Category: Arthrtitis | Living with Spondyloarthritis

An unhealthy health care reform in Switzerland, part 2

In my last blog I wrote about the Swiss healthcare reform which is proposed by the Swiss Council of ministers and about a controversial measure to introduce budget limits to outpatient healthcare, putting expenditure limits on treatment. The details are explained in my last blog. This measure is almost universally opposed by those affected: by patients, doctors, insurers and industry.

The proposals were presented to parliament in Spring. This blog title photo was published on Twitter by Michel Guillaume correspondent for the Federal parliament for the Swiss newspaper “Le Temps” and shows attendance at the parliamentary session on 31.05.2022. It documents the involvement and engagement, or rather lack of it, of Swiss parliamentarians to discuss one of the most important issues for citizens and society – health reform to create a healthcare system that delivers the best care for all in society. As Michel Guillaume of Le Temps reported, not even ¼ of parliamentarians attended the debate. Against this background of indifference, the law was duly passed on 07.09.2022, the Federal Council adopted the legislative bill to amend the health insurance legislation.

The approved strategy overlooks many other opportunities to save costs and improve the quality of care. In particular it ignores the cost-saving opportunities presented by listening to patients – something that I have written about in this and other blogs. These would be considerable — if the right incentives and structures are made available.

Patients at the centre of healthcare

Reform should put patients at the centre of healthcare and create the conditions for the system to prepare for future challenges and opportunities. Politicians seem to see the Swiss health system as a fiscal burden, which is managed by cost cutting efforts and budget restrictions. In my view an effective and efficient health system is an investment into the workforce as a pre-requisite of a flourishing and equitable economy. I do not dispute that there are enormous cost inefficiencies in the Swiss system. Anyone using the system is frequently confronted by them. The government’s reform efforts seem to have identified the problem to be doctors carrying out medically unjustified treatments and overprescribing to outpatients, who by implication do not really need the treatment and are perhaps just making it up. Is this really the root cause of the problems?

Like most people affected by chronic diseases[1] I go to the doctor relatively often and I take expensive medication. Maybe budget restrictions will result in my doctor limiting my healthcare, and thus reducing the direct costs of my treatment as an outpatient. But chronic illnesses also cause indirect costs, meaning the loss of productivity of patients and their families due to illness. There have been times when I couldn’t walk to the local shop, I couldn’t sleep, I couldn’t work. In total, I have spent five years of my life collecting unemployment benefit. I now work part-time.

My situation is not exceptional. There are thousands of people who are living this way.[2] If the outpatient services are restricted, which enable people like me to get back to a normal life, indirect health costs and the associated misery and hardship of the affected patients may increase. And these costs are not negligible. As the graph below shows, the indirect costs of musculoskeletal disease are much higher than the direct costs of outpatient treatment. Let’s look at this in more detail.

Health costs are not caused by doctors!

In Switzerland 80% of health costs are due to chronic, or non-communicable diseases (NDCs) – in normal times outside the Covid-19 pandemic. The four largest cost drivers are shown here with direct costs shaded purple[3] and the indirect costs mentioned above and shaded turquoise[4]. The largest disease group are the musculoskeletal disorders. It is apparent that the total indirect costs for the four most costly diseases are higher than their direct costs. These figures were last published in 2011. According to the Federal Office of Public Health (FOPH), the costs of NDCs in Switzerland increased by a further 28% between 2011 and 2019.

The new measures will restrict outpatient health care, but they do not address the area where the most costs are incurred: namely indirect costs. Instead, the measures will almost certainly reduce the quality of care and restrict patient choice, which may lead to higher indirect costs. Furthermore, they will result in higher administrative costs, because of the paperwork required from medical staff to prove that they are not overspending. This may well lead to undesirable evasive manoeuvres and side effects…. What, for example, will be the effect of these bureaucratic measures and red tape on the motivation of doctors and nursing staff, many of whom are already demoralised by over two strenuous years of the pandemic?

Patients Know Best!

My doctors want the best for me. They have enormous expertise and know a lot about my conditions. But I also know a lot about myself because I live with my illnesses 24/7. Especially with chronic patients with multimorbidity, no clinician can ever acquire this knowledge if she/he sees a patient perhaps 1-2 times a year.

Healthcare has a century-long tradition of patriarchy and not listening to its users. Think about it: in what other industries are consumers not consulted about their needs and wants? I started writing this blog over 5 years ago because it seemed the best way to get my voice as a patient heard. Since then, the Swiss National Science Fund (SNSF) has begun funding some medical research projects, where patients must be involved. The Swiss Clinical Trials Organisation (SCTO) has started creating resources about PPI (patient and public involvement) in clinical medical research. The Swiss Patient Organisation SPO is establishing an advisory Patient Council consisting of patients. Other patient organisations are taking similar initiatives, although these patients are not as yet embedded in decision-making organs. Patient-led organisations are almost unknown in Switzerland.[5] RheumaCura Foundation, which I co-founded last year, is one of the first.

In public health commissions, which advise government, the inclusion of patient representation is becoming more common, although up to now the position is usually delegated to a health professional, rather than a patient with lived-experience. If a politician wanted to talk to me, I would have many questions. Two are raised by this blog:

Why are the indirect costs of healthcare not addressed in health reform?

Why aren’t the chronically ill supported in such a way that they use fewer health services, can work as long as possible, actively participate in society and through their earnings contribute tax revenues to government?

[1] These are also called non-communicable diseases and are broadly defined as conditions that last 1 year or more and require ongoing medical attention or limit activities of daily living or both. This is opposed to acute medical conditions, which occur suddenly, have immediate or rapidly developing symptoms, and are limited in their duration, e.g. like flu.

[2] A call to address the indirect costs for chronically sick patients has been made using the example of cancer survivors. Françoise Meunier former president of the European Organisation for Research and Treatment of Cancer calls for action to end discrimination against cancer survivors at the workplace and financially, which leads to high indirect costs of the disease.

[3] Wieser (2014) defines direct costs as medical costs that are incurred directly through the expenditure of resources for the treatment of a disease (inpatient costs, outpatient costs, medication costs) and non-medical costs such as adaptation of home facilities, which was not measured in this particular study. See Wieser et al. (2014) Die Kosten der nichtübertragbaren Krankheiten in der Schweiz, Schlussbericht im Auftrag des Bundesamtes für Gesundheit.

[4] Wieser (2014) writes that productivity losses among patients occur in the form of reduced performance during work (presenteeism), temporary absence from work (absenteeism) or permanent absence (early retirement). In addition, productivity losses can occur due to premature death. For relatives, unpaid care (informal care) causes productivity losses.)

[5] Patient-led in the sense of the European Medicines Organisation (EMA)

“This horror will grow mild, this darkness light”

John Milton, the English poet, wrote these lines in the 1660s in his epic poem Paradise Lost. It was a time of failed revolution, religious repression, and endemic plague sweeping through the land where there were no vaccines, effective protective measures, or intensive care units.

I am often reminded of his words, and they give me hope. Thankfully today in Switzerland few of us know the terrible suffering of those who have lost loved ones or are chronically ill as a result of the pandemic. Recent discussions have been about whether we can go skiing, or if the trams will still run. For most people SARS-CoV-2 is an inconvenience rather than a life-threatening illness. Nevertheless, the pandemic is causing huge suffering in the world, and it helps me to remember that pandemics are nothing new, that normal life will indeed return.

That’s why, in the middle of the pandemic, I and three companions launched an initiative for more patient-centred research into rheumatic and musculoskeletal diseases. In May we established a foundation called RheumaCura. You can find out more on our website.

At the time of founding RheumaCura I wondered if we shouldn’t be addressing this immediate crisis. Milton reminds me, that these times will pass, and the challenges to solve will still be there. Better treatment and finding cures for rheumatic diseases is still important and there’s much to do.

Our quest for more patient involvement in health care does perhaps have a link to the current crisis. Overcoming the pandemic is slowed because not enough people have been vaccinated. In Switzerland a vaccine is readily available for all, but a significant proportion of the population do not want it. This may be now leading to an unparalleled health crisis in Switzerland, which according to the health experts would be entirely avoidable. If we’ve learned one thing from Covid-19, it’s that the public health authorities are powerless to beat the pandemic if the people do not support their initiatives.

The reasons why people refuse vaccination are complex, but one important aspect must surely be trust. Mike Ryan, head of the health emergencies program at the World Health Organization stated recently: “What’s shocked me most in this pandemic has been that absence or loss of trust,” he said of people’s unwillingness to follow the advice of public health leaders and the containment policies set out by governments.

People who don’t have confidence in health experts or substantiated scientific evidence, or democratically elected government authorities, or the media, will not have faith in information provided by these sources. They succumb to fears without any scientific basis. The American scientific journalist, Tara Haelle, writes thought provokingly about the reasons for vaccination hesitancy, about its long history, and why nobody should be surprised.

However, even among the vaccinated majority, a common perception is that health care is strongly influenced by the pharmaceutical industry, health care providers such as gigantic hospitals, and corporatist bodies such as the associations of health insurers. The Swiss system is highly complex, hierarchical, and not easily understood by outsiders. Patients often feel like objects in a huge and powerful industry, where they are by definition vulnerable. More trust and cooperation could be generated in the health service if it were closer to its citizens. An obvious way to do this would be to listen to and involve them more, and enable them to be more active.

A health care system in which the patient’s voice is heard at all levels would provide better care, and furthermore, it would also increase trust and encourage compliance with public health care advice. Patient compliance with health care advice is always essential for the best outcome, and we have never seen it so clearly as in the pandemic.

Read more about our vision and work on the RheumaCura website

Milton, J (1674), Paradise Lost (2nd ed.), London: S. Simmons

Sunset in Bern — “This darkness light” Reflections on the Covid-19 pandemic

Climbing the Eiger at 60?

“You’ve got to be kidding!” said my friend Jeannie about my plan to climb the Eiger over the Mittellegi ridge. Or maybe she thought that I was mad. After all, I have suffered from severe Spondyloarthritis and moderately severe Inflammatory Bowel Disease for decades.

However, the medication I take has a huge positive effect on my quality of life and makes such a mad plan thinkable. But there is a big difference between feeling ok, with bearable pain and being able to manage to get through the day, and feeling really, really fit and strong and confident. And that is the change in the last two years since I became aware of the power of “lifestyle medicine”.

Changes in my lifestyle have transformed my life and made it possible for me – a 60 year old woman with chronic illness – to climb the Eiger. I want to share my experience. Maybe my learnings will be useful for others. But please remember, I’m not a doctor and this is not medical advice. Everybody is different. Try things out, get professional support if you can, and observe carefully what works for you!

If you get to the end of this blog there is a slide show of the Eiger tour!

What is lifestyle medicine?

According the American College of Lifestyle Medicine, it uses evidence-based practice to help people adopt and sustain healthy behaviour that affects health and quality of life. Some Lifestyle health factors are now well-established: don’t smoke; keep your weight under control; exercise regularly. But the benefits of taking these lifestyle changes even further don’t seem to be recommended by most doctors. Perhaps they aren’t proven enough, or not well-known, or not believed in. For whatever reasons, these are all things that I have found out more or less for myself.

Lifestyle medicine focuses on sleep, nutrition, exercise, and stress reduction.

Sleep

Worries, overwork or medication have all affected my ability to get a good nights’ sleep in recent years. Many people know what a problem insomnia can be, and how lack of regular sleep can affect well-being, and how great it is to get a good night’s sleep. One source of support has been from Dr. Guy Meadows and his approach called ACT (Acceptance and Commitment Therapy). At the Sleep School he teaches how to overcome insomnia by observation and acceptance. It often works for me. Trying to control my fears and anxieties in this way matches my approach to Stress Reduction through meditation and mindfulness (see below).

However, the most important factor affecting my sleep is nutrition, which I will explain in more detail.

Nutrition

I’ve been watching carefully what I eat for some time, and have reported my experience in a previous blog called Am I really what I eat? I am still following the recommendations that I received from dieticians, and eat a Mediterranean diet with lots of fruit and vegetables. Now I can’t imagine eating any other way. It’s delicious!

But what about eating less or less often? My first thoughts and impressions about Fasting were A new F-word: FASTING – Love or Hate? Since starting interval fasting in August 2019, I believe that it has had a huge effect on my well-being!

There has been a lot written about diet as a factor in controlling inflammatory diseases, but what I have discovered in the last 6 months or so, is that it is just as important when I eat, as what I eat. Interval fasting has made a real difference to my sensitive gut, and I believe that reducing intestinal irritation, or even inflammation in my gut affects my whole well-being and may even have contributed to reducing inflammation in my back and joints. For over 6 months now, I generally eat my last meal by 6pm in the evening, and fast for 16 hours, meaning that I have a herb tea in the morning and then a delicious breakfast with coffee, fruit, whole grain muesli and yogurt sometime after 10am.

Dr Satchidananda Panda of the Salk Institute of Biological Sciences in California explores the circadian rhythm, and how this cycle of functions, which repeat themselves over 24 hours, affects our performance, mood and overall health. The best-known example is the sleep cycle. Dr. Panda believes that the benefit of sleep for the brain in the circadian rhythm is just the tip of the iceberg. Other organs have a circadian rhythm and also need time to rest and recuperate, such as the digestive system. The circadian clock may even mediate the immune system. He has tested the benefits of fasting extensively over the last 20 years and believes that every cell in our body has its own circadian clock. Every hormone, neurotransmitter, gene in our body has times when it functions best, and times when it needs to rest, repair, and reset. The circadian clock is not just linked to sleeping, but also to eating and exercising. So, it’s important not just to sleep at the right time, but also to eat at the right time.

His first results were with mice who were given a set “Western” diet. One group could only eat within a limited time window of 8 hours. The other could eat exactly the same amount of food, but without any time restrictions. After a few weeks, the mice who fasted 16 hours a day were much slimmer, more energetic and generally healthier than the mice who could eat or snack all day. In the last 5 years he has extended his research to thousands of human volunteers, who monitor their eating habits. The results indicate that similar results can improve the well-being of people. Apart from weight loss, improved mood, better sleeping, trial participants report other benefits such as reduced joint pain and inflammation. Dr. Panda explains his work in the BBC podcast Don’t tell me the score.

This seems entirely plausible to me, because the effect of interval fasting in the last months on my digestion and thus on my general well-being has been nothing less than dramatic. Through fasting I give my digestive system a period of down time when it doesn’t have to digest new food and can rest and repair. I can feel how my gut is more relaxed, how much better I can sleep, and how energised I am. For somebody who has suffered from a leaky gut and chronic inflammation for decades, this is a real gift for me.

If you understand the science (which sadly I am not trained in), then this work is summarized here: Mattson MP, Allison DB, Fontana L, Harvie M, Longo VD, Malaisse WJ, Mosley M, Notterpek L, Ravussin E, Scheer FA, Seyfried TN, Varady KA, Panda S. Meal frequency and timing in health and disease. Proc Natl Acad Sci U S A. 2014 Nov 25;111(47):16647-53. doi: 10.1073/pnas.1413965111. Epub 2014 Nov 17. PMID: 25404320; PMCID: PMC4250148.

Getting fit

To keep my spirits up during Lockdown I made a plan “5 tips to manage your day” which included daily exercise. I used an online fitness programme with a huge of variety of options from stretching and yoga through Pilates to PIIT (professional intensive interval training!). It was amazing how doing this every morning for several months made me fitter than I could ever have imagined, despite never going far from my own house, let alone to the mountains.

Stress Reduction

The key to stress reduction for me is a few minutes of mindfulness or meditation before starting the day. Collecting my thoughts and intentions by keeping a journal also helps. If you are interested in this topic, I reflected on Stress Reduction in a previous blog, the Lockdown.

Putting it all together to climb the Eiger!

These practices all help disease management and improve my well-being. It’s a gradual process. It has taken months for lifestyle changes to translate into improved well-being. Discoveries have been a process of trial and error. No clinician has advised me to adopt these practices. I have had to sort through the available material and decide myself what is quackery and what is responsible advice. If I’m not sure about a theory, I check if the author of recommendations has been willing to expose his or her ideas to scrutiny by publishing them. If there are no recent publications on PubMed, then I’m sceptical about whether the work is serious, and discard it.

There needs to be much more research to provide evidence-based, mainstream recommendations for the benefit of all patients. The Spondylitis Association of America recently published an excellent webinar on lifestyle healthcare, but otherwise it’s hard to find trustworthy information. I believe that if healthcare research were more centred on patients well-being, rather than being driven by commercial considerations or personal aspirations, these areas would be given much higher priority.

Above all, I believe that without all these lifestyle changes…. I never, ever, could have climbed the Eiger at the age of 60!

Here is the Eiger tour in pictures – enjoy!

The whole Eiger tour from the tiny hut on the right to the descent to the left
Ascent to the hut (1)
Ascent to the hut (2)
Arrival at Mittellegi hut
Sundown before the tour
Climbing at daybreak (Photo: J. Zaccaron)
Two more climbers were behind us
Wonderful rock
Warm sunshine at last
Grindelwald below to the right
The glaciers of the Aletsch UNESCO World Heritage Site below to the left
Climbing, climbing (J. Zaccaron)
Much narrower than that: the thinnest snow ridge ever (J. Zaccaron)
Summit after 4 hours!
South: Ewigschneefäld (Eternal snow field)
North: Looking towards Bern
East: Schreck- and Finsteraarhorn
West: Mönch, and Mont Blanc in the distance
Looking down
Walking down (J. Zaccaron)
Abseiling down
Sometimes going up again (J. Zaccaron)
The glacier is getting closer
Last steps to the hut
View of the ridge on the train ride home

Covid-19 Lockdown: how is it going?

As the Lockdown started in Switzerland in mid-March I wrote about my strategy to manage Corona times. I named 5 things that I thought might help me through this extraordinary period. So where am I now? How do I feel?

Today decisive measures will be loosened, schools, shops and restaurants will open again. Like many Swiss people I am relieved that the last two months have not been as deadly as anticipated. But I am also deeply mistrusting. Will there be a second wave? Why is it ok to open up now? Weren’t we told that there has to be widespread reliable testing first? So much is unknown and there are about as many opinions on the pandemic outcome, as there are people expressing them.

My personal expectation is that it’s going to be a long time until the health authorities tell me that I can embrace the people I love …. travel to places I long to visit….. live without fear that I may become ill, or cause harm to other people…… I’m not even sure to what extent I can make my own judgements or must abide by regulations. What is my responsibility to myself and to the society that I live in? How is the lockdown impacting my health and well-being?

So, time to revisit my intentions, examine my feelings, and consider…

How did the 5 intentions help me?

Moving my body

A trainer sent me a link to a fitness studio which was broadcasting about three daily workouts – everything from Yoga to tough Interval Training. So I’ve done a workout every morning, and it really feels terrific. Sometimes went for a run or walk instead, but mostly I was @home.

Meditating

After a shaky start, a friend told me that Jon Kabat-Zinn was broadcasting mindfulness to thousands of people every evening during the pandemic. Bless him! His talks have been a marvellously soothing and comforting way to end the day. Sometimes we break out after the meditation session into small groups on zoom and exchange ideas and experiences across continents. I’m slowly understanding what mindfulness is about.

Getting overdue tasks done

Every Sunday evening, I take a piece of paper and write on it what I want to get done the next week. Work, but also household chores, gardening, reading. Many things I enjoy, and some I don’t – like doing my tax declaration. I’ve got quite a lot done and found a good structure, but I’ve been so preoccupied with ticking things off on my list, I sometimes forgot to enjoy what I was doing.

TV before bedtime

It’s an almost morbid fascination following the world in crisis and how different leaders and cultures are managing it. I was often drawn to the News in the evening. There are also many interesting “in depth” programmes. Watching them in the evenings nevertheless made me miserable and unable to sleep. It took me a long time to stop doing this to myself.

Love and compassion

It’s been easy to remember the power of love and compassion. The wonderful gestures of love and solidarity, particularly through the work of artists and musicians on social media, or spontaneous online support groups, or neighbourhood help with shopping or singing on balconies. The marvellous dedication of front-line health workers, and essential service workers delivering our food, and generally keeping things running has been quite extraordinary. (Meanwhile many of the white-collar office community enjoyed the luxury of deceleration in lockdown and closer family life offered by home office working).

So, everything is fine?

You might think everything is ok for me. Actually, reading my journal of the last 6 weeks is quite sobering. I write about nice things I did, comforting phone calls with friends, baking tasty cakes, sunshine, making a fire in my garden in the evening, interesting podcasts, new fulfilling work, and yet … my entries are short and terse. Phrases like “I feel better now” or “I feel ok” appear frequently. Beyond the reports of my flourishing activity with the 5 tricks to fight the Coronavirus, I also read about sleepless nights, a sort of numbing dread and disbelief, loneliness and boredom.

Anybody else?

I imagine many of us feel this way. The uncertainty of the future has become threatening. Strange, when you think about it, because the future is unknown and uncertain by definition. It always will be, however much we try to plan and insure against risks.

I remember the nuclear disaster at Chernobyl in 1986, which also happened during a wonderful April. Living in the Black Forest of Southern Germany at the time, the beauty of the emerging green and the spring light was in stark contrast to the unseen threat of radioactivity that the people in Southern Germany felt was literally raining down onto them. This crisis feels similar, except the enemy hides not in the clouds, but in people and creates distrusts even amongst ourselves. People I encountered on walks near my home sometimes didn’t even look at me, let alone greet me. We were all so afraid.

How am I touched by events?

The word “touch” has become key to me during these times. I am touched by the examples of solidarity that I have seen. I am touched by beautiful expressions of humanity and creativity that artists from all walks of life and everywhere in the world – both professional and amateur – are creating and spreading freely on the internet. I am touched by the friendship that I experience from neighbours and by the new encounters with people on the internet, who I have never personally met. I am touched by the appalling suffering that I have watched on television or can imagine just by reading newspapers.

The UN reports that the number of people on earth facing “acute food shortages” will more than double this year. I am touched and horrified by the thought that actually nobody has to starve, even now. If the wealthy gave to the poor, then the millions of workers worldwide who have lost their employment and have no income wouldn’t be in danger of starving.

Many people are faced by existential crisis, and even death. The world is on an unfathomable roller-coaster of transformation. My mind and soul have been touched during this pandemic as never before. However, in all this inner chaos, my body has got left behind. I have not been touched physically: not since the beginning of the lockdown and the introduction of social distancing.

After 2 months, I am realising what this means. I acutely miss the touch of a handshake, or an embrace, a close dance or a kiss… I even miss my physiotherapist extending a joint or massaging a tense muscle. I believe that this is the source of my strange despondency and the feeling of emptiness.

By nature we are beings that need physical contact. Documentaries show primates who groom each other to reduce stress and resolve conflict. Scientific papers report about the various hormones that are produced by touching. There is even a medical term for what I am experiencing: “touch starved” — also known as skin hunger or touch deprivation. There is information on many webpages describing this phenomenon and what I have so intensely felt in recent weeks. Lockdown is opening up in many countries, but even in these places, people at risk are still being told to shield themselves and maintain the strict rules. If the post lockdown “normal” is to continue isolating people at risk, the effects of touch starvation must be addressed, because it is as important as getting food to people. People are not being nourished adequately, if we just leave a bag of groceries on their doorsteps.

Groceries delivered to people sheltering at home in the Covid-19 pandemic. Photo by Alex Alpin — Groceries delivered to the doorstop (Alex Olpin)

Coronavirus: 5 tips to manage your day

The news gets grimmer every day. Many of us are living in Lockdown. We are frightened and understandably so. The Coronavirus disease is causing a pandemic which is shaking our beliefs, culture, daily habits and the very essence of our lives. These are life changing events for us all. Whatever this leads to, whatever we suffer, or learn, I suspect life will never quite be the same again.

Will I fall into a chasm of fear, helplessness and despair? I’ve been there, and that taught me that we have choices and it’s never as bad as our fantasy and creative mind can allow it to be. Rather use that creativity to generate hope and optimism, and on a strictly practical level – make a plan to keep myself afloat.

5 things to manage Corona times

What follows is my list of things to do every day. If I keep to them, I will be OK. It helped me to visualise the plan. My artistic efforts are pictured above!

Maybe a plan like this might be helpful to you? Other ideas are around. For instance, the Unicef Executive Director, Henrietta H. Fore has been broadcasting a Video diary from her home office. In the broadcast on Day 4, she recommends to make a Well-being plan.
(If it’s relevant to you, Unicef’s advice about looking after children and teens during the pandemic might also be worth reading.)

So here is my personal list of what I need everyday for well-being.

1. Move your body!

Movement and sport is absolutely essential to me. It’s the way to keep Spondyloarthritis at bay. If I move, I’m usually pain free. If I don’t, the pain comes back within a few days. So how to replace the weekend mountain trips, the back classes, training gym, climbing gym, physiotherapy and the fitness centre which keep me moving?

As long as I’m allowed to, I will go running in the hills behind my house early in the morning. I meet nobody and feel safe. Or some days, I practice Rickie Moore’s wonderful yoga for inner peace, which takes an hour. I can also go walking. The incredible value of walking was made clear to me by the neurologist Prof. Shane O’Mara on a BBC podcast called Don’t tell me the score. In summary, walking benefits our muscles and posture, helps to protect and repair organs, aids digestion and can even turn back the aging of our brains. Moreover, it encourages us to think more creatively, helps our mood to improve and our stress levels to fall. I’ve tried to follow Prof. O’Mara’s recommendations on walking, and I really think that they work. A quick summary with 8 reasons why walking is so good for you is here.

2. Look after stress levels by meditating

Sometimes I get really stressed out, which leads me to make mistakes and misjudge situations. I can even feel my heartbeat accelerating, or my voice getting tense. To relax again, I need to get myself into the here and now. I’m never tense if I’m in the present moment. It’s reflecting on some event in the past, or worrying about the future that makes me stressed.

Climbing, running, swimming, or other physical activities all help to concentrate the mind, but meditation has a special healing quality. Sometimes I can sit on my cushion and physically feel the tension falling away from my body. There are so many schools and techniques to meditate. If you are curious, it’s all on the internet.

Mindfulness is also a very helpful tool to reduce stress. It’s not the same as meditation. I like this simple way of distinguishing these two practices:

Mindfulness is the awareness of “some-thing,” while meditation is the awareness of “no-thing.” (here’s the reference)

Mindfulness is being aware of the present moment. It’s noticing and paying attention to thoughts, feelings, behavior, and everything else, but without making judgements. Jon Kabat-Zinn founded the Mindfulness-Based Stress Reduction (MBSR) program at the University of Massachusetts to treat the chronically ill.

Personally, I prefer meditation. It’s the fascination of trying to get to a completely different level of consciousness. Albert Einstein famously said, “We cannot solve our problems with the same thinking we used when we created them.” Meditation often enables me to reframe problems and find solutions.

There are masses of information on the internet. I find Andy Puddicombe a fascinating person. He co-founded the App called Headspace. I don’t know it, although it’s probably the most popular one. He has worked hard to make Meditation and Mindfulness more accessible and relevant in today’s world.

I’ve been meditating for about 8 years now. Sometimes only for 10 minutes, but every day is the key. I still get distracted a lot, and this is quite normal, unless you are really, really experienced. My practice has not (yet) enabled me to switch into altered consciousness every time I sit on my cushion. My practice is learning to catch myself drifting off into other thoughts and bring myself back to quietness. This does help with problem-solving and calms my mind too. I also enjoy meditations that help develop a certain state of mind, such as Loving Kindness, or Compassion. There is no wrong and right way to meditate!

3. Get some overdue work done

Lots of people feel this way about the Lockdown. They can finally get some work done, which they’ve wanted to do for ages, or read some of those books stacked on the bedside table…. I am looking forward to blogging more and am launching new professional activities as a patient representative/advocate in medical research. Maybe you have other projects, or can contact old friends again.

4. NO TV before bedtime!

We all know that we shouldn’t be online in the evening, let alone watching the news. A few evenings ago there was an evening report from an intensive care unit in Bergamo in Italy, a city 30km from the Swiss border, where an old friend lives, who had a liver transplant. I was stupid enough to watch it – woke at 3am, feeling sick, my head spinning. I felt feverish but was too dizzy to move. When I did manage to measure my temperature, I had slightly over 35C! No fever whatsoever!

In the evenings I am generally to tired to read, so I need to do something very passive. That’s why TV is such a temptation. My solution was to get out some of those old coffee table books with stunning photos about beautiful places in the world and look at them again. Wonderful! I haven’t looked at such books for years!

5. Remember the power of Love and Compassion

It’s important to me to feel connected with others and to feel the power of Love and Compassion. A marvellous doctor called Sir Harry Burns, who I have been so privileged to work with, emphasised the need for Love and Compassion in health care in a recent talk. He was referring to the care of others, but it’s also important when caring for ourselves. (Sir Harry has also done a great TED talk on What causes Wellness).

I’ve heard that Neuroscience says that it is better for your health and well-being to give than to receive. I don’t know if there is really any evidence-based research on this, but I can believe it. Helping each other, staying in touch, supporting each other, will make a big difference to how we overcome this crisis. And I am sure that despite a bit of hamster shopping, people will rise to the occasion. Just knowing this, gives me strength and hope for the days and weeks to come.

Take care, stay at home, stay healthy, and stay in the space of Love and Compassion.