RETRAINING AFTER AN ILLNESS [Muscle as Medicine]

Good day and welcome to Medicine Health. We're back in our Muscle as Medicine series, and now we want to talk about retraining after you've been sick, after you've had surgery, after some sort of trauma in your life. And so in a previous section, we talked about the concept of graded exercise tolerance, which can be used, uh, especially is useful if you are out of shape, untrained, etc., and you're trying to get back into some kind of shape, but you don't want to fall over with hypoxia or, you know, or cardiac event or something like that. You want to get your body working again. So this becomes more of an issue if you've recently had a physical trauma. So that could be a car accident, that could be surgery, that could be a recent illness, it could be a chronic illness. Any number of things can happen. And so one of the things, and, you know, our practice is really focused on the chronically ill patient and then patients with cancer, and both really have a lot of crossover, and both are really chronic illnesses. So in those settings, we often get the question, well, geez, you know, I just got done with chemotherapy and you want me to start to move my body and work out? You know what? What do you got in mind there? Or, you know, gee, I've got a chronic illness and I'm, you know, my treatment really wears me out and I'm very fatigued and I'm not doing well. And, you know, and I just, I haven't felt good in so long. I can't remember when I felt good the last time. And so how am I supposed to start to do any exercise or move my body, et cetera? Yeah. And those are really, really good things. And the idea behind it is not that it's an all-or-nothing thing. Very few things are all or nothing. But the more ill your body is and the more traumatized your body is, the more that you need to think about— A, muscle is medicine and it will help on my road to recovery if I build up some muscle and get it working. B, I am not currently doing very much in that respect, and I'm very out of shape. And C, you know, maybe, uh, the way that I just feel every day is so bad that I, you know, I'm not very motivated to start doing things. So the thing that you need to consider in recovery, either during a chronic illness or after a bad illness or after surgery or whatever, is you kind of have to let go of your past athletic prowess and how well trained you were or whatever. Because the new trauma, whether it's infectious or surgery or car accident or whatever, kind of knocks you back a number of pegs. Now, what about the chronically ill patient? I have this conversation a lot with chronically ill people where they'll say, well, I was able to do this, you know, I was able to do this length of a hike or this whatever, and then I had a flare of my chronic illness. And now I can't. It's like I'm untrained almost already. What happens when you're chronically ill, or sometimes in patients in the cancer journey, they get a new therapy. As I said, it's sort of like a new trauma, like an infection, acute infection, or surgery or something. It knocks your feet out from under you. And so to a chronically ill patient who is really having trouble wrapping their head around why they can't You know, just go out and do what they were doing last month if they've had a flare. The reason is, is the flare is sort of like a new stressor. It's a new trauma on your body. And so you cannot expect your body to go right back to that place that you were prior to the flare. It's the same idea. It's the same logic as I was moderately trained, I was doing this amount of exercise, and then I had a big surgery. Or then I had chemotherapy, or then I had COVID, or then I had whatever, and it just knocked me down and I can't get back to where I was. This is another place where the idea of graded exercise tolerance can be very helpful. What you can do, depending on your prior level of fitness and training, etc., is if you were trained to a certain point before this new trauma or the flare-up in your disease or whatever, You can look at what that was, and then you can restart your exercise with a portion of what that was and see if you can handle it or not. And so if you were a regular, you know, 10-mile-a-week-in-total hiker, you know, let's say, and you were doing fine doing that, and then you got COVID or you got real sick or you had a flare-up of your chronic disease or whatever, and now, you know, you tried it and it— like, you were, you were not well for days afterwards. That's too much. So you could dial it back. You don't have to go and become sedentary and non-active, but you can do the first week and, and try maybe a mile twice during the week. You used to do 10 total miles, so 2 miles. If that goes really well, then the second week, go up to 4 miles or whatever you can do. But for a lot of people, especially our COVID patients where they are recovering, they might have been super trained before and now we are having them get out and do just fractional amounts of the workouts they did, but still something. Another thing that comes up in people with retraining and post-activity, etc., is you have to let go of your expectations of your body and realize it has had a shock or a trauma. or an infection, or you flared up your chronic illness, and you got to give it a little grace, a little bit of a break so it can come back. And part of that can be if you're at the gym, and I think about this a lot when I'm at the gym, you know, especially if you're there kind of at the same time, you know, and there's people around that know you, you might be doing a lower amount of, you know, weight reps and whatever else you do in your healing process. And you may be at the gym a shorter amount of time, or maybe with rest breaks longer, amount of time. And so you have to let go of the expectation that, well, I got to go back in and save face and, you know, really be able to work out and all this stuff. That's, that's not going to serve you in trying to get over something. Now, based on your underlying condition and the level of trauma on your body, you may be able to get back into shape and online much faster. Then if the injury, trauma, flare-up of your disease, whatever, was bigger, your road to getting back to where your training was before may be a lot slower. Now, why is this idea of retraining and exercise graded exercise tolerance, why does it come up as a controversy in the world of, say, chronic fatigue syndrome or CFS/ME? The reason for that is not so much that the concept is bad, it is that In my experience in working with hundreds, if not thousands, of people with chronic fatigue and fibromyalgia, etc., A, you don't feel well. B, in chronic fatigue specifically, you have an intolerance to movement and exercise, and that's part of the disorder. So the way that we have found to deal with that is chronic fatigue has many areas of the body where it it is affected. It's not just triggered by one thing. It's not like getting an infection or something. And so when we think about that, what we try and do with people is say, look, you know, yes, walk around your house as much as you can and do what you can. Don't push yourself to the point of being unable to move the next day, but move as much as you can. But as we work on these other underlying areas of your chronic illness, your body will get more reserve and be able to respond to the exercise. And then we will do more of this, you know, little baby steps, graded exercise tolerance. The problem, at least in the papers I have read, where they are really down on exercise tolerance in chronic fatigue patients, etc., is largely because they are not doing anything about the other parts of the body and the other areas of the body that are being stressed. And if you don't do that with a chronically ill person, then, uh, their body will never recover. And so just as an aside, well, what areas are you working with? Well, the big areas that we look at in chronic illness or recovering from cancer or whatever are going to be, uh, cell function, which includes your nutrients and your mitochondrial function and all of that, uh, exposure to toxic materials, environmental exposures. resistance factors for common chronic infections that you may not even know you have. Getting your immune system as functional as possible. Some of our chronically ill patients actually have immune disorders, and that's— you have to work around that. Some just have such a beat-up immune system it doesn't work very well. Then your hormonal system in any trauma or chronic illness can be thrown way off. Um, your psychosocial interactions— how well are you doing with the people around you? How do you feel inside? We need to work on that. Uh, your function of your digestive tract, which is so terribly important, and also what are you putting in it? What are you eating? And then physical and structural things, because sometimes people have been sick for a long time, may have a lot of trigger points. They may have a lot of musculoskeletal problems. They may have other things that go along in the physical realm that are important. So what I would say about the controversy around graded exercise tolerance and specifically chronic fatigue syndrome is we have never really had a problem with it, but that is because it was a part of working on all these other areas for the chronic fatigue patient or the fibro patient or a bad autoimmune case or something like that. The person is having the other areas of their health attended to, and we're, as I said, getting more margin for their body to be able to do the exercise. But the other thing that's real critical is in someone who has, say, chronic fatigue or fibromyalgia, or they've really flared into chronic illness, they may have to start with almost nothing and do it for not a week but like a month. And then month 2, they go to a little more than almost nothing. And month 3, they go to a little bit more. We've had people recovering, you know, after chemo or in a bad flare, you know, with a chronic illness. And the first thing was just standing up and down out of their chair more times a day or walking, you know, one more trip to the kitchen, not to get any food, but just that was the only trip they made during the day, kitchen and bathroom usually. And so just a little bit more, just a little bit more. And then they'll say, well, but, you know, next week I can do more. Well, if they're really, really sick and their metabolism is really suppressed, no, we might do it for 4 weeks. And so that extra trip, you know, the kitchen, you might do 2 of them or something. But then the next month, you see how they're doing, you see how they're tolerating all of that. And then you say, okay, I think we can go to here. You know, what do you want to do? Do you want to add a walk around the block? Do you want to add going up and down the stairs a couple of times? What do you want to do? And we just keep building it. But the idea is a little longer steps. So they're baby steps, but they're wider, longer steps. And they're little steps each time. It's not like when you were 15 years old and went out for track and you were sore for the first week and then you're running like a gazelle. It doesn't work that way anymore. It's all elongated when you have chronic illness. And I will put in the show notes some of these studies just so you can take a look at them if you want to. Anything else of interest we put down there in the show notes. I do want to thank everybody, all the subscribers on the various podcast platforms. We're on all of the pod burners out there. We're live on CTR Radio right now. We're Facebook streaming, and then we put the video over onto YouTube. my YouTube channel. And if you can't find, uh, DRA Online, Dr. A Online, just go to the hub website, which is dranow.com. And on there will be links to all the media and all the other stuff that I do. And so you can find it there on dranow.com. Also, um, please do not only like, share, and subscribe if you like this, But do the notifications because sometimes the algorithm doesn't think it's important and you'll never know that the video was put up if you don't have notifications on. All right, well, we're out of time for today. Thank you so much. And our helpful therapies— muscle as medicine was our subtopic today— and I'll see you all on the radio next week.