Goal 2 - Jogging

In these 3 months my fitness levels improved significantly - I was 20 pounds lighter, could perform 100 sun salutations (Goal 1) and post that walk for 30 minutes at 6 kmph at an incline of 12. I couldn't help but wonder if I should attempt more...

When Hussain had started treating me in Jan 2012, he had promised that I will be running by June and I had laughed at his statement. But now that goal looked achievable. So I decided to start with some jogging on treadmill. In between incline walks at 6 kmph I started jogging, in intervals, at slow speeds of 7 kmph at a mild incline of 1 or 2. I would walk for a minute and jog for 2 minutes - first day I managed 17 minutes of jogging in the 30 minutes that I spent on the treadmill. I couldn't believe it...

Next day I was able to increase the  jogging time to 20 minutes and average speed of jogging also went upto 7.5 kmph. I know that for most people this is brisk walk pace but I couldn't risk higher speeds, lest I increase my pain. Hence I stayed at lower speed, mild incline and in about 3 weeks I could jog at 7.5 kmph for 40 minutes non-stop (5 km in distance) . In order to avoid overtaxing same muscles, I would intersperse jogging with swimming and incline walking. 

This, incidentally, was also a time when I was in between jobs and hence enjoying a 2-month break between my last working day at previous company and joining date at the next one. Since I had time on my hands I was still doing 100+ sun salutations a day (increasing by a few every now and then) in addition to the walking/jogging/swimming. I would start my day with breathing exercises (pranayama) and 100 plus sun salutations (18-24 minutes depending on the count). This would be followed by 40 minutes of jogging or 30 min of high incline walking. Morning workout would end with about 20 minutes of stretching to soothe my sore muscles. If I had energy I would also go for a swim in the evenings.

Being at home these 2 months allowed me to eat early in the evenings. My diet now was tea, marie biscuit and fruits or oats for breakfast. An early lunch (11:30 AM) of 2 chapatis and vegetables. Mid afternoon I would have tea/coffee with marie biscuits. And I would wrap up the day with an early dinner (6:00 pm) which again constituted of 2 chapatis and vegetables. If I felt hungry between 6 pm and bed time, I would consume a glass of hot milk (sans sugar). I would also have my occasional rum with diet coke or a small piece of chocolate but I kept those indulgences to minimum. This no longer had to do with losing weight. Any time I ate more at night or ate late or indulged in alcohol, I was not able to enjoy my workout the next day. 

By third week of May 2012, I could jog at 7.5 kmph for 50 minutes non stop. So I decided that it was time to let go of the confines of home & treadmill and step out in the open. First attempt, I managed to run 5+ km in 41 minutes - while it was much slower than the speeds I was used to 5 years back, it was an achievement none the less. In less than 5 months I had reached my second goal - this was freaking awesome!

The last variable

To get to the fitness level I wanted to achieve, I had sorted 2 of the 3 variables so far - first was intake, second was pain management but third one, that is, the spend was still not determined. While the pain was reduced, I was still unable to run or do physically demanding workouts as I was neither that fit nor did I want to risk increasing my pain. It was after almost 5 years that my pain had come down to reasonable levels thanks to Hussain and I wasn't ready to rock the boat just yet.

Then I learnt that trigger point therapy kind of weakens muscles and in turn weakened muscles develop trigger points easily. So more therapy I took, more I increased the probability of fresh trigger points. Only way out of this situation was muscle strengthening. Years of just walking, swimming and yoga combined with this therapy had left my muscles very weak. I couldn't even lift my purse/bag without wincing in pain - a fitness regime to build muscles sounded almost impossible.

As I was about to lose hope, yet again, I stumbled upon a book that reminded me of something I had kind of forgotten. Yoga. Yes I was doing yoga everyday but more as a stretching regime and not as a holistic approach to strengthen my mind, body and soul. From my previous experience with yoga (at the age of 15) I knew that yoga works in a different fashion - it speaks to the mind from inside and to the body from outside and while it takes time to get them, the results are no less than miraculous. 

So I started the day with breathing exercises (pranayama) - mostly Kapalbhati, Agnisaar and Anulom Vilom. Then I proceeded to do Surya Namaskar (Sun salutation). I started with 2 on day one and decided to add one more every day. My body was too weak to lift its own weight and the first day when I completed 10 salutations, I felt I was going to die. I was out of breath, my arms and shoulders were paining and my quadriceps were screaming. But I kept at it, now adding two every day and 20 days later I had crossed 50. After I crossed 50, I started adding 4 every day and in about 45 days since I had started I reached the count of 100! 

For me this was exhilarating. I had only heard stories of people doing 100 sun salutations in one sitting, I had never imagined that I would be able to the same. Next day when I started the salutations, I wasn't sure I would reach 100 - after all it could have been a fluke. But I managed 100 again and the next day and the day after...

In addition to yoga, I was still doing incline walking on weekdays, swimming on weekends and dedicated one day a week to yoga that started with pranayama and 100 sun salutations, included asanas for upper body, core & lower body and ended with meditation. 

3 months into this new regimen, I started to look and feel better. Under the weight of my own body while doing sun salutations, my shoulders and arms had started to strengthen. Incline walking had started to work on quadriceps, glutes & calves and rest of the asanas had started to work on my core and smaller muscle groups all over. I had also lost 20 pounds and was able to workout for longer duration now that my knees and ankles were carrying that much lesser weight. 

The pain during this period had definitely gone back up but I was able to manage it with therapy and meditation. The 3 pronged approach that Hussain had laid out - medication, meditation and muscle strengthening - I was following it religiously. Every day I would report out my workout, share where the pain had gone up and plan next day's workout under his guidance. If he told me to not do some specific exercise or asana, I wouldn't do it. And I must stay that listening to him helped. A few months later I figured out that I don't need his consult every day if I just listened better to my body but as of now I wasn't anywhere near that stage and relied on Hussain to guide me during this beginning phase. Looks like I had the last variable almost figured out!

A new beginning

After 4.5 years of being in pain and trying various remedies - homepathy, ayurveda, naturopathy, accupressure, acupuncture and ofcourse still on amitryptiline and physical therapy, I had come to the conclusion that I needed to change my approach to solving this problem. I was working primarily to fix the symptom, i.e, pain. I needed to fix this problem in a different manner.

I still didn't know the root cause of fibromyalgia (actually no one still knows for sure what causes it- some say it's genetic, some say is just stress, some say it's environment) and hence couldn't attack it. Only thing I had realised was that therapy and medication alone will not cure me. As I was searching for these answers, fate sent Hussain into my life. (No not DJ Hussain - though I agree that shaking a leg to his music does help me :)) 

Hussain was my new physiotherapist as last one who was treating me found another job and was finding it logistically tough to give me private sessions. At first I was vary of this change because I would need to go through my history all over again and explain what works, what doesn't and then slowly build a rapport that is needed when you spend an hour with someone on a daily basis, while screaming in pain most of the time! 

After 3.5 years of taking therapy I was speaking therapists' language like which muscles are paining or which ones were treated yesterday so shouldn't be treated today and so on. So once he went through my treatment history at a high level, I told Hussain to treat a particular area on my upper back. Most therapists would finish the treatment in about 30 min. But he took one hour and still we couldn't cover the entire area under question. I was surprised but I didn't say anything because every therapist has their own style. Next day again he took longer to cover another portion of upper back. I was tempted to ask him the reason but I chose to keep my mouth shut. As I woke up on the third day I found that pain in the areas treated by him was significantly lower than I had ever remembered. Now I was sure that he was doing something different but what exactly I didn't know that.

Armed with this positive news, I decided to find out why his brand of same therapy took longer and how it yielded better results. The answer was simple - most therapists focus on bigger trigger points to give pain relief in shorter time. But he treated on small ones as well because when left untreated for a long time they can undo the work being done on bigger ones. 

I decided to work with Hussain for some more time to see if his approach was really more effective in the long run. The cost in terms of money and time just doubled up for me. Now I needed 2 hours of therapy a day to ensure that we cover all key muscles atleast once a week. But the relief was noticeably more and was lasting much longer. To me, this was the first ray of the rising sun after a long cold weary night! 

Another Plateau!

After my naturopathy treatment, I tried sticking to their diet plan but it was difficult to sustain schedule of lunch at 11 am and dinner by 6 pm. Slowly some of the old habits came back, for instance, weekend cosmopolitans or late dinners due to work pressure.

However since I could exercise more, I didn't gain weight…instead I lost about 5-6 pounds. But that wasn't enough...I still had 30+ pounds to shed. I stayed on this track for a year  - still marginally in obese category, but eating healthier than before and exercising more.  I did make another farm visit in between for a week, lost no weight but could exercise even more, though still could not jog/run.
I wasn't getting results at the pace I would have liked but I was not ready to give up. I would work out religiously, stay away from high calorie stuff like pizza or ice-creams but something was not working. I was stuck at this weight.

Then came time for my annual vacation at a beach resort. Earlier vacation for me meant eating and I would usually end up gaining 5-6 pounds in 5 days. So this year I was determined not to gain weight. I went to gym in morning, swam for an hour in evening. I kept my drinks to maximum 2 a day; stuck to 2 meals a day – late breakfast and early dinner; didn't eat ice-creams or chocolates and yet I gained a pound a day. 5 days and 5 pounds later I was devastated…where did I go wrong? I worked out (as best as I could with the pain), I ate sensibly and yet I ended up gaining weight!!!

I knew I had to get to the root of this problem and for that I needed data (those who know me are probably smiling right now :) ) I knew I have to now start calculating how many calories I am eating, how much I am burning and then find out where the problem lies.

Last time when I had started calorie counting it was a pretty painful exercise, I had no tool, no database and everything was manual. But this time I remembered someone who had lost about 60 pounds, a couple of years ago, by using a calorie counting app. So I went ahead and downloaded the app on my smartphone, created my profile, entered my weight loss goals and got back the net calorie goal. Now I was ready to start logging in.

As I started logging in my food entries, I found that while my main meals were not an issue in terms of calories, it was the so called healthy snacks (sugar free biscuits for instance) that were adding to my calorie count. I also learnt that walking doesn't burn as many calories as I had thought. In summary my intake was same as spend and hence I wasn't losing weight. The first step to get moving from this plateau was to create a calorie deficit through lower calorie diet and more exercise.

For diet correction, I went back to drawing board - this time a virtual one and designed a 1200 calorie diet for me. I created recipes on this app, using actual quantities of raw ingredients being used in my kitchen, and computed calories of each serving of daily food that I was consuming. Soon I realized that I needed to cut down on the second helping of "healthy" vegetables because while we may all curse potato, a big chunk of healthy vegetables are also calorie rich. Yes they provide additional micro-nutrients that a potato doesn't but that doesn't mean we should consume them as much as we want to. While the app in itself wasn't the solution, but it was instrumental in educating me about making better food choices. I could no longer tell myself that since I have walked for 30 minutes, I have earned that slice of pizza.

Next step was upping my calorie burn - this was a tougher variable to solve for considering I was still in pain and still in need of daily physical therapy sessions. In addition, Praveen had left Bangalore and since them I had been through a series of therapists - all of them were good but none could provide me lasting relief.

By this point, I had been in pain for 4.5 years and 3.5 years since the diagnosis of fibromyalgia. For last 3.5 years I was using therapy as an alternative to consuming pain killers as the latter is toxic (though much cheaper). While I was aware that physiotherapy is not going to cure me, I just didn't know what truly will. In summary, this plateau was something I hadn't figured out a way, yet, to move from.

A tryst with Naturopathy

One day I saw this colleague who had lost 20 pounds in a month by going to a health farm that uses naturopathy to cure ailments including obesity. I am usually very skeptical of such farms but naturopathy sounded good and cost was not prohibitive, so I decided to send an application. The process includes a doctor reviewing your application and granting you admission if they find that you will benefit from the stay.

Key reason I had applied for admission was treatment for fibromyalgia because I knew that once I get rid of pain, I can buckle up and lose weight as I had done before. My application was approved and finally I landed there for admission.

Let me give you an idea about the facility and treatment. No outside food is permitted in the facility, only very important medicines (approved by a doctor there) are allowed, you have to deposit the rest. Surprise checks of your accommodations ensure that all patients comply with these two rules. The doctor, after a detailed and long consultation, decides on a course of treatment which is accompanied by a diet.

Diet is as much a part of the cure as the treatments they have. You can’t cheat on the diet because it is written on a card and you are given food per the instructions on your card. Plus there is nothing interesting anyway that would tempt you in the first place! In addition to a strict diet, naturopathy also means that you can’t have anything toxic or addictive like tea, coffee, tobacco, alcohol, meat. Even dairy is considered unnatural. Your food mainly consists of fruits, vegetables, whole grains and soy milk.

Treatment includes various kinds of packs & baths, colon-cleansing techniques, yoga, acupuncture, reflexology and physiotherapy.  A typical day starts at 4:30/5:00 am with a walk, followed by yoga, then after a glass of juice for breakfast your morning treatment begins. Lunch starts at 11 am so post treatment you have lunch and can get an hour of rest before afternoon treatment session. Then you have disease specific yoga class, acupuncture, reflexology, swimming (if you’ve energy left). Dinner wraps by 7 pm. Most folks take long walks post dinner as well.

For most people lunch and dinner is usually fruits and boiled vegetables in controlled portions. Some lucky ones get to eat whole wheat chapatti. And if you are unfortunate your lunch and dinner will comprise of a just a glass of juice each. These are called fasting days and are used as a detox. During my stay I was on fast for 3 days...first day is the toughest - you experience severe headache but by third day you are full of energy and ready to take on the world. The decision on the diet is doctor’s – you can shed a few tears and get him/her to be lenient for one meal but mostly they are strict about what you should eat based on your ailment.

I was at the farm for 10 days but I didn't lose much weight inspite of walking 6 miles a day and eating only fruits and vegetables. However, I did see a significant increase in my stamina to exercise and flexibility of my body. There were certain yoga poses that I couldn't perform perfectly when I had landed at the farm but by the end of the stay, I could do all of them with perfect form.

I came out about 5 pounds lighter (most people lose 10+ pounds in the same duration) and physically a lot better than I had expected. I, personally, give their colon-cleansing treatments a lot of credit for the difference I felt in my stamina. I had 3 of them and while I found  them painful, I still remember feeling better after each successive treatment.

One thing that I learnt from this experience that there is a lot of merit in eating natural/fresh foods as against processed/preserved items that we consume a lot. Eating wrong food (even if low in calories) damages our body more than eating higher calorie right food. I would rather eat a 160 kcal mango as a snack than eat a 150 kcal protein bar.

One step at a time

In tough times food becomes a source of comfort and creates a vicious cycle. You gain weight, nothing fits, you get upset so you eat more food for comfort, gain more weight, get more upset and eat even more...

In order to break away from this, the most important and toughest step is admitting the problem. It took me a few more months to realize that I was using food and alcohol to comfort myself during this pain ridden difficult time. The key challenge with this problem, which millions of people worldwide deal with, is that there is no easy fix for this. I did't know what to do about it or how to fix it.

Amidst all this chaos, in a rare moment of sanity, I decided to try meditation. I signed myself up for a 10 day residential course on the outskirts of the city and without thinking landed there. In hindsight, had I thought a lot about it I would not have attended the course.

I will not get into the details of the course in this blog (you can read about it here in stead) but it helped me stop using food and alcohol for emotional comfort - the first step towards recovery! I stopped gaining more weight and started thinking about how to shed the 40 pounds that I had gained.

Now that I was controlling my diet and weight gain had stopped, the second step was exercise. I had been exercising on and off - walking, elliptical trainer, yoga but I wasn't able to push myself too hard due to the pain. By this time I had started private therapy sessions with Praveen as my schedule at work was more hectic than ever and I was unable to find time to go to the centre for treatment.

While the doctor was still against me exercising, Praveen said that we would start slowly and that he will help manage the pain with therapy. Under his guidance, I started incline walking on treadmill and as expected the pain did go up but with extra therapy and my determination and his motivational words, I kept increasing the incline and speed and distance walked.

There were many times when I felt discouraged either because of pain or when I would think of how I used to run at high speeds for an hour or so before fibromyalgia, but I didn't stop working out. First I increased the time to 20 minutes, then I increased the incline, then the speed and then time again ...and in a few weeks I was walking for 30 minutes at 6 kmph at an incline of 10.

I had broken out of the state of inertia, I had taken 2 important steps - stopped using food for comfort and started a walking regimen. While I knew that there were many many more steps that I would need to take to reach fitness levels of an average individual, I refused to think about it. I kept my focus and directed all my energy to putting one step in front of another!

No light at the end of the tunnel

A few more months went by and the therapy became part of my routine - wake up, go to work, leave work, go to clinic, reach home, apply hot pack, have dinner and have restless sleep (thanks to fibromyalgia). This was all that I did for 4 months. To break the monotony, I decided to take a short vacation to lift my spirits. But as luck would have it, just a few days before the vacation, my pain increased manifold. I didn't know what else to do so I increased my therapy.

I still remember the day when I went to clinic in the morning as I couldn't wait for my evening sessions and after that instead of going to work, I came back home and broke down. At that time I was convinced that this ordeal of mine is not going to end, ever!

By this time Praveen (who had become a friend over this period) was moved to another centre and I was working with a young therapist who was still learning the technique. Poor guy gave me therapy even on his birthday as I was in so much pain but in his zeal to make me better, he inadvertently ended up causing more harm. He used too much pressure at the same points resulting in severe soreness and tenderness of the area in question.

I wasn't any better but I popped in some pain killers and went ahead with my beach vacation. After I came back, I met with the doctor as pain had not come down and he told me to lay off trigger point therapy and get some ultrasound and taping done. He also changed my medication from Pregabalin (the usual treatment of fibromyalgia) to Amitriptyline - who knew that I would respond better to a drug that costs one tenth of the latest and greatest Pregabalin!!!

With this new medication  the tenderness and soreness across my body started to come down and I could take more physiotherapy. Due to my bad condition, the center head and a very senior therapist (Muniyandi) took over my case. While he also mostly provided trigger point therapy, he used much less pressure and mixed it up with gross myofascial release and muscle energy techniques. Soon I was feeling better and was hopeful of starting exercise in a few weeks. I had gained about 10 pounds but I knew that once I get back to my earlier schedule, I would lose these in no time.

As luck would have it, things took a turn for the worse. Another 4 months since the change of medication and therapist, while the pain had come down, I had started to feel very tired and fatigued- so much so that I would lie down at the back seat of my car while I was driven to work. (Due to severe pain I had stopped driving almost a year back). And suddenly I started gaining weight as well - that too at the rate of 6 pounds a month. By the time I found out the cause of the problem and began treatment for that, I was back in the obese zone.

This weight gain was a result of severe thyroid inactivity -  my TSH levels were 160 (normal is less than 5.5.) We found anti thyroid antibodies in my blood, proof that my own immune system was killing it - for that matter had already killed it (hence the super crazy TSH levels). At this time I also tested positive for antibodies linked to fibromyalgia - establishing the fact that the two conditions were inter-related and that both were auto immune diseases.

Since it was almost a year since I had to give up exercise, I decided to get back to it slowly - same as I had done before at the weight of 200 pounds. I started walking again - increasing a bit every day. I also started GM diet...but I was too much in pain to stick to it. Then I started soy diet and then realized that soy doesn't help hypothyroid patients and gave it up. Lost a bit of weight each time I went on a diet and gained it all back and some more every time I gave up the diet.

6 months of this yo-yo dieting, comfort eating (and drinking) and minimal exercise due to pain, I gained another 10 pounds. Now I was totally miserable but didn't know how to get out of this vicious cycle. I had no willpower left to diet (managing day to day pain took care of that) and exercise at my increased weight was even more difficult. I was depressed, irritable and angry - at myself and everyone else around me. Unhappy, unwell and depressed, I continued to look for comfort in food and alcohol and gained some more weight and soon was pushing the limits of obese zone as well - at that time it felt that there is no end to this dark long weary painful tunnel that lay ahead of me!