Kinesiology Tape Tips for Chronic Pain & Joint Instability

I did not really know much about kinesiology tape until a couple of years ago. I was introduced to it as a means of managing pain and instability. Being the born skeptic that I am, I could not imagine tape would be that helpful, but was also willing to try. I could not believe how much it helped! There is no evidence supporting tape for treating pain or injuries. There is little information on why it works. The best I have been able to understand is that tape provides direct stimulus to the skin, which aids in cuing proper muscle use, and provides proprioceptive feedback. Regardless of the science, or lack thereof, tape remains in my tool box of options for managing pain.

Although tape works well for me, I did encounter drawbacks. These presented in the form of my known sensitive skin that tends to react to many adhesives. Through trial and error, we discovered that my skin tolerates RockTape brand tape better than KT tape brand. I am not trying to promote one brand over another, simply sharing what I have found in my experience. Once RockTape seemed to work well, I saw no need to keep trying other brands. Additionally, Cavilon skin barrier film (as wipes, swabs, etc.), helps protect my skin if we apply that first, allow it to dry, then apply tape over the top. The tape still adheres well, but the skin has a layer of protection between it and tape adhesive.

I soon found that kinesiology tape stays on well, even through showers, working out, and swimming. Because I am a swimmer, my favorite tape has been RockTape H2O as it stays on even better in water. Before my shoulder surgery, my shoulder was taped most of the time. I have gone as long as a week before removing it. However, my skin was not happy. The allergist who manages MCAS (mast cell activation syndrome), suggested a maximum of three days of tape, then give my skin a full day to breathe before being taped again. He also prescribed a steroid ointment to help calm tape induced rashes. This has helped keep reactions minimal and manageable. 

I learned that Cavilon makes a lotion as well, that the lotion costs less, but also that it is easier to have issues with tape sticking as well with the lotion than the film. I also learned that tape works very well for a total sunblock over surgery scars to protect them from sun exposure. I used to use waterproof bandages, but tape is easier, and with healed incision scars, it does not matter if waterproof or not.

More recently, we have experimented some with leukotape. This tape lacks the stretch that kinesiology tape has. It is also a harsher tape, and needs to be placed over the top of another tape, called cover roll. It did not take me long to realize that this taping technique worked well because of how firm the support was, as well as my skin tolerating cover roll better than any of the other tapes!

My latest discovery is something called Thrive Tape. I was introduced to this first in a Facebook support group for EDS (Ehlers-Danlos Syndrome). I then received an email about it from the Ehlers Danlos Society. My curiosity was piqued, but I was skeptical as usual. I knew tape worked, but why was this tape so special? They advertised using far infrared technology in kinesiology tape. I have asked about this, still do not fully understand. The best explanation thus far, is there is a chemical reaction with skin. I was also told it was designed with fragile EDS skin and reactive MCAS skin in mind! I had the opportunity to actually try Thrive tape for myself when I attended an EDS conference. Understatement--I am really impressed! Even knowing that kinesiology tape helped, I was not prepared for how much this tape helps. We applied it without any barrier film or lotion. My skin never got itchy under the tape as it does with other tapes. When I finally removed the tape after 5 days, yes pushing limits to give a test, my skin was fine! It was not red and irritated! That five days included showers, working out, a couple of swimming days. It stuck as well, or better, than other tapes, was easier on my skin, and was more effective. I definitely noticed when I removed the tape. Oh my. Sometimes there is gradual improvement with tape, but more noticeable and rapid return of pain after removal of tape. Additionally, this tape has instructions for taping for different issues, but also states that if unable to tape properly, simply place tape over painful areas. I have tried taping myself some, and am not as capable of taping correctly, but the tape is still helping! I have been following a three days on, one day break pattern with Thrive tape since the conference, as I received a free roll of tape. I use. I am officially sold on its worth. The next challenge, is balancing its cost, as it does cost more. 

For those interested in taping, I found it helpful for physical therapist or chiropractor to tape me. We started with only very small area, and only left a day or two at most. As we learned what my skin would, and would not, tolerate, we tried other areas. There are videos and instructions on taping. However, my providers used variations specific to me. Some areas of my body I can tape myself--knees, for example. Others, I cannot, or not very well. My shoulder is impossible to do myself. Taping my own back is possible, but challenging, as it is difficult to get tape truly in most effective placement. 

Again, these are only my experiences. I am not receiving anything from any of the companies mentioned. I am not trying to promote one brand over another, simply sharing what works for me and my skin and body. The point of sharing that different brands affect me differently, is that if one brand does not work, it is worth trying another. I have heard others who do better with KT tape than with RockTape. It is individual. I am sharing what I have found helpful over the past couple of years. 

More Links
RockTape
RockTape H2O
KT Tape
Cavilon swabs
Cavilon wipes
Cavilon lotion
Leukotape
Cover roll
Thrive Tape
Copyright © 2019 by Chronic Wholeness. All rights reserved.

Ehlers-Danlos Syndrome Diagnosis Round 2

I wrote previously about my diagnosis with Ehlers-Danlos syndrome. Well, I appear to be on round two of diagnosis, this time pursuing genetic testing. Things are still in process, thus results unknown at this time. However, sometimes I find recording or reading about the process can be helpful as medical journeys tend to be more about living through the process than the end result.

I was clinically diagnosed with classical EDS in 2017. At the time, I was informed genetic testing was approximately 50% accurate, not worth pursuing due to expense and chance of being negative. When the diagnostic criteria changed shortly thereafter, recommending classical EDS (cEDS) be tested, as genetic testing was then considered 80-90% accurate, I asked about genetic testing. Because my clinical diagnosis was being taken seriously, I was getting needed treatment, precautions were being taken with procedures, genetic testing was again determined not worth the expense.

I am a reader and learner. I am aware that a couple more variants in classical EDS have been found and reported in the literature in the past year. This further confirmed in my mind that genetic testing was not guaranteed to be insightful.

I had some serious complications with some surgeries several months ago. It was all thought to be due to EDS, diagnosis not questioned. However, it got me reading deeper into things. I'd had emergency GI surgery that found perforated bowel, addressed that, resulting in temporary colostomy. I read about EDS and bowel perforations, learning all types of EDS can have bowel perforation from colonoscopy, surgeries, etc. The main type of EDS with reported spontaneous bowel perforations was vascular. I was never quite clear on exact cause of perforation in my case, but since I was post up another GI surgery when it happened, figured it was combination of weak tissues and recent GI surgery. I never questioned if classical EDS diagnosis was correct. However, a recent test showed very unexpected findings. This test was a preliminary check to determine if rectal stump had healed well and was ready to reconnect to reverse the colostomy. It was a barium enema of the rectal stump. I was watching on screen, because I always do this if screen is visible. After the procedure, the radiologist went back and showed me the images, explaining things as he did so. He showed me the sealed end of the rectum where it had been surgically closed after removal of sigmoid colon several months prior. He pointed out that no dye was getting through. This was good as this was most likely place for leaks, but showed I had healed well from surgery. This was good news, was anticipated. However, he went on to show me where swirls of dye were leaking out along the side of the rectum. This was not at all normal, was very unexpected, he was not sure other than probably connective tissue disorder related. Oh my. That left me sort of in shock as I knew if leaking, there was no chance of reconnecting things to reverse colostomy until it had healed. But, the new leak raised questions if I'd ever be able to be reversed if my body had either never healed, or apparently had a new leak, since this was a different area then would be expected. Additionally, since it appeared to be a new leak, raised questions regarding vascular EDS, because of spontaneous perforation--new leak unprovoked. From reading, I knew that in vascular EDS reversal surgery to reconnect GI tract to rectum is contraindicated.

Not unexpected, my surgeon said reversal this summer is impossible, and he recommended against ever reversing. He said what he saw in surgery months prior, what happened then, this test result, made him very concerned. He said I am very high risk of leaks, perforation, sepsis, and likely death, if we try. That being said, he recommended second surgical opinion, said we can try repeating the test in a few months and see what it shows.

Long story short, I was worked in for geneticist appointment on urgent basis after explaining the situation. Clinically, I definitely have a connective tissue disorder, have characteristics of classical, hypermobile, vascular, but was told there is overlap between them. The exam and history do not build a strong case for vascular, but the bowel perforations are concerning, worth genetic testing. Classical EDS is typically mutations in COL5A1, or COL5A2. Vascular EDS (vEDS) is typically caused by mutations in COL3A1. My understanding from the geneticist is if testing is normal, we keep current clinical classical EDS diagnosis. Best case scenario, testing confirms classical, worst case scenario, testing shows vascular. The geneticist was reassuring, told me not to worry. She said there is a COL1A1 mutation that is associated with vascular issues in classical EDS. She also said some vascular is milder than others, and with how far I got (30s-40s) before serious issues, she suspects if vascular, it is mild. We will discuss things further once we have results. I will either edit to update this post once I have results, or will write a second part.

Edited to update 9/19/19. RESULTS
The results from the genetic testing are back. I am negative for vascular EDS! This is a huge relief! I am also negative for everything else tested. I was told testing for vascular EDS is 98-99% accurate, thus it is pretty confidently ruled out. However, testing for classical EDS is approximately 90% accurate, thus 10% of patients with classical EDS will test negative. A negative test does not rule out a clinical diagnosis. Hypermobile EDS has no genes identified. I was told to keep my clinical diagnosis. If asked for details, I have clinical diagnosis, with negative molecular testing.

Resources
2017 Classical EDS
2017 Hypermobile EDS
2017 Vascular EDS
Vascular characteristics in classical EDS
New discoveries in variants in classical EDS
New information in vascular EDS
COL3A1 in Vascular EDS
COL5 mutations in Classical EDS
Avoid ostomy reversal surgery in vEDS
COL1A1
COL3A1
COL5A1
COL5A2
Bowel perforation in EDS
Bowel perforation in vEDS

Copyright © 2019 by Chronic Wholeness. All rights reserved.

Tips for Swimming with an Ostomy

I normally try to write posts in an order of sorts, but right now, am choosing to right on what it is easiest. For now, this is practical tips from real life, rather than in-depth information on conditions.

I wrote about unplanned, emergency surgery, but no details regarding what those surgeries actually were. This blog is anonymous on purpose to allow me to write about topics that can be uncomfortable to talk about. However, even with anonymity, I find it hard to write about some things. The first GI surgery was repairing complete rectal prolapse thanks to tissue laxity from Ehlers-Danlos syndrome. I am planning to write more about this in the future. The second surgery was addressing bowel perforation, and cleaning things up, resulted in a temporary colostomy to allow my GI tract to rest and heal. It was a rough recovery in ICU as I was already malnourished from first GI surgery complications—difficulty advancing ability to eat. I also do not like surprises. I like to know what I am in for. I research things, plan ahead the best I can. I go into every procedure hoping for the best but preparing for the worst. However, no one, myself, surgeon, etc. saw this scenario coming. I work to accept what life throws at me. But, I am struggling to accept the colostomy. I did not ask for it, I do not want it, it is one more set of tasks I have to take care of. But, it saved my life. I am choosing to be grateful for it, am choosing to accept it for now, but most likely will be reversing it once recovered enough to be able.

One of my major concerns when I discovered I had a colostomy, was how it would affect swimming, pool therapy. I asked the ostomy nurse and my surgeon about this while still in the ICU, even though I knew I was nowhere near being able to consider getting into a pool. I couldn’t walk very far and was slow, was not allowed out of bed without aid because of IVs and other lines. But, swimming was so important, that it was a burning question. Both assured me swimming is very doable and surgeon told me stories of various athletes with ostomies.

Being new to the colostomy, afraid of leaks or issues, I was really nervous with first attempt once surgeon cleared me for pool about a month post op. Because I was still weak, deconditioned from lengthy hospital stay, malnutrition after surgeries, first pool trip was short and sweet. I taped the wafer down with kinesiology tape as that was what I had on hand, knew from taping joints that kinesiology tape stays on in the pool. I also wore a mild compression tank top to help hold appliance securely in place, then regular swimsuit over top, except so swollen still through abdomen, I wore an older, sort of stretched out suit. Things went well. Appliance stayed put, tape stayed on, no issues. As I slowly got stronger, pool sessions slowly got longer. I also experimented with other things. Online support groups are amazing! I asked for advice from others with ostomies who swam. I was given numerous ideas of things to try. Ostomy nurse suggested contacting companies, asking about free samples to try before ordering something that might end up not working. I did so. I tried barrier extenders and learned that when exposed to water, these swell, get gummy, sticky, messy, and allow water to reach wafer. They also pull up the wafer when removing the gooey strips. I used Hy Tape, which sounded amazing. It is waterproof, designed for sensitive skin, is latex-free, etc. That was my most disappointing experiment as it was the one I most expected to help. The tape did not stay stuck, allowed water under wafer, etc. I am only 12 weeks post op, so only been swimming several weeks, but have already figured out that the appliance stays in place fine without any additional strategies. Tape is not needed, tank top not needed, belt not needed, special swim suit not needed. I do my normal appliance routine, wear my regular one piece swimsuit that I have used for years (keep replacing as they wear out with the same thing). If I am nearing change day for the appliance, then I will sometimes tape it down with kinesiology tape and/or wear the simple little belt that clips onto the ostomy bag. I am back up to 2-hour sessions at a time in the pool with a mix of lap swimming, pool walking, and physical therapy exercises in the pool. All going well. As I become aware of other possible aids, I may try them, but for now, I have a system that works for me. I am so grateful to be back to swimming, even with an ostomy. When I was assured in ICU that swimming was possible, I envisioned it being a huge ordeal, taking months to be able to get to that point. I was pleasantly surprised to learn that no, or very little, additional steps need to be taken to be able to be in the pool with an ostomy. I was also grateful to discover the time frame was based on recovery from surgery, incision closure, similar to other surgeries. The ostomy itself had no bearing. My body thrives in water, so being able to be back in the pool has aided recovery and rehab from surgeries. This is one more hurdle behind me on the road to recovery.  

Copyright © 2019 by Chronic Wholeness. All rights reserved.

Chronic Invisible Illness: Working as a Team

One of the character qualities I often feel like I lost with chronic illness is that of independence. The reality of complex illness is that it requires a lot of support and an entire team of medical professionals. It has been a journey of being able to accept that I need help. I am incredibly grateful for the support of my family and friends, also that of my medical team.

Copyright © 2019 by Chronic Wholeness. All rights reserved.

Chronic Invisible Illness: When the Unexpected Happens

Something I have learned over the years of chronic illness is that the only predictable thing about illness, is that it is unpredictable. This held true with a recent procedure. I was scheduled for an abdominal gastrointestinal surgery to repair some issues due to lax tissues from Ehlers-Danlos syndrome (EDS). The surgery went well, my surgeon was pleased. He took extra precautions because of the EDS. We knew I'd be in the hospital anywhere from a few days, up to a week. Well, at a week, I was still in the hospital, no closer to going home. I was struggling with being able to advance diet back toward normal, but this needed done before I could go home. As days passed, I struggled more. I eventually ended up back on clear liquids only (first stage of trying to advance diet). I also was getting more abdominal pain, more bloating/swelling, spiking fevers at night, etc. My surgeon was watching me, checking labs, ordering abdominal x-rays, etc. As I continued to struggle, he had me started on IV nutrition to help support since I was not eating enough. IV nutrition requires placement of a PICC line (peripherally inserted central catheter). But, once the PICC line was placed, then labs could be drawn from it rather than being stuck each time. (And, why do hospitals think 4 am is a good time to draw labs and turn on the bright overhead lights?) Anyway, surgeon ordered an abdominal CT scan. Once he had those results, he came by, said he was planning exploratory surgery with goal of being in the OR in the next hour....this was a Saturday morning. Wow! It was a lengthy surgery. It turns out I had a perforated bowel and that all needed cleaned up, damaged part of bowel resected. I did not wake from surgery until middle of the night so had no idea what all had happened. I knew I woke with even more tubes. I learned I was in ICU, not back in the adult inpatient unit I had been after the prior surgery. I was on oxygen, CO2 output being measured because of being on IV morphine, had a nasogastric (NG) tube suctioning (gross), numerous IV lines for nutrition, antibiotics, fluids, various medications, morphine, etc. They wanted me up walking, but I was so weak, light headed, unstable, that we ended up with a walker for stability for me, two people going with to help with the two IV poles, oxygen tank, being able to hold onto me via gait belt, etc. We were quite the little parade. 

This second surgery really wiped me out. I go into every surgery as strong as possible physically, mentally, emotionally. An emergency surgery left me no time to prepare, plus I was already physically weak from the prior surgery, difficulty eating, infection, etc. It took work to try to find the positive. it took work to choose to smile. Once I realized how close of a call I'd had, I was grateful to be alive, grateful to be well cared for. I knew no one wanted what had happened to happen, that all were trying to help me get well, that all were rooting for me to go home ASAP, and hopefully in time for Christmas. My surgeon was super strict one morning about the compression stockings. We explained I had pressure sores starting. It turns out that was the morning my platelet count spiked critically high. We found a compromise of using the calf compression sleeves, but no compression stockings. 

I was certainly deemed complex. Apparently healthy looking when admitted initially, but prone to pressure ulcers, struggle to recover from first surgery, need second surgery, struggle to recover from second surgery, etc. White count very high, platelet count very high, heart rate high. Cardiology and hematology called in. 

After the second surgery, I struggled more with back pain, neck pain, and shoulder pain. Physical therapist was there to help take me for walks, but he helped problem solve positioning for me to try to relieve the other pain. Through trial and error, figured out how to sort of mimic cross between my zero gravity chair and my pillow nest in my bed at home. That helped. It was still very hard to sleep. However, more than one nurse commented on how comfortable my "nest" looked. 

Progress was counted by removal of tubes. The one I was most excited to get rid of was the NG tube. I had started gagging on it for no reason by the time it was pulled. Removal was not fun, but so glad to have it gone. It still sort of felt like it was there for another day or so. I was not really claustrophobic, but had gotten so I did not want any face tubes snug, kept loosening oxygen and CO2 lines. This was partly because of nausea that was severe at times and anything close to my neck or nose/mouth made things worse. In fact, some nurses let me have a break from the CO2 tube when nausea was at its worst. The last lines to go were the IV nutrition, IV antibiotics, and I think one other. Then, I was finally allowed up by myself! I could take myself to the bathroom without help! I could take myself for walks in the hallway by myself! My nurse said she did not care where I went as long as I stayed on the floor and out of the critical section of ICU. (I was in a step-down ICU, but all of ICU was the same floor). 

The recent events may seem like not much good happened. However, I am alive, had excellent care. My family was supportive and kept me going on days when I wanted to give up. I also had the opportunity to educate various other providers on EDS and mast cell activation syndrome. Although, one evening at shift change, when the day nurse was explaining to the incoming night nurse what was going on with me (lengthy process). The night nurse asked me what type of EDS I had. Most asked what EDS is, are not aware there are multiple types. So, I knew she knew more. It turns out she has a child with EDS. 

Something else I learned. I may be a dietitian, trained in nutrition, know in theory how to advance diet post-op GI surgeries. However, that does not mean all bodies respond well to standard protocol, and mine certainly did not. Plus, it is impossible to be fully objective with oneself. Also, if sugar, artificial sweeteners are recommend against early post-op, then why do the standard supplements used right after surgery contain so much sugar, or other suspicious ingredients? I avoided the supplements after second surgery as I was afraid of them after what happened after first surgery and trying to use them to keep protein intake up. It helped I was on IV nutrition for second surgery, thus had less pressure to rush advancing diet. Also, one of the most helpful pieces of advice I was given early in trying to start eating post-op second surgery was by my surgeon. He said if it sounded good, try. As crazy as it sounds, the first thing that actually sounded good was tomato soup. This is also the first food I successfully kept down. So, it became my "safe" food that I ordered every meal in addition to whatever I was trying next. Mashed potatoes were another early "safe" food. I tend to come from an intuitive eating perspective, but also science-based. These often go together, but not always. Tomato soup did not really make sense as a good first food, but intuitively, it worked. I also learned that one can pick and choose off of a hospital menu. Just because an entrée comes with specific sides per the menu, does not mean one has to have those sides. I did a lot of substituting. Otherwise, I was leaving a lot uneaten that I was not ready to try yet.  

This whole situation was quite the learning experience and I suspect will continue to be for a while. I am grateful to be home, to be sleeping better, no more blood sugar checks, insulin injections, lab draws, Lovenox injections, etc. I am still thin, weak, tired. I have a lot of healing and recovery ahead of me. It is hard to be patient. Eating, walking, self-care are tedious, tiring. But, these are my tasks for now. I have regained strength, weight, and muscle after other surgeries. With these surgeries, the loss is more global, but I can regain again, even if it takes longer. I am choosing to move forward with hope. Hope that recovery goes well, hope that these surgeries give some amount of relief. 

Copyright © 2019 by Chronic Wholeness. All rights reserved.

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Updated contact info! Yes, I have Instagram now! No, I do not know how to use it! Learning....please bear with me.


Chronic Wholeness

Pursuing wholeness in brokenness, strength in weakness, health in illness.

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Copyright © 2018 by Chronic Wholeness. All rights reserved.

Tips When Traveling for Surgery

I have had multiple surgeries, some local, some long distance. I have another long distance surgery coming up, thus have been preparing for travel for post-op, thinking back over the past travel after surgeries, what went well, what did not, etc.

First long distance surgery, two of my sisters were doing the driving and navigating. I was already flared from travel earlier in the week, but for some reason we thought it was a great idea to leave super early morning of surgery, drive the three hours, then outpatient surgery, drive back yet same day. I was exhausted, flared, surgeon gave different pain medication than I was used to and was dealing with side effects from that, surgery was a Friday, so sort of stuck over the weekend. When I was scheduled for the next long distance surgery a few years later, I was really nervous based on this initial experience. However, for the next surgery, surgeon asked that I plan to stay overnight in the area, then start PT there next morning with one of his recommended PTs, then OK to travel home after that. Surgery time was early enough that I drove up (with a sister) day before surgery. That worked so much better!

For the trip home, I was recommended by surgeon's office to stop often to move around, but physical therapist had told my sister if I was asleep, to just keep driving. This meant she drove past a rest stop, I woke about ten minutes later stiff, uncomfortable, so had to find somewhere to stop, let me get out to "walk" (with crutches) a bit. Had quite a bit of swelling by the time we got home. With the next long distance surgery, I was more awake, and we just made sure to touch base, stop often. That went better.

For travel after surgery, I recline the seat fully, have something to prop surgical side with--foot if leg-related surgery, arm if arm-related, etc. Pillows for support, throw blankets to roll for support, or to cover if chilled from icing. I have my good ice packs that stay cold longer with me.

This time will be a longer distance and shoulder instead of hips. Apprehensive. Planning to carry forward all that has worked in the past, plus a few new ideas. Hotel reservations are made for same hotel as last two surgeries as they have done well. They have let us borrow a wheel chair to get me from car to room after surgery, and from room to car when checking out. They have let me keep my ice packs in their freezer so they are really good and cold prior to travel. Traveling there day before surgery, staying overnight, then surgery, stay overnight after surgery, then surgeon said alright to travel home. Planning to bring ice machine again as that has helped in the hotel. However this time, we are planning to run it in the car as well on the way home.

Update written post-op, post-travel
The plans went well! For being nervous about the distance, of travel itself, of hotel set up for shoulder recovery, etc., things went so well. So grateful! I had brought my zero gravity lawn chair that I have used with other recoveries, my cold therapy machine and used both at the hotel and it worked well. (Links to both are in this post on preparing for surgery.) The cold therapy machine worked quite well in the car, too! I started out with my ice packs since they were good and cold and changed them every stop, or about every hour or so. About halfway through the trip, ice packs were exhausted, warm and squishy, not helpful. So, switched to using the cold therapy machine. It could not get as cold as ice packs had, but was far more effective than spent ice packs! My sister had a converter so we plugged that into a cigarette lighter, then the ice machine into that, thus could run it continuously. Normally, continuous icing is not a good idea, but with bulky post-surgery bandages, the cold from constant icing still cannot truly penetrate to level of incisions/surgical site. I have learned to ice 24/7 until bulky bandage is off. If the ice pack or pad to ice machine extends beyond bandage to bare skin, I make sure to have a barrier between it and skin that is as thick as the bandage to avoid frost-bite. I also check skin often to make sure things are OK.

What I learned
A zero gravity chair makes for a comfy recovery spot post-op shoulder. However, because it has no sides to speak of above arm rests, we had the chair between end of bed and a desk at the hotel and them stuffed pillows between desk and chair and between bed and chair for support to help hold in place the pillows I was using to support me. Once home, I figured out taking a large blanket and putting it on top of the body pillow I use for a cushion, then putting in all of my rolled blankets and pillows for support. I wrap myself and all of my support items into the chair, holding all in place. It actually works quite well, is very comfortable and I have been sleeping much better than pre-op.

Advance planning can really help! The travel went so much better than I had thought and hoped. Thinking ahead and having things available was worth it and helped things go smoothly.

Copyright © 2018 by Chronic Wholeness. All rights reserved.