quality of life – Chronically Living

Can Turmeric Help Your Depression?

Depression is commonly comorbid (co-occurring) with chronic illness and chronic pain. It makes sense. Our lifestyles drastically (and often suddenly) change. We may lose relationships (of different sorts), our purpose in life may change, and not to mention the pain centre of the brain is right next to the mood centre. Even the most resilient of us struggle with depression and a bit of an identity crisis upon having a chronic pain/illness diagnosis (or even no diagnosis but jut the onset of symptoms). I have also struggled with depression. Some of it stemming from childhood trauma, but I really noticed it after the onset of my pain/illness. Actually I was in complete denial about it at first and went to counselling only for anxiety (though my very perceptive counsellor was certainly treating me for depression as well).

Could turmeric have helped my 2016 post-diagnosis struggle (I started seeing a naturopath later that year, who did recommend turmeric, specifically for pain)

So, personally, I’m not a fan of a lot of medication. I take what I need to, and try to find alternative solutions for other things. I would never say that I’ve been more than mildly depressed. I use exercise for pain and it also happens to help with depressive symptoms. When I notice my mood is low I practice behavioural activation. Example – a few weeks ago I noticed I had low mood which was definitely correlated with an increase in pain and decreased energy. I had plans with friends and my partner for a board game night, and while a part of me really wanted to cancel on them, I made myself go because I knew it would improve my mood. Guess what? I really enjoyed the night, had a great time, and slept in the next day so it was all good (actually it was great!).

Exercise and behavioural activation are great and there is tons of research to show their effectiveness for pain and depression. There is a growing amount of research showing that turmeric (or more accurately the active ingredient in turmeric – curcumin) is as effective as anti-depressants in treating depression, including with Major Depressive Disorder (MDD). It also happens to decrease inflammation in the body, leading to less physical pain. According to the research I’ve linked below, it doesn’t seem to make a huge difference in the amount of curcumin/turmeric used and there were only mild side effects in some patients who were taking doses of 12g/day. Definitely some interesting and potentially helpful research for anyone who, like me, prefers to stay natural as often as possible. Now, I’m by no means dissing anti-depressants. Many people benefit from them and need them. If that’s you, please stick with it. This is more of an option for anyone who doesn’t want to use them, and is looking for alternatives.

Turmeric can come in different forms. Powder that you use on food (popular in many Asian cultures), and supplements you can buy from a health store are the most common and popular. I also have a lovely turmeric tea that I buy and try to drink more often when my pain increases or my mood is low. Definitely a few great options if you’re interested in giving it a try. As with everything, I take a scientific approach and view any of these ideas as an experiment. Clearly the research shows that it works for a lot of people. Will it work for me or you? The only way to find out is to be curious and give it a try. Maybe it’s another way we can keep making the most of it!

Reference:

Ramaholimihaso, T., Bouazzaoui, F., & Kaladjian, A. (2020). Curcumin in Depression: Potential Mechanisms of Action and Current Evidence – A Narrative Review. Front Psychiatry, 11, 572533. doi: 10.3389/fpsyt.2020.572533

Why Walking is Beneficial for Your Chronic Pain & Mental Health

I LOVE WALKING. Truly. I aim to walk 10,000 steps every day (give or take 1000) and will often end up on a hike that pushes me past that. Walking is something that I believe has really helped me move from being in a lot of pain and more ill, to being in remission. It’s not the only factor of course, but it is a very big part of my lifestyle. The easy part for me is that I actually enjoy walking. I’d rather walk than take transit (if I’m going somewhere “walkable” – 45 minutes or less). I even have friends that live nearby – transit takes 30 minutes to get there, walking takes 35 – easy answer for me. That being said, I know that not everyone actually enjoys walking. However, if you can get yourself to do it (or any other mild to moderate exercise), especially if you have pain, you also might start to see the benefits.

Selfie with headphones (and/or a hat, and/or sunglasses) = me on a walk.

There is a lot of researching showing that the greatest benefits of exercise, including walking, on chronic pain are mid- to long-term. So we can’t expect immediate results (as with many things). These benefits include reduction in pain, improvement in quality of life, less fear avoidance, and a decrease in disability. Some of the reasons that these results occur are due to movement promoting healthy nutrition of the cartilage (connective tissues) in our body, and engaging with the endogenous opioid system and other parts of the brain known to decrease pain. Basically all of our bodies natural pain killers are activated, which I think is pretty cool. Walking and exercise also decrease stress, and stress is a trigger of chronic pain and illness flares for many people.

As far as mental health goes, in addition to decreasing stress, study after study shows that walking and especially aerobic exercise (like jogging) can decrease anxiety and depression/improve mood. There are some other benefits such as improving self-efficacy (our belief that we can do things), improving social interaction (especially when walking with others), increasing our self-esteem (we feel better about ourselves), improving our overall cognitive functioning (memory, concentration, etc.), and improving sleep (being outdoors and exercising are both on sleep hygiene recommendations). A benefit that is good for both physical and mental health is weight reduction – though this certainly doesn’t have to be the goal/intent. There are a few reasons all of this happens: walking and exercise can serve as distraction from thoughts and feelings, and I think more importantly, it gets a lot of those natural happiness boosters activated, like serotonin.

Of course, make sure you talk to your doctor before starting any new exercise plan, including walking (and your physio/physical therapist, etc. as well). Start slowly and work your way up – even if this means just walking around the block once! Make sure you have comfortable shoes, possibly a friend to go with, and water to drink. And try to make it fun! Take different routes, listen to music or a podcast, or try some mindful walking. With all the benefits, it’s worth at least giving it a shot so that we can all keep on making the most of it!

Myths & Misconceptions about UCTD

One of my diagnoses is undifferentiated connective tissue disease (UCTD) and while according to my new rheumatologist my disease seems to be more-or-less in remissions (still some mild symptoms) I wanted to talk about some misconceptions about UCTD that many people – patients, doctors, family members, allied healthcare professionals, etc. have about it.

It’s a diagnosis given when they don’t know what’s wrong with you.
Not exactly, technically UCTD is its own diagnosis. It is given when someone has some symptoms of a specified connective tissue disease (like lupus/SLE or rheumatoid arthritis/RA) but doesn’t not have enough symptoms to warrant those diagnoses. Some of the confusion here might be the word “undifferentiated” which is vague at best, but isn’t meant to be that vague. There is also no diagnostic criteria for UCTD, meaning that differential diagnosis is used (the doctor doesn’t have a better explanation and uses a judgment call)
It’s the same as MCTD.
Mixed Connective Tissue Disease is different in that in MCTD there are symptoms of several different connective tissue diseases present. This doesn’t occur in UCTD, where there are some symptoms of a specific connective tissue disease present.
The symptoms aren’t that bad.
It depends on the course of the disease of course. The most common symptoms are joint pain and a positive ANA. Other common symptoms include arthritis, Raynaud’s phenomenon, rashes, alopecia, oral ulcers, etc. Again, not enough would be present to give an SLE or RA diagnosis for example. Most of these symptoms are not that fun. The good thing is that there is usually no organ involvement – the kidney, liver, lungs and brain are usually fine.
It will turn into a connective tissue disease like SLE or RA.
Actually, probably not. Only about a third of people with UCTD end up with a specified connective tissue disease.
It will drastically affect quality of life.
Controversial, but part of this is up to you. Here’s what I mean. So as in #4, only about one third of people end up with SLE/RA/etc. What about the other two thirds? Well, about one third remain with relatively mild UCTD. The last third end up in remission. The medications used are much milder than immunosuppressants (which is good!) and lifestyle changes can really affect the course of the illness moving forward. UCTD does not mean we should give up!

I hope this helps clear a few things up! I would love to hear what my fellow UCTD warriors think and if anyone has run into any other misconceptions about it!

Keep making the most of it!

How to Figure Out Your Values When You Have a Chronic Illness

Which would you rather do – something (a behaviour) to give yourself short-term symptom relief or something (a behaviour) that aligns with your core values, even if the goal isn’t to bring you symptom relief? The first option, by the way, isn’t necessarily connected to your values. There was a time for me that I probably would’ve done the later. Hell, I did do the latter! I definitely acted in ways that weren’t indicative to what was important to me at all but did help me out in the moment. Things like lying in bed, avoiding exercise, asking my partner to rub my back or just stay near me for hours, missing work, and on and on and on. And I’m not even saying that any of these are bad things. They were just bandaids that made that moment better, but didn’t help my pain long term and ultimately had a lot of costs (like the end of that relationship, feeling physically weak, and making work more difficult). Over time, reconnecting with my values became a much more viable response – and in some ways, even helped to decrease my pain.

Image from: https://www.nettl.com/ie/incorporating-brand-values/

What are values? They are our principles or standards of behaviour that we want to engage in. They represent what is important to us. Some examples are:

acceptance
adventure
assertiveness
authenticity
caring/self-caring
compassion-self-compassion
cooperation
courage
and on and on and on

Different values can also show up in different areas of our life, like work and education, relationships, personal growth and health, and leisure. Values often motivate how we behave in different situations. Sometimes we just live by our values without thinking about them. However, sometimes, when we find ourselves dealing with chronic pain and chronic illness, we can get removed from our values, like I did. There are two things we can do to figure out if we have been removed from our values while dealing with the terribleness of chronic pain and illness.

Figure out what our values are – using a checklist and/or a bull’s eye.
Figure out (nonjudgmentally) what “unworkable action” we are engaging in that is acting as a “bandaid” but isn’t really lining up with our values and how we want to be long-term.

Unworkable action occurs when: (a) the solution is short-term, and (b) the behaviour takes you away from your values.

Okay, but why should we do all that? You might be wondering why not just stick wth the bandaid solution. And you can. But typically we have better overall quality of life if we live by our values. We engage in behaviours that are more fitting to the person we want to be and the life we want to live. And, what research finds (plus just looking at my own life and the lives of my clients), is that pain and other symptoms bother us less. It doesn’t mean they go away, they just don’t really interfere with our lives anymore. The research finds that our self-care for our illnesses and pain improves when we are motivated by our values (everything from self-direction, pleasure, and health to responsibility and socialization). We become more willing to “make room” for our difficult sensations (and thoughts and feelings) when we live by our values.

There are many ways we can live by our values. For example, when I travel I balance the adventure/activity part with rest.

I’ve shared in a number of posts different ways that I live by my values. Here are a few consistent ways I do in my life.

Presence (aka mindfulness) – I meditate daily, do yoga several times a week, and just try to fully engage in as many activities during the day that I can.
Fitness/health – I eat healthy (gluten-free, dairy-free, meat-free – though I do allow myself some cheat days) and I exercise daily (walking and/or strength training, and/or physio exercises)
Creativity – I’m writing a book, I play the piano, I write screenplays with a friend
Adventure – I travel (looking forward to getting back to that), hike, kayak, try new restaurants, meet new people

Actively living by my values doesn’t take the pain away, it takes the hold the pain has on me away.

And those are just some ways I live by my values even with an autoimmune disease and chronic pain. It took a lot of work to get here though, so be kind and patient with yourself (hey, that’s the value of self-compassion). I hope this helps you to make the most of it!

6 Ways I’m Managing a Weather-Caused Flare (+ 5 More Ways I Could)

Long title, I know. But nonetheless I thought I’d share some of my tips with you, plus a few other evidence-based ones I found online as I’m trying to get through this. I’m writing this exactly one week before it will be published so fingers crossed that it’s over by the time you’re reading it, but if not, then I’ll just have to accept it as it is. My flare is likely caused by a few things. First, I recently moved and moving is stressful (even a relatively easy move like I had) and stress can cause a flare. Second, I moved from a dry climate in the interior of British Columbia to the wet, lower mainland of BC. I always notice my symptoms, especially pain gets worse when it rains… but then I knowingly moved to a rainy climate (*face palm*). All jokes aside, my symptoms are increased pain, increased fatigue, really bad jaw pain, my left foot is super veiny and sore (my calf is fine though so unlikely anything super serious). How the heck can I manage all of this?

Even on a flare I’ve managed to explore my new neighborhood.

Acceptance. Yes, I know some of you are rolling your eyes or saying that this is ridiculous or unlikely to work. But I find it does. I accept that my pain is here, while knowing that the intensity changes hour by hour, sometimes even minute by minute, and I know that when my flare is over I’ll go back to baseline. Acceptance is helpful. I’ve been doing body scans and other mindfulness activities to help with the acceptance, but honestly just acknowledging my experience without getting wrapped up in it is helpful. Check out this acceptance practice.
Exercise, Movement and Stretching. If you read this blog regularly you know that I like to exercise. And I still pace myself by trying to stay consistent with what I do. I definitely increase my stretching during flares. Particularly I focus on the areas that seem to hurt or need it the most. For example, my jaw is the worst today as I write this, and I’ve made sure to do jaw stretches throughout the day. For more on jaw pain specifically, check out this podcast episode with Dr. Shirazi.
Warm Baths. I LOVE my baths. I literally take a bath 4-5x a week in the winter months. And with the rain, I’m definitely needing them. They help relax my muscles, keep me warm, and are very relaxing. Trust me when I say I could never (and would never) live in an apartment without a bathtub. Knowing what is vital to your self-care is essential to dealing with a flare. Check out this podcast episode on it.
Dressing Warmly and in Layers. Vancouver, if you’ve never been, is a city where everyone dresses in layers. It will likely rain at some point during the day, though you never know exactly when. It could also start off cool and warm up, or vice versa. So I’ve been making sure to put on 3 layers when I go out, and have a pair of mittens on me. I need to remember a hat and/or an umbrella, but I’m working on it!
Hydration. I tend to drink a lot of water. Admittedly more when I’m working. Staying on top of my water intake is so important to managing my flares and really my health! I’m trying to drink 5 full glasses of water a day minimum. I basically keep a glass of water next to me all day and every time it’s empty, I refill it. Listen to my podcast conversation with Beau Berman about gut health and how important drinking water is to him.
Omega-3’s and Vitamin D. I typically try to get these from the foods I eat. Lots of fish mostly (rich in both), as well as mushrooms, spinach, avocado and tofu and really a variety of others foods are rich in vitamin D. These are really important for reducing inflammation naturally and honestly are just really good for you! Also, Vitamin D is a way to combat with the “winter blues” (which I often get) and the more severe, Seasonal Affective Disorder.

Image from: https://www.medicalnewstoday.com/articles/323144

So those are the 6 things that I am doing, but what are the 5 things that I’m not but probably should be?

Acupuncture. This is actually an evidence-based and recommended treatment for chronic pain. I’ve had it in the past and I’m hoping to start back up with bi-monthly sessions next month. Listen to the podcast episode on recommended treatments for chronic pain for more info.
Massage. I miss getting massages. It’s been nearly a year since I had one, and this is also a service I used to get bi-monthly. I’ll likely also start these back up soon as well. Clearly I need to. The benefits of massage can be heard in the podcast episode with Danielle Potvin.
NSAIDs. I’m not a fan of these drugs to be honest. They can cause stomach problems when on them long term. I’ve drastically cut back on them and only take them to supplement the more natural medications I take (i.e., CBD). If you’re aware of the risks and find them helpful then this can be a helpful solution.
Natural supplements. The only natural supplement I currently take is magnesium bis-glycinate which is a muscle relaxant (and I mainly use it when I’m menstruating). Other recommended supplements are fish oil, ginger (which I sometimes have in food and/or tea), turmeric (which I sometimes have in tea), and gingko. These are definitely worth checking out to use in addition to some of the other suggestions.
Limit Stress. Oh I can’t wait until I’m passed the stress of the move and starting up new counselling practices. The truth is there is always some kind of stress in our lives and it really comes down to how we manage stress. I typically do a good job with mindfulness, meditation, yoga, and relaxation practices. So this might just be a reminder to do a bit more of that. And also, if you are able to avoid stress then that’s a good plan (I do not plan on moving again for quite some time!).

Taking it easy on Halloween. Needed some time to relax after the move.

So that’s it! 11 ways in total to manage a flare. Keep making the most of it everyone!

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My Experience at the World Pain Summit ’21, Part 2

If you read last week’s blog post then you know that I recently attended the World Pain Summit, put on by the Alberta Pain Society. I did this as both an allied healthcare practitioner (as a clinical counsellor) and as a person with lived experience. By the way, this event is apparently always free to people with lived experience, so keep an eye out for it next year. The summit was 3 days and had so much info, that this is going to be part 2 of a 3-part post, and focuses on the content of Day 2. Without further ado, here’s what I learned.

Image from: https://www.facebook.com/hashtag/wps21

How Living with a Dog Can Improve Quality of Life and Well-Being in People with Persistent Pain. The first bit of interesting info was a bit of an aside – only 1% of the curricula for healthcare professionals is on pain, which means if your doctor doesn’t understand (and isn’t attending these kinds of conferences) that is likely why (definitely not an excuse – all healthcare professionals should be attending conferences/summits/etc throughout their careers). The most interesting parts of this session was the statistics on dog/pet owners (cats and other kinds of pets count):

they report lower pain
less depression and anxiety and loneliness – i.e., better mental health
improved well-being and meaning/purpose in life

Having a pet also gives you a non-judgmental listener whom you can talk to, and petting an animal releases oxytocin in our brains, which has a calming effect. Yay for pets!

Is Supported Pain Self-Management Your First Choice or Last Resort?: 5 Key Coaching Support Skills. This was present by Pete Moore, a person with lived experience, who wrote a book on the subject. The 5 key skills he talked about were: (1) goal setting and action planning; (2) practicing daily activities – I know ADLs can be hard for some people but they are important to well-being; (3) problem solving; (4) keeping active, moving, including stretching and exercise; and (5) knowing what to do if you have a set-back (i.e., planning for that in advance). Much of this involves having a support team, pacing, prioritizing, being patient with yourself, learning relaxation skills, tracking your progress, and resilience.

Pete Moore presented this cycle, which really resonated with me and probably many others.

How a Pain Doctor is Using Social Media to Spread Knowledge About Chronic Pain. This was a session more for healthcare professionals on how to start a YouTube channel (and why they should). But some interesting factors for Spoonies: the current quality of medical information on YouTube is very low, so please be careful and look for trusted sources (i.e., trained healthcare professionals in different areas).

My YouTube channel is for meditations (with an emphasis on pain and illness).
Let me know if I should include other psychoeducational content and skills.

Trauma, Illness, and Healing – Dr. Gabor Mate’s keynote. I’ve written a ton about Dr. Mate’s work in the past, and there was obviously some repeat in content about trauma, childhood abuse, insecure attachments and stress and their relationship to chronic pain and illness. A couple of things I will share:

mind body practices (like yoga) should be included in chronic pain treatment
a lot of back pain is associated with psychoemotional stress (tension, stress, trauma)
Go to a physician for what they can do (prescribe medications, perform surgery, etc.) and find other practitioners to help you with the other parts of treatment
diagnoses are descriptions, not explanations
psychological and spiritual support is important

If you’re not familiar with Dr. Mate’s work, check out When the Body Says No (I also did a post about the book awhile back).

Dr. Gabor Mate is world leading expert on the trauma-stress interaction with illness.
Image from: https://californiahealthline.org/news/addiction-rooted-in-childhood-trauma-says-prominent-specialist/

Challenging Chronicity Thoughts: Words Matter. So this was a mental health session, if the title isn’t clear! It emphasized that psychological factors are an important component of pain experience and are the most powerful psychological predictor of adverse health and mental health outcomes associated with pain – they even affect our treatment responses to medications, injections, physical therapy, and most other treatments. Recovery is not just about talking (to a therapist), needs and activity but also about ways of thinking. Two important notes for my fellow Spoonies: (1) pain is perceived by your brain (all in your head) but it is real; and (2) the word pain takes you right to thinking about/feeling pain (check out this podcast episode I did on externalizing language and pain/illness).

Chronicity thoughts are about way more than language. I highly recommend seeking therapy if you find you think about your illness/pain a lot.

Next week I’ll bring you a post on the information from the final day of the summit. I hope that you find some of this helpful when thinking about illness and well-being. Keep making the most of it everyone!

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Daily Exercise: Mini Golf

https://videopress.com/v/ohZnWWqE?resizeToParent=true&preloadContent=metadata

Sorry about the sound quality. It was raining and the mini golf course had a fountain nearby.

Who says mini golf isn’t exercise?! Any kind of movement, especially if you haven’t really been doing any because of your condition, is good movement! So let’s keep it fun and easy and just take our exercise regimes one step… or one put… at a time. Please consult with your healthcare team before starting any new exercise. If that made you laugh, then check out this podcast episode on how humour can improve your well-being when you have a chronic illness. And of course, keep making the most of it!

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Daily Yoga: Hip Openers

https://videopress.com/v/H108687A?preloadContent=metadata

This week we’re doing some more yoga postures that I absolutely love for the hips: reclined butterfly and a butterfly forward fold. I find they help with a nice stretch in my hips, which is something I need. As always, please consult with your healthcare team before making any lifestyle changes, such as adding yoga. If you already do yoga, I’d love to hear if you like these poses or what poses you do. Until next week, keep making the most of it everyone!

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How do body scans help chronic pain?

I love body scans. I find them a great way to get into my body, sometimes helping me relax, but more often helping me with pain management. I do remember the first time I did one though. The thought I had, “this sounds terrifying! Why would I want to move towards the pain that I’m already experiencing?!” And yet, there is a ton of research showing that many, many, many other people with pain conditions have had the same experience as I have. As with any mindfulness practice, the goal isn’t actually pain relief. It’s 5, 10, 15, 20 or more minutes of doing nothing but noticing what’s happening within, as you move through different parts of your body.

Image from: https://www.stopbreathethink.com/body-scan/

If you’re not familiar with mindfulness and have no idea what a body scan is, don’t run away yet (actually no one should be running away at all – that’s the opposite of what we want to do here!). A body scan is a mindfulness practice in which you are lying down (or sitting, depending on what type of mindfulness you’re doing). You begin by focusing on your breath, and then slowly move through each part of your body beginning with either the top of your head or your toes, just noticing what is happening in your experience. Once we’ve moved through every part of our bodies, we notice the entire body as a whole, and then usually return to our breath before finishing. You can also breathe into parts of your body that feel tense or have more pain, using your breath as a way to help them release (though that’s not always possible, and I personally don’t normally use my breath this way). Here’s a quote from Jon Kabat-Zinn (Full Catastrophe Living), “another way to work with pain when it comes up during the body scan is to let your attention go to the region of greatest intensity. This strategy is best when you find it difficult to concentrate on different parts of your body because the pain in one region is so great. Instead of scanning, you just breathe in to and out from the pain itself.”

What I think the body scan really teaches us, and why it can be so powerful (with regular practice) for chronic pain is that it is really about acceptance. We learn to accept sensations more easily when we can just notice them, without being over taken by them. When we learn that we can move our attention to other areas of our bodies, and see that the pain isn’t always as great as we think it is. Yes, I said think it is, because we all have thoughts about our pain. Acceptance, and turning towards pain can help us improve a number of things, according to the research: reducing pain-related distress, our perceived ability to participate in daily activities, our perceived likelihood of pain interfering with our social relationships, and even desire for opioid (and other pain medication) use (not to say we will use less though). Most of the research comes from people practicing for 10-20 minutes/day for anywhere from 2-8 weeks. Now, imagine long-term regular practice. One of the explanations for why this works is that it increases our interoceptive (inner) awareness and stimulates the parts of the brain involved in that process.

You can practice the body scan sitting or standing, and anywhere you are.

Sometimes when I practice a body scan, I do notice pain that I didn’t before. Very subtle pain in my hands, or a bit of a headache I didn’t even realize I had. And I get that can be distressing for some people. This is why I approach it with curiosity. How did I not notice that before? What am I noticing instead? Is any of my pain really as bad as I sometimes think it is? And sometimes I fall asleep during the body scan (especially if I’m laying down, so I recommend sitting) because the process can be relaxing, even though that’s not the point. Again, I must emphasize the goal of any mindfulness is to do nothing! Not to achieve a certain result (like less pain). Just do nothing (or in this case scan your body) and see what happens! Try it out and let me know your thoughts. Keep making the most of it everyone!

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Daily Yoga: Twists

https://videopress.com/v/IYzzSqj6?preloadContent=metadata

Yoga has been one of the ways that has helped me a lot with my well-being in the past year or so. These are two versions of one of my favourite poses for the back – seated and laying twists. Yoga not only has a lot of physical health benefits (such as improving flexibility) and mindfulness benefits (such as mindful movement) but also mental health benefits as therapeutic yoga is used as an embodiment approach to mental health. As always, talk to your doctor or other healthcare professionals before changing your exercise routine.

For more ways to improve your well-being, check out the podcast. And for more mindfulness practices check out the meditation channel. Keep making the most of it everyone!

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