Fear of Change

Fear of Change stops Transformation

Fear of Change stops Transformation

Fear: painful emotion caused by impending danger or evil, state of alarm

Change: alteration; substitution of one for another, variety

(The Concise Oxford Dictionary)

During the past week I have seen two very different situations that have brought me to consider the Fear of Change, experienced both by others and myself.

In the first instance, I was visiting a person in the community who had engaged in an exercise program to promote balance and lower limb strength – the aim of which is to improve older peoples’ mobility and confidence so that they can safely live in their own homes independently.

Many of the elderly people I visit still live in the family homes where they raised their children, where they have experienced trials, tribulations, triumphs and great joy. The homes in which they have lived full and rich lives. Some are now alone, their partner having died or separated years ago. Their walls are adorned with family portraits and photos spanning generations, and memorabilia precious to them. Some homes are light and airy, others stuffy with curtains drawn. The homes take on the personalities of their owners and occupants.

Community Health workers may be the only external people to enter some homes, especially if the client does not have family living close by or friends who visit regularly. It is both a responsibility, and a privilege, not to be treated lightly.

This particular person lives alone, has multiple medical conditions and no family living in our city. It was clear to me that she was not managing the considerable upkeep of her large family home and her own health and well being, and I had been wondering how to be of best assistance to her, within the scope of my practice.

Her fear of change intervened.

At my most recent appointment she met me at the door, and told me she would not be inviting me inside, as she believed I had criticized her home – the home that her husband built for her and where she had lived all her married life.

She elaborated that she would live in her home for the rest of her life and that no-one would be able to force her out so long as she was coping.

I had not criticized her home. I had agreed with her when she had mentioned that there were mice in her lounge which she could not be rid of. She took my agreement as criticism, and must have then felt fear that I would set some actions in motion that could force her to accept help, or worse, present her with the notion that she would need to consider more manageable living arrangements.

Her Fear of Change caused her to reject beneficial action: the exercise program to help her stay in her own home!

The other circumstance is that of a friend going through a relationship break up. Raw emotions of grief and disbelief, if-only scenarios, wishing it were different. The shared home lovingly transformed over the years has now been sold. The garden is coming into its full summer glory, almost making a mockery of the hours spent visioning and planting. A new house has been bought, and awaits some loving attention. A new future beckons, with new opportunities for joy, for self-expression. Yet still there is the tug, the pulling backwards into what was. “I am scared of change. I want what is familiar”.

The Fear of Change holds us back, yet again.

“The events that transform us are usually not the things we would choose. As someone said, we never want to go through what we need to go through to become what we want to become.” Andrew Matthews – Follow Your Heart.

Reflecting on these two situations I am left pondering where I am allowing the Fear of Change to influence my own decision making. Only by letting go of the shore will my boat have the freedom to sail!

What Fear is holding you back from Change?

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Want A New Knee?

total knee replacementWant a new knee?

Last Saturday morning I attended a study morning, dedicated to the topic of knee replacements, hosted by the New Zealand Orthopaedic Nurses Association. I learned a lot!

 

Prof Gary Hooper, Orthopaedic Surgeon, spoke about the history of knee replacements and the complex functional problems which arise when the alignment of the prosthetic parts is faulty. He also stated that the incidence of joint replacements is increasing in New Zealand, and is expected to reach epidemic proportions due to:

  • Our aging population
  • The increasing numbers of healthy retired people
  • The greater expectation of the population to access free health funded procedures

He also reported that statistics for the USA predict that by 2030

  • Total hip replacements will increase by 157%
  • Total knee replacements will increase by 673%.

New Zealand statistics show that we model similar trends.

The NZ Orthopaedic Association has established a NZ Joint Registry which collates information about joint arthroplasty outcomes. Using data gathered between the years 1999-2012:

  • The incidence of Total Knee Replacements has increased by 157%
  • The incidence of Total Knee Replacements is 57% higher than Total Hip Replacements

These statistics are attributed to the physically orientated population, high levels of obesity, ethnicity, and favour females between the ages of 70-79 years of age.

By 2018, it is predicted that the number of Total Knee Replacements will exceed the number of Total Hip Replacements.

The Survival Rate of the prosthesis has been found to be 95%, for a period of approximately 14 years – after which a revision of the procedure may be necessary. This is the main reason why people under the age of 55 years are discouraged from having the surgery as their chances for requiring a revision are greater.

Reasons for requiring revision can include:

  • Prosthesis in the Tibia loosening
  • Patellar problems
  • Deep infection
  • Pain

Prof Hooper was very clear in stating that any person who has had any form of joint replacement could be at risk of deep tissue infection for the rest of their lives. Any haematological infection (carried in the blood) such as a respiratory tract or urinary tract infection, could cause a “seed to plant” in the replacement area. Any such infection must be treated by prophylactic antibiotics.

By far the commonest cause for revision is PAIN. Even after revision, which is usually cementless, the person will probably still experience PAIN.

With my background in Pain Management, this is not at all surprising, as numerous people return to surgery to “investigate the source of pain” after “failed” procedures, leaving the person worse off than before, as the pain pathways have yet again been excited / assaulted.

According to Chris Scott, Physiotherapist, scar tissue management to reduce pain is one of the vital postoperative goals in order to return to full functional activities. This was covered in a later presentation.

Take Home Message:

  • The incidence of joint replacement is reaching epidemic proportions
  • Be Proactive – ensure that you remain physically healthy and active
  • Do not depend on the public health system to automatically be able to cater to your health needs

Have you received a joint replacement?

How has it influenced your life?

If you have found this post interesting, please repost and share.

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A New Name for Chronic Fatigue Syndrome

 

Managing Systemic Exertion Intolerance Disease (SEID)

A New Name for Chronic Fatigue Syndrome.

An article in Medscape caught my eye last week. If you suffer from Chronic Fatigue Syndrome, you may find it interesting too.

 

problems with movement?

do you experience fatigue, perhaps sleep difficulties, and brain fog?

Dr Paul Auwaerter is based at the Johns Hopkins Division of Infectious Diseases, Johns Hopkins University in Baltimore, Maryland. He reports that some of his most challenging outpatient visits are with patients who describe long-standing problems that include fatigue, perhaps sleep difficulties, and brain fog.

 Often they may not be functioning well, perhaps experiencing problems in school or at work. Most of these patients are quite bright; they are analytical and sophisticated. They are hoping that something can be found to explain their fatigue and symptoms.

He explains that patients want to embrace something that makes sense. In fact, science has determined that the human brain likes distinct answers, and that uncertainty seems to amplify problems.

The term “chronic fatigue syndrome” or “myalgic encephalomyelitis” was developed and the defining criteria included:

  • more than 6 months of symptoms
  • an inability to perform customary activities.

The term resulted in a fair amount of controversy and sometimes even stigma because many clinicians believe this could be a psychosomatic illness; while others believe it is quite real. There is also symptom overlap with other syndromic problems, including fibromyalgia and irritable bowel syndrome.

“Within this context, the Institute of Medicine (IOM) was charged by several federal agencies to come up with a new name, some subcategories, and other aspects. In sum, the IOM committee decided that it would be important to rename chronic fatigue syndrome something that captures the nature of this. They have called it “systemic exertion intolerance disease,” or SEID.”

The criteria for SEID include:

  • substantial decline in functional activities for at least 6 months
  • post-exertional fatigue
  • non-restorative sleep.

And then at least one of the following:

  • cognitive impairment or orthostatic intolerance
  • gastrointestinal issues
  • pain
  • stimuli hypersensitivity
  • lymphadenopathy
  • sore throat

Some patients may develop SEID / chronic fatigue syndrome after having an authentic infection from which they never seem to recuperate and for others, there seems to be no precipitating factor. The condition afflicts a large number of people, children and young adults included, and the best treatment strategies -compiled by Simon Wessely and colleagues, (who did a fair amount of work on chronic fatigue syndrome and Gulf War syndrome), and others include:

  • graded exercises
  • conditioning to build up tolerance
  • cognitive-behavioral therapy.

Once again, a graduated approach to increasing physical activity is one of the most beneficial interventions.

What are your thoughts about these recommendations?

 

Reference:

Dr Paul Auwaerter

Medscape Infectious Diseases © 2015  WebMD, LLC

Cite this article: Managing Systemic Exertion Intolerance Disease (SEID). Medscape. Mar 03, 2015.

 

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What Is The Most Effective Weapon For Fibromyalgia?

Aerobic Exercise !

aerobic exercise is the most effective ‘weapon’ that we have

People with fibromyalgia benefit from continuous physical exercise.

 

A recent article in www.medscape.com by Alice Goodman summarised an overview of research on fibromyalgia treatment that was presented at the Paris 2014 European League Against Rheumatism Congress.

Winfried Häuser MD, from Technische Universität Munchen is an expert in the field of fibromyalgia. He believes that treatment for people with fibromyalgia should be individualised and include non pharmacalogical approaches, as these are often more effective than drugs. He explained that aerobic exercise is the most effective ‘weapon’ that we have and both healthy people and people with fibromyalgia benefit from continuous physical exercise.

He and his colleagues recently published a network meta-analysis which was an indirect comparison of all available therapies for fibromyalgia. They were unable to find any significant differences in effectiveness between drug and non-drug therapies. While the effects of drugs are lost once the patient stops taking them, the effects of aerobic exercise and multicomponent therapy are sustained but declining at 1 or 2 years.

Dr Häuser advocates a graduated approach to treating fibromyalgia.

Mild fibromyalgia: can be managed with reassurance from the doctor and encouragement to engage in regular physical and mental activities.

Moderate fibromyalgia: should be managed with aerobic exercise and the temporary limited use of drugs.

Severe fibromyalgia: can be managed with aerobic exercise, drugs and the psychological and/or psychopharmalogic treatment of mental comorbidities.

Dr Mary-Ann Fitzcharles, a rheumatologist at McGill University in Montreal who treats people with fibromyalgia, agreed with the patient-tailored approach outlined by Dr Häuser. She cautioned about overmedicating people, and keeping them on continued medications which have side effects. Non Pharmalocological therapies have no risks, she explained.

Dr Fitzcharles went on to say that non pharmacologic therapies are probably the most important ones for people with fibromyalgia. In her experience, every person with fibromyalgia should be managed with exercise, promotion of an internal locus of control and education.

Activity pacing is the key, in order to not overdo or avoid exercise.

Non Pharmacological therapies include:

  • Aerobic exercise
  • Acupuncture
  • Psychotherapy

Pharmacologic / drug therapies include:

  • GABA analogues
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs)
  • Tricyclic antidepressants
  • Serotonin-specific reuptake inhibitors (SSRIs)

References:

  1. Aerobic Exercise ‘Most effective weapon’ for Fibromyalgia. Medscape. June19, 2014. Annals of the Rheumatic Diseasesard.bmj.com
  1. Comparative efficacy of pharmacological and non-pharmacological interventions in fibromyalgia syndrome: network meta-analysis

          Eveline Nüesch, Winfried Häuser, Kathrin Bernardy, Jürgen Barth, Peter Jüni

               Ann Rheum Dis 2013;72:955-962 doi:10.1136/annrheumdis-2011-201249

 

 

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