mizducky's migrations: a weight management blog with attitude

Arthritis and the hazards of overdoing it

Sigh. I have managed, once again, to do something weird to my bad left knee, the one the doctors have for-sure identified as having osteoarthritis going on. No doubt osteoarthritis is also happening in other weight-bearing joints as well, but it's the left knee in which they've actually spotted something in an X-ray that might possibly be a bone spur. And it's the one that most frequently misbehaves. Among its repertoire of bad behaviors:

• occasional "rice crispies"--little clicking noises, sometimes more a sensation of something catching than an audible click
• less frequently, something in the joint catching enough that I can't quite totally straighten the knee. Sometimes standing upright will cause the knee to "click" again and release; sometimes that only happens with a lot of pain, and sometimes nothing can persuade that knee to unlock short of getting the hell off that leg and letting it rest undisturbed for a few hours.
• thankfully very rarely, a sensation of something shifting laterally within the joint, immediately followed by excruciating grab-all-your-attention pain. When this happens, it can take days or even weeks for the knee to return to normal, until which time I've sometimes even had to resort to crutches.

And then there's just everyday random assorted stiffness and achiness--upon arising, upon standing in one place too long, upon walking a litle too far or too fast, upon stepping down too hard or with unexpected torque on the joint, after resting it motionless for too long. In other words--when doesn't it bug me?

Sometimes these knee misbehaviors seem to come out of nowhere--somehow I manage to sleep with my knee at a funny angle, despite all my attempts to protect the knee with pillows and whatnot. Or I stumble and land on my left foot harder than I intended. Or the weather is doing something screwy--yes, the thing about arthritic joints acting up during stormy weather is not an old wive's tale. But a lot of the time my knee screws up because I get tempted into overdoing it.

This is an incredibly common dynamic among arthritis sufferers, as well as many others living with chronic diseases whose effects fluctuate. One day you wake up and you're feeling uncommonly good--well rested, full of energy, pain absent or greatly reduced--and your first reaction is "Hurrah! I feel so good, I think I'll take a walk!" Or whatever other physical activity you haven't done in awhile and miss dearly. So you take your walk, and you try and take it easy, and it feels really good. So you try someting more strenuous--and wow, you can do that too! And it feels pretty good too! So you do a little more ... and you go on like that, feeling great ... until the next day when your body goes "uh-oh!" and you realize that once again you got suckered.

I've been really enjoying my recent spate of renewed energy and reduced pain, presumably due to my progress in taking weight off my body and my knees. But as of yesterday I got the first signal that I had definitely slipped into overdoing mode, when my knee started in with its occasional-locking routine. This particular behavior is typically ascribed to a tear in the meniscus, the little wedge of cartilage that rides between the (also cartilage-covered) bone-ends that make up the knee joint. These kind of tears typically bedevil two groups of people: young athletes, such as football players, who get their knees banged up in their sports; and (usually) older folks whose cartilage is suffering the cululative wear-and-tear damage of osteoarthritis.

In either case, sometimes a little bit of torn meniscus cartilage flops around so that it's obstructing the smooth motion of the joint--voila, a locked knee. The "click" sensation is presumably that little cartilage flap popping in and out of its correct location. And often the disturbance is enough to kick off the body's inflammation response, so now you're dealing with painful swelling around the knee in addition to the locking biz.

The problem with cartilage is that a lot of it does not have its own blood supply, so that it's not receiving the kind of nourishment tissues need to self-heal. Still, if the tear can be calmed down a little bit, you can usually get on with life. So the usual first line treatment is to be conservative and just use rest, anti-inflammatories and occasional icepacks to calm the whole area down. If that doesn't work well enough, though, you're basically looking at surgery.

Even if a meniscus tear isn't involved, overdoing it can provoke a general arthritis flare--an annoying state in which even joints you swear you weren't using decide to start aching in general sympathy with the joints that got the brunt of the abuse. And when it happens, there's nothing for it but to take it easy, get out the ibuprofen and icepacks, allocate an evening for a long hot soak in the tub, and just wait the sucker out.

Then you're confronted with the next conundrum: completely motionless waiting, or not? Because your arthritis will also cause your joints to stiffen up if you keep them motionless for too long. So, now you're in a balancing act of getting the angriest joint enough immobility time to calm down, vs. gently stretching and moving the body--including that joint--so that it doesn't stiffen up on you while you're waiting for relief.

Plus you're no doubt juggling a whole bunch of emotional crap about the whole situation as well: "Ah shit! Not again! And I was doing so well! Is this ever going to end? Am I never going to be able to exercise safely without putting myself back on the bench again? Oh hell, what's the use?" And on and on and yadda yadda yadda.

The most damnable part of this whole thing, though, is how subtle the line is between healthy doing and damaging overdoing. Yeah, you can usually tell pretty immediately if you do something that actively bangs up the joint, but oftentimes there is no detectable sensation when you cross the magic line into overdoing-it land. You feel good the entire time. You may not even feel like you're especially pushing yourself. Your only defense is knowing, from painful past experience, how much you historically get away with before having a problem the next day. But if your general condition is improving (or, god forbid, deteriorating), that danger point can move.

So if you're determined to increase your physical activity, you're stuck in a continual process of trial-and-error, in which you cautiously work up to your previous limit, then wait to see how your body handles that, then the next day maybe do just a little bit more, wash rinse repeat. Except for those times you just say hell with it and decide to boogie like a madwoman to a tune on the radio. In which case, all bets are off--but at least you can cheer yourself up with how damn good that boogie-ing felt at the time.

I'm still very much in struggle with this. There really isn't a helluva lot more that I can do about it on the physical/medical plane than I'm doing right now--well, there's the surgical option, of course, but I'm bound and determined to avoid that (besides, I'm willing to bet no surgeon would operate on my knee while I still have so much weight on my body ready to damage the knee some more). But in the meantime I've got anti-inflammatory drugs; I've got ice packs and epsom salts; and that's pretty much it.

So, as in so much of the rest of my health-improvement effort, the big action seems to be the mental game: keeping my attitude positive despite the (almost literally) two steps forward one step back dance of the crappy knees. While I am considerably bummed at this latest bout of knee-locking, I am also trying to bear forcefully in mind that this bout is considerably less nasty than others I have experienced in the past, due no doubt to all my other recent health-wise efforts. In other words, even though this is one step back, the net progress is still forward.

As long as I don't freak out, say hell with it and run away (crawl away?) to console myself with the Dreaded Takeout Pizza Self-Destruction. Which, especially when put that way, doesn't really hold a whole lot of appeal. Nope. No running away. This too shall pass ... and I shall soon be up and (hopefully not over)doing it again.

Excellent article about body fat

From the website of the magazine Diabetes Self-Management: a long, thorough yet easy-to-read exploration of the function of fat in the human body. Though the emphasis is, as its title states, on getting rid of fat through exercise, I found the article most helpful for telling me a whole lot of fascinating stuff I did not know about the mechanics and chemistry of how the body digests, stores, and uses fat. For instance, I did not realize that fatty tissue deposits function as glands as well as storage for fatty acid molecules, secreting a host of enzymes, hormones, and neurotransmitters. And the exercise advice is actually rather helpful too.

Link: Diabetes Self-Management - Burning Fat Through Exercise.

Today's weigh-in: breaking the 30-pound barrier

Yep, I went to my class today, and at weigh-in discovered I'd lost yet another two pounds this past week, for a grand total of 30.5 pounds so far. And I'm feeling pretty damn good about that. Well, all except the parts of me that are tired out from the exercise part of the class. Damn, but those folks in the Chair Dancing videos put you through the wringer!

Speaking of those Chair Dancing videos: they do indeed give you a workout, but the aesthetics of the tapes are definitely a little on the tacky side. On the other hand, I can't think of a single exercise video I've ever seen that didn't have at least a few tackazoid elements: either cheesy sound track, or low-budget set, or hokey routines, or gratuitious cutseyness on the part of the instructor, or some other damn thing. In fact this morning while we were working out in class, I was suddenly seized with the notion of creating a spoof exercise video that parodied these tackazoid features to the max. It would be even funnier if it led you through a legitimate workout--then you could laugh and poke fun at yourself while getting your exercise in. Like I say, laughter really is the best medicine.

Anyway ... just reflecting on this past week: this past week included a significant planned splurge, dinner at a local Vietnamese restaurant with some fellow foodie friends. It also included some moments of emotional upset, and some ramping up of other PMS-y symptoms (as I've gotten deeper into perimenopause, my PMS has only gotten longer and more baroque than ever). Yet not only did I not seize on any of these situations as excuses to go off-plan and binge my brains out, but I made significant strides in getting more physically active. And--I kept my food real clean, and I continued to maintain my rate of weight loss. Hurrah for me! :-)

Groovin' on a Sunday afternoon

It turned into an absolutely gorgeous afternoon, temperatures mild and the skies a profoundly deep blue. So when I got done with church I decided to take my recently-less-achey bod and my brand-spankin' new walking shoes and hie me to Mission Trails Regional Park, this wonderful greenspace preserve that just happens to be right near my home. Mission Trails comprises a swath of rocky hilly terrain surrounding a narrow stretch of the San Diego river. Its trails range from challenging (one of the summits tops out at over 1300 feet above sea level) to placidly plodding, and it users range from families with toddlers and dogs (on leash) in tow, to mountain-bikers and horse-riding folk.

After a brief consultation with a very helpful (not to mention bubbly and sympathetic) ranger at the park visitor center, I drove over to the trailhead nearest the Old Mission Dam, the remains of a waterworks originally built in 1813, when the area was still under Spanish rule, to provide water to the Mission San Diego de Alcala, about six miles away. The first part of the trail was indeed marvelously accessible, paved and nearly flat, with numerous benches for people with creaky knees to pause and admire the river (more like a creek at this point) through the trees.

The path takes you over the little river via a footbridge, after which it starts heading upland over a ridge. I turned back at this point, but not before watching wistfully as people and dogs continued up and over the ridge. I made a vow to myself then that one of my goals would be to get in sufficient shape to make it over that ridge myself.

I have no idea how far I walked today. In actual feet and footsteps, it really wasn't all that far--I saw toddlers following their parents over the same distance with no noticeable problems. But psychologically I covered a huge distance--this is the first time I have done anything that would even remotely qualify as "hiking" in literally years. I now have plans in my head to make Mission Trails Park a major feature of my continuing efforts to return to full physical activity. I will probably be sticking to the flat trails for some time to come, but hey--it sure beats hell out of walking around shopping malls.

Coping with post-exercise pain

Anti-theme song for this post: "Beauty Knows No Pain" by Frank Zappa (yes, I'm a Zappa freak).

I am sitting here with hair still damp from a long hot soak in a bath full of Epsom salts. You see, not only did I do my weekly exercise class yesterday morning, then a bit of impromptu mall-walking that afternoon, but that evening I couldn't resist getting up to boogie through an entire song from the CD I was listening to. I really think it was the butt-shaking, however brief, that put me over the edge, because among the many aching muscles that greeted me this morning was a set of sore gluteal muscles like you wouldn't believe.

At least this isn't the "Oh no I think I injured something" type agony I had been getting after exercise up to now. Still, it is considerably uncomfortable. The hot bath certainly made it all feel better while I was actually in the water, but now that I'm out and drip-drying, the pain, while lessened, is still most definitely there.

There's no two ways about it: coping with post-exercise pain is probably going to be a regular feature of my life for some time to come. I just wish I could come up with some more constructive ways of dealing with it.

The only solutions the medicos have to offer, alas, are pills--either NSAIDs, which bring with them the risk of serious damage to the lining of the stomach; or opioids, which scare the living shit out of me (I have personally known people who started taking these things for chronic pain and got addicted--the detox was absolutely hair-raising). I do happen to have scripts for both an NSAID (Relafen) as well as an opioid (Vicodin); the Relafen I take on a daily basis, and the Vicodin I take for breakthrough pain only when it gets really unmanageably vicious. Neither really seems to do all that much for post-exercise pain.

Insert here one impassioned rant about the hypocritical mindset behind the US War on Some Drugs, such that medical marijuana is still held to be a dangerous brain-rotting "killer weed" despite a ton of research to the contrary (not to mention the considered opinion of a majority of California voters), but scarily addictive drugs with horrific detoxes such as Vicodin are cheerfully foisted on patients by an oblivious medical industry, despite a ton of evidence concerning their hazards. I mean--really, folks, what the hell is up with that shit?!? How anybody  can stand up and with a straight face maintain that marijuana is more hazardous than Vicodin is beyond my capacity to comprehend ...

Anyway, moving right along: I know that a lot of people get relief from alternative therapies such as accupuncture, massage, and other forms of theraputic bodywork. In fact, back when I lived in Seattle and had a career that allowed me a lot more discretionary income, I went for theraputic deep-tissue massages every other week, which seemed to really help loosen up the locked-up places. However, now I'm living in much more frugal circumstances, and my HMO does not cover much in the way of alternative therapies. So for the time being getting my bod prodded in an organo-groovy way is outsky.

There are also a lot of people who swear by various nutritional supplements to relieve certain types of pain, such as that of achy joints. I am all for the idea of such treatments, but alas the ones I've tried so far haven't made much of a dent in my condition. I've been taking glucosamine for, geez, I don't even know anymore, certainly close to a year if not longer, without any noticeable improvement. I've also been taking fish oil capsules for a few months now--my doctor recommended them for dealing with elevated triglyceride levels, but while they're also supposed to have some benefit for joint pain, I haven't noticed any improvement I could attribute to them either. I have also tried MSM and SAM-e, again without noticing any effects one way or the other. So, no luck so far on that front.

My lines of defense against post-exertion pain remain: my regular dose of Relafen; gentle heat as provided by long hot baths or heating pads; reuseable cold packs, especially for angrified knee joints; extremely gentle stretching exercises to coax any offending muscles to relax; and under extreme duress, the cautious use of Vicodin.

If anyone reading this has additional suggestions on how to deal with this kind of pain--especially ones that don't require a huge investment--I'd love to hear about them.

Weekly weigh in--plus baby gets a pair of new shoes

Today's weigh-in at my weekly class/exercise/support group thang: down two pounds. Very good. Especially since that's after not one but two "controlled splurges"--one pre-meditated, one a bit more impromtu--plus adding an additional "starch" food exchange to my baseline daily food allowance, bringing me to about a 1400-calorie-a-day regimen (erm, when I'm not allowing for a controlled splurge, that is).

For those of you playing along at home, that means I've now lost a total of 28.8 pounds in ten weeks' time, for a current weight of 305.5 pounds. While I'm trying my best to avoid the diet-freak mindset around wanting to break below 300, there's no denying that it will be some kind of moral victory for me.

Anyway, I think I've got the food front in the groove at this point--at least until my metabolism decides to shift yet again because of this whole regimen. As readers may recall from the last two weigh-ins, while I was certainly pleased to be dropping 4 pounds a week, it was also making me a tad nervous that it was a little too fast for the safety of some of my other health issues. So proving to myself that I can apply the brakes gently enough to slow the descent without grinding it to a halt feels really reassuring to me. Control issues? Moi? Heh.

In other news, my recent encouraging improvement on the joint-pain front prompted me to go buy myself some new decent walking shoes. This was a victory on two fronts: convincing my inner skinflint that proper exercise footwear was a worthwhile investment in my health and sanity; and convincing my mall-phobic self to actually darken the doors of a shopping mall. Whew! I actually had to snap at a mall employee to please take no for an answer already and get the hell out of my face with the free food samples he was so persistently brandishing at me. Thank goddess it wasn't one of those ladies with the freakin' perfume samples.

Anyway, I survived being "malled", survived the overly-chirpy young thing at Lady Footlocker, and survived the welter of glitter-bedrenched space-age-looking footwear in her store, and am now the proud owner of a pair of New Balance walking shoes--white, with a minimum of glitter and gewgaws. I actually already owned a pair of NB walking shoes, but they were a bit too heavy for my liking. I have a thing against totally-enclosed and lace-up shoes to start with, much preferring slip-ons or even going barefoot, which is why the old NBs wound up languishing in my closet. Yet I really do need the support that only a well-designed athletic shoe can give, to lessen the impact on my knees and hips when I walk. So--now I've got nice light shoes, with plenty of stabilization against my tendency to overpronate, and nylon mesh uppers for breathability. Lookin' good!

Oh yeah--speaking of exercise: Hey, I went walking around a mall, on the same day I did aerobics exercise class! That's a first, folks--two spates of exercise in the same day! Yeah, I know it doesn't sound like much, but given where I'm coming from, it's pretty mega to me.

I love exercise--I could sit and watch it all day

There's a very good reason why the entirety of this blog so far has concentrated on food issues, and given short shrift to the exercise part of the health-enhancement program. And that is: regarding exercise, boy do I ever have issues.

Firstly, I am one of those people whose childhood psyches were scarred for life by miserable public school phys ed classes. You know that old saw about "those who can't do, teach; those who can't teach, teach gym"? Okay, I know plenty of teachers who disprove the first half of that saying, but alas I can't think of a single one of my school PE instructors who did not fully live up to the second half. And between that, and my peers then deciding to fill in the gaps in our instructor's attentions by harrassing less-athletically-inclined kids like myself, well ... let's just say I have enough fear-and-loathing memories (not to mention revenge fantasies) to fill up some three or four "Carrie" sequels. And to this day, I still can't enter a locker room without feeling a sense of impending humiliation. Call it post-traumatic PE stress syndrome.

In fact, while I have witnessed tons of fingerpointing over the current sorry state of physical fitness in the US, blaming everything from TV to the automobile to video games to fast food to 80-hour workweeks to the breakdown of the American family, I have yet to hear word one faulting the general lousy public-school physical education experienced by a whole generation or more of US schoolchildren. I understand that there have been some improvements made since I handed my ego over to these classes back in the 1960s and 70s. But I say to you, if these classes still include any of those ego-busting moments like having the whole class watch as you miserably fail at hauling yourself up a rope, or games like dodgeball that are thinly-veiled excuses for all the class bullies to bombard all the class social pariahs, then they're still guaranteed to scare yet another generation into exercise avoidance.

It's some kind of miracle that, despite my high school gym angst, which caused me to swear off participatory team sports for life, I did manage to be pretty athletic. I adored long bike rides, and taking hikes into the woods up beyond my house. Whenever my folks took us to the shore or the local swimming hole, I'd stay in the water for literally hours. Whenever I lived in an East Coast urban environment, I walked everywhere (in Manhattan and Boston, it's nuts to drive.) And whenever I went out dancing with friends, I'd hit the dancefloor like a whirling dervish.

And in my 20s, when I had my greatest and longest-lived weight loss episode, getting down to goal weight and keeping it off for two years, I even got over my Fear of Gyms, took up body-building, and actually succeeded in getting my body fairly buffed. Though even then, I was starting to receive little warning twinges from my knees that they weren't totally cheerful about my exploits.

Things began to go a bit downhill, though, when I moved to the West Coast, picked up a high-stress job involving long hours in front of a computer, and slowly but surely fell prey to the drive-everywhere/sit-on-ass-endlessly syndrome. The goal-weight maintenance thing had fallen apart even before I moved; and my loathing of gyms returned in full force, causing things to spiral even further downward. Still, I did manage to get in a goodly amount of walking around Seattle ...

But then the real killer arrived, in the form of joint pain.

It crept up very slowly, not unlike the fable of the frog who doesn't notice that the pot of water he is resting in is very gradually heating up to boiling. So I don't remember exactly how it started, but I do recall all too clearly the day I realized I was in Big Trouble. I had set out on a much-anticipated walk from my then home on 12th Ave. in Capitol Hill down to the Pike Place Market. I made it only as far as the bus stop on Pine and 11th, and had to sit down, immobilized with pain in my hips and panic in my heart.

I couldn't walk. I. Could. Not. Walk. My hip joints had seized up on me, so that they would flex only with great amounts of pain. I sat there for about 15 minutes, and they gradually unlocked somewhat; and then I was stubborn enough (and desperate enough to disprove my disability) that I still caught a but down to the Market. I spent a little while creeping slowly around the market like a little old lady, and finally caved in to the pain and headed back home.

And thus began the endless cycle of going to doctors and getting frustrated. I eventually forced out of the docs a diagnosis of osteoarthritis in my left knee; only recently was gout added to the diagnosis, but I suspect I must have had elevated uric acid levels in my bloodstream for years beforehand (gee, thanks, docs, for not bothering to test me for that). No explanation from doc-land on why my hips and other joints hurt so bad; I have suspected I might also have some low-grade variant of fibromyalgia, but given how ignorant many doctors still are about that disease, well, good luck on ever getting a straight answer on that score. Certainly neither osteoarthritis nor gout account for how, when I'm experiencing a flareup of pain, even non-weight-bearing joints such as the ones in my shoulders ache.

And then there was all the brilliant advice. "You realize your condition would be helped if you took off some weight." No shit, Dick Tracy. Got any bright ideas on how I should do that, given all the methods I have tried and failed at? Nope, no bright ideas--once they said that, they apparently felt they had done their duty. Only thing they had to offer was scripts for ibuprofen (gee thanks, doc, like I couldn't just go buy that at Rite-Aid, assuming it even helped, which it didn't) and lame-ass sheets of dubiously helpful exercises to strengthen the muscles around my joints (erm, tell me exactly how I'm supposed to exercise if my joints are screaming with pain, please?). Oh yeah, and then there was that one jerk who wouldn't take "no bariatric surgery" for an answer. I'm just glad nobody had the temerity to suggest fen/phen to me. Sure--you take it first, doc, and tell me how you like having large holes blown in your heart?

Oh, and my favorite piece of unhelpful advice: "For arthritis it's better to exercise even with pain than to sit there and let the stiffness lock you up." Oh yeah? What if every fibre of my being (plus those few years of bodybuilding training) are screaming "nope, sorry, what I was taught is that pain is your body's way of signalling to quit doing whatever is causing the pain because you're damaging something." "Oh, but that's just normal achiness after exercising, because you're out of shape." Gee, thanks, docs, for putting such trust in the patient's own powers of observation. Just so happens that I know the difference between post-exercise soreness and the agony I'm experiencing after a day of exercise, and believe me, it is most decidedly the latter rather than the former.

And what if my suspicions are right and there's something like fibromyalgia going on, which is actually worsened by ill-considered exercise? Do I need to add that none of the many medicos and physical therapists I talked to had apparently ever suffered either a weight problem or an arthritis problem, nor any other chronic pain problem? Bet they wouldn't have been so all light-and-breezy about "oh just work through the pain" if they'd ever experienced for themselves the sensation of diamond-grit sandpaper in their hip joints.

Anyway, given such brilliant unhelp from the professionals who are supposed to know about this shit, I've spent the past several years unable to halt my slow but steady loss of ground in terms of mobility and pain level. I eventually had to resort to a cane and a disabled parking placard. Ibuprofen gave way to naproxen, plus heavy-duty anti-heartburn meds (gee, thanks, drug industry, for coming up with chronic pain meds that eat holes in your GI tract with long-term use). For a couple of years in there I was on Celebrex (gee, thanks, drug industry, for foisting on the public a chronic-pain drug with a risk of fatal side-effects with long-term use). Then I went on a more traditional NSAID called Relafen. Doesn't do all that much, and might be eating a hole in some other organ I don't know about yet. And that's where things have remained.

Fast-forward to the beginning of this year, when I start this HMO weight-management program for people seeking to avoid knee replacement (yeah, the knee has gotten that bad). Determined to quit waiting for someone else to figure out what the hell is wrong with me, I throw myself into the whole program ... with the exception of the exercise part. There, I'm still leery as hell. But glory be, for this class primarily full of retirees, all of whom have crapped-up knees, other health problems, plus their own histories littered with failed diets and exercise programs, the health authorities have finally wised up. We spend a half-hour of each class exercising to a video of aerobic exercises performed while seated! And are actually discouraged from doing any movement that causes any kind of pain. We are also each issued our own fitness ball to take home and try more gentle seated exercise.

Still, even the seated exercise routine causes me trouble at first. After each of the first session, I am imobilized with pain for two full days afterward. Those weeks, that one weekly session is basically the only exercise I get in. But even with that slight inroad, things very slowly begin to improve. By about 4 weeks in, I'm only immobilized for one day following a class exercise session. Then the next-day achiness begins to lessen somewhat. But I still feel enough chronic ache and stiffness that I'm not especially chomping at the bit to exercise on my own outside of class.

But then, only a very few days ago, I found myself in a situation in which I had a bunch of time to kill, and wound up walking around this little outdoor shopping mall for about 20 minutes. And not only did it not feel half bad to take that little stroll--but I had almost no post-exertion pain whatsoever the next day.

And then just last night, a song I love came on the radio, and I found myself spontaneously rising out of my chair to dance to it. Not very vigorous dancing, mind you--more just standing in place and gingerly shaking my booty. But I could shake it. My hip joints actually enjoyed the sensation. It actually seemed to be loosening up what little stiffness was in them, rather than adding the sandpaper-thing to the mix. I was amazed and astonished.

And majorly filled with hope. These fleeting moments are probably the first episodes of real improvement I have experienced in literally years.

It does indeed cross my mind that perhaps some of my unhelpful advice-givers were right after all, that exercising through the pain did start to loosen things up. Perhaps if I hadn''t had my objections so airily pooh-poohed and received some more specific and sympathetic advice on good pain vs. bad pain--not to mention how long it might take for a reversal to be seen--I would have gotten to this point a good few years earlier. (And it wasn't as if I didn't ask for such guidance, numerous times.)

But I'm actually of the opinion that several other factors are also at play here. For one thing, I have now been eating a significantly cleaner diet for some ten weeks, and I just have a real specific gut feeling that getting all that excess crap out of my system has somehow done something on the metabolic level to lessen the general stiffness in my joints. Plus, somewhere around week 4, I moved into less stressful housing and work situations. Given that I have had almost non-stop high-stress life situations the entirety of my adult life (and for that matter, in my youth as well), I cannot ignore the strong possibility that stress is a huge part of this equation.

Anyway, I'm aware that exercise may well continue to be fraught with anxiety for me, not unlike all the anxieties I bring to the concept of dieting. But whatever the reason for this sign of improvement in my physical condition, I now intend to start slowly but surely figuring out my own strategies for what works and what doesn't on the exercise front, much as I have been doing on the food front. I am knocking on wood even as I type this, but I think I have finally glimpsed the first real glimmer of a light at the end of my mobility/chronic-pain tunnel--and hallelujah, I'm pretty sure it ain't a train this time.