Written by Dr Richard Pile | Parkbury House Surgery, St Albans, UK
Disclaimer: Dr Richard Pile is a GP partner at Parkbury House Surgery, St Albans, specialising in cardiovascular and lifestyle medicine. He is involved in training, mentoring, and appraising GPs. He is also on the board of Herts Valleys Clinical Commissioning Group, leading on Wellbeing and Urgent Care. As part of his interest in lifestyle medicine he is both a GP advisor to Thrive Tribe, an award winning national healthy lifestyle provider, and also a director and cofounder of Living Life Better, a company that provides wellbeing support and advice to individuals and companies. More information can be found here https://livinglifebetter.uk.
One week ago, I sat on the side of my bed and measured my oxygen saturation (sats). Our local COVID-19 pathway, which I was involved in creating, stated that a safe level was 94%. Mine was 89%. Strictly speaking, I should have rung 999 and been taken to hospital. One week later, as I write this, my wife and I are recovering from what we do not doubt was COVID-19. It has been the most scary and unpleasant illness that either of us can recall. I thought it might be helpful to share our experience both as affected individuals and a family, not just of illness but also of how we preserved our wellbeing throughout this challenging time.
My wife and I were both very concerned about her catching COVID-19. She has a history of moderate asthma with two previous intensive care unit (ITU) admissions and bouts of pneumonia. We weren’t taking the risks that many of our friends were as they continued with social gatherings despite growing concerns. We withdrew our children from school the week before they shut; I wrote to the headmaster explaining that school was, in my opinion, the kind of “mass event” we were being advised against attending in all other walks of life. As it happens, we were already incubating the disease.
Symptoms started with a headache and lethargy. Nausea, dizziness, and reduced appetite were followed by a fluctuating temperature and rigors. Then came the muscle aches and pains, along with severe localised backache that made it impossible to get comfortable. Next was the cough, chest tightness, and difficulties with breathing 7–10 days after it had all started. Throughout all of this, I was still trying my best to look after my wife, who was more unwell than I was and confined to bed, do telephone triage consultations for the patients of our practice, and fulfil my responsibilities as Clinical Commissioning Group (CCG) Board Urgent Care Lead. It was at this point that I realised, sitting on the bed, checking my sats, unable to finish a long sentence or move without getting breathless, that maybe I wasn’t doing anyone any favours. I decided against going to the hospital as I knew the ITU was already full of people who were sicker than me and much less fit to start with. I instinctively felt that I would be alright if I could just focus on my breathing and not have to do anything else. Over the next few days my wife and I gradually improved. There were setbacks and fluctuations of symptoms, but we are now well on the way. We’re both still wiped out. I’m surprised by how tired I feel after a simple walk. I tried going for a run yesterday. It was more of a walk-jog; I fell asleep in a conference call shortly afterwards. My wife had never seen me sleep during the day in 25 years of marriage. She took a picture of me on the couch the other day, commenting on social media that this was evidence that I was human after all and not, in fact, Tigger. I have the picture on my phone; the digital equivalent of someone whispering in my ear “Remember, you are mortal.”
One area that has been particularly testing for my family and I throughout all of this is ‘wellbeing.’ I have a special interest in lifestyle medicine. I’m known for banging on about it at length during consultations with my patients, conversations with my colleagues, and in blogs and podcasts. I’m currently studying for the British Society of Lifestyle Medicine (BSLM) diploma. I have set up a wellbeing business with some like-minded colleagues which provides support and advice to both individuals and companies. Lifestyle medicine may be perceived by some as a bit fluffy, stating the obvious, an obsession of middle class quantifiable-self-ers, and not really core when push comes to shove! So, what have I learnt from this experience of acute illness and being faced with mortality?
Here are my top lifestyle medicine and wellbeing tips:
- Whatever the circumstances, the pillars of wellbeing remain constant: sleep, movement, nutrition, relaxation, connection, purpose, and meaning are all important. Our ‘health’ only accounts for about 20% of what determines our wellbeing and life satisfaction, so we ignore the other parts of our lives at our peril. Sleep is particularly important for your immune system and mental health, so try to optimise this by giving yourself plenty of sleep opportunity. Remember you are allowed to exercise outside each day, separating yourself from others. Green spaces are best, but anything is better than being inactive. Shorter bursts of higher intensity activity (such as star jumps, press ups, sit ups, squats, and lunges) can be done no matter what the weather and no matter how small your living space.
- Be kind to yourself. The challenges thrown up by COVID-19, such as social isolation and difficulty obtaining the foods you would normally prefer, are real. Don’t beat yourself up over whether you are sticking to your low carb diet every day or have managed to do Joe Wicks’ workouts every single day. Most people will get to the end of this pandemic without having learnt a new language, written their first novel, or built the Taj Mahal out of matchsticks.
- Think about your locus of control: the things that you can change. These may primarily be things around your home at present or specific work-related issues. Have a good routine at home. Get up and get dressed each day, unless you are intending to go viral after that video conference call wearing only your top half. Plan your mealtimes and put structure into the day, for your and your children’s sake. Try to limit yourself to watching the news twice daily at most, ideally not too near bedtime, it doesn’t change much even in this current climate.
- Focus on your family. Our oldest son has severe epilepsy and a learning disability and lives away from home. We are missing him terribly and he will have to celebrate his birthday without us this year. We are in touch with him every day and are in awe of his amazing carers who have created a great timetable for him every day. Plan to spend time each day with the family members that you live with. Eat together and play together. Many of us will look back on these weeks and months fondly. Most younger children won’t remember much about COVID-19, but they will remember that their parents were available to spend precious time with them.
- Connect with others creatively. Social isolation is one of the toughest things for most of us. Think about who you would normally see or speak to each day and try do this at least as much as you would, using phone or video technology where you can. If you normally attend a class or a social group, can you set one up virtually using an online platform? I have twice shared a virtual beer before doing some online gaming with friends and everyone has really enjoyed it. My children are in a band, Princes To Kings, and have kept connected to their fanbase with daily updates and even live-streamed a gig from our house because the original gig, to raise money for the Epilepsy Society, had to be postponed.
- Limit social media. Having extolled the virtues of modern technology in helping us to keep in touch, a lot of social media at present is quite negative. This is partly because of the content and partly because of how people react to it. You know those really irritating people that make you feel bad about your life because they present a carefully curated view of themselves? They’re still out there, and now they can humblebrag about how well they are doing self-isolation.
- Look after your health, particularly if you have a long-term condition. Make sure you don’t run out of your usual medications. Remember that your GP surgery is still open. If you do have symptoms you are concerned about or questions you would like to ask, you can still get advice and treatment. This is likely to be over the phone initially but could also be a video consultation or face-to-face if necessary.
- Remember that “this too will pass.” It can be hard to keep a sense of perspective, particularly if you or your family members are unwell or worried about each other. Sometimes it can be hard to visualise the light at the end of the tunnel, but it will come. There will be a time, in the not too distant future, when we will look back on this period and have a lot of stories to tell each other: triumphs as well as tragedies. As the Queen herself said, we will meet again.
We should be careful in talking glibly about silver linings and positive outcomes from the COVID-19 pandemic, as we are in the peak period. Many people have lost loved ones or are being treated for serious symptoms as we speak. Isolation is much more difficult for some depending on their circumstances; however, there’s nothing wrong with at least considering what we might learn both on an individual and societal level from the radical changes that have been forced upon us in this current crisis. Months of families spending more time together, exercising more frequently, and stopping to reflect and think more deeply about meaning and purpose in life, without the usual distractions, may well produce long-term benefits. Many of us are hoping we can get back to life and business as usual as quickly as possible after this pandemic is over. I have some sympathy with this view. I look forward to catching up with friends over a coffee or a beer, to being able to shake hands with colleagues and to hugging my friends and family. However, if I’m really honest, I am looking forward to a new normal, to living life better.
