I have had a spate of athletes, young and older, seeking assistance with chronic tendinitis and joint inflammation. Some are understandably distressed. Nobody wants a diagnosis of arthritis or an auto immune disease affecting the connective tissues. It is extremely frustrating to have put in months of hard training for an event like a marathon, only to have it come to nothing due to a niggling tendinitis that comes back within minutes of resuming training.
Medically, the solutions for the patient may be very limited (steroids, anti-inflammatories, muscle relaxants, physiotherapy), relatively ineffective and may come with the risk of side effects that can be worse than the original problem.
Here are two emails received today (I get many like these):
A former athlete, now trying to get fit again:
(Refer to her Hair Analysis to right) Athlete "A"
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| This pattern is consistent of over-stimulated but exhausted adrenal glands (elevated sodium, potassium, phosphorus) complicated by the presence of a significant burden of arsenic. Adrenal exhaustion and arsenic are closely associated with fibromyalgia, joint pain and inflammation. |
"Hi Gary,
I have arthritis in my fingers, and hips. My fingers are swollen and my left leg gets a weakness in the thigh and aches and at times I have to sit down. I find it hard to sleep at night as my joints hurt and I cannot wear any rings. This condition really took off after my fourth back to back international trip when I was pushing hard to fit everything in and has gotten worse the past few weeks. I am taking homeopathic remedies for the past three days which has temporarily worsened the symptoms (or so I am told) and I am taking a morning smoothie with all sorts of sprouted seeds, whey, joint factors and hemp oil. Not sure if this covers it but I know this is right up your alley. So do you have any comments or suggestions so that this does not 'set in' and wreck my joints?"
A runner who is unable to run:
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| This pattern is consistent with adrenal exhaustion (depressed sodium and potassium), plus a problem with zinc and chromium metabolism. This pattern is consistent with tendinitis and poor healing. This athlete is generally "running on empty". |
(Refer to his Hair Analysis to right) Athlete "B"
"Hi Gary
My knee seems quite slow to mend, I have not run on it but can continually feel it if I walk around for a while.
I did go for a bike ride on Saturday but kept that gentle as I could feel it whilst riding as well.
Assume it will just take time, and I keep apply anti flam cream and applying heat – I just need to be patient?
Any comment would be appreciated."
Fortunately, we have had Hair Analyses taken earlier on for both of these apparently fit and healthy individuals.
While their hair analysis tests are a few years old, they tend not to change in a hurry - in fact, they tend to get worse with ageing, unless the person has made a concerted effort to bring about change, such as eliminating stress from one's life, dietary modifications and often the need for daily consumption of dietary supplements over several months to correct any imbalances that have been identified.
These tests are revealing
While their hair analysis tests are a few years old, they tend not to change in a hurry - in fact, they tend to get worse with ageing, unless the person has made a concerted effort to bring about change, such as eliminating stress from one's life, dietary modifications and often the need for daily consumption of dietary supplements over several months to correct any imbalances that have been identified.
These tests are revealing
On the surface, it would appear that each of these athletes have different ailments. That is correct. Athlete "A" appears to be developing a condition like rheumatoid arthritis while Athlete "B" has tendinitis of the knee tendons. However, there is a common factor to both: Stress - chronic stress over several years, if not decades.
We are talking about stress that is associated with punishing training and racing spread over many years. We are talking about the stress of modern work. We are talking about the stress of long distance air travel and jetlag. We are talking about the stress of a young family. We are talking about the stress of toxins in our environment. Have I missed anything out? Oh - yes - financial stresses. Uncertainty about the future. You get the idea - Modern life is stressful enough as it is without thrashing one's body as a past-time.
Although we tend to take the stress of modern living for granted, the sad fact is this:
We are talking about stress that is associated with punishing training and racing spread over many years. We are talking about the stress of modern work. We are talking about the stress of long distance air travel and jetlag. We are talking about the stress of a young family. We are talking about the stress of toxins in our environment. Have I missed anything out? Oh - yes - financial stresses. Uncertainty about the future. You get the idea - Modern life is stressful enough as it is without thrashing one's body as a past-time.
Although we tend to take the stress of modern living for granted, the sad fact is this:
Modern life is unhealthy!
Is stripping off to one's underwear and frantically running about the streets really a healthy past-time?
Don't get me wrong: Exercise, like running the trails and hills can be healthy and refreshing; but too much of a good thing, or poor timing can be unhealthy. Its all about a establishing a healthy balance between physical stress and recovery and this can be difficult with all the hustle and bustle of modern living.
It is no coincidence that these ailments (tendinitis, arthritis) are often preceded by combinations of events such as:
- Work stress, exams, performance review, loss of job.
- Relationship and family issues.
- A bad flu, an infection or even an accident.
- The depths of winter (depressing!).
- Excessive travel, especially across time zones.
- Over training
- A tough competition that is bruising and exhausting.
- Heat and dehydration.
- Lack of scheduled or effective rest.
- Poor diet or disruption to usual healthy diet.
Adrenals: Your master glands for health, performance, healing and immunity
Your adrenals are so important that you have two of them. Each produces dozens of steroidal hormones in almost instantaneous response to ever changing demand. These hormones regulate inflammation, healing and your immune response. They regulate your response to stress such as exercise, competition and even the ringing of the phone! It is these hormones that quicken the mind and heart and prepare the muscles for life-preserving action. However, these tiny glands, each about the size of half a walnut, are only designed for brief periods of stress punctuated by long periods of relative boredom. They are poorly adapted for the hectic bustle of the modern lifestyle.
As the adrenals become exhausted and dysfunctional due to excessive demands the following can happen:
As the adrenals become exhausted and dysfunctional due to excessive demands the following can happen:
- The stress response may become exaggerated with levels of cortisol soaring to extreme levels and then plummeting to dangerously low levels (Cortisol is a hormone produced by the cortex of the adrenals hence the name "cortisol"). This person may over-react to stress and have occasions of feeling unbelievably wasted following a stressful event, having no choice but to lie down and rest. This may have a consistent circadian pattern of plummeting levels, such as requiring a morning or afternoon nap. This is consistent with the Hair Analysis pattern in Athlete "A".
- The adrenals may reach the point where the tiny cellular workers decide they have had enough and down tools. A person with this pattern will feel constantly exhausted. They will look "washed out". They will not handle stress well, withdrawing into depression, much preferring to avoid rather than confront the issues. If we were measuring daily cortisol levels we would find a pattern of depressed production. This is consistent of the Hair Analysis pattern in Athlete "B"
- The over-reactive and exhausted adrenals may become confused and the immune system may respond inappropriately. We may see the development of auto immune diseases such as Lupus and rheumatoid arthritis. This is consistent with the Hair Analysis of Athlete "A".
When we examined Athlete "A" we found muscles that are hard to the touch, inflamed and very tender. Athlete "B", on the other hand, has muscles that are unusually soft to the point of feeling flaccid, while being equally sensitive to pressure. These findings are consistent with two forms of adrenal fatigue. In the case of "A" we may assume she has cortisol levels that are extremely high at times which then dive to levels that are near subterranean. With "B" we may assume his cortisol levels have pretty much bottomed out and may stay that way for most of the day. Let me elaborate:
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| Source: |
http://www.adrenalfatigue.co.nz/
In the healthy person who is handling stress well, cortisol levels peak and trough predictably over the 24 hour circadian cycle (refer chart above). You will note that what (protein is most important) and when you eat can help maintain and smooth cortisol levels throughout the day. If the peaks and troughs are exaggerated, as may be the case with Athlete "A", then we may see periods of extreme exhaustion most likely first thing in the morning, mid morning, mid afternoon and during the evening. These people typically are not morning people and they tend to gain a second wind late evening. They may be at their most productive when most of us are snoring away (they are night owls). I know these people because they are the ones who send me emails at 2am!
Blood pressures may be up and down like a yo-yo for Athlete "A". Athlete "B" may tend towards persistently low blood pressure. He may complain of occasionally feeling light-headed when standing up quickly.
The link between cortisol and tendinitis
Cortisol and other steroidal hormones that are produced by the adrenals stimulate and regulate tissue repair. If levels are low, healing will, at best, be a slow-burner. Seemingly minor injuries that were once shrugged off, fail to heal, instead becoming disabling. levels that wildly peak and trough throughout the day may end up confusing the healing processes.
Exercise wears the body down
This is what a physical workout does. The healthy body responds to this by growing stronger. The process of breakdown is known as "catabolism". During rest, the body beavers away to repair any damage and to strengthen the structures in anticipation of more stress. This process of building up is known as "anabolism". It is how we get stronger and stronger when we exercise regularly while getting sufficient rest in between.
In a healthy person, an hour of intense exercise (catabolism) will require about three days of rest during which the anabolic processes repair and strengthen the structures that were stressed. These anabolic processes are regulated by the adrenals. If the adrenals are weak or dysfunctional, these anabolic processes may not respond, healing may be tortuously slow, or may not happen at all. The injury may even worsen during rest - disaster!
Let's think of an athlete who is on the verge of adrenal exhaustion (most are!), due to constant hard training, a dose of the flu and having to fly here and there to do with work. She runs a hard half marathon, doing a personal best. Rather than go into a compulsory rest for several days, the euphoria of a PB keeps her running. A week into it she pulls up lame with a sore knee (tendonitis). Despite weeks of rest and physiotherapy the knee is still no better. A few minutes into running and the pain is as bad as ever. What's going on here?
Adrenal fatigue
The problem is most likely due to adrenal fatigue. The inability of the adrenals to produce adequate amounts of cortisol and other healing hormones. Athletes "A" and "B" fit this scenario to a "T". The solution for both athletes is a combination of "Active Rest" and some physiotherapy, while undertaking an "Adrenal Fatigue Recovery Programme". More about solutions later. I want to ensure you understand why the adrenals are so critical for resolution of these athletes' woes.
The link between chronic stress, adrenal fatigue, rheumatic pain and arthritis
Here we are talking about Athlete "A". Constant, excessive stress. High levels of cortisol and other steroidal hormones.
Chronically elevated steroidal hormones, be they endogenous (from within) or exogenous (from outside) may have the same negative consequences: thinning of tissues like skin and intestines, softening of bones and cartilage and weakening and confusion of the immune system. The person may become nervous, jumpy and easily exhausted.
When elevated cortisol levels plummet, as they inevitably do, such during sleep, the anti inflammation properties of the steroid is lost. Inflammation takes over and the person may become extremely uncomfortable with muscle and joint pain. Most often, this affects the shoulders, back and hips.
Experienced chiropractors know that their regular back and neck pain customers
most often report for treatment following periods of illness or stress.
A related aside: Asthma medication - what they do not want you to know!
Asthma preventers are synthetic corticosteroids. The downsides of asthma medication give us an insight into the effects of stress and adrenal fatigue on connective tissues such as tendons, joints and bones.
Take note of the name of the steroid used for treating asthma: "corticosteroid". This derives from the the adrenal "cortex". Hence the name. When an exogenous source of cortisol (a synthetic corticosteroid) is chronically introduced into the body over a period of years going onto decades, the body's own production of cortisol is progressively shut down leading to a state of "Adrenal Fatigue". In its extreme of complete adrenal shut-down, the condition is known as "Addison's".
Take note of the name of the steroid used for treating asthma: "corticosteroid". This derives from the the adrenal "cortex". Hence the name. When an exogenous source of cortisol (a synthetic corticosteroid) is chronically introduced into the body over a period of years going onto decades, the body's own production of cortisol is progressively shut down leading to a state of "Adrenal Fatigue". In its extreme of complete adrenal shut-down, the condition is known as "Addison's".
If the asthma medication is withdrawn for any reason, healthy adrenals would normally take up the slack. In the presence of adrenal fatigue this may not happen and the person may plunge into a state of low to non-existent cortisol. This will result in raging symptoms of adrenal fatigue, including worsening asthma.
Excessive steroid use softens and thins tissues, including skin, tendons, bone and cartilage
Symptoms of long term use of asthma medication include severe back pain and early onset of arthritis, sometimes leading to hip and knee replacement as early as 40 years of age. Chronic use of asthma medication can lead to further ailments that remarkably mirror adrenal fatigue, such as fibromyalgia, osteoporosis, hypothyroidism, depression, anxiety and nervousness. As the first echelon of users of asthma medication move into their 40's and 50's we are seeing an epidemic of these conditions inundating health services.
Let's discuss this matter of adrenal fatigue and hypothyroidism further because this is essential for understanding these cases of tendinitis and arthritis.
The symptoms of adrenal fatigue are familiar to most people...
The 30 symptoms of adrenal fatigue include, but are not limited to:
1. Excessive fatigue and exhaustion, chronic fatigue
2. Non-refreshing sleep
3. Sleep disturbance, insomnia
4. Feeling overwhelmed or unable to cope
5. Craving salty and/or sweet foods
6. Sensitivity to light
7. Low stamina and slow to recover from exercise
8. Slow to recover from injury or illness
9. Difficulty concentrating, brain fog
10. Poor digestion
11. Irritable bowel syndrome, IBS
12. Low immune function
13. Premenstrual syndrome
14. Menopause symptoms
15. Low blood pressure
16. Sensitivity to cold
17. Fearfulness
18. Allergies,
19. Frequent influenza
20. Arthritis
21. Anxiety
22. Irritability
23. Depression
24. Reduced memory
25. Low libido, sexual drive or interest
26. Lack of lust for life and/or food
27. Excess hunger
28. Low appetite
29. Panic/anxiety attacks
30. Irritability, impatience, quick to anger.
(Source: http://selfadjustingtechnique.com/30-symptoms-of-adrenal-fatigue/)
Interestingly, some of the symptoms of low thyroid (hypothyroidism) are remarkably similar to adrenal fatigue.
Symptoms of low thyroid (hypothyroidism)
- Memory Problems
- Depression
- Trouble Thinking Clearly
- Swelling of Tongue
- Sleepiness
- Fatigue
- Weakness
- Dry Skin and Brittle Nails
- Dry Cracked Heels
- Loss of Sex Drive
- Heat Intolerance
- Hair Loss
- Hoarse voice
- Constipation
- Irregular or Heavy Menstrual Periods
- Muscle Cramps
- Weight Gain
- Inability to tolerate cold
- Inability to tolerate heat
(Source: http://www.squidoo.com/symptoms-of-low-thyroid)
The reason for these similarities is each of these organs, including the hypothalamus gland, regulate the others in a three-way feedback loop. If one is dysfunctional then the others are negatively affected. In terms of hierarchy of treatment priorities, I place the adrenal glands at the top. Successful treatment of the adrenals will usually result in normalisation of the other glands, such as the thyroid. It is not a coincidence that diseases like hypothyroidism are usually preceded by a significant history of stress (resulting in adrenal fatigue).
Thousands and thousands of New Zealanders are being treated for thyroid disease. In my opinion, the treatments (thyroxine) are symptomatic only and not treating the real cause. In most cases the underlying cause happens to be adrenal fatigue. The underlying cause of adrenal fatigue is the combination of stress and nutrient imbalances and deficiencies.
If you rely on vaccines to get through the seasons, perhaps it is time to get your immune system in order?
Approximately 100 clinical syndromes are classified as "autoimmune". These include Hashimoto's, Graves, Crohn's, rheumatoid arthritis, Lupus, scleroderma and fibromyalgia.
An average of 75% of cases involve women. Hormones are believed to be an integral part of autoimmune disease, especially oestrogen and progesterone. High oestrogen causes copper retention and zinc depletion. Imbalances and abnormalities between copper and zinc are associated with rheumatoid arthritis. And it just so happens that adrenal fatigue and poor thyroid function also have profound effects on copper and zinc within the body.
Adrenals regulate immunity. In all cases of autoimmune disease, actual or suspected, it is an absolute priority to support and strengthen the adrenals. While it would be irresponsible to suggest there might be a "cure", it is rather surprising just how many incurable autoimmune conditions go into "sponateous remission" with this strategy!
The link between thyroid disease and muscle, joint, tendon, candida and other health problems
With hypothyroidism there is usually an associated dysfunction between zinc and copper in the body. This will usually show as elevated or depressed copper and elevated zinc relative to molybdenum on the hair tissue analysis. Understanding the complex interplay of mineral patterns on a hair analysis can be confusing and it may take a couple of tests over a year or so to figure out exactly what is going on. Here's the thing about zinc and copper:- If the adrenals and thyroid are exhausted, there will usually be an elevation of copper on the hair tissue analysis. It can work both ways: If copper is elevated due to environmental exposures (copper plumbing, copper cookware, working with copper or even wearing a copper bracelet), use of a contraceptive, or past exposure to a severe viral infection (usually hepatitis or glandular fever), then adrenal and thyroid function may be depressed. There is usually a consequent loss of zinc from the body (this may show as elevated zinc on the hair analysis).
- Zinc and copper regulate collagen synthesis and collagen cross-linking. These minerals, when plentiful and in balance, ensure strong collagen with the right amount of elasticity for the job. When depleted and/or in excess and/or in imbalance, collagen disorders can be the result. Common disorders include stretch marks, tendinitis and ligament injuries.
- Interestingly, zinc and copper are closely associated with progesterone and oestrogen. As oestrogen rises, so does copper and down goes zinc, along with progesterone. The opposite occurs when progesterone rises - down goes copper as well as oestrogen. With oestrogen dominance there is an associated weakening of collagen. This is essential for preparation for child birth. It just so happens that contraceptive devices, such as the IUD, are copper-based. Most birth control pills contain oestrogen and, therefore, cause copper retention and zinc depletion. Oestrogen dominance is one of the best theories for explaining why women feature disproportionately for tendon and ligament injuries.
Female contraception: The largest uncontrolled
experiment in human history - ever!
- As an aside: The immune system uses zinc as part of its arsenal in the constant fight to protect the body from viral, fungal and yeast invasion. If zinc is depleted due to high copper levels which may be the result of adrenal and thyroid disorders, contraceptive use or simply the surge of hormones during puberty, then the person may suffer severe and chronic viral, fungal and yeast infections. Candida, athletes foot, acne, IBS, dandruff, warts and glandular fever come to mind as common adolescent ailments which happen to be most severe in females (oestrogen dominance) as compared to males. As a matter of interest, yeast and fungal infections are such a huge problem with contraceptive use, some contraceptive pills now include anti-fungal drugs in their formulation.
- Zinc is required in huge amounts or tissue healing, such as following hard training, a car accident, infection, or following surgery. In such cases, the end result can be a severe and lasting zinc deficiency.
- Zinc deficiency and copper dominance help explain why viral infections may progress like wildfire in the zinc depleted person. This may prove to be fatal! It just so happens that copper is a powerful antagonist to vitamin C as well as zinc. High levels of copper are often associated with a history of a severe viral infection such as glandular fever or hepatitis, the use of a copper or oestrogen contraceptive, adrenal fatigue and/or hypothyroidism. Hypothyroidism and copper dominance may deplete the body of vitamin C as well as zinc.
- Interestingly, young women with a history of anorexia or bulemia tend to have elevated copper and depressed zinc. It is peculated that this is due to the disordered eating patterns triggering a desperate attempt by the body to conserve energy. A kind of simulated hibernation. The hypothalamus shuts down the thyroid which shuts down energy expenditure. This causes a kind of stasis in the liver which happens to be the organ that regulates copper levels in the body. This process can work back the other way as well: If the liver is damaged from a drug or virus, copper levels will soar and the knock-on effect is low thyroid, adrenal fatigue, muscle pain, tendinitis, loss of appetite and so on! And extremely vulnerability to viruses, fungus and yeast.
Be a sitting duck for seasonal influenza: Depress zinc and vitamin C!
If you rely on vaccines to get through the seasons, perhaps it is time to get your immune system in order?
Autoimmune conditions
Autoimmunity happens when the immune system attacks healthy cell in your body by mistake. This may be due to a weak response of the immune system and consequently failing to complete the stages of developing full immunity following a viral infection and consequently becoming confused. Some speculate that this is the link suspected between vaccinations and autoimmune conditions.Approximately 100 clinical syndromes are classified as "autoimmune". These include Hashimoto's, Graves, Crohn's, rheumatoid arthritis, Lupus, scleroderma and fibromyalgia.
An average of 75% of cases involve women. Hormones are believed to be an integral part of autoimmune disease, especially oestrogen and progesterone. High oestrogen causes copper retention and zinc depletion. Imbalances and abnormalities between copper and zinc are associated with rheumatoid arthritis. And it just so happens that adrenal fatigue and poor thyroid function also have profound effects on copper and zinc within the body.
Adrenals regulate immunity. In all cases of autoimmune disease, actual or suspected, it is an absolute priority to support and strengthen the adrenals. While it would be irresponsible to suggest there might be a "cure", it is rather surprising just how many incurable autoimmune conditions go into "sponateous remission" with this strategy!
Chronic connective tissue inflammation and pain: Focus on adrenals and thyroid health
What this all comes down to this: If you are suffering from chronic connective tissue inflammation and pain, concentrate on restoring adrenal and thyroid function. This requires commitment and persistence of the highest order. Each person with adrenal and thyroid issues has similar treatment needs while requiring personal tailoring.We are all unique Beings while also being the same
It is tempting to give a prescriptive "One size fits all" solution. Prescriptive solutions may be better than nothing at all; but the best solutions are the ones that are carefully tailored to each unique person and their individual circumstances. So, I will talk in generalities here and, if you feel the need, get hold of me and we can tailor a programme to suit.Identify, eliminate or mitigate the following:
Psychological stressors
Many may be present, such as:- A job you don't like, or aspects you don't enjoy, like an over-bearing boss.
- Unhappy relationships, including loneliness.
- Lack of privacy and constant interruptions such as being tied to your phone, Face Book.
- Doing and saying things you later regret.
- Poor study habits, exams, leaving things too late.
- Financial pressures.
Of course, some of these factors can be hugely difficult to deal with, such as being stuck with a job you don't enjoy. It is often easier for the short-term to just live with it but the long-term results can be disastrous to health. If you don't deal with such issues now, the issues will deal with it for you later by giving you something like a heart attack. Then you will have to quit!
Perhaps the best approach is to tackle the easiest stressors first and leave the really tough ones for later on. It can be beneficial to enlist the assistance of a detached expert such as a careers adviser or counselor. The worst thing to do is to procrastinate - Action please!
Body burdens
- Excessive exercise.
- Excessive competition
- Lack of regular sleep and rest.
- Exposure to toxins - alcohol and other drugs, medications, vaccinations, chemicals on the job, air and water pollution.
- Infections such as a dental abscess, worms and other parasites.
- Malnutrition.
Measure your health status
(These will help identify hidden "Body Burdens" as well)
- Blood tests ordered by your doctor.
- A Hair Tissue Mineral Analysis.
- Adrenal Fatigue Questionnaire.
- Then pull these all together with a consultation with me (Gary Moller)
The gold standard for treating adrenal and thyroid issues nutritionally is the programme and products developed by one of the leading authorities on this issue, Dr James Wilson (I am a registered practitioner with Dr Wilson). Please take some time to read some of the information here:
- About Dr Wilson: http://www.adrenalfatigue.org/who-is-dr-wilson
- Dr Wilson's website: http://www.adrenalfatigue.org/
- One of the most informative sites anywhere on the subject: http://www.adrenalfatigue.co.nz/
When Dr Wilson's programme is combined with lifestyle alterations to reduce stressors the results can be quite dramatic. Restoring adrenal and thyroid health will give you a renewed vigour for life in just about every way imaginable, including a gain in strength and endurance as well as recovery.
Most important, in the context of this article, there will be a noticeable reduction of:
Most important, in the context of this article, there will be a noticeable reduction of:
- Tendinitis.
- Bruising (visible).
- Joint pain.
- Muscle pain, including fibromyalgia.
- Back and neck pain.
- Fatness while increasing lean muscle.
- Headaches including migraines.
- Period pains, PMS, menopausal symptoms.
- Panic attacks.
- Heart palpitations.
- Blood pressure - high and low - it will normalise.
- Frequency and severity of infections.
- Weak and thinning hair, skin and nails.
- Osteoporosis
Massage
Massage has several benefits in the context of this article:
- Relaxation which is highly beneficial for the stressed and fatigued person. Take a leaf out of the books of professional athlete's: They would never be without a thorough massage after a hard day at the "office".
- To flush toxins out of the body. The stressed body is charaterised by fluid retention (Soggy Body Syndrome). Massage is the most effective way to flush this excess dirty fluid from the body. Sweating in a sauna is a good supporting therapy as is gentle exercise such as hydrotherapy.
- Reducing muscle spasm.
- A stressed person invariably has areas of the body that show painful knots in the muscles. These are typically found in the shoulder and back muscles, as well as any muscles used vigorously during exercise, such as the calf muscles. These knots typically mirror "trigger points" and respond very nicely to firm massage.
- To soften and free areas of hardening and scarring about joints and tendons.
How long does it take to see an improvement?
Most people will notice an improvement in symptoms within 4-8 weeks. Some people may take longer than six months if the condition is severe and entrenched. Recovery time can vary enormously and is partly dependent on how comprehensively the person takes to the programme. Young people generally respond faster than older people; however, older people are often better at applying themselves to an intervention programme with better longterm compliance.
Changing jobs and weaning off medications, like steroids, may not happen overnight. Patience and perseverence are the keys to lasting success. Like a journey of a thousand miles, those who complete the journey are those who concentrate on taking one step forward at a time, then the next, then the next, then the .......
