​I set a goal for myself. An unimaginably audacious goal. In fact, before this year, any goal requiring fitness, strength, and endurance was undeniably out of my reach. Or so I thought. In August, 2023, for my 60th birthday, I will climb Mount Washington.

The pinnacle of New Hampshire’s White Mountain range, Mount Washington isn’t a huge mountain compared to the snow-capped peaks of the Rockies. The summit is only 6,288 feet above sea level. It is, however, a challenging and potentially dangerous hike. Mt Washington is notorious for having some of the worst and most changeable weather in the world. It is never more than 72°F at the summit and even in summer the temperature can plummet to below freezing with hurricane-strength winds. It is a strenuous, steep hike that usually takes 8-12 hours to accomplish. Fortunately, I will be in good company; my husband Alex, an experienced hiker who has climbed Mt Washington, even in winter, will be my Sherpa, and his trail-savvy daughter Ginny will accompany us.   

I have been to the summit of Mount Washington several times, by auto road or Cog Railway. I have braced against snow-laden windy blasts in June, with lacy fingers of frost crunching beneath my boots. If I tried to hike Mount Washington today, I would not be able to endure more than an hour or two on its arduous slopes. But I have set a goal that is just inside the realm of the possible. By the time I turn 60, I will be the product of rigorous strength and cardiovascular training. I will have progressed from short hikes of moderate intensity to long, strenuous excursions carrying a heavy pack. Ill be ready. I know I will.  

Fitness is its own reward. In the 3 months I have been committed to weight training and cardiovascular fitness, I have gained strength, endurance, confidence, and a greater feeling of emotional wellbeing. It is always not fun to muscle though a workout, but afterwards I feel strong, proud, and accomplished. But I need a tangible goal. My goals of bigger and stronger muscles, greater endurance, and a healthier, more beautiful body are not quantifiable. Just how large does a muscle need to get for me to consider it bigger and stronger? How do I measure endurance?

For decades, I have enjoyed challenging myself by picking a goal that seems almost impossible and finding a way to accomplish it. When I was a single-mother EMT attending community college, I moved away from my family and friends to study nursing, and ultimately achieved a Masters Degree in  from an Ivy League University. I always wanted to write a book- to date I have written 14, one of which has become a birth emergency skills training workshop for midwives.  I like challenging myself. I like doing difficult things. I love expanding myself, growing, learning.
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So I dropped a pin on the map of fitness training,  and will be orienting my path towards the imposing slopes of Mount Washington. Follow my journey. It’s gonna be fun. 

What would you do if your doctor told you that you must become a body builder? What if your doctor locked his eyes on yours and said “If you do not engage in a rigorous program of strength straining and cardiovascular conditioning, your arms will begin to randomly fall out of the sockets, you will no longer be able to work as a nurse-midwife, and your husband will have to wipe your butt?” I have Ehlers Danlos Syndrome, just like my sister, whose shoulder would dislocate when someone gave her a “high five”. Dr Lavallee also has Ehlers Danlos, and knows the score. “I have treated thousands of patients just like you. I have seen the outcomes. If you start a serious workout program, you can probably continue to do all of the things that matter to you for a very long time."
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That was 3 months ago. I joined the Y, hired a trainer, and never looked back. I have been astonished by my progress. My arm circumference is larger, and I am noticing the beginnings of muscles. My endurance is much greater. My heart does not pound as hard when I exercise. Moreover my mood is calmer and my creative energy is high. I walk taller and with greater confidence. I am considerably stronger on the circuit training machines. Recovering from a frozen shoulder, when I joined the Y in March I couldn’t even maneuver my injured arm into most of the arm machines. Now I can use them all and am steadily progressing on weight.

My schedule is not fixed, because I work irregular 24 hr shifts at work. I do something every day. On a leg day I do 30-60 min on the elliptical, all of the circuit training leg machines, back and torso machines, and finish with a stationary bike. On an arm day I usually row for 20-30 min, then do all the arm and ab machines, then some dead lifts, bar presses, bar curls, etc. When I train with Tammy, she teaches me lifts with low or no weight to focus on technique, then we increase the weight.  If I have down time at work I do a yoga tape on my phone or use the stationary bike. I try to hike once a week.  Occasionally I swim. At home I can row, lift little barbells, use the exercise ball, work with the horses, Bowflex, hula hoop, or do cardio on the Wii.
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I am three months in and fitness is now a way of life. I’m learning about nutrition and target heartrates. My trainer Tammy helps me to optimize my workout for muscle hypertrophy- large muscles are necessary to stabilize my joints. I don’t always love the actual workout, but afterwards I feel strong, accomplished, and happy. I’m looking forward to the strength I will have next year, and the beautiful changes in my body. But fitness is not so much about what I will have down the road as what I can do today, and today, and today. And today, I soldier on. 

When I start a session of cardiovascular exercise – rowing machine, elliptical, hiking- I feel a strong emotional resistance to the workout. I previously interpreted this opposition as my body telling me that it was incapable of performing the task at hand. But after a month of pushing through the resistance to engage in daily exercise, I came to realize that my greatest obstacle was not my poorly- conditioned body, but the saboteur in my mind.

About 1-2 minutes into every workout that involves cardio, the annoying voice in my head tries to derail me. I named her Atë in a previous post, after the Greek goddess of mischief, delusion, ruin, folly, rash action and reckless impulse. Atë thinks I should give up the moment it gets difficult or boring.  Atë pressures me to stop after 5 minutes in favor of less demanding pursuits like reading or playing Words With Friends.

But Atë isn’t the one doing the work. When I hear Atë’s impassioned plea to stop the workout, I check in with my body. How does my body feel? Is it struggling? Is it in pain or showing signs of cardiovascular injury? Is the workout compromising or damaging my body? 

Invariably, my body answers “Thanks for checking in, but I’m fine, I can keep going.” Through this initial month of daily exercise, I have learned that my body is point-and shoot. I set it to a task and it will do its best to complete it. My physicality is trustworthy. My body is absolutely willing and increasingly able to engage in exercise, including cardio, weights, core exercise, yoga, or anything else I ask it to do. The obstacles are in my mind.

When I do cardio, my body settles into a rhythm, my muscles working in a strong, satisfying way. I feel physically challenged, but clearly this work is well within my capabilities. Atë screams ever-louder “NO! this is too much, we hate to work out! Lets stop. You don’t need to do more than 5 minutes.” I remind Atë that she is not the one doing the work and my body is comfortable engaging in the work I set before it.

At some point in the workout- at about the 10-minute mark for the elliptical and 12 minutes with rowing- Atë's presence begins to fade away. My body still feels strong and capable. It can do more. It wants to do more. Human bodies are built for exercise, and to become fit is to reach one’s biological potential in this capacity. Strangely, I find that the pressure to quit is much stronger after exercising for 5 minutes than it is after exercising for 20 minutes.

How do I feel after the workout? GOOD! Proud. Strong. Astonished. Empowered. I am astonished that completing workouts of this magnitude was even possible for me. What a crazy idea, that my tachycardic, breathless, pulse-pounding, jelly-muscled body can engage in respectable workouts without complaint!

For those new to my blog, the backstory goes like this:
A month ago I redefined myself as a person who incorporates serious exercise into my daily routine. This paradigm shift was monumental. My self-concept was that of a person who hates aerobic exercise. My heart pounded with even the lightest exertion and that was very unpleasant.

I had been diagnosed with dysautonomia decades before I was diagnosed with Ehlers Danlos Syndrome. Dysautonomia is a malfunction of the autonomic nervous system, a control center that regulates involuntary functions like heartbeat, breathing and digestion. I have had issues with rapid heartrate and fainting throughout my life. These cardiovascular symptoms appear mostly when I am standing for a long time. Whenever I exercised vigorously, I felt a similar pounding of my heart and shortness of breath, my pulse racing out of proportion to my activity. I concluded that my autonomic malfunction rendered me unable to exercise, and I operated under that assumption for decades.
I was wrong.
In this month of daily rigorous exercise, I learned that my racing heart on exertion was merely the response of an unfit body. My heart was pounding because I hadn’t been exercising. My misperception had become a feedback loop that reinforced the belief. My mind said “I cant do cardio because my heart races”, so I didn’t exercise, then became progressively weaker and deconditioned, which decreased my tolerance for exercise, which strengthened my belief that I “couldn’t” do cardio.
I was wrong.
When I started working out on February 24, 2022, I could do 1.5 minutes on the rowing machine and 0.11 miles on the elliptical. After reaching these thresholds, I felt exhausted, with racing heart and burning thighs. My saboteur mind chimed in “See, you cant do cardio”.  Yet after a month of daily workouts, I could work out on the elliptical for 50 minutes/3.7 miles or on the rower for 3 eight-minute sets, each followed by a weight-lifting regime for arms or legs. Once a week I had a mega-workout day, wherein I would row or elliptical, lift weights or circuit train, then take a 2.5 mile brisk hike over hilly terrain. Astonishing. 
  
For me, the key to fitness is to listen to my body and ignore the inner voice that seeks to derail me. I know now my body can easily complete my workouts. In fact, the exercise has improved my dysautonomia; I have fewer episodes of tachycardia and I am better able to tolerate prolonged standing -after a single month of daily exercise! Wow, what a game-changer! All of my obstacles are self-imposed and come from that inner voice of negativity and resistance. I am learning to quiet my inner critic and focus on the health of my body, mind, and spirit. Because that is the true source of my wisdom. 

​Today is day 30 of my program of near-daily workouts. I began exercising as a person with no prior success in initiating or maintaining an exercise program. This time was different. I redefined myself as a person who exercises at least 5x a week, every week, for life. Some of you wanted to follow along as I reach my goals and grow stronger. I have a really great personal trainer who is tailoring exercises to my capabilities and limitations. I love working out at the Y. Here is my progress:
Elliptical: On day 1, I could only do 0.11 miles. Today I did 3.7 miles in 50 minutes at a moderate pace.
Rowing. I could do 1.5 minutes of rowing on the rowing machine on day one and thought I would die. Now I can do three consecutive 8-minute rows with 2 min breaks inbetween.
Circuit training: I do the leg, trunk and back machines 2-3 times a week. I can’t do the arm machines at all, either because they are too heavy or because the injured arm does not have sufficient range of motion.
Arms: I do arms 2-3 times per week. On day 1, I could bicep curl 1 lb on the injured arm in 2 sets of 8. Now I can curl 3 lb in a set of 10 reps and 2 lb in 2 sets of 15 reps. I lift light weights while sitting on the ball for core and balance. I do the TheraBand exercises and bar pushups (cant do one on the ground, never could). I do the exercises assigned by my physical therapist to stretch the arm.
Core: I do some core every day. I am doing bridges, marches, crunches on the ball, squats, “dead bugs” “bird dogs” leg lifts on the ball, and hula hooping.
Swimming: I am strong enough to do a quarter lap without stopping, one time, using a kickboard. Im building endurance with a kickboard and doing floaty “weights” to build strength. I want to be able to do laps someday.
Hiking: At least once a week I do brisk hike of moderate difficulty between 1 and 2 miles.
Fitbit: I hit 10,000 steps or more about half of the days, and 6,000 steps or more on almost all of them. It really keeps me motivated, I love seeing my data.
Protein: As it turns out, it isn’t too hard to get enough protein if I make protein powder smoothies every day. I get about 100 g a day or more.
Water: It is very difficult for me to get enough water. I must have been chronically dehydrated all of these years. It is difficult to reach my 100 oz goal, particularly when I am at work. Nonetheless, I reached my goal about 85% of the time.
Calories: I previously had trouble graining because I wasn’t eating enough. I want to gain very gradually, muscle not fat. I figured out that I can increase the calories in a smoothie by adding coconut milk, which is nutritious and high calorie and very digestible. When I need more calories I add more, when I am gaining too fast, I add less or don’t use it at all.
Effects: I have adapted to workouts surprisingly fast, and am astonished by how quickly I am gaining the ability to do cardio. I do feel healthier overall and feel the pride of accomplishment after each workout. Last fall I had a slumpy, round-shouldered  posture when sitting and walking, due to a weak core that was not holding me upright. My posture has definitely improved and I feel like my core supports  me on a more vertical plane. This morning I felt the tiniest hint of a muscle developing in my upper arm!
I try to focus on the positive effects of each workout - feeling proud, feeling vibrant, feeling accomplished, and that fuels motivation. My Fitbit also fuels motivation when it displays encouraging messages when I hit 10,000 steps or drink 100 oz of water. These are the rewards that keep me going. That and the knowledge that quitting is not an option. This is my path now. 

When I first embarked upon this new way of life (workout; push water; push protein; push calories – inserted into already-busy days) I suspected that motivation to stay the course would be my most hazardous potential pitfall. But why? What is the root cause of the inertia that prevents action? I am a strong person with decisive clarity of mind when I choose to exercise it. Why is there a dichotomy of wills if I am a single individual?  Who else is in there with me?

Upon deeper reflection, I can see that my best self is my super-ego persona, Strong Bonnie.  I have had a lifetime of practice building her, and she is steadfast, reliable, and always true. But darting around my peripheral vision is this sneaky little id-imp that attempts to lead me astray whenever my guard is down. Throughout my life she has been devious, amorphous, shape-shifting. It has been hard to pin her down for more than a few minutes at a time. But now, I will give her a name: Atë, after the Greek goddess of mischief, delusion, ruin, folly, rash action and reckless impulse.

Atë, step forward into the light, please, so I can call you out, strip you naked, and learn your game. Oh! There you are! You’re not as imposing or substantial as I thought you would be. Atë, my nemesis, my friend, we are on the same side- after all, we are the same person-- and we need to pull together for the optimal health of the body we share.

I will be listening for your voice, Atë. Your impulses have a strong emotional pull but they almost never lead me down the path of greater good. You are childlike, capricious, and fickle. Your version of truth is not to be trusted. Our new path places my physical and emotional health at the center of the hub, and all else that is good and necessary will be worked in from the periphery. Our health now has a tangible blueprint.  When you try to derail or distract me, Atë, I will stay the course and honor my convictions, my decisions, and my perseverance. If you choose to use your powers for good, I will greatly welcome any positive contribution. If not, I will ignore your distractions, fix you with a stern glare, and shame you into silence.

I am a certified nurse-midwife and women's health nurse practitioner who was not diagnosed with Ehlers Danlos Syndrome until the age of 55. All of the signs and symptoms were there since childhood, and I often sought medical care for conditions that pointed directly to the diagnosis. EDS, however, is an uncommon and largely underdiagnosed condition that slips under the radar of even conscientious providers. The evidence for my condition was right there in front of them, but they saw only the presenting complaints, not the condition that created them. Likewise, I am a highly educated medical professional, and I too failed to put my own puzzle together. 

Clinicians (doctors, nurse practitioners, physician assistants, nurses, physical therapists) can change the lives of people with undiagnosed Ehlers Danlos Syndrome (EDS) by noticing the clinical signs and referring appropriately. Many people with EDS go their whole lives without ever realizing that they have a connective tissue disorder. If they are unaware of the condition, they are more likely to suffer pain, dysfunction, and disability. Getting proper treatment can make a lifetime of difference for these people. Individuals with Ehler's Danlos Syndrome can have manifestations of the disease in virtually any bodily system: musculoskeletal, autonomic nervous system, integumentary, cardiovascular, digestive, respiratory, neurologic, and so on.  

• They may have loose joints. Hypermobility is the tendency for a joint to move beyond its normal range of motion. Flexibility is a good thing when it is coupled with strength. When the person has weak muscles or an imbalance of strength, joints move too far and injury can occur. Shoulders, elbows, wrists, fingers, sacroiliac joints, hips, knees, ankles, and feet may develop subluxations, locked movement, acute or chronic pain or frequent injury. The person may report joint dislocations that occur with minimal provocation.
• They may have chronic pain. Often, the person has been dismissed or labeled by other providers as drug-seeking because they appear outwardly healthy. But Ehlers-Danlos Syndrome involves joints that shift and place pressure on nerves, sending referred pain to unaffected regions. It involves spasm as  muscles clench to compensate for excessive joint movement. Often people with Ehlers Danlos must adjust to a baseline level of pain which is present every day, no matter how well they appear to be functioning.  And yes, some individuals are drug-seeking, hoping to get some relief.  Some individuals turn to substance abuse to achieve some level of comfort to get though the day.  But most are uncomfortable and are simply seeking a strategy to lessen the pain. Physical therapy with a provider familiar with EDS can be a godsend. 
• They may have hernias and pelvic prolapses.
• They may have numerous dental cavities. People with EDS are also often less sensitive to Novocain.
• They may have wide, flat scars. Even small cuts may leave prominent scars.  Often there are large  scars on the knees from childhood falls.
• They may have orthostatic tachycardia or POTTS. Some people with EDS faint frequently.
• They may have easy or unexplained bruising. People with vascular EDS often have large bruises in various stages of healing with poor recall as to how they occurred.
• They may have delayed gastric emptying and slow gut motility. They may have difficulty swallowing.
• They may have a diagnosis of fibromyalgia. The muscles of a person with EDS are often rigid from holding joints in place and may have painful trigger points.
• They may have chronic fatigue, anxiety, depression. Wouldn't you if you were struggling, quite literally, to "hold it together" every day?
• They may have Mast Cell Activation Disorder,  a condition in which the mast cells in the body release too much of the substances that cause allergy symptoms.
• They may have obstructive sleep apnea if soft tissue or excessive neck flexion impinges on the airway during sleep.
• They may have poor proprioception and have trouble knowing where the body is in space. They are prone to misjudging distances and walking into doors, chairs, etc.
• They may have family members with the disorder. EDS is autosomal dominant. Statistically, if a person has EDS, at least half of their children will have it as well. Ask about other family members with these symptoms.

Suspect your client might have EDS if you come into the exam room and the person is sitting in some weird position. And you’re thinking how can that be comfortable? The person with EDS adopts unusual positions to relieve pain and tension elsewhere in the body. 
​Suspect EDS when your young adult client develops cystoceles, rectoceles, and other pelvic support problems. Pelvic support problems can even occur in nulliparous teenager with EDS.
Suspect EDS if your obstetric client has a separated symphysis or other pelvic girdle issues. A person with EDS is three times more likely to require treatment for pelvic girdle pain and instability.
Suspect EDS if your client has a precipitous delivery. Labor is all about overcoming the resistance of maternal tissue. A mother with stretchy tissue may dilate rapidly.
Suspect EDS if your client has massive varicose veins in the legs and vulva.
Suspect EDS if your client has uncommonly velvety soft skin. The skin of the face may have a more youthful appearance, but the hands may appear more aged and wrinkled. The skin may be abnormally stretchy. 

You can change this patient's life by making appropriate referrals. If a connective tissue disease is present, the sooner a diagnosis and care plan is made, the better a lifelong quality of living this person will have.  Referral to the primary care physician is a good starting point. Some people will require a referral to a geneticist to identify which disease process is present and determine the characteristics of the disease. Some people will require referral to physical therapy, a rheumatologist, a gastroenterologist, a cardiologist, an orthopedist, or other professionals. A structured, professionally-devised  exercise program is critical for the person with Ehlers Danlos Syndrome. Low-impact cardio such as swimming or elliptical with a regimen of strength training can extend the number of healthy years for these people, reduce the risk of joint damage and dislocations, and reduce chronic pain.