It is usually not hard to convince me to do anything physical.  My friends know that I genuinely relish the opportunity to do manual labor.  I am deeply offended if you do not invite me to help you move, replace your lawn, take down a shed, or demo a house.  I will choose hikes that purposely have no view as a reward to endless gains in elevation in hot summer heat.  I really like exercise . . . most of the time.  

This past week has been very challenging and my patients have mirrored these feelings.  For the most part, I have done ok with a statewide shutdown, endless amounts of cleaning, hours behind a mask, and the worry of owning a person to person business at a time when those interactions are cautious.  I was generally productive and calm in my time away from the office.  My “it is what it is” attitude served me well these past few months.  When the fires started I did not have much anxiety.  They seemed distant and a not uncommon occurrence as climate change continues to change the west coast weather.  As the fires progressed rapidly and the situation worsened things changed a little bit.  Once the smoke invaded Portland, things really changed for me.  I have previously had a complete loss due to a home burning down.  I lost any photos from college or before that, paintings, family heirlooms, and potentially inherited a curse from my friend (but that’s a story for another time).  I also nearly lost my life, my friend’s lives, and my dogs life.  The fact that any of us made it out alive, according to the fire marshall, was miraculous.  During that incident I tried to go into the house twice to try to find and save my dog. Both times I was immediately rendered completely incapable due to the density of the smoke.  It was completely impenetrable.  Only good luck had my dog scrambling down wooden stairs to come running outside.  That night, my partner at the time told me that I was yelling and twitching in my sleep.  Much of that even created many positives for me but it left a scar that I didn’t even know was there.

Since that fire, certain kinds of smoke will trigger an acute awareness of my surroundings.  Campfires and wood burning stoves won’t do it as there has to be a slightly different smell.  That smell usually creates an immediate evaluation of my safety that quickly dissipates.  With the recent smoke, it did not dissipate.  As the evacuation boundary moved closer and we seriously talked about what we would gather with us and where we would go, the cortisol really started to pump.  For days I had an elevated heart rate, massive carb cravings (which is rare for me), and a constant edge.  By Saturday morning I finally had a small meltdown.  It just all became SO MUCH.  

This was a sentiment shared by nearly all my patients this past week or so.  We had all managed fairly well, but we all have our limits.  In response, the medical interventions changed to meet patients where they were at, but also served as a strong reminder.  We all need REST.  There is a time to work and a time to rest and the need for rest is always reactive to your life and all that goes in it.  We need to remember and allow that.  As clinicians, we also need to plan for it.  In hindsight, nearly none of our patients have been prescribed a period of deloading.  Deloading is the prescribed and planned lowering of training intensity during any training cycle.  It is usually manifested as doing the same movements but at much lighter, sub-threshold loads.  ALL training plans MUST include unloading phases.  No human athlete is an exception to the need to back off and slow down.  Given the air quality and my cortisol levels, this last week has been a rest week.  It should probably be the same for you.  If you are consistent in your health, taking a week off of anything you are doing really won’t matter in the long run.  If you eat well most of the time, binging on vacation won’t matter.  If you have been doing your rehab exercises for the past 6 weeks, a few days won’t set you back.  In my experience, I usually come back stronger after periods of rest.  There is no problem working with life rather than against it.  There are natural flows to all things and rest is part of that flow.