Doctor’s Orders

Filed in Health

It’s raining. If not, I would be out there on my morning walk. If I were, this would be the first time I achieve the three-times-a-week routine I’m supposed to do. So far, it has been either twice or even just once a week, usually the latter. Some weeks, there were none.

Of couse, I could go and use the walking machine in the gym on the ground floor of my apartment block. I’ve used that before. But ever since I got into the semi-habit of walking outdoors, the indoor alternative has not seemed attractive at all.

This is for my own good. For my health, in general, but specifically, for my bones. It’s what my rheumatologist says I have to do.

Back in March this year, I took the bone mass density test. The last time I had it done was maybe 2 years ago. The results, when compared to the last set of tests, showed that my bones had deteriorated about 8% over the last 2 years.

I could immediately think of the reason for it. Steroids. Prednisolone. It’s one of the two main meds for my lupus condition. Not a big dose, just one 5mg tablet every other day, but over 15 years (with higher doses some months during those years due to a flare in my lupus), it adds up.

But there is another reason for the bone deterioration. Menopause. This is supposed to be a major milestone for women, complete with mood swings, hot flushes and whatnots. For me, it was a quiet transition to the next stage of my life. Actually, I’m assuming I’ve gone thro menopause. There is one less item on my shopping list, which accounts for this assumption. But I digress …

Rheumie also said bone changes are at the highest in the couple of years after menopause. Couple that with my long-term prednisolone use, and that explains the 8% bone deterioration.

Was there anything I could do to put a brake on this?

Yes, there were two items. One was imposed from the outside, the other from the inside, requiring self-discipline.

The outside imposed item was an addition to my meds in the form of a weekly Fosamax dose. I was familiar with Fosamax, having helped to give it to my mother quite a few years ago when she needed it. It’s used to treat postmenopausal osteoporosis, and according to the official website, “the only treatment with Vitamin D, which helps absorb calcium and build strong, healthy bone”.

Prior to this, I had been taking Caltrade to maintain my bone’s health, supplemented with Rocaltrol for the Vitamin D to absorb the calcium. Apparently, the combination was not enough.

Taking Fosamax requires some self-discipline. It’s a once-a-week dose to be taken on the same day, and to be taken first thing in the morning, before food, and after it’s taken, I cannot eat and must remain in an upright position – no going back to bed – for 30 minutes. So far, I’ve been good with this, I even brought along the required dose for my trip to see my pandas in May. I only managed to forget once. When I did, I checked the instructions and found that I could take it the following morning. But I forgot to take it the following morning, and was in a bit of a dilemma until I realised that the following-following morning would still be another 5 days to the next official dose, so by my own reasoning, was still okay to take, better than not taking at all.

The second item ordered by my rheumie was more exercise, particularly a weight-bearing exercise that would get me moving and my bones acting, or re-acting. The easiest weight-bearing exercise, believe it or not, is walking. It is also the least likely to cause injury. I can’t run, or even jog, because the impact would affect my weakened bones. So, I had to walk. And I had to want to walk. That’s where the self-discipline comes in.

It took a while before I settled on my current routine. Initially, I used to go for evening walks around the school field near my sister’s house. But it was a difficult routine to keep; some evenings, I would be late getting there, and if the rest of the family were already home, I couldn’t very well say, wait, let me go for my walk and then we can have dinner. So it was an erratic walking schedule.

Next, I tried indoor walking, inspired by a short story by Preeta Samarasan in the MPH collection, Urban Odysseys. It was fun because I got to look at the window displays as I walked past the shops. But indoor walking just didn’t cut it for me.

Finally, I decided to try the path across the road from my apartment complex. So simple. It was right there in my own “backyard”, but I’d resisted it, mainly out of embarrassment – what would people think? Actually, what do I care what people think – my health is more important.

So now, my walking routine is established, and just needs to be boosted and maintained at three-times-a-week. I even have a little side-routine to get the most out of each walk. I’d read up about it, and have learned to check my pulse before and after each walk, to see if my walking rate is sufficient to keep my heart pumping within an acceptable range – it is. I also wear a simple digital pedometer to help me count my steps on each walk. There’s one more thing I do – I use the stopwatch function in my handphone (mobile / cell) to time each walk. So far, I’ve averaged 35 minutes and 4,000 over steps each walk. Oh yes, there’s one more thing I do – I keep a walking log on my Evernote account, so at a glance, I know how many times I walked each month, and how I fared each time.

Walking. It’s so simple. And inexpensive. And I can say it’s made a difference to my previous sedentary lifestyle. Especially when done in the morning before the rest of the day catches up and drags me down. It may not be much, especially when there are lots of other more exciting ways to keep and stay fit – swimming, jogging, running a marathon, hiking, mountain climbing … But different ways to keep and stay fit for different people, and for me, walking is my way.

Tree-lined and with a rocky side on the left, this walking path across from my apartment complex is shaded against the sun and helps keep my lupus in check