Engage – Angela Donaldson

We feature Angela Donaldson of Arthritis Care Scotland who blogs on the challenges people with arthritis encounter everyday.

A bit of a Dilemma – Promoting Healthy Lifestyles for Ordinary People

I have lived with RA for a long time, 28 years and counting to be precise.  During that time I’ve faced a few challenges, physical and emotional; you know; the usual stuff. The big questions like, ‘If I sit down in that chair will I be able to get up again?’, or ‘Will anyone ever understand, why it is that just as the party gets going, I need to go home?’.

Luckily, I’ve never been one to run from a challenge, and have always made an effort to live my life to the full. In a way, getting RA at an early age has helped me do that.  I’ve never felt able to take things for granted, particularly my health, and was made aware at an early age that I couldn’t ‘have it all’. But I’ve always worked at achieving some kind of balance between the life I want, the life I can have, and what I need to do to have it. I’m not a bad person.  Nor do I consider myself weak.

I know what I need to do and I try my best to achieve it with the tools I have at my disposal; determination, knowledge, will, energy, money, time, commitment, love and the support of others. I don’t always get it right, but on the whole I’m satisfied that I am doing my best.  There’s room for improvement, but then there always is, isn’t there?

So today I find myself on the horns of a dilemma.  This dilemma has come about because I’ve been asked to speak at a conference this week about health promotion for people with RA, from the patient’s perspective and I’ve been giving a great deal of thought to the benefits of a healthy diet and regular exercise on my RA, and how obesity and smoking make it worse.  Those who know me will already be seeing the panic in my eyes!

I will be informing key health professionals, how to inform me about how I need to change my lifestyle.  I am indeed the target for all of their health promotion key messages. How did this happen?

So, I’m struggling a bit with this presentation.  It would be easy for me just to say, ‘you should do this and you shouldn’t do that’, but that would be hypocritical. It’s not that I don’t know that being overweight puts extra stress on my joints and makes me more tired, or that smoking can encourage my RA to flare up. I do know this. There’s lots of evidence to prove it. I’m bombarded with messages on a daily basis about what is good and bad for my health according to the latest research. So why haven’t I lost weight or stopped smoking? That was a rhetorical question. I can give you a million reasons, or excuses.

And that’s the point I’m trying to make.  What is it that motivates us to turn that knowledge we already have, about what we need to do to look after our health, and ultimately ourselves, into taking action to change our lifestyle? If it were that easy, then we’d all be doing it, and there would be no need for me to speak to these people at all!

There’s lots of invaluable information out there in the public domain around how to live a ‘healthy’ life with RA, and Arthritis Care produces a great deal of it through its information booklets, website and helpline, but still people, including me on occasion, choose to ignore it.  What is that about? And how do we support people to make different choices? Because it’s clear that information alone is not enough.

Looking at a real scenario, I saw a video piece on the BBC news last week about a young man who smoked. He said he knew all the risks, as a smoker you’re faced with them every time you lift the packet, but he enjoyed smoking and was willing to take them. He thought the only thing that might make him stop was if his daughter asked him to, but that she wasn’t old enough to understand yet.

Or in terms of RA, the woman who knows that by going swimming regularly, she will feel so much better, have more energy and be able to eat the things she likes most. But she has to get to the swimming pool first. And she’s had a long hard day at work. Her joints hurt, and she’s not sure if she could get out of the chair without help.

I’m not saying that health promotion campaigns and messages don’t work.  They do. And there’s evidence to prove it. Eating 5 a day and drinking plenty of water is on the increase, drinking alcohol and smoking is on the decline.  That’s the result of many years of work by various governments and health agencies trying to change attitudes. But it still hasn’t worked for everyone.

So when does the penny drop? The penny which motivates the need to change the behaviour, and how do we support people through that change process when it happens? How do people assess the risks associated with their health choices within the context of their own life? And still choose to take the risk? I think there are as many answers as there are people, and it’s important for us all to recognise that.

In the context of living with a long term condition like RA, it becomes even more complicated. Every week I’m prescribed medications by the very health professionals who are trying to encourage me towards a healthy lifestyle.  The contra indications listed on the patient information leaflets included with the medication are more often than not, enough to make my hair curl!

If I take this yellow pill, it may help with pain, but could make me sick. If I take this white one, it’ll stop the sickness but may make me drowsy.  If I inject myself with this, then it’ll help my RA, but could cause liver failure and increase my risk of heart disease and strokes. Where does it end? Is it ok to eat chocolate and drink red wine, or is it not?  I don’t want to live forever. I just want to live what I consider to be a good, productive life for as long as I can. And without being judged unfairly for how I choose to go about it.

To reiterate, I learned at the age of 22, that as far as my health was concerned, I couldn’t ‘have it all’. I’ve always worked at achieving some kind of balance between the life I want, the life I can have, and what I need to do to have it. I’m not a bad person.  Nor do I consider myself weak.

Sometimes I have the balance right, and sometimes that balance needs to be readjusted, but I keep trying to achieve it, with the support of other people around me.  It’s a lifelong process. Not as easy as flicking a switch. I do feel another shift in that balance coming on though. Due to reasons many and various, I have recently been neglecting my own health. I need to eat less rubbish, and exercise more and yes, the stopping smoking question needs to be addressed again. I’ll work through my life challenges keeping in mind the risks, in order to live my life to the full. I’m happy to support other people to do that too, ensuring they have the appropriate information to assess their own health risks and support them to make different choices if they want to.  But I make a point of only allowing myself to be judged by those who have walked a mile in my shoes. 

Onward!

Angela Donaldson
http://www.arthritis-care-connect.org.uk/scotland/blogger/angela