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You Are How You Feel

One of the first questions out of your doctor's mouth is often something like, "How are you feeling?" More than just a conversation starter, your answer to this question can often be one of the best predictors of how healthy you actually are and will be. You see, nobody knows your health better than you and nobody can have a bigger impact on your health than you.

It turns out that many different researchers in many different papers have come to a similar conclusion: people's self-rated health has a strong relationship to their actual physical health. Most people, it appears, feel healthy. Studies using a single question that asks people to evaluate their own health have found that nearly 97% of people say their health is generally good or better. In our own studies of people with spinal cord injury, it's not much different. Almost 93% of about 1000 surveyed people with spinal cord injuries said they were generally healthy.

Although it may seem that the answer to such a simple question might really mean very little, the extent of it's meaning is sometimes surprising. In one study, feeling you were unhealthy actually increased your risk of dying a little more than even having a chronic disease. A different study found that hose who said their health was poor were more likely to develop a chronic disease in the future.

Healthy Choices
The best way to feel that you're in good physical health is to undertake healthy behaviors. In studies of people with and without SCI, people who felt healthy were more likely to have healthy behaviors. SCI survivors who feel healthy use less alcohol. They don't smoke. In fact, those who do smoke are almost twice as likely to say they are unhealthy than those who don't smoke. While our particular study did not find a difference in self-rated health between SCI survivors with fitness programs and those without, other studies of people with and without disabilities have found that people who are more fit also feel more healthy.

Being Healthy
Of course, being healthy is not just about behavior, but … well … your actual health. Two problems are quite common in people with a without spinal cord injury who report being in poor health: fatigue and pain. Fatigue can be associated with depression, age, overuse, and medication. Pain can be as a result of neurologic changes, other injuries, and overuse. Among our studied SCI survivors, more than half of those people who reported being not healthy experienced either some kind of joint pain, fatigue, or both. In fact, nearly half of those who didn't feel healthy had both fatigue and some kind of upper extremity, back, or neck pain.

There's more: having good health is more than just physical health, but mental health and well being as well. Two-thirds of the study participants with good general health also reported good overall quality of life. In our study, those who reported their health was poor had higher levels of stress, less satisfaction with life, and more symptoms of depression. In fact, they had enough symptoms of depression to be diagnosed with clinical depression.

Health Means Many Things
Feeling healthy is a very personal thing. For example, one study of women in Australia found that women of different ages looked to different things to evaluate their health. For the young, it was things like fitness, while the older women tended to look more to purely physical functioning of the body. A different study of men with SCI - a study not specifically about general health - found that there was a tendency for people to value what they are physically capable of doing.

Feeling generally healthy does not mean having perfect health. In our study of people with spinal cord injury, many of the same people who reported feeling generally healthy had one or more health problems. Some were minor, like excess sweating, some were major, like chest pain. For some reason, these people still felt healthy. That's not so surprising actually. What does this all mean? Well, it seems that, if constipation and urinary tract infections are an ordinary part of your life, and you still live a full life, you may not think you're unhealthy. Are you deceiving yourself? No, not really, you're just doing what only you can do, deciding what's important and figuring out how well you're doing at what is important to you. That's the real message of this health kick: find out what matters to you or most impacts your life and work on improving or maintaining that. That's what leads to satisfaction and the big share of the benefits of feeling healthy.

So What Can You Do?
Prioritize, investigate, and act.

Step 1: Figure out what's important to you; what makes you feel healthy. Is it being able to keep up a non-stop pace? Is it not feeling pain? Is it just having no serious disease? Whatever it is, that's your starting point; that's your goal. If you can reach this goal and stay there, your sense of healthiness is likely to stick around. Remember that the important part is that you figure it out. It's important to listen to what others offer, but, in the end, the biggest impact is going to come from what you value most.

Step 2: Find out what things can cause you to have or lose what's most important to feeling healthy. If feeling chipper every day is important, find out how to deal with or avoid depression. If being athletic is important, do what you can to keep your joints healthy and pain free. Don't be afraid to ask for advice. No matter how much money your doctor makes from your visits, be assured that all doctors would rather have you feeling healthy than not.

Step 3: Once you've got a plan, act on it. You've already figured out what matters and how to get it. Now it's time to make it work. The important part here is to make sure that you're not forgetting something or doing something that, in the end, is going to make you feel worse. If you've done everything you can to feel athletic, make sure you play sports safely, so that joint pain or heart problems don't take away everything you've worked for. Remember, getting healthy is good, but staying healthy is even better.

So how would this work in reality? Let's look at an example. Consider Sheila. Sheila has complete paraplegia where she can neither move nor feel anything below the bottom of her ribcage. In high school, Sheila was a soccer player. She was injured while rock climbing, and now Sheila is one of the best wheelchair tennis players around. Both Sheila and her family are pretty healthy. Like many other young women, Sheila's idea of feeling healthy is being able to stay as active as she wants to be without any medical problem getting in the way. She feels healthy now and wants to keep it that way. It seems that Sheila's got the first step out of the way: she knows what's important to her.

The planning part is a bit more difficult. She wants to stay active in sports, so she needs to have a healthy heart, lungs, and joints. Since she's still young, her joints seem to be mostly in good shape, but, if she keeps up too fast a pace, they may not last. In short, she has to find some way to be active and stay active. Since sports are important, she decided to keep up the tennis, but instead of wheeling everywhere she goes, she's gonna' get that car out of the garage and use the sliding board her therapists pushed on her back at the hospital. Her lungs are fine, she's never smoked, never been around much smoke, never even sniffed glue. Sheila should be careful with her left shoulder, however. In high school, she was an all-state soccer player, in part, because she played so aggressively. Along the way, she dislocated her left shoulder three times. Although it hasn't been a problem since then, Sheila decides it would be a good idea to get her shoulder checked out by her doctor. So, now the plan's in place.

Having gone this far, the rest is pretty straightforward, it seems. After seeing her doctor and talking about her plans, everything about her left shoulder checks out, but the doctor warns her that that little twinge in her right shoulder - that seemed like such a small thing that she didn't even think about it - could also cause a problem with sports. After checking in with a physical therapist, Sheila finds a solution. By gently building strength and flexibility in her shoulder, she can keep up moderate amounts of tennis, enough to feel good without wearing out her shoulder, her heart, or her opponents - well maybe wearing the opponents out is OK after all.

Just in case you haven't already noticed, there are several points to this whole thing. First, feeling healthy can be as important to your health and well being as actually being healthy. Feeling healthy is about getting the things that make you feel healthy. Getting those things and keeping them requires careful thought and planning. So do it!

This brochure is part of a library of educational brochures developed by Craig Hospital with a federal grant titled, "Marketing Health Promotion, Wellness, and Risk Information for Spinal Cord Injury Survivors in the Community." The opinions expressed here are not necessarily those of the funding agency, the National Institute on Disability and Rehabilitation Research of the US Department of Education.

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