"We're cutting you loose."

This is what my ankle doctor said to me at my final post-op appointment earlier this week. "Everything looks great, it sounds great, you can opt to have physical therapy or you can give it more time, you can start working out or you can give it more time. It's all up to you."

I thrilled to the sound of that, because I am a good deal happier when things concerning me are also up to me. If they are not up to me, I try very hard to make them become up to me PDQ. And hilarity ensues. Or not.

We chatted then about working out. "Three times a week would be optimum for you to work up to," he said.

This statement was so reasonable, so grounded in actual reality, that I nearly swooned. If I had a dollar for every time some scrubs-clad nimrod with a sheepskin and a stethoscope has chastised me, "YOU SHOULD BE EXERCISING EVERY DAY (invisible hot-pink neon sign flashing: you fat, lazy sack of skin)!" I could afford to take a couple of luxury cruises every year for the rest of my natural life on Earth.

Refraining from any personal declarations of undying love, I then asked, "Can you talk to some other doctors I know? Can I give you their numbers? Please?" He laughed, but nodded too. I expanded on my experiences with such doctors and he rolled his eyes and appeared visibly annoyed. "I don't know why they do that," he said.

He related that his wife wanted them to start doing cardio together and that he had agreed, saying, "Great, I'm all for it. Just not every day." His wife persisted-- positive they should do cardio every day--but he stood his ground and said, "No way. We'll burn out."

EXACTLY.

Most people do not exercise every day. Not even thin people. Many thin people actually never exercise at all. For instance, I happen to be married to a man who has never in his life--not once--exercised on purpose. Yes, he has an active job, but it has not always been thus--and yet, he has always been thin. I know many others like him, just as I know many large people who exercise regularly and remain large.

Exercise is a wonderful thing--in theory if not always in practice. It has a multitude of well-documented and rather obvious health benefits, and we should all be doing it regularly to the best of our ability--but that doesn't mean it needs to happen every day. Furthermore, exercising every day is not a realistic expectation-- particularly if you hate, dread, and have to force yourself to do it.

My ankle doctor and I agreed on this very thing. In those exact words. It was an absolutely lovely conversation that validated several thousand moments of frustration I have weathered throughout my entire life. It was definitely worth the co-pay! I joked (with Freud's seed of truth heavily present) that one shouldn't exercise every day for the simple fact that one should have not exercising to look forward to, and he agreed with that, too. Sometimes one is coming down with a cold, has a thousand other things to do, or doesn't want to go out in the horizontal rain. Sometimes one just doesn't freakin' want to!

This is not a moral failing, this not wanting to exercise every day. I suspect I am not the only person who would be happy to receive external validation of this fact from a certified medical professional. Whether I weigh 98 pounds or 398, I have the right to say, "You know what? I don't feel like it today."

So--doctors, haters, clueless wonders--put that in your juice box and suck it.

Exercise physiologist

Saw him yesterday. I think it was a better appointment. We joked around about our cats and how crazy they are. It's amazing how many people I've met who I had nothing in common with except telling pet stories. It's made many conversations and situations a lot less awkward over the years.

I did 25 minutes on the treadmill, and I could feel it, but wasn't in pain and am not today, thankfully. I am going to try walking again as my regular exercise and hope my ankle doesn't give out. He suggested I get a walking stick. It will double as a weapon, so that cheers me. Giggle.

He also taught me some strength training exercises. They were really similar to the type of exercises I've been given in physical therapy in the past. (I need to go buy an exercise ball to do a couple of them. I hope the cats don't pop it.) I also need some heavier free weights; mine are only a pound.

He told me I wasn't the most difficult patient he's ever had, which made me laugh, because it can be a lot more difficult if he wants; I am actually making an effort not to be. He also suggested I see a psychologist if I was able to because it might really help with my feelings around exercise. I know I need to, but I just don't think we can afford any more copays. I did call the insurance for a list of providers.

The towels at his office say "MOVE IT" which I guess, on some level, is cute, but in that sick-making way that makes my face twist like I've been sucking a lemon. (I'm not one of these motivational types, or perhaps I should say I'm not motivated by what is "supposed to" motivate people. Never have been.) He also said something about how exercise shouldn't be too comfortable or it isn't really doing you any good, because you have to push your body past the point of what it has adapted to. My response to that is: if you have had any part in motivating me to exercise three times a week for more than a month or two, you have effectively performed the miracle of your lifetime. I'm not going to turn into a triathlete, nor am I trying to. I'm trying to remember what my friend said about his guidelines being for an ideal world.

It all goes back to perfectionism, too--not wanting to do anything you cannot do perfectly, much less that you might fail completely. I've already failed at it completely several times. I think of exercise as torture, because it has essentially been used against me that way in the past, and not just in P. E. classes in school like everyone else. That's probably why I need the psychologist. Sigh.

Blech

This last week I have felt rather uninspired to tow the line. I totally blew my diet as of Valentine's Day, if you can call it a diet...the half-price chocolate was just too tempting. I haven't been in the mood to exercise that much, and I see the exercise physiologist again tomorrow. I'm really going to get to the bottom of why I have to see him; if he's not going to teach me something I don't already know, I'm not going to keep racking up the fees just to write more crap in a journal or whatever.

Had a really good talk with a friend of mine today; she was talking about how what "they" want me to do is in a perfect world, not what a real person is going to end up doing, and that I'll have to modify their guidelines to fit my life and not take it personally if I don't meet every goal they set, because all their advice and suggestions aren't going to work for me. It made total sense.

My friend and I talked about some other interesting stuff too--such as the way exercise forces a person to be present in their body, whether they like to be or not. Articulating that fact made me realize (dingdingdingding) that is *exactly* why I am so uncomfortable with exercise, considering that separating myself from my body has been a coping mechanism for me for most of my life, and when I'm not separate from my body, I'm hyperaware of everything that touches it. If I'm not physically comfortable, I am completely freaked out--even when I just get dressed up, I'm really irritable until I can get into comfortable clothes again, to the point where I can't even enjoy myself because I can't stop thinking about how miserable the clothes feel.

The nutrition piece of this process isn't bothering me nearly as much as the exercise stuff is; I've been working on eating healthier for a long time. It is a trip for me to be eating things like raw zucchini with hummus on a regular basis; I've come a long way from the Doritos and other convenience store staples of yesteryear. But so many other issues are tied up in the whole exercise thing than I ever really realized, and that is really discouraging to face right now.

Exercise physiologist

I saw the exercise physiologist yesterday for the first time. Due to the various continuing insurance snafus I'm dealing with, I have been without sleep medication for weeks and without antidepressants for several days, so I felt about an inch tall when I went in there. (Thank G-d, they both got here today.) He was nice, and I was my usual blunt and honest self, so I'm sure I presented quite the challenge.

I have a T-shirt that reads: "I get enough exercise just pushing my luck." (I do push my luck, at least verbally, but I think of it more as participating in life than anything.) I really, really hate basically anything to do with exercise. The things I like to do best are all sedentary activities--reading, writing, watching movies. When I travel, I like to relax. It doesn't mean I just sit on a couch stuffing my face with cookies, it just means I like to read and be on the computer and don't tend to move a lot. Dancing is a lot of fun, and I really enjoyed doing that when I was younger and lighter. Of course, there is also the possibility of negative comments, which make it a lot less fun. I do still dance sometimes, but I get uncomfortable quickly and don't have much stamina. I enjoy lap swimming, although anxiety surrounding being in public in a bathing suit cancels the enjoyment out of it. The arthritis/bursitis/joint pain I've had since I was young (it started to get bad about age 25 for me) doesn't help, and it's a vicious cycle; you don't move because it hurts, and it makes it harder to move when you don't move. Feh.

I started walking outdoors a lot last year, but my ankle kept giving out at random and getting twisted and sprained, plus you never know when some jackhole is going to drive by and scream or throw something. I bought a recumbent stationery bike, but it hurts my joints (knees, ankles, hips) to even do that for more than 10 minutes. ("Why don't you read on the recumbent bike?" my friend asked me. My response: "It interferes with my cursing.")

So optimally, they want me doing 30 minutes in the target heart-rate zone and 15 minutes cooling down after that four times a week. I'll do the best I can, but when stuff starts to really hurt, I stop doing it. (In the immortal words of Daffy Duck, "I don't like pain. Pain hurts me.") It sounds like I'm just making excuses, but people don't see me walking around like Quasimodo in the mornings with my joints sounding like popcorn. The t'ai chi is basically worthless--it's a good "day off" activity--but is it really a day off if I'm still doing t'ai chi? A day off means hallelujah, no exercise. Feh x 2. Of COURSE the t'ai chi isn't worth anything, I was actually enjoying it and it wasn't causing me physical discomfort!

The exercise physiologist was explaining to me about different kinds of pain with exercise, oxygen getting to cells, etc., and how after about two weeks the good kind of pain dissipates. He also told me the latest research showed that it wasn't beneficial to stretch cold muscles, saying that it was better to just do it after a workout. That was something I had never heard. People in better cardiovascular health have a better chance of not developing complications from surgery, recover faster, etc., which goes without saying.

The first part of the exercise physiology assessment was cardiovascular, so I did about 15 minutes on the recumbent bike with him. True to form, everything hurts today. I see him again next week for the strength part of the assessment. I bought a heart-rate monitor that is kind of cool--you put a band around your upper abdomen and wear a watch, so you know what your heart rate is. I went for the bottom-of-the-line model with basic information; there was one available with more bells and whistles that tracks calories burned and stuff like that, but I don't want to go there. I can look at a clock and tell how many minutes I've worked out, and the number on the watch is the heart rate, so that's straightforward enough. I'm just going to make it part of the food journal in terms of tracking it.

I told him my biggest concern with exercise is learning to motivate myself to do it just because it is good for me/for my health, not to be so *extremely* goal-oriented that it feeds into old perfectionism/defeatism and eating-disordered behaviors, etc. (Although I didn't say "eating-disordered behaviors"; I probably should have. But he's not a therapist per se, I didn't feel like I should tell him my whole life story. Of course, I really didn't want to be there in the first place, so there was that, too.) Toward the end, he asked me if there was anything else I wanted to tell him and in retrospect, maybe that was a hint that I should have disclosed more. I can always tell him next time.

I didn't know what an exercise physiologist even was, so I asked him a lot of questions. He said it was a lot like a physical therapist that also focused on the heart and lungs as opposed to just joints and muscles. It sounds like a very competitive field. I'm glad he is such a nice guy. He was certainly patient.

I saw the term "exercise resistance syndrome" in a book, which cracked me up. I think it's safe to say I have it. With bells on.