This post is part of a Patients For A Moment blog carnival that Duncan is hosting. More specifically, it’s part of Duncan’s “ILLiteracy Project” carnival.
Category Archives: community education
This post is part of a Patients For A Moment blog carnival that Duncan is hosting. This month’s PFAM blog carnival topic is “What is your favorite book about illness?”
(Note: Those of you who interact with me via twitter, etc know that I read voraciously. This means that my favorite book about illness today may not be my favorite book about illness tomorrow. I’m going to try to post book reviews from time to time of books that I have loved or not loved and why. However, for the sake of this blog carnival topic, I decided to pick up a book that was recommended to me, but I hadn’t read yet. As such, it isn’t my favorite, but I thought it was worth writing up a post about. I’m excited to see what other bloggers chose as their favorite books. I think my to-read list is going to be growing considerably in a few days…)
The book How to Be a Friend to a Friend Who’s Sick by Letty Cottin Pogrebin was recommend to me by my therapist when we were discussing how hard it is sometimes for me to be a good friend and equally to deal with unsupportive friends/family. Pogrebin started thinking about this topic when she was fighting breast cancer and noticed the varied reactions of her friends and family. The book is actually a collection of short stories from people with varied experiences intermixed with Pogrebin’s own story. What I liked about the book was that she included the reactions to friends’ behavior as well. There are Dos and Don’ts lists and varied suggestions for how to rephrase common questions that are inadvertently offensive or difficult to answer. I chuckled over her commentary and lists of commonly heard comments and questions, many of which I’ve heard myself. A lot of this advice feels obvious, but it’s easy to forget in the stress of seeing a loved one fighting what they’re fighting. Moreover, I think different people will get different things from this book based on what their experiences have been so far and what sort of guidance they are looking for. It did seem a bit long, but I think that’s partially because it’s clearly geared to be helpful even to people who have never had an ill family/friend before.
I think the trick to reading this book (for both patients as well as friends/family) is to try to keep an open mind, remember that everyone’s needs are different, and not to get too offended when you disagree with something that Pogrebin or one of interviewees opined. The book is theoretically aimed at the friends/family of patients, but I think patients can get a lot of out of this book as well. One of the things that made this book feel more appealing for me was the inclusion of incidents in which Pogrebin felt she had failed her friends/family in terms of offering support. And, in truth, even a person fighting a chronic illness can be inadvertently unsupportive of someone else fighting the same illness, because the two people have completely different needs from their friends. There is no one size fits all answer to the “How do I be supportive?” question, and this book drives that home.
As a patient, it’s nice to hear stories that show me that I’m not the only one that has struggled with incidents where friends/family that I rely on were unsupportive. However, reading through these stories was also a great reminder that people generally don’t intend to be unsupportive. They want to help, but they don’t know how to help ME. I emphasize that because one thing that struck me as I read this book was that with so many people fighting so many varied illnesses, especially when combined with how much each person’s needs vary from the next, it’s entirely possible that friends/family are doing what they were told was helpful and supportive for someone else. If you’re told that it was helpful once, it stands to reason that you would offer the same help/advice again. From a patient’s point of view, one of the best things that I got out of this book was a reminder that I need to be clear about what I need from people. It isn’t fair to always assume that they’ll be able to guess, especially if what I’m going through is totally beyond the context of their own experiences or that of their other close friends/family. Reading what worked for other people gave me some new ideas of how to direct my friends/family towards what is actually helpful, hopefully without making them feel hurt or offended, because I know deep down that they’re only trying to help.
For friends/family looking for ideas on how to be supportive, this is a really good place to start. Reading different people’s experiences might provide a more detailed and diverse view of what a patient is feeling in these circumstances. This book may also provide some guidance of what is commonly found to be offensive. Of course, what one patient in the book found helpful might be totally offensive to your own loved one. However, the book can only provide a limited amount of guidance here. This is what I would suggest: I think that the lists of Dos and Don’ts are a good place to start. Pogrebin also included helpful re-phrasings of common questions/comments. For example, “What are you feeling right now?” instead of “How are you feeling?” or “I can only try to imagine what you’re going through.” instead of “I know just how you feel.” These are a good start, but at the end of the day I think that most people would be open to your sitting down and saying “Hey, I can’t begin to understand what you’re going through, but I really want to be supportive. Here are the things I’ve read, but I don’t know whether they apply. What would be helpful for you?” Remember, though, that if you ask and then don’t follow through, that person is going to be even more confused. The fact is, if you’re reading blogs and books to find out what you can do to be helpful, then you’ve already realized that you don’t have the information that you need. Blogs and books like this one can get you part of the way there, but you need to be able to customize that information to your loved on. There’s only one person who can tell you what you truly need to know, and just sitting down and having an open conversation shows how much you care and makes it possible for both of you to be happy in your friendship.
This post is part of a Patients For A Moment blog carnival that Lorna is hosting. This month’s PFAM blog carnival topic is “change.”
When I first got diagnosed with lupus at 16, after 6 months or so of testing, I got really lucky and the first round of prednisone pushed it into remission. The doctors were surprised, but obviously really pleased. As a result, though, I didn’t really have to learn to live with the condition until it flared back into existence 5 years later. For the purposes of this post, I’m going to focus on the changes that have occurred in my life from that point forward.
To say “everything has changed” might sound a little melodramatic, but the truth is that very few things are the same as they were before. Every hour of waking time is different from what waking time was like before. Sleeping hours, when I manage to sleep in the first place, are also a whole different situation. My relationships – with friends, family, and potential partners – have all changed too. People think that dealing with a chronic illness means just dealing with the physical illness and maybe its mental effects like the frustrating brain fog that makes me forgetful. Oh and maybe the inconvenience of swallowing lots of medications.. but there’s a lot more to it than that.
First there are all the things that I can’t do because they’re too physically challenging. Contact sports are out, and I can’t run because it makes my knees swell so anything that requires running is out too. I get tired too easily to be on my feet all day, but sitting in one place for hours is rough too which makes long distance travel difficult. This means travel is hard in general (for many reasons, of which this is only one). This impacts hobbies and outings with friends as well as travel and family events.
Changes in weather prove to be a huge problem too. I think sudden changes in weather are a problem for everyone to an extent.. outdoor plans get cancelled, you suddenly need an umbrella, or a hat, or a sundress, etc. However, changes in weather for me can be debilitating. Rainy days make my joints achey. Extreme heat or cold also leave my body aching and often drain my energy. Plus, sudden changes in temperature have similar effects.
Then there are the changes to life plans. When I went into that flare, I was in medical school. I was forced to leave that program, and won’t be able to go back to medical school. So now I’ve had to reassess the rest of my life from a career standpoint. There are some careers, like medicine, that I can’t manage not only because the rigors of the education required to get there are more than I can handle, but also because the hours and time on my feet involved in the career itself wouldn’t be possible.
Even eating isn’t easy anymore. With all the meds that I take, I have to arrange appropriate food at appropriate times to coincide with not only the timings of my medications doses but any requirements for what they need to be taken with. I also have a lot of trouble with nausea, which makes eating hard. Sometimes my pain levels contribute to the nausea too. Then there’s the fact that gastroparesis makes it difficult to eat much in the first place, and end up throwing things up fairly often. Plus there are eating restrictions – like I can’t have soy milk.
It’s changed my relationships with my family members too. Dealing with a child’s illness is an awful lot for a parent to deal with, and my parents sometimes deal with denial or denouncement. My sister tries to help when she can, but sometimes too many offers of help can be frustrating too. I feel like a burden on my family, which is something I never had to deal with before.
Making plans with friends is hard, because there are a lot of things that I just can’t do anymore. Oftentimes, I don’t know for sure that I can make it until the last minute which means that I flake out without much warning. While most of my closest friends are understanding overall, it still strains the relationships. I feel unreliable, and it’s hard to make plans very far ahead.
Having a chronic illness also has a huge impact on my love life, or lack thereof. Dealing with all the ins and outs of a chronic illness is a lot to ask of a person who doesn’t know you all that well yet. It makes dating hard (see plans with friends above). It also makes it hard when you start talking about what a life together would be like. I’ve found that it’s a deal breaker for a lot of people. And while I know I should be holding out hope for that one person who won’t care, it’s a frustrating experience all around in the meanitme.
All in all, pretty much everything has changed.
This post is part of a Patients For A Moment blog carnival that Duncan Cross is hosting. Duncan is a dear and always includes me on his mass emails so I know when he’s hosting an interesting topic. This time’s topic is “What does it feel like?”
<<Side note to my regular readers: I’m so sorry about the inexcusable lack of posts lately. The summer sort of got away from me, and the post that I thought was all set to go up in August disappeared somewhere between when I set it post and the time it should have posted. It seems silly to post about summer stuff now, so I’ll save it to post next summer. Life updates to come as soon as I can manage it.>>
The idea of trying to explain what it actually feels like to have a chronic illness sounds so much easier than it turns out to be. I find that when people actually ask me this, I’m tempted to respond with generic phrases or even just shrug. It’s not that I don’t want to explain. Most of the time, I’m all about educating people who are interested in learning, but it’s hard to describe pain in words. First it’s hard for people to get their heads around the foreign concept of constant pain. Then their perception of what I’m feeling might be nothing resembling what I’m actually feeling because everyone perceives pain differently. However, being able to explain how I feel is useful beyond the hallowed halls of my rheumatologist’s clinic exam room, and I hope that this will help the readers who email me because they are trying to understand what a loved one is going through.
“It hurts,” is sometimes the best I can do when someone asks how I’m feeling. I realize that this doesn’t really explain much, but when everything hurts it can be hard to formulate a coherent response. The best way that I can describe it is to ask you to imagine the worst flu you ever had. The kind of flu where you feel like someone took a baseball bat and beat you black and blue from head to toe. That achy painful feeling in your muscles and joints? That all encompassing fatigue that makes you feel like getting out of bed to walk all the way to the bathroom in the next room might be physically impossible? That’s more or less my baseline. That’s how my body feels every day. On a good day.
My muscles ache and stiffen like I’ve been doing crazy weightlifting workouts and they cramp up. My joints get swollen and stiff, and that makes them painful too. This includes the connections between my ribs and my sternum in the front and my vertebrae in the back. Those rib connections get swollen and every time I take a deep breath it feels like I’m stabbing myself right at each of those points. Even shallow breaths get to be painful. My hips, knees, and the joints in my hands give me the most trouble but almost all of my joints swell sometimes. If I sit/lie still for too long, my joints stiffen up and I end up having a hard time moving them. This can mean it’s hard to straighten out a joint, or it can mean that it’s hard to bend it depending on how I was sitting. After a full night in bed, this is even worse.
I get headaches. I get skin rashes – sometimes across my nose and cheeks where they are conspicuous, and always if I go out in the sun and forget sun protection. I get mouth sores that make it hard to eat or drink anything. My mouth almost constantly feels like I’ve been walking around with cotton gauze in my mouth – no matter how much water I drink. I also get nerve pain which feels like someone turned my nerves into electrical wires and then started running shocks down them. I get restless legs which make it hard to sleep because I feel like ants are crawling up and down my legs. A lot of times I feel like I have a fever, but it’s very low grade and often times I don’t even have one but it feels like I do anyway. The roots of my hair hurt sometimes, even if I haven’t tied it tightly or pulled it in any way. My hair falls out a lot more than it should too. Sometimes my eyes go blurry and unfocused, though thankfully that’s rare, and they often get dry and scratchy. I often have trouble with insomnia, and that aggravates all of these symptoms. I’m also almost always exhausted, which is frustrating. All of this together means that when I say I hurt all over, I mean that I basically hurt from the roots of my hair all the way to the tips of my toes.
A description of the physical aspects of my chronic illnesses really only encompasses a part of what these illnesses “feel” like though. There are also a slew of emotional aspects to living with a chronic disease. I feel like a burden when I can’t do my share of the work, and can’t work enough to move out of my parents’ house. I find frustration is key when I can’t do what I want when I want – especially because in my late 20s I feel like I ought to be able to do those things. That frustration plays into a number of other feelings as I often plan things with friends and then have to cancel at the last minute. It causes feelings of inadequacy along side the frustration. Sometimes it also induces worries about losing those friends. Even the most understanding friends, quite understandably, get a little frustrated when I’m cancelling plans, or falling asleep in the car while they drive us to/from an event, etc. I think the inadequacy extends beyond personal relationships to the concepts of career/life goals and feeling like I’m living a meaningful existence. My illnesses cause me to feel awkward when I can’t figure out how to explain a situation without talking about my illnesses when I’m uncomfortable doing so such as in a work setting or with someone I don’t know very well. They certainly causes stress when it comes to dating because I can’t figure out when to mention them or how. (I think a separate post on dating with chronic illnesses will probably be up in the next few months.)
It doesn’t help that some of the meds used to treat these illnesses can cause symptoms like weight gain or puffiness which play into the whole self esteem concept like feelings of inadequacy can. On a more philosophical level, on a really bad day I start to wonder “why me” and it makes me feel like maybe I did something to cause my illnesses even though I logically know that I didn’t. Or I start to feel as though I’m not living life to the fullest as I don’t know that my life will be as long as everyone else’s, even though right now my health is in fairly stable shape. Plus I have trouble with “brain fog” which makes me feel confused or lost. I forget things and I feel like I’m not absorbing everything around me. Even barring things like work/school, this can be incredibly frustrating as it makes conversations difficult and a lot of things that need to get done get forgotten.
I often feel like I’m constantly acting. I pretend to be feeling all hunky dory when really I’m in so much pain that I could cry. I pretend that I’m not about to fall asleep. I pretend that I’m not uncomfortable with the way I look, or my dating situation, or the amount of time that I spend with my friends. I pretend that while I’m always overjoyed by my friends’ happy times, I’m often feeling a twinge of jealousy too. I pretend that I can balance life/work/school/etc even though I feel like I’m drowning. I pretend that I can brush off peoples’ dismissal of the reality of my illness, even when it sometimes feels like someone punched me or as if I’m talking to wall. I pretend that I’m just stretching casually when really I’m trying to loosen a sore muscle. I pretend that I just stood up to reach for something when really I want to make sure that my joints have enough time to get used to the change in position so I don’t fall when I try to walk. I pretend that I don’t worry about going bald every time I run my fingers through my hair and a huge number of strands come out. I pretend that I’m ok with the way my life and career have gone off the rails that I worked so hard to put it on. I pretend that I’m not bitter about the million things that I have had to give up because it’s just not possible to do them with the illness that I have. I pretend that I can see the abandonment of people who I thought were friends as only a blessing in disguise rather than a painful blow. I pretend that I worry about ending up old and alone more often that I should. I pretend that I don’t know I’m overdoing it when I choose to be irresponsible and knowingly overdo it.
This is how I feel with my illnesses. I’m sure that even with the same illnesses it is very different for different people. Lupus is notorious for the way that it presents differently in different people. So how about all of you? What do your illnesses feel like? Help me and my readers to understand what you go through…
This post was written for the Patients for a Moment blog carnival hosted by Diana Lee at Somebody Heal Me
The topic was “Who are you without your disease? What makes you more than just your disease? How have you adapted these aspects of your life so they’re not completely overcome by your illnesses?”
To you, I am a medical record number and an attached diagnosis. You see me in lab test results, medical file notes, and medication logs. You see my signs and symptoms and what has been prescribed to treat them. What you don’t see is … ME.
Medicine is supposed to be about treating the patient not the disease, but the reality is that 15-30minutes to review how I’ve been, assess how I am now, and consider options for the future leaves little time to get to know me. So here is a little peek into who I am outside of your exam room:
… expect you to see me as more than my disease, even though I sometimes struggle with that concept myself.
… will drop you in an instant, even if it means waiting 6 months for another doctor, if I think you are condescending in any way. I am not an idiot, I know my body and I know enough about what is used to treat my ailments that I won’t stand for someone talking down to me. If you don’t listen to me, I don’t see any reason why I should have to listen to you.
… am loyal to a fault.
… am ready to forgive, but never to forget.
… but not forever. I have zero tolerance for people who take advantage of me or take me for granted. I refuse to be in one-sided friendships.
… will never be found without a book near at hand. Of course, this is stressful for my wrists, so these days you’ll probably find me with my Kindle in my hand. My disease my make my wrists hate paper copy books, but I will never let it take away my love for reading.
… would do just about anything for the people who love me.
… love to travel, but almost never get to do so.
… don’t eat meat. No matter what you have to say about it and my nutritional (or malnutritional) state.
… don’t practice any religion, and don’t take kindly to people trying to convert me to theirs. As far as I’m concerned, the Dalai Lama has said it as well as I ever could: “Kindness is my religion.”
… you will probably never know it, but I write this blog. I do so because I know that there are thousands of people out there that don’t have access to resources any more than I did. I hope that I can be a resource for them.
… won’t eat the same thing two days in a row if I can help it. When it comes to food, I definitely need variety. Across different cuisines if at all possible.
… am still afraid of the dark, and not ashamed to admit it.
… love dogs, but hate rodents and will run out shrieking at the site of a cockroach.
… manage to handle the physical pain I live with, but can’t bear to see others suffer.
… have an unreasonable collection of shoes, clothes, and makeup. Yes, I know this. No, I probably won’t stop buying them.
… work full time. Ok, this one might be in your files. What might not be is that I don’t do it simply to be in defiance of your orders. I do it because I struggled to feel like I am a contributing part of my society, and I can’t handle that feeling.
… cannot be held responsible for punching you if you tell me that something is “all in my head” or “I don’t look sick.”
… am irrevocably hurt by betrayal.
… wish that there was a support group for people my age living with lupus or other similar diseases. I know you keep telling me that I need one, but I just don’t connect with the group that does meet.
… hate when you describe the mechanism of medicines to me like I’m a two year old when you can clearly see that I’m using pharmacological terminology. I hate that. Same goes for any aspect of my illness.
… work in clinical research, so I actually talk to breast cancer patients all day. And it kills me that I can’t actually tell them how much I understand some aspects of what they’re going through.
… hate talking to on the phone to anyone other than friends and family. If I can do something by internet or letter I will.
… of course, this doesn’t really work out, because I have to spend hours on the phone arguing with my health insurance provider.
… don’t tell anyone at work anything about my illness. In fact, I don’t even tell them that I’m sick. This means hiding my medical ID bracelet.
… attended medical school, and had to drop out because of my illnesses. And you didn’t. So I will always resent you for that.
… will not trust anyone until they have proven they are worthy of trust. This includes you. You have to earn it, just being a doctor doesn’t mean I’m going to bow at your feet and accept every word you say at face value.
… believe that an excellent bedside manner absolutely matters.
… think that some of you should never have gotten into medical school, and ought to get off your high horses. You’re not better than me just because it says “MD” after your name.
… and, finally, I have the most respect for doctors who actually ask about my life outside their exam room, instead of skipping that section of the medical history.
So the next time that I walk into your clinic, please remember, that THIS is who I am.
Painkillers have been all over the news lately. It seems like report after report talks about deaths from overdose, how many teens abuse them, or how they’re over-prescribed. What those articles seem to gloss over (if they bother to acknowledge it at all) is how many people actually do need those painkillers. People are different. People feel pain differently. After all – when doctors us to rate our pain on a scale from 1 to 10, your 10 could be a 2 on my scale. Or it could be a 20 – far beyond my comprehension. Does needing a medication make us inherently drug-seeking fiends? I think not.
People don’t like to acknowledge the ill. It’s like it goes against nature, and society wants nothing to do with it. Evolutionarily, we’re weak – and only the fittest survive right? But does that really mean that we’re to blame for our illnesses? No, but it does mean that we have to battle with insurance companies to make them believe we need and deserve the coverage we require. We must battle with government agencies for disability coverage – which means that we then have to battle with the people who think that coverage like that supports lazy people who refuse to do a decent day’s work. Suddenly, it becomes a big political issue and the suffering people who sparked it are forgotten by the side of the road.
The idea that ALL ill people who request painkillers are drug-seeking addicts is preposterous. Unfortunately, worries about malpractice suits or ruined professional reputations mean that many doctors are too scared to prescribe painkillers. Which means that suddenly we are even battling with our doctors for the care that we need. I have friends who have been told by their doctors that although the doctors recognize that the patient needs the painkillers, they are unwilling to prescribe them. Doesn’t this sort of defeat the purpose of the entire medical industry?
All of this often leads to issues of people being unwilling to admit that they take them at all. And, so, I must admit that I have also been needing painkillers lately. By lately I mean since last Spring, and I must admit that a blog post about that change has been half-finished since then. I’m somewhat ashamed to admit that even knowing that the stigma is wrong, I still fell prey to its force. Who wants to be judged by friends, family and doctors alike? Who wants to see pity on their faces? Be told that they’re weak? I sure as hell don’t know anyone like that.
People see us as weak. As if by taking the pills, we have given up. We aren’t fighting for what we want. To that I can only say that if you are a person who can survive such excruciating pain 24hours a day without needing pain killers, then all the more power to you. Unfortunately, my body doesn’t work that way. Other people say that we rely to much on medication and not enough on natural methods. I can’t speak for anyone else, but I can say that I meditate, I do yoga, weight training and aerobic exercise. My mother performs reiki and massage for me. It’s just not always enough.
Painkillers are about more than pain. They’re about quality of life. I can’t say that I take the med every single day – or even every single week, but I can say that it makes a tremendous difference when I do take it. Some days, it just isn’t possible to manage without the help, unless I aim to spend my life whimpering in a ball on my bed. Believe me, I don’t. If the only way to prevent that, and to keep some purpose and direction in my life is to take a painkiller sometimes, then I’m ok. Because here’s the rub: it’s not like we want to take the painkillers. It’s not like we say “Oh, hey, let me go talk my doctor into prescribing a painkiller for me. that sounds fun!” We discuss our pain with a doctor because we were miserable and unable to live our lives due to the excruciating pain. Nobody wants to live like that, and so far this is the only way that society has found to help us.
Of course, the one pain the painkillers can’t relieve is the pain caused as a result of the stigma they carry.
This post was included in Chronic Babe Blog Carnival #42: The Winter Wellness and Fitness Edition.
People with lupus and fibro are always hearing how important exercise is to manage our pain and keep flares in check. Ok, ok, we get it. Exercise is important. Perhaps doctors don’t get how hard it actually is to get that exercise in though. Actually getting a regular workout is incredibly hard when you’re always exhausted and in constant pain. It takes an awful lot of willpower to get past those two major concerns. It’s something that I’ve really been working on over the last year and a half. Having lupus means that there is a limited amount of time that can be spent in the sun. this is unfortunate as a lot of exercise promotion efforts focus on the idea that it canbe fun to go have fun running around outside. Nevertheless, I have found a few (indoor) activities that seem to work for me – maybe other people will find them helpful too.
This is probably one of the most important things that I do. It is incredibly helpful with relaxing and stretching my joints. It also seems to do wonders for my stiff and cramped muscles. I definitely notice a huge difference when I miss yoga too often. I try to do yoga 2-3x/week. If you don’t have access to a yoga studio, I know people who do yoga at home from exercise DVDs (I think Netflix also has some on instant watch) or even just do some basic stretching.
2. Gentle Walk/Jog on an Elliptical Machine
I find that walking on a treadmill or outside can cause a lot of knee and hip stiffness the next day, probably due to the impact of my feet hitting the ground/treadmill. However, an elliptical machine eliminates this issue for me. Gentle aerobic exercise 4-5x/week really helps to relieve my muscle stiffness and reduce fatigue levels. ( I do sometimes go for a walk around the lake in the summer with my family – equipped with a hat and lots of sunscreen, of course!)
Swimming would be even more ideal, but unfortunately my gynecologist doesn’t let me swim because I’m prone to yeast infections with my immunosuppressants. If you are able to swim though, it’s the best of the low-impact aerobic exercises. Some of my friends go for walks with spouses/partners/significant others or walk their dogs regularly.
3. Personal Trainer
I have been very lucky to find reasonable, flexible personal trainers who have experience, training and schooling working with physical therapy and recovery. This has been very helpful in helping me to gently build up muscles around my joints, which helps me to take pressure off of them. We have also been working on strengthening my lower back muscles which is important when I spend so much time sitting and/or sitting up in bed. It helps that my trainers have been very understanding about my illness and its limitations. They get that I sometimes have to cancel last minute. At this point, they can also predict that some days won’t work for me based on the weather that day. They are also very understanding about my limited budget – and don’t push me to buy too many sessions. In fact, we split the 2 sessions/month into 4 30min sessions which is more than enough at one time.
If this isn’t a feasible option for you, you might want to see if your insurance will cover some physical therapy. A physical therapist should be able to put together some strengthening exercises for you to do.
In talking to my friends with varying chronic diseases, it seems that different people have found different levels and ways of doing these things. Not being able to go outside may be a restriction for people with a lot of illnesses, but for people with lupus it’s all the same. Except, of course, that the cold aggravates stiffness and pain for many of us. Trying to keep up with these exercises really helps me to balance out the effects of the cold weather. Rain in the summer hurts us as much as the shine of the sun too. Basically, we need the exercise – regardless of the weather (most of which hurts us anyway).