Shoes glorious shoes…. flats, kitten heels and stilettos!

Shoes….

So, does anyone else have a real problem with shoes?! I love shoes! I hate shopping, I’ve never been that bothered by clothes or bags, but I do love shoes.

I like flat shoes and I like high shoes, but I really really don’t like uncomfortable shoes. And this is where the problem lies… Most shoes, especially pretty shoes are uncomfortable (after a while), combine that with feet that are uncomfortable, and you get… unbearably painful feet that make looking nice in pretty shoes very very difficult!

I can remember the last time I wore high heels, my friend’s hen do… It was this May bank holiday last year, at York Races! The weather was a bit different!! Here are the shoes:

My beautiful shoes on my already swollen feet!

My beautiful shoes on my already swollen feet!

 

 

And here are the girls and I (shoes cut off!):

IMG_2234

That’s me at the front in the cream dress

 

I took a pair of flip flops in my handbag as I knew it was a pipe dream to think I might be able to stay in them all night!! And by the time we left the races to head into town, the flip flops were on…. Now I must say, I was a bit smug, as everyone else had sore feet, but the difference is, they could just keep going, there was absolutely no way on this earth that I could have continued in my shoes, but I knew that would be the case, and I had planned for it. From then on however, wearing high shoes has been impossible.

There could be two reasons for this, May was the month I stopped taking my Methotrexate, over the next 5-6 months I noticed a gradual increase of pain and swelling, so it could have been a coincidence that the May bank holiday in York was the last time I was pain free enough to wear high shoes.

The second reason is that I developed a very inflamed second MTP (Metatarsal-phalangeal) Joint with associated bursitis (swollen ‘sac’ of fluid within an anatomical space – we have bursa everywhere, but the main ones that tend to bother people are the ones on our hip – trochanteric bursitis, and in our shoulders – subacromial bursitis). This, thank fully got addressed as soon as I brought it up with my rheumatologist, they arranged an ultrasound guided cortico-steroid injection which helped enormously, but I think the impact of stopping my medication had already taken its toll, and although it meant I was now able to walk around at work without ‘hobbling’, it didn’t quite make high heels ok!!

So now I just keep my eyes out for lovely flat shoes… but these too have problems. The problems with flat shoes aren’t as obvious as with high heels, but are more numerous!!

Flat shoes can’t be too flat!! Flat shoes soles can’t be too thin or too hard! Flat shoes don’t have enough support – at the ankles, at the heel, at the arch!! It’s a mine field!!

The best, most comfortable shoes I own…? Trainers of course! But who looks pretty at a wedding in a pair of trainers!? I’ve done it at a university ball, but my dress was more than floor length, and the party went on until 10am the next day, so endurance was the key for everyone!! Not just me!!

Now I know that there are companies that make very comfortable shoes, and yes, they have started branching out into more ‘fashionable’ styles, but really… here are a few snap shots of the shoes that come up when you Google women’s comfortable shoes:

comfy shoe comfy shoe 7 comfy shoe 6 comfy shoe 5 comfy shoe 3

 

I know, I Know…. There probably are nicer shoes out there, in fact I know there are. Such as:

comfy shoes 12 Comfy shoes 11 Comfy shoes 10 Comfy shoes 9 Comfy shoes 8

 

 

 

 

 

 

 

But… they just don’t cut it with a pretty dress!! Well, not with my legs anyway… but that’s a different story!

So my question is… why is it so difficult to make gorgeous shoes with soft, spongy, contoured soles, with appropriate straps (Either good flip flop style (as I have yet to find an ill-fitting pair of Havaianas), or round the ankle support/straps) that make your feet and legs look gorgeous, and don’t feel like they are stabbing pins into your feet??

Surely it can’t be that hard? I’m not asking for miracles, I’m not asking for comfy stilettos, just some supportive shoes that haven’t been made for the over 50’s?!

I’ve wondered this for years… So does anyone out there have any tips on where to get these magical shoes that must exist… it is 2014!

 

 

 

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Lesson Learnt…. well, maybe!

So… Effects of the pacing from my active Wednesday night?? My shoulders are killing me!! So was it the rowing? the mowing? the hanging out the washing?

The answer…? Who knows… because I did them all on one night, I’ll never know… I did not pace myself well!!! Ah well, lesson learnt for now 🙂

Tonight was the ‘mother in laws’ birthday, so we went out for Chinese!! So no huge amount of exercise, back on it tomorrow!

To cycle or to row… That is the question!?

21/05/14

So, in my last post I stated what a poor patient I was to myself as a Physio, and that I intended to improving my pacing.

Well, the following day (Tuesday) I had a day off work to go to my rheumatology clinic appointment ( the hospital being a 2 hour drive away). Of course that was a good day… But why? Because I got up, had breakfast, cleared the kitchen, and went upstairs for a shower… No rush, no haste. That extra long shower eased so many aches, I then attended my appointment had a good chat with the doctors and a management plan was created for the coming 6 months, I was happy. I had their number if there were any problems. I drove home.

After having a bit of food, I took my own advice and by 15.30 I was out in the sunshine on my bike. I only did 30 mins, two short laps of the local village, but I loved every minute! The wind in my hair, the sun on my skin, the muscles in my legs working. Yes my knees hurt a little, and my wrists and fingers made changing gear and braking a little tough… But that’s what exercise does to you, you don’t focus on the pain, you feel the enjoyment… Granted if it had been a miserable day and I was on an exercise bike in the gym, I don’t think it would have had quite the same effect, but thankfully it wasn’t and I wasn’t!

So, Tuesday was a good day, why? (Oh I also took the dogs to agility, but that was pushing it a little too far, so Andrew did the running around for me! I’m not superwoman… Yet!)

Was it because:
1) I was off work? It certainly relieves a little of the stress of a morning, even if I don’t feel stressed most mornings
2) I had a long shower (10 mins-ish, but I wasn’t clock watching because of 1)!!!
3) My clinic consultation felt worth while, I had a plan, and felt supported
4) I paced my self through the day, not overloading myself with ‘to do’s’
5) I got out on my bike and released all those endorphins that have lay dormant in me for so long
6) It was sunny

It could have been any of the above, and more likely a combination of all of them, but, that’s not a typical day for me, 5 out of 7 days I’m in work, the luxury of pacing such as the above isn’t afforded to me. But, what I am making a mindful effort to do, is give myself time, don’t stress about things that aren’t getting done (they will do eventually… I hope), and drip feed in a little more exercise here and there….

So what happened today, Wednesday…. Well, the first difference is, I have started a short descending course of Prednisolone. 10mg today and for the next 3 days, descending by 2.5mg until nothing, 16 days in total (following on from the clinic appointment on Tuesday).
I also retuned to my usual 8.30-5(ish) job on the ward. No huge changes to pain early in the day, but definitely an improvement as the day progressed, which can be very normal for me, as moving does help enormously, until i stop!!
It has been a glorious sunny day all day, so I have been dying to get into the garden… But I also felt I aught to do something exercise wise. I could have convinced myself, that as I am pacing myself, there would be no shame in resting today, and returning to it tomorrow, however, I am 29 with a previous level of fitness that means I could easily do a little something (stop talking yourself out of your own advice!).

To cycle or to row? It’s been hot, the rower is in the gym… It is stifling in there… Back on the bike it is… GOOD GRIEFE my bum hurt! I had to do the first quarter in standing! But it eased, it got easier, I could sit for short periods, but I decided I’d only do one short lap of the village…. My knees felt better, my wrists felt ok (still twinging), but I was determined not to over do it. The joy I got was still the same though 🙂

Since my sore bum shortened my ride, I decided to do a short burst on the rower too… My aim is to maintain strength and tone in my arms and back, not to become the next Mathew Pincent, therefore I did 50 rows in pronation and 15 in supination (to get my biceps… I had aimed for more, but my right wrist has been so bad I seem to have lost range in supination, and I found it particularly awkward, something else to monitor and work on).

But… As any poor pacer/patient would do, why stop there?! The garden is getting wild, so I whipped out the mower and did the grass, then hung out the washing and put on a white load…… Well, in one sense it’s pacing, they are all different activities using different muscles and different postures, not one of them took longer than 30 mins in total…. Let’s see how I go for the rest of the week!

So, on reflection, what has changed….

Yes Prednisolone does work wonders for me, and always does, there are side effects possible when pregnant, but they are small, and on the whole better than other medications, plus a mobile, stress and pain free me must be kicking out more favourable hormones for mini me?! – But could Prednisolone really have worked so quickly…. I look at my joints and I’m inclined to say yes, I guess we will see in 8plus days time when the dose reduces to what I have found in the past to be non therapeutic for me.

Is it my determination to act? To take a stand and do something active about this pain that limits me? I know pacing itself doesn’t ‘work’ after two days! So how much of the change about me is psychological? I’m afraid to say it is probably a pretty huge proportion, again, we will see in a few short days as my Prednisolone reduces, if I gradually get worse it’s the drugs, if I remain well it could be the drugs, it could be my mental attitude and my mental state. Only time and effort will tell. I don’t doubt there will still be tough times ahead no matter what, but there will be good times too.

Peaks and Troughs of Activity

As a physiotherapist I always prided myself on my ability to empathise with the patient. To be able to talk on a level about chronic pain and pacing, the do’s and don’ts, the reasoning behind it, and the need to avoid peaks of activity followed by troughs of inactivity and pain and the downward cycle of deconditioning.

I felt able to use myself as an example of it working, and of pacing’s benefits. But perhaps I never appreciated how much of a pivotal role my pain management played in my being able to achieve appropriate pacing.

Of course, I knew how important pain medication and pain management was with pacing. I regularly encouraged patients to go back to their doctors and consultants to discuss better pain management. But I think I lost sight of how much my medication was helping me! Until I had to stop taking it!

Over the last year, since stopping the methotrexate and just being on the Etanercept (Enbrel) my pacing has been POOR! My lifestyle and my pain levels don’t match well at present, and it has taken me a whole year to be able to look back and appreciate this… I am a rubbish patient, I have always been a rubbish patient, I have never taken my advice well, but now I wonder, if it’s about time I started to listen to myself.

In the past year my activity levels have plummeted due to the pain and exhaustion of a full day at work. I have managed little more than two dog walks a day, and that has now dropped to one more often than not. I have deconditioned. I am now feeling the effects of the deconditioning – Right Achilles tendinopathy, Right anterior knee pain, the list could go on – hills and steps have become my nemesis…. I’m 29!!!

For the last two months I have been giving myself exercises to combat these secondary problems… but like a bad patient I have done them infrequently, and therefore they are useless.

I feel that at the moment, work is my peak of activity, I have exhausted all I have by 4.30pm, and my trough of inactivity is the evening. My feet throb from being stood up all day – I want to sit down, then I seize up and struggle from the chair, my hands scream from holding, supporting and facilitating people all day – I don’t want to hold or touch anything in the evening. And the rest of me aches and feels heavy and difficult to move.

I know however, I have to start doing something to break up the inactivity of the evenings, I have loads of options easily to hand… cycling, swimming, rowing – all low impact, with the benefit of strength and cardiovascular fitness. Of course I know this! I’ve suggested those and many other activities to hundreds of patients… I’ve just got to listen to my own advice!!

So… the plan is… well, the plan is still forming! But I’m going to, I have to, get more active in the evenings… Ideally I’d get to rest a little in the day, but that’s not going to be possible, so instead I have to manage my time in the evenings better, relaxation can’t be on the settee… as I can’t get up again, and going up stairs to bed becomes a 10 minute ordeal. Perhaps going swimming, or pregnant yoga, or out on the bike… my problem is, I’ll miss my pooches, I have to cook dinner at some point… and will I burn myself out? People keep telling me that as a pregnant woman I should be getting some rest… it’s going to be a work in progress!

In the meantime, I’m waiting for an appointment with a colleague, so I have someone else telling me this stuff!! It’s a lot harder to ignore someone else, it’s very easy to talk myself out of doing things! Although that’s a trait I am working on.

And finally, what better motivation to stay in shape and find ways of pacing myself now… because in six months’ time, I’m going to be looking after someone else too, time management is going to become imperative!! And I know myself, if my muscles weaken, and my joints don’t get their support, on top of additional weight (both baby and the odd cake!) it’s only going to make my life harder!!

 

Welcome to Wordpress!!

Hi there!! So please bear with me, this is my first ‘blog’!!

I’m Nina, I was diagnosed with Rheumatoid Arthritis in 2007, I was 23, it wasn’t a huge surprise to me, I had just finished a physiotherapy degree, so I was pretty clued up on the early symptoms, so when I went to my GP with pain and swelling, I think he was more surprised than I was at the blood results. I was, however still pretty devastated, which thankfully once on the right mix of meds, ebbed away.

I didn’t ever think about blogging about RA, I didn’t have much to say, I was well controlled early on (after a rather shaky start**), and had a career and a life to be getting on with!! In fact I didn’t know much about blogging until very recently (and I still don’t know much at all!) when I met a colleague who was blogging about her life here in the UK, following a move from South Africa. This piqued my interest… but only over the last 3 months have I really seriously considered writing my thoughts down.

So what happened 3 months ago? Well, it actually started last May (2013). When my other half and I decided we were finally as ready as we were ever going to be to start a family***. I was, at the time, pretty well controlled by Methotrexate 25mg, and Etanercept 50ml injection once a week, and to start the planning of our little human, I stopped the Methotrexate.

Straight away I noticed a difference, but I put up with, and managed myself with the addition of NSAIDs (Non-Steroidal Anti-Inflammatory Drug) until October. I had decided to be off the Methotrexate for 6 months, rather than the 3 months suggested by the consultants, because I wanted to be sure it was clear of my system…. (I think if I were to do this again I will look a bit more thoroughly into the evidence behind the recommendations, as six months was tough!). In October I got in touch with my consultant and the addition of Prednisolone helped me cope enormously! Steroids really can be magic…. Forgetting about all the side effects for a moment!!

Along came February… and the news we were all hoping for!! I was PREGNANT!

So here we are, 15 weeks in, due in November… all meds stopped 15ish weeks ago… No steroids, No Etanercept, No Methotrexate… exhausted, worn out, and in pain.

And this brings me to why I’m here, I have been looking for an outlet for all my thoughts and feelings at this time of my life (which I have A LOT of!!) and hopefully connect with other people that might be going through the same dilemmas, highlights and lows. Since deciding to take this on, I have discovered that there are LOADS of blogs about RA, and I am only just beginning to scrape the surface of them… I wish I had known about them over the last 7 years of my life… I might be far more educated and informed than I am now…

So, my fist blog completed…. Let’s hope I manage a few more!

 

 

** Initially I was prescribed Sulphasalazine… which did not agree with my liver AT ALL!! So apart from being in pain, I was very unwell, but thankfully, a change of hospital, consultant and DMARD (Disease Modifying Anti-Rheumatic Drug), and I was well on my way to being very well controlled for the best part of 5 years

*** well, add a little human to the house hold, as there is already the two of us, two pooches Riva and Zeus, and two Yellow Bellied Sliders George and Gonzo – photo’s to follow!

 

Waiting patiently on a picnic break in the hope of a buttie!

Waiting patiently on a picnic break in the hope of a buttie!