!

So I'm writing today.  Without having any planned direction or goals.  I've seen a post going around on Facebook that people want to remember what was happening because this is going to be a historical event.  My parents remember when JFK was assassinated and my friends and I all remember where we were on 9-11.  This will be another memorable event for so many people... and nobody will forget where they were because we've all been on our couches for three weeks already!  So this is not my usual blog-writing approach. Welcome to my stream of consciousness.  My apologies for being scatterbrained.

At the beginning, I thought this was challenging because I felt trapped with nowhere to go.  My family is far away.  I was still seeing patients early on and didn't want to risk getting anyone sick. The first week I saw friends who had already started working from home, but then it seemed wrong for me to be around them.  Once I got into a rhythm, particularly with regular afternoon FaceTime gatherings, things started to improve.  The hardest moments have been worrying about my friends who work on the front lines, concerns about my parents and not being able to help them, and realizing that the Final Four was not going to occur.  This weekend should have been the Women's Basketball National Championship - often referred to as my favorite holiday.  Several of my friends here in Seattle have been connived into outings at random bars around the city to watch games with me.  I'm more than happy to treat my friends to some nachos if it means company to watch the Huskies. The NCAA College Basketball Season was so suddenly aborted after the best year of competition EVER. I don't think it quite hit me until all the replays from previous championships started popping up on social media and I realized how much sports can bring people together, how many years of my life I've spent watching basketball games, and how serious this pandemic really is.  You'd think being told to wear goggles, masks, and gloves to treat my few remaining patients would have been sufficient. If you've never worn them - those things are hot, sticky, and make your glasses fog up! 

So now that I've rambled on, I guess I should find some sort of purpose for taking your time.  All I can come up with is gratitude. On Wednesday, March 18th, I went into my clinic to call my patients and cancel their scheduled appointments. That was sad, but a few days later, I started to really miss what I do. I have fortunately had a few days in the office to treat high priority patients and each time I've seen a patient, I've felt life being restored to my body, air returning back to my lungs, energy surging, and the return of my dimply smile.  Endless gratitude reflecting on how my career has unfolded to this point where I have the world's best coworkers all collectively waiting to restore our previous routines.

I'm grateful for the small businesses in my local community who have been able to transition their usual operations to help support everyone at this time.  I've enjoyed some really good take-out meals in the past 18 days at home and highly recommend supporting your small local businesses that are trying to survive.  I'm grateful for all the people on the front lines - healthcare workers, front desk workers, environmental services cleaning crews, demand flow services, and leadership - in my office and throughout the country and the world who are taking care of so many sick people.  I'm grateful for books, the fact that I had too many out from the library when this all started that I'm slowly working my way through, and also audiobook downloads available from the library, and Netflix and Amazon having rentals to watch movies.

I'm grateful for all the different electronic user interfaces that have made it possible for me to have face-to-face conversations with so many people.  Between FaceTime, Facebook Messenger, Skype, WebEx, Zoom, Google Hangouts, and HouseParty - it really isn't hard to connect, but those virtual gatherings don't quite feel the same. There were a few days last week where I bounced from call to call catching up with old friends, seeing how family members are doing, and trying to find that missing sense of connection.  Today my extended family gathered on Zoom in preparation for Passover to begin on Wednesday.  Check that out! People in 20 different homes in at least 10 different states ranging between Washington, Connecticut, Florida, Ohio, Oklahoma, California, and Washington, D.C.

I'm worried for my friends who are working to save lives.  They have families and kids of their own and are at extremely high risk. I wish I could do more to help them, to help sick people, I guess just to help anybody. The most any of us can really do right now is to stay at home and prevent further spread of the virus. I'm very hopeful that when this all ends, there will be improvements made to how we operate as a country and as a healthcare system.  Let's hope this wraps up in time for everyone to enjoy summer.  Let's hope this doesn't destroy families financially, or in any other ways.  Let's hope we can resume travel soon.  Let's hope everyone stays healthy and safe.  And let's hope we can have a massive celebration together on the other side. Let me know if there's anything I can do to help you out.  We're all in this together.

Reconciling Pain Science and Biomechanics

Greg Lehman

It's finally happened. I finally attended a course presented by a Canadian! I also work with a
Canadian Occupational Therapist and from my sample size of n=2, I think it's possible that Canadians are smarter than Americans. Why is it that Canadians seem to know more about American politics than we do? I can only inadequately describe how our government operates and I know absolutely nothing about theirs.  It's like they care about what happens in the world, or something. We should do better, America.

Anyways, since I'm sure you also want to take a course instructed by a Canadian, I'm sure you want to know what course it was? "Reconciling Pain Science and Biomechanics" by Greg Lehman. Greg is a physiotherapist, chiropractor, strength and conditioning specialist, and biomechanist who also teaches a course called Running Resiliency, which is probably excellent if you run or treat runners, which I try to avoid.  (I avoid running.  I don't mind rehabbing runners).  "Reconciling Pain Science and Biomechanics" is a two day course that bridges the gap between the clinicians who focus heavily on pain neuroscience education and the psychological side of the biopsychosocial model versus practitioners who tend to focus primarily on perfection of movement patterns and anatomical tissue structural damage as potential drivers of pain.  If you're working in orthopedics or with pain management you should definitely check this one out.  The course was overall broad with big concepts that ideally could apply in multiple situations.  It also came with an extensive set of resources including his presentation and a huge number of literature papers for consideration.  So much evidence to support the discussions. 

I've previously written about pain here (and several other posts).  Greg defines pain for this course as "When all your loads/stressors exceed your ability to adapt/cope."  Pain is the balance between all the things that are harmful to you and all the things that are good to you. I often like to use the concept of inputs versus outputs with my patients, especially because people often don't recognize that pain is an output. I can't put pain into you. Pain is an output message from your brain in response to stresses that have been applied.  I can apply stresses to you so that a painful output occurs, but instead I try to find the minimum effective dose of stress to input so that your output is positive adaptation, not pain. 

Some examples of inputs: mechanical stress to tissue such as an incision or deep touch or the feeling of your rear end on the chair you're sitting on, chemical stress such as dehydration or improper nutrition, emotional stress such as those from your family or your job, light, sound, and temperature changes.  Inputs are not good or bad, they are just stresses that we have to process in our body.

Some examples of outputs: pain, emotions, sweat (loss of heat), neuromuscular adaptations such as increased strength, seeing your mental health counselor and talking it out, breathing, coping/calming strategies.

So when a person is experiencing pain, anywhere, the options for treatment could include:
1) Can you decrease some of the inputs?  Examples: Turn off the lights, focus on some breathing strategies, go for a walk, change your body position, change the temperature, increase or decrease the amount of touch on the area that hurts. 
2) Can you increase some of the outputs?  These could actually be the same as above because of things like hot versus cold where changing temperature in one way actually accommodates both, but also doing some yoga, exercise, see your therapist, take your regularly prescribed medication if you have diagnosed anxiety or depression that is being medically managed, or spend time with friends.
3) Or can you make it so that you're able to accommodate for more inputs without changing the input or output?  Again, there is overlap here.  But for many people, building up tolerance through strength training or meditation practices or learning ways to desensitize your skin can all have this sort of impact. 

It's important to also consider what is getting in the way of making some of these changes. Is the patient fearful of going for a walk because they have pain in their foot?  Are they catastrophizing or perseverating on horrible possible outcomes by participating in a certain activity so they're unwilling to try?  What are the current beliefs and expectations about their condition?  Knowledge about how the mind and body connect and work together can help decrease these roadblocks to facilitate recovery.

Greg provided some important questions to ask patients to help them return to their favorite things.  For example, "In what ways do you think you could be healthier?"  This open-ended question allows a person with headaches to consider that maybe they could better hydrate, have more nutritious meals, sleep at more optimal times, go for a walk at lunch time, maybe acknowledge some of the recent spikes in stress at their job or school... but it allows them to identify potential sources of their pain, allows them to outline what they believe is happening, and also gives you a chance to better learn about the patient. 

Greg Lehman and Me

He also discussed the importance of asking "What activities are meaningful to you?"  So, for me, I really like to play softball.  When I hurt my knee a few months ago, I was disappointed that I couldn't play for a week or two, but then I was able to return in a modified way.  If I hit well enough, I could hobble my way to first base and get myself a substitute runner for the rest of the bases.  I didn't think I would damage my knee worse by doing this, and I actually didn't have much pain when I tried that.  I spent a little more time in the dugout instead of alternating innings so I could avoid spending so much time in my catcher's squat position.  So, I was able to dose my activity so that I could do some rather than none at all, and this actually built my confidence to return back to my usual level of participation after healing and recovering. 

Which leads perfectly into "Encourage the patient to ask themselves 'Will the activity harm me? and/or 'Will I pay for this later?'"  Like with my softball example, I didn't hurt myself worse by participating and I didn't hurt more after playing. Certainly there are times when doing activities can be harmful. As a physical therapist, it is our job to recognize when that is the case and appropriately guide our patients, but modifications are often possible.  In particular, I really think it's important for our post-surgical patients who can't be playing their sport to spend time around their teammates. Be the team manager!  Learn more about your sport.  Spend that time with your friends.  It's better for mood, learning of the game, growth with teammates (and they'll get better support if they're around and showing their progress over time." 

Best Thanksgiving Food

In another example, this past weekend I attended a delicious Friendsgiving dinner at my friend's home. I've been managing some gut issues lately and had been eliminating several foods to try to identify where the problem was coming from. After a month with no wheat and two weeks without any onions or garlic, I wasn't exactly sure what would happen if I had some stuffing... but I really wanted it!  I actually did use this line of reasoning while I ate.  Will I do any permanent damage to my body by eating this? Not likely, no. Will I pay for it later? When I made the decision, I wasn't entirely sure, but I thought it was possible, which impacted my decision for quantity of stuffing that I took (dose). And yes, I felt like crap from it.  But was it worth it? That's very individual, and up for me to decide, and now I have data. Next week when I'm home for family Thanksgiving, I get to decide if I want to repeat this same thing knowing what the likely outcome will be, or not.  But I'm empowered to determine what I do to my own body, and that's something I think we can teach our patients, too. 

What else can we do as physical therapists to help our patients who are experiencing pain?  We need to help make sense of their pain using their own understanding of what's going on. A person who thinks their "back is out" can't just be told "that isn't really a thing, backs don't ''go out.'"  They'll never buy into your message if they have a belief of what's wrong and you just strong-arm them into an opposing idea.  So instead, we acknowledge their beliefs, educate them on how adaptive the human body is, and we facilitate cognitive restructuring.  An example that was suggested in the class was "I bet someone has told you that your spine is twisted," and by acknowledging their perspective, you can try to bend that belief just a little bit, "but actually your pain could be from something else, so why don't we work on getting you moving in ways you can tolerate."  You create a small hint of doubt into their beliefs and see if the patient gives you an opening and slowly you can chip away at the beliefs over time.  We can facilitate adaptability by using intentional application of specific stressors that induce adaptation for increased resiliency, and this includes with beliefs. We must meet our patients where they are at with the psychological and physical approaches, progressive loading ooth their thoughts and their tissues, which might be a really little bit of loading at the start, but sometimes that's all they can manage. We work hard to encourage their autonomy and self efficacy.  One of Greg's quotes which I really enjoyed: "Requirements for adaptability: 1) Human. 2) Not Dead."  He also made sure to include a statement about how physical therapists don't fix people.  We facilitate them.

Bob Ross

And so physical therapists need to understand barriers to recovery, which could be at the tissue healing level, or could be in the psychosocial realm, or a whole host of areas in between.  And we need to appreciate that what we do is, in fact, an art, while also being a science.  That makes Greg Lehman just like Bob Ross, I think.  He painted this one beautifully. So many happy trees.

And with that, I'll finish with another quote from the course "Limping is a helpful adaptive pattern. It is successful in keeping people moving. It decreases pain. But should we advocate for everyone to start limping?"

Thanks so much, Greg.  I hope you'll come back to the USA soon!

Mindfulness in the Sensory Deprivation Float Tank

Today I did a thing.

No big deal, really.  You can stop reading, now.  Seriously... I'm not even sure why I'm writing this post. Today I did an activity that initially seemed far outside my comfort zone. You see, I've been working on my vulnerability and my mindfulness. For some, that may be easy. Ever climb a huge mountain?  Facing vulnerability and mindfulness seem that difficult to me. I can't explain why, but they're a struggle.

According to dictionary.com, Mindfulness is "1) The quality or state of being conscious or aware of something 2) A mental state achieved by focusing one's awareness on the present moment, while calmly acknowledging and accepting one's feelings, thoughts, and bodily sensations, used as a therapeutic technique." I won't bore you with the issues I have acknowledging and understanding my own feelings or my dissociation from my own body, but mindfulness is one of the strategies I've been working on for those issues.

My first attempt to work on mindfulness was when it was recommended that I read the book "Eating Mindfully" somewhere around February 2015. I really tried to absorb what was being recommended and even attempted some of the activities in that book. But when they walked me through putting a pistachio nut, in its shell, inside my mouth to taste the salt and then break it with my teeth to experience the cracking sound so close to my ear and then focus on the textures of the soft, green nut... I couldn't handle it.  Too many adjectives.  Too much thinking about food. Too much self awareness.  No thank you. I think the book even recommended trying to feel the ridges of a raisin with the tip of your tongue, but maybe I made that ridiculousness up... it's been a while. Either way, I didn't think mindfulness was the route for me to go to approach the eating issues I was facing, so I gave up. For a while.

Now, years later, I've learned that I don't actually practice mindfulness in a whole boatload of areas of my life. I am still not a mindful eater. I eat breakfast in my car twice a week paying attention to traffic and not to whatever I'm consuming. I eat a snack in my car on the way home from work daily so that I make myself a sensible dinner rather than hitting the drive through. There is a snack bin on my back seat now.  I usually also drive while listening to an audio book... so, yeah. I eat lunch while I'm talking to my coworkers or, on the rare occasion when I would be eating alone, I also read a book or scrolling around aimlessly on my phone.  The last thing I do while eating is pay attention to my food. But I am also not mindful of the space I take up when I'm moving around.  I bump into things.  I've been called a "bull in a china shop" more times than I care to admit. In sessions with my therapist, sometimes she'll ask me to sit with my feelings on a topic of conversation and I burst into laughter or start fidgeting and can't even look her in the eye.  It's horrible.  This could continue, but the purpose of this whole mindfulness conversation is more about things I'm doing to try to be more mindful, not really the reasons why I need to.

The most mindful activity I've come upon has been yoga, which I wrote about here, during which I'm very present in that moment. I definitely feel my emotions and they change in various positions. I also am more aware of my body in yoga than in most other ways.  So far, yoga has been my favorite mindfulness strategy... but I haven't gone in progbably six weeks, so I should maybe get that in soon.  I sometimes find swimming to be pretty mindful... I did that a few days ago.  It makes you focus on your breathing and your body or else you drown.  A little bit of life-or-death mindfulness, anyone?  And lifting weights does this a little bit, but is usually a lot more distracted than those other activities.

The problem is that I've been searching for mindfulness strategies that don't make me move.  I've tried those progressive relaxation strategies where you relax your big toe, then your foot, then your calf, up the whole trunk and to the top of your head and back down the other side. Eh. I can't seem to tolerate meditation the way most people seem to. All of these things seem harder than I think they should.  Why can't I just sit in a quiet space and focus on my breathing for ten minutes?  That doesn't seem hard.  I have never made it ten minutes. So when it was recommended that I try a Sensory Deprivation Float Tank, and would be forced into a quiet, dark space for a whole hour, I was very intrigued. I made a reservation a few days ago at Float Seattle in Greenwood (neighborhood in Seattle) and talked to several coworkers and friends about it over the past few days.  Only one person I spoke to had ever tried it and had some really interesting perspectives on it. Most people felt exactly how I felt... like it was insane to try and that I would probably freak out.  Despite those expectations, it was actually pretty awesome.

I arrived at the Float facility where Dean, the owner, gave me a little tour of how things worked, made some recommendations about positioning in the tank and best way to get the ear plugs into your ears and making sure your face is really dry before getting into the pod to avoid touching your face with a super salty hand while in there. He showed me how the tank worked, where the lights and sound are adjusted, and then left me in the quiet.  I took a neutrally temperatured shower to be clean, but not too hot because then the tank would feel cold, before entering the pod filled with 10 inches of water and 1000g of Epsom salts.  Because the water is set to basically match your body temperature, you almost don't even feel it.  There were a few periods while floating that I felt a little cold and then moved around a little bit and it quickly resolved. I was shocked that it didn't really smell like anything - which was one of the concerns I had because I tend to be smell sensitive, particularly with florals and some soaps that make me miserable and headachy - but later learned that reduction of smell is one of the many sensory inputs they're trying to reduce. The room had towels with just enough fluff to them, which brought me Marie Kondo level of joy.  I hate rough towels and would have been super annoyed to remove a ton of sensations for an hour only to come out to sandpaper towels.  And so I did the thing.

Me, in the Dead Sea, on January 14, 2004

I got into the pod, closed myself in, and transitioned from what felt like sitting in a bathtub into supine floating on the Dead Sea.  I've done that before... but I was covered in mud, it was nearly fifteen years ago, and I was not alone. That salt burned my skin.  This salt did not.  That trip was so long ago, I didn't have a Facebook account yet and I was still using a camera with film.  Guess I can't share images from that day. Just kidding, I dug into the scrapbook and took a picture of this picture to share with you. It took zero effort to get to floating and all the fears I had about potential claustrophobia were gone.  I turned off the blue light, and tried to relax while looking at the little twinkle lights in the ceiling of the pod.

Carmen, in case you don't know.

It felt a little like I was inside a planetarium and I had a flash of "Where in the World is Carmen Sandiego" because she was exploring outer space when I went to the planetarium as a kid.  And maybe because one of my friends was her for Halloween, so it was on my mind.  And then I started to let it all go.  I had the option of listening to music - I went without.  I had the option of keeping more light than the twinkle lights or going all the way into the darkness.  I did a little twinkling, but mostly in complete darkness.  I had the option of using a little foam pillow for my head if I wanted it - I tried both ways.  And let me tell you, I really enjoyed it. The only thing that seemed odd to me was that I had completely lost sense of time.  I don't think I fell asleep, but maybe I did.  I don't think I moved around a whole lot, but I did a little bit.  They told me that I would know the float was over because the music would start playing and then the light would come back on.  Maybe 30 seconds before that happened, I put the twinkle lights back on feeling like I was starting to get a little antsy.  OK actually I was starting to think I had to go to the bathroom.  But I made it!  The whole hour!  And I didn't lose my mind!  I also didn't cry, which I had thought was a serious possibility.  I hadn't really thought about anything that much... mostly I just let my mind go blank, which is something I really struggle to do.

According to the Float Seattle website, "There are many benefits of floating regularly. Most commonly our guests and members float for stress relief, pain relief, athletic recovery, and meditation/introspection."

It makes sense that you might have some stress relief from removing many of the inputs our body receives constantly throughout the day.  I spend a lot of time working with kids in pain, trying to find ways for them to output various stresses - through exercise, emotions, breathing, desensitization sensory input overload strategies... but it's so hard to remove input!  Removal of the input of light or computer screens, changing temperatures, sensations from sitting or from clothing allows the brain some freedom that is normally occupied by these things.  It makes sense that you might have pain relief soaking in saltwater that could potentially reduce inflammation and allowing muscles to relax in new ways.  But just having it make sense is not good enough for my science-minded brain.  I needed to see research!

So the Float Seattle site does include a list of publications here and when I searched, this other floatation company had an even longer list here. It summarizes that "The float environment systematically minimizes external sensory input to the nervous system including signals from visual, auditory, olfactory, gustatory, thermal, tactile, vestibular, gravitational, and proprioceptive channels."  A 2005 meta analysis is cited suggesting that this type of treatment does reduce stress and there are papers studying different hormone levels of change following sensory deprivation treatments.  I couldn't read all the articles between my float and getting this post put together, but I did read numerous headlines and how they used it with challenging patients with severe autism to reduce sensory input with some successes, and how several health markers improved by using floating.

Then I watched this YouTube video from comedian Joe Rogan about his experience floating, and all in all, I decided to share my experience with all my blog followers. If you're in the nearby Seattle Area, the cost at Float Seattle was $39 for the first session (and for all Happy Hour time sessions right now, which is basically the normal work day for most people, but I work a healthcare provider schedule and have days off during the week which means I can go on my day off for that rate). Yes they tried to sell me a package. No I didn't buy one... I think I would prefer to achieve the mental state I get from doing yoga, instead, but yes, I do think I would go again, particularly if I'm having a stressful week... or if the clocks have just changed and the world seems like it's going bonkers around me!  Have you tried floating?  Let me know what you think!

It Takes a Village

ID 6052480

© Sgame

| Dreamstime.com

Happy Thursday, blog followers!

Warning: In this week's blog post, I'm being selfish.  I'm making a situation that has nothing to do with me, entirely about me.  But it's OK to do that if you admit it up front, right?

This past week, I received some terrible news. The instructor of my weekly Turbo Kick class, Meg, informed our class that she is moving away.  I’m sure she’s making all the right decisions for her family, but to me, this was crushing, devastating, drop me to my knees in tears while unnecessarily over-reacting, punch me in the gut, painful news. I didn’t see this coming. I’m not prepared.  Do I have enough time to get used to the idea of a new instructor coming in?  It took me SO LONG to psych myself up into attending her class in the first place! And it just can't be the same with another instructor.  Say it ain't so!

So, this week I'm writing about the village of people I've assembled to help me get my health in order as well as the positive impact of attending group exercise classes. This was a great reminder that you might be changing someone else's life without knowing it.  Sometimes I forget this when I'm working with my patients.  I have no clue how I've impacted people other than with their physical therapy, but I hope I've helped others the way Meg has helped me.

I joined the YMCA in August 2018 as part of my elaborate and carefully plotted plan to combat my eating disorder and body image issues, which I first discussed here.  I had been in severe denial about what was going on in my life, blissfully ignorant to reality, and had started seeing my therapist at the same time.  I decided to create a small village of people to help me with my journey: a therapist, a dietitian, someone to revamp my physical fitness - who ultimately became Meg - along with some family and close friends. I was entirely unmotivated to move my body - which I was currently hating - and I was sick of my training routine. I wasn't looking for group classes when I joined, hoping could manage my physical health myself, but considerd I might need another person in my village to oversee that, too.

I was initially opposed to group classes because I experienced a particularly uncomfortable CrossFit situation when the instructor told me that "a girl of my size should be lifting a lot more weight." To some extent he was correct - I could squat and deadlift a lot more than I was using there.  But at that time I hadn't been training much and knew the planned workouts included high repetitions and the volume was too much for me to load up the barbell as they recommended.  They pushed me to lift more, I pushed back saying I wasn't ready, and it was ultimately an embarrassing and painful situation.  It is specifically why I treat my own patients meeting them where they are - not where I want them to be.  So I had that experience, plus, I hate the idea of people seeing my body moving.

2008 CT Sun Yoga Class

Those reasons led to apprehension for group classes with the exception of yoga. In 2008 I went to a group yoga class with the Connecticut Sun and have been able to continue with yoga intermittently since then. I wrote about my recent return to yoga here, but, as I previously wrote, I only do hot yoga where I get high (or delirious) from oxygen deprivation that I basically can't tell anyone else is in the room.  Group exercise class?  For sure the others would notice that I'm fat, that I can't jump, that I will get tired, that I sweat a lot and breathe heavy, and that I'm not very coordinated.  Now, many months later, I'm here to tell you none of this occurred.  It was all in my head!

In October 2018, after walking by Meg's class on several preceding Mondays, I finally talked myself into trying her class.  I told myself that I knew the music was good and that I had to complete the class but that if I absolutely hated it, I would try one different class before swearing off group classes for the rest of eternity.  Dramatic much? Thankfully, Meg ran up to me that first day, super spunky and upbeat, introduced herself saying that her class was super fun and that it didn't matter if I knew any of the steps, just keep moving however I wanted to. I've been hooked ever since.

Here’s why Meg’s departure hit me like a ton of bricks.  I was in a deep dark hole of emotions and confusion when I started this journey and quickly learned that I needed to ask for a lot of help. I built my village including three smart, beautiful, strong women to help me pick myself up off the floor and put my pieces back together.  My therapist and dietitian knew each other, use similar approaches for treatment, and know all about my issues. I don’t think they intend to be sympathetic towards me, but sometimes they are, and sympathy isn't what I want or need.

But Meg is different.  She's not sympathetic towards me because she has no reason to be. She doesn't know why I'm in her class or what I'm dealing with. She barely knows anything about me, really, and that's just how I liked it. She's empowering and motivating because that's in her nature. And yes, it's her job, but there are other instructors in there with totally different vibes. I've walked by their classes a bit, too, wondering if I should add to my routine. Choosing her class was not a mistake. She welcomed me in, kick started most of my Mondays since October with high energy, a positive attitude, motivation, and joy. I purposefully attend her class right before going to see my therapist because turbo kick is basically a class where you can punch and kick your problems in the gut and my G-d I needed that.  It also lets out a lot of energy, which calms me and helps me organize my thoughts before saying them out loud.  When I started pairing turbo kick with therapy, I was really struggling to see my therapist because it was so vulnerable. Dance fighting with a room full of strangers is vulnerable, too, but way more fun than one on on conversations in a room with a couch and too many boxes of tissues.  I can’t actually tell which “treatment” has helped me more over the past six months, but I can tell you what this class did for me.

First- a group class has other people working towards their own goals- but the goals can be kept private as you work towards them together. I don’t know if people in the class are trying to lose weight, get stronger, let off some anger issues, or hear some current music. I don't know if they secretly wish to be a performer on a stage - but instead work as an accountant because they need to pay their bills. I don't know if they want to learn ways to protect themself if they were attacked, because truthfully, I would definitely use the moves I've learned there if someone came at me. I don’t actually care why they’re there. It doesn’t matter. We’re all going to do the same moves and at the end be disgustingly sweaty and high five each other with a sense of accomplishment towards our own goals.  I can go deadlift and have an awesome lift on my own, but there won't be anyone to high five me when I'm done. And because people start recognizing each other, it really does start to feel like community. Like if you missed a week, someone might ask if you were OK, or if you went on a nice vacation. Sometimes you just need that!

Second- all my concerns about other people watching me were entirely unfounded.  Nobody else is looking at what I'm doing in this class. They don't care. Once we get started, I barely even notice there are other people in the room, except to watch out for kicking my neighbor and to follow Meg instructing the moves.  Everyone is trying to get the steps right for themselves.  The rule is to keep moving even if you don't know the steps... but sometimes I know the steps and choose to do something different. For example, I CAN do burpees... but I hate them... so when there’s a burpee in the routine, I do jumping jacks or squats or whatever I want. Because for me, the whole point is to move. Not get better at burpees. Once I stopped exercising to lose weight and started doing it because it made me feel good, things in my life started to get a whole lot better. It’s still a struggle to make myself move regularly, so I attend a weekly dance party with some uppercuts and roundhouses thrown in and I actually feel like I’m prepared to conquer the week - whatever it may throw at me.

Third- and probably most important for my personal journey- the room is lined with a wall of mirrors. For the first several weeks, it disgusted me to see myself in the mirror. I was sure others could see how gross my body was. When I was diagnosed with my eating disorder, my testing suggested that I didn't have any body image issues. This was apparently very wrong. I've learned it was/is a huge problem. Prior to facing my issues, I didn't realize I was avoiding mirrors.  We have them at work, too, and I didn't even notice how much I put my back to them.  If I lifted at the gym, I didn’t want to see myself doing it. I don’t have a full length mirror at home and have never had one since I moved to Seattle.  I didn't actually realize how much I had been avoiding looking at myself until one class I caught myself in the mirror while doing a punching move and realized holy crap! That's me!  That's my body! It's doing all these things.  It's working hard and feeling pretty good. I’m actually able to tolerate looking in the mirror and smile at myself a little now.  That may not sound big... but for someone who went from not knowing what their body looked like at all and hating her own skin to tolerating her body and appreciating the things it’s capable of, I think it's huge. I’m sure somewhere down the road, there will be a time when I might like my body- and maybe even love it. That's not where I'm at right now, but I’m sure that the road started with the mirror in turbo kick.

And so, while I am sad to know my village is evolving, I’m eternally grateful for the role Meg played in it at the beginning.  Can't wait for the next Turbo Kick class.