Friendsourcing Motivation

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Sunrise, Sylvan Dale Guest Ranch, Loveland, Colorado. Photo courtesy of Dr. Anne Dixon

Greetings, friends!  How goes it, halfway through January of the New Year?  How are you doing with those resolutions?  I always feel conflicted about announcing such commitments, preferring to call them ‘intentions’ (see here, here, here, and here!).  I’ve read too many articles dismissing resolutions as mindless, unhelpful, and ultimately a waste of energy.  And yet, the start of a new year naturally prompts reflection and renewed motivation for self-improvement, which are good things.

Once again, taking a more nuanced view helps here.  It’s not that resolutions are bad.  It’s that we need to be thoughtful and realistic about them, as the linked article above suggests.  Whatever we call them, commitments to behavior change can lead us to transformation.  But it’s anything but simple or easy!

My post on experimental questions got a boost in views this past week.  I wonder what prompted that?  I wish I knew who was reading it and why, what they think, and what it means to them?  Since that post was published, I have continued to ask my 4 newest questions, of both patients and myself.  The recent traffic on that post parallels the evolution in my own reflections and answers:

In the coming year, what do you see as the biggest threat to your health?

My hedonist impulses, no question:  Ice cream and office sweets, mostly, but also online washi tape sales and paper, clothing, and shoe stores.

What is the biggest asset?

My friends, also no question, my pit crew.  They encourage me, keep me honest, and lend perspective.  They teach me and inspire me.  They hold me up.

One year from now, what do you want to look back and be able to say about what’s important to you?

In January 2021, I want to look back and say that I got fit again, that I regained the exercise discipline I lost in 2019.  I got control of my eating, decreased my sugar intake by at least half.  I put my phone down and was more present with my kids.  I was more intentional and executed better on how I spend my time and energy overall.  I exercised agency over my life better than ever before.

What support (external to yourself) do you already have and/or may still need to recruit, in order to make that vision a reality?

On November 10 when I posted these questions, I honestly had not answered this one yet.  It was harder than I had anticipated.  Since then, as I continue to ask patients, I see that I’m not the only one stymied.  My first response resembled my patients’, something akin to, “Well, I just have to do it.”  We type-A, independent peeps often rely first and foremost on ourselves.  We don’t ask for help.  And even though I have written and spoken ad nauseum about the importance of support, I found it difficult to identify my own need for it.  This is why I have added the ‘external to yourself’ clarification to the question.  Support comes from somewhere or someone else.  And we all do better when we have it.

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Friendsourcing Motivation

The whole time, the answer was right there in front of me.  The biggest asset to my health is my friends.  We know that social support (sometimes in the form of peer pressure) can be the key to success in behavior change.  Why else would people attend Weight Watchers meetings, or to go AA?  I need a workout buddy and a healthy eating buddy, I realized—I can tap my assets!  Eureka!

Easier said than done, however.  Who should I ask?  What should it look like?  Over a month or so, I worked out my specifications:

  • I need support from friends, not strangers (thus fitness classes will probably not be my jam)
  • I don’t want to be constrained by schedules with my buddies—flexibility is key
  • I need a two-way arrangement—someone who also has a goal that I can support them in
  • The arrangement must be concrete and accountable, but not feel oppressive

Tadaaaaah—Habit Share*!

On our sunrise walks in Loveland last weekend, two friends from LOH and I agreed to be one another’s buddies.  It was perfect—we all wanted the same things; we just needed an easy way to connect.  One of us, the youngest, most tech-savvy one, found the Habit Share app.  It’s free and perfect.  We each define our own goals, and simply share them with each other online.  We receive notifications when our friends check in, and we send messages of encouragement and solidarity.  It’s perfect!  I have already shared the app with patients and other friends, and am now connected to two more friends.  Our habits range from exercise to reading, to flossing.

Holy COW, what a difference!  Just knowing that I’m tracking my goals, and that my friends are seeing and supporting me, it’s been exponentially easier to motivate and execute these seven days than the entire past year.  It’s easy, aesthetically pleasing, costs no money, and connects me with people I love.  It is–wait for it–PERFECT!

I know, I know, it’s only been a week.  Who knows what all of our app screens will look like in another week, a month, or three months from now?  Will we all still be connected and holding each other up in a year?  Who can say?  But what’s the utility of thinking that far ahead?  Yesterday I set the new goal of getting up early once a week to write.  Today I can check it off.  I still have a chance to say no to ice cream, work out, turn off my phone apps by 10pm, and floss!  My friends will know when I do it, and they won’t judge me if I don’t.  It’s all good, and we can all take it one day at a time.

So, what support (external to yourself) do you have, or may still need to recruit, to make your best-self vision a reality?

*I have no financial or other interests in this business.  In fact, I want to contact them to give them feedback about how to make it better, but I cannot find a ‘contact’ page on their website…

November 21:  Cardio Catch-Ups Make Me Better

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Ummm, this may not be my photo!  It was on my phone from 2017 and I can’t remember where it came from–I usually ask friends for permission to use… If it’s yours please claim it!

NaBloPoMo 2019

Is there something you should do but you don’t always want to?

Exercise perhaps, or laundry?  Dishes?  Cleaning and decluttering?

Last year I listened to Better Than Before by Gretchen Rubin.  It was a fun, relatable, well-researched and –reasoned book on habit formation and change.  I have recommended it to many patients for its myriad practical strategies.  One that particularly resonated with me was the idea of pairing.  Basically if we combine the thing we should-but-don’t-want-to-do with something we like or do-want-to-do, we are more likely to form and strengthen the habit of the ‘sbdwtd’.

In one of those Eureka! moments of instant understanding and integration, I started saving my favorite TV show to watch while doing the interval program on my elliptical.  Thanks to the hubs for positioning the cardio machine right in front of the TV in the basement!  Sadly, The Big Bang Theory has concluded and there are no other 30 minute shows quite so compelling to get me moving.  Thankfully I have my favorite podcast and Liked Songs list on Spotify, so I’m not totally sedentary.  On days when I’m really motivated, I still do the 7 minute workout or a TRX program.

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Do you wish you could connect more often with friends?

Years ago I remember talking on the phone while unloading and putting away groceries or folding laundry.  My friend was in San Francisco, I in Chicago.  We knew each other’s days off and would just call when we had a moment, and talk if we were free.  Farther back, in college and med school, we could all just hang out at each other’s apartments, pretending to study, but really just eating and talking.  Now we text, which is nice, but it’s not the same.  Somehow it feels harder to get folks on the phone anymore, and even harder to meet in person…  I miss my friends.

I’m getting a little better, though.  Sometimes I make phone dates with people for my commute.  It can be challenging across time zones, but we make it work.  It’s finite and somewhat reliable—I have to spend 30-40 minutes in the car at some point on any given morning and evening on workdays.  I even managed to connect with two Counsel members for pep talks before important meetings recently.

This month my new friend Alex and I started a new connection method, the Cardio Catch-Up.  She lives in DC and has to walk her dog.  I still need to work out, which I usually do in the evenings.  So we arranged a call over exercise tonight.  It was perfect!  I had to commit to a certain time, and my friend held me accountable.  I got on the machine and didn’t even notice the time going by (okay it just went by a lot faster), while we bonded over our LOH learnings, musings on human behavior and tribal dynamics, and our shared progressive values and aspirations for the planet.  I got my workout in, check.  And we both alighted on themes for future blog posts.  Tonight’s nascent idea:  Is the contagion of urgency the best vehicle for motivation?  Who knows where it will lead, into what it will grow, with what it will merge?  Regardless, it was born of an optimal pairing.

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The Cardio Catch-Up is the perfect multi-win:  Move the body, release stress and tension, connect with another beautiful human, exercise the mind, and inspire the spirit.  Who wants to do it with me next week?

Bring It

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NaBloPoMo 2017: Field Notes from a Life in Medicine

Had my knee MRI yesterday.  I had been looking forward to it for over a week, trying to predict what it would show.  I was thinking a serious meniscal tear, since I have had crackling in my knee for so long and I surely must have arthritis by now, from all the falling on it I did in my youth.  I lay perfectly still and started to get sore where I expected to feel medial meniscus pain.  I could not wait to know the results.  I just wanted to know what I’m dealing with, so I can figure out next steps, get moving.

Since it’s a weekend, I won’t know the radiologist’s report until tomorrow.  Suddenly part of me doesn’t really want to know.  What if it’s really bad and the only option to regain function is surgery?  What if it looks like I’ll be permanently disabled in some way, never able to get back to my previous level of activity?  What if that prognosis totally throws me off and I let myself go, become a sedentary lump, weigh over 300 pounds, and die in five years from heart disease and depression?  Truly, this could end my life, some poisonous voice hisses in the recesses of my mind.

But hubs is the ordering physician and he looked at the images with me tonight.  Lots of fluid/swelling.  Bruises on both bone ends of the joint.  Good news, the menisci are intact and look normal!  Woo hooooo!!  Posterior cruciate ligament also looks normal—thick, uniformly black (swelling and inflammation are light on this image), well-positioned.  Can’t find the ACL.  Huh.  He says 10% of people don’t have one.  That’d be cool, because if I never had one then it couldn’t be torn.  But the bone bruises alone are not enough to explain the swelling and pain.  So either it’s so inflamed that the fluid obliterates it on the MRI, or I have completely ruptured it and the little stumps have retracted out of view.

I had wondered which I would rather have, a serious meniscal or ACL injury.  I had leaned toward the latter, because the ACL can be fixed.  Meniscal tears really don’t heal; the body smooths them over somewhat with time, but the end result is just less cartilage, faster wear, and more tear.  The problem with an ACL injury, however, is that it increases the risk of future meniscal tears.  So either way, the knee will never be the same and now I have to deal with it.

We will wait for the official report, and I may see the sports orthopod.  Here’s what I don’t want from that appointment: For him to tell me, “Cathy, you should stop playing volleyball or anything that requires jumping, sudden movements, or the like.  You’re too old and your knee will just be hurt again.”  I will be polite, but in my mind I will think, “You can’t tell me what to do, I’ll play f*ing volleyball if I want to, and I will do it with or without your help.”  What I would love for him to say is this:

“Cathy, here is what’s going on in your knee.  It’s likely that these factors contributed to the injury (lists possible risk factors that he knows from my history), and also it was a freak accident that can happen to anyone, especially jumping female athletes (which is true).  It’s a good thing you’re pretty healthy to start with, and that you had gotten fit these last few years.  What do you want to do now?”

I’ll tell him that I really want to get back on the court and play.  I’ll tell him I want to keep doing all the training I’ve been doing: elliptical, Kangoo running, TRX, pistols, golf, and Betty Rocker workouts.  I want to take up new things like Orange Theory, kickboxing, martial arts maybe, and who knows what else?  I want to be the most active person I can be, and I want to JUMP.  I’ll tell him that I want to be responsible about it; I’m not going to ignore the risks and be stupid.  I want to know the risks, the evidence as it applies to me as specifically as possible, the 44 year-old mom with lax ligaments and super-flat feet.

Then I hope he tells me, “Okay then here’s the plan.  We gotta rehab the knee really well.  Ya gotta be patient.  Keep up with your trainer, strengthen all the muscles around your knees, continue working on core, posture, and form.  When you start jumping again make sure you know better how to land, train that muscle memory and get it down, own it.  Take your time, and take it easy when you start again.  There are braces you can use when you play that will help keep the knee stable.  And you still might hurt yourself again, there’s no way to predict what will happen. But if that’s what you want to do, I’ll do my best to help you get there.”

Because here’s the deal, my friends:  I own my decisions, but I need help to make them in the most responsible and informed way possible.  I don’t need someone paternalistically telling me what to do, how to live my life.  I need the doctor to explain to me the risks, benefits, and costs of what I may want to try.  Then I need to him to trust that I will make the best decision for myself, based on my own core values and goals.  I understand that nobody can predict the future.  But I also have a clear vision of the future I want.  I want to live a very active life, able to try new things and connect mind with body with spirit, and with other people.  I want to look back in 10, 20, and 30 years and say, “I did what I wanted to do, I made my decisions with the best information I had at the time.”  I may hurt myself again.  I may end up with a knee replacement before age 60, and never run or play volleyball again after that.  But if I get there having thoroughly assessed the risks of my actions, having taken all reasonable steps to proceed safely, and having continued to have fun and enjoy my mobility as long as I could, then hopefully I will regret very little.  I would much rather live this scenario, than get to that age wondering, “What more could I have done?  Did I sell myself short?”

This is how I discuss decision making with my patients, particularly when it comes to screening.  Their decisions must originate from their personal values and health goals, not mine or anyone else’s.  How do they understand the risks, and which worst case scenario of screening or not screening, treating or not treating, will they regret less?  A very athletic yet osteoporotic 65 year-old woman really does not want to take medication.  So we review her daily dietary calcium, vitamin D, protein, and vitamin K intake.  We make sure she continues weight bearing exercise every day.  We pay attention to balance, flexibility, strength, vision, and fall risks.  We reassess her risks and goals every year to make sure that we are still on the path she chooses for herself.  I present her with as much evidence as I can, for efficacy of medication, her personal fracture risk, and potential consequences of fracture.  In the end the decision is hers and hers alone; I serve as consultant and guide.

Meanwhile, knowing what’s likely happening in my knee gives me peace and confidence.  Now I can make a plan.  I’m convinced this is why my knee feels better tonight than it has in days, although the ibuprofen I took this afternoon probably also helps.  I have a new compression sleeve that fits under my dress pants.  I can get back to my workouts, and maybe add on a little every week.  My motivation to eat healthy just got a fierce boost (Betty Rocker really helps with this—I have no financial interests in her business, I just really like what she does and how she does it).  I’ll start physical therapy soon.  No volleyball for likely 6 months.  But I got this.  Bring it.