Super Healing

In the fall of 2006, Arlene and David Rubin were flying home to Boston after a vacation in northern California wine country. But somewhere over the Midwest, Arlene looked up from her magazine and got the shock of her life. Her 80-year-old husband’s eyes were rolling around in his head, his skin was purple, and his tongue was blue.

“I’ve never seen anyone that color before. It was very scary,” Arlene recalls. “I yelled, ‘David, David, David!’ but he didn’t answer. Then I yelled, ‘Help!’ and the flight attendant told me, ‘Get out of the way!’”

David’s heart had stopped completely. But three strangers were determined to save his life. A doctor and a nurse who were passengers worked side by side with a flight attendant trained to use an automated external defibrillator. The pilot made an emergency landing in Milwaukee, where David underwent open-heart surgery.

Today David has returned to his work as a highly successful Boston real-estate developer. Remarkably, he was able not only to survive that life-threatening episode but, just as important, to heal from it and regain his strength.

How did he do it? His body’s natural healing processes did most of the work. Each of us possesses a surprising capacity to bounce back from illness and injury, under the right conditions. But David also took specific steps to help the process along. These steps—suggested by scientific research—can help anyone weakened by trauma or disease to find the strength to heal.

Healing is my specialty. I’m a physiatrist, a doctor in the field of physical medicine and rehabilitation. The first physiatrists helped injured World War II soldiers. Modern-day physiatrists treat people with a variety of serious illnesses and injuries, including strokes, spinal cord injuries, and lower-back problems. Two words summarize what we do: we help people to “physically recover.” (The American Academy of Physical Medicine and Rehabilitation makes it easy for people to find physiatrists by providing a map on its website, www.aapmr.org. When you click on your state, you will see a list of doctors to choose from.)

Your body will work hard on its own to help you recover—even if you do little to help the process along. Thousands of chemical and biological reactions occur throughout the day and night to help you to heal. When you’re injured, white blood cells called neutrophils rush to the site, to ward off infection. Other blood cells called monocytes transform themselves into scavengers (macrophages), to engulf and devour dead tissue and help to control inflammation. If you break a bone, bone cells called osteoblasts kick into action to knit the rough edges back together. And cell damage caused by illness—or by harsh therapies, in the case of cancer, hepatitis, and other diseases—gets mended by the same hordes of microscopic miracle workers. There are so many cells assisting us in healing that we could never count them all.

But even though these processes are involuntary and automatic, there are things smart patients can do to speed and strengthen their recovery. The best healing occurs when you are able to optimize your immune system to avoid infections; encourage the healing of skin, bones, muscles, nerves, and tendons; and build strength and endurance.

In my practice, I have developed an eight-part strategy to put patients on the path to optimal healing. And at the heart of this strategy are three fundamentals: how you eat, how you sleep, and how you move.

We physiatrists have a saying: “Good health is a temporary condition.” So I fully expected to face serious illness myself at some point. But that didn’t make things much easier when, at age 38, my time came. I vividly recall the day the surgeon came into the exam room with tears in her eyes. I wanted her to say what other doctors had told me in the past: “Go home; you’re fine.” Instead, she softly said, “You have breast cancer.”

I can still feel the overwhelming sadness and pure heartache of that day. Every time I looked at my children, I wondered how many weeks, months, or years I’d be able to see their faces.

The surgery and chemotherapy were grueling, as I knew they would be. I also knew that the end of treatment would be only the beginning of getting well. I had helped many people with all kinds of illnesses heal; now I needed to help myself.

Like most people struggling with serious illness, I lost my appetite, slept fitfully, and became less physically active. From a human standpoint, this was perfectly understandable. But from the standpoint of a body trying to heal, it was a disaster.

Skipping meals saves time in the short run. But in the long run, it can delay healing and hinder your return to health.

I call inadequate nutrition, lousy sleep patterns, and physical deconditioning the Triple Threat to optimal healing. These three factors affect almost everyone who has had a serious injury or illness—including chronic-pain conditions such as arthritis or fibromyalgia—and they work synergistically to interfere with your body’s natural healing processes, creating an environment for mediocre healing at best and unnecessary disability at worst.

I knew the Triple Threat was keeping me from healing optimally, and I needed a plan to combat it. The answer seemed simple: eat better, sleep better, and exercise. But these goals don’t seem so simple when you’re weakened, depressed, and isolated by the million worries on your mind. For me, the trick came from having learned not only what to do but why and how it all works to accelerate healing in the body. When I acted on this knowledge, I got results, and I know you can, too.

STEP ONE: DON'T NEGLECT NUTRITION

We often read about how to eat to avoid disease. But once you get sick, there are also foods that will help you get better. For example, skin and bones need vitamin A to repair themselves. Vitamin C is crucial to the formation of collagen, the main protein of our connective tissue. Bromelain, a mixture of enzymes found in fresh pineapple, reduces swelling, bruising, and pain, and it improves healing time following trauma or surgery. And adequate protein is absolutely essential for optimal healing.

When people are healthy, they often get away with bad dietary habits. Skipping breakfast and using coffee as a pick-me-up might have worked fine for you in the past. But if you are ill or injured, these timesavers will actually cost you time, because your recovery won’t go as quickly as it might otherwise.

I tell my patients to eat five times a day: three small- to medium-size meals and two nutritious snacks. This helps prevent severe drops in blood sugar levels that can leave you fatigued. A registered dietitian can be helpful for patients who need to gain or lose weight, or who have other specific needs.

So what are the best eating habits for optimal healing? Some will sound familiar, while others may surprise you.

Carbohydrates These compounds provide ready energy, and they are crucial to a healing diet. All carbohydrates are broken down into sugar when digested, but complex carbohydrates such as nuts, seeds, legumes, and whole grains break down more slowly than simple carbohydrates such as sugar and white bread. The slower a carb breaks down, the less likely it is to cause a blood sugar spike. Since these spikes can spark inflammation and lead to damage on a cellular level, you should avoid them always, but especially when you’re healing. A measure called the glycemic index indicates how fast the body converts a food into sugar. As much as possible, stick with complex carbohydrates and other foods that have a relatively low glycemic index (below 55). One reliable source of this information is www.glycemicindex.com.

Protein The building block of cell repair, protein gives you energy, as well. Generally, it’s a good idea to get about 15 to 20 percent of your calories from protein, though some conditions, such as burn recovery, may require more. If your body has undergone extensive cellular injury, talk to your doctor about what your protein needs are. Plant-based proteins such as beans and nuts have some advantages over animal proteins, especially if you don’t have much of an appetite. In addition to having cell-repairing properties, plant-based proteins provide phytochemicals (which can help with healing) and fiber.

Fruits and Vegetables Eating at least five servings each day of fruits and vegetables is one of the best things you can do for your body. A colorful array of fruits and vegetables provides a remarkable assortment of healing nutrients, including high amounts of vitamins and minerals that can promote physical recovery. Vitamin C, for instance, helps heal wounds, strengthen blood vessels, and ward off infection. Lycopenes—particularly powerful antioxidants that can boost immune function—are plentiful in tomatoes, apricots, guavas, watermelon, papayas, and pink grapefruit. As a general rule, dark-colored fruits and vegetables are richer than light-colored ones when it comes to phytochemicals and antioxidants.

Supplements While your doctor can best advise you on which supplements you may need, food is usually the best source for healing nutrients. We know that fruits and vegetables are extremely important in helping to prevent particular kinds of cancer, but we aren’t certain which ingredients are the most important. In addition, there is some evidence to suggest that taking too many antioxidant supplements (such as vitamins C and E) might actually depress rather than enhance your immune system. And while zinc, among other minerals, is critical to wound healing, taking too much of it can inhibit recovery and even lead to a copper deficiency. Foods such as beef, peanuts, and lentils are rich in zinc, and they’re the best way to get it.

The one supplement I routinely recommend is a multivitamin. This is a good idea even for healthy people, since it’s nearly impossible to eat a perfectly balanced diet every day. Consider taking a multivitamin that provides 100 percent of the Recommended Dietary Allowances (RDA) for essential nutrients established by the U.S. Food and Nutrition Board of the National Academies/Institute of Medicine, and ask your doctor whether you need calcium and vitamin D supplements, too.

STEP TWO: MAKE SLEEP A PRIORITY

If you’re like most people, you need seven to eight hours of sleep each night. During an illness you may need more rest than that, because some of your body’s healing processes require sleep to work. For example, the hormone melatonin is produced during sleep. This hormone is believed to boost your immune system and to help repair corrupted DNA. It may even play a role in preventing some forms of cancer. But if you’re tossing and turning at night, your melatonin levels can be diminished.

After David Rubin’s heart stopped on the airplane and he underwent surgery, he spent many weeks trying to get his sleep back to normal. In fact, up to seven out of every ten people who undergo heart surgery sleep poorly during the recovery period. This problem is of special concern because it can lead to rises in heart rate and blood pressure, both of which can cause unnecessary strain on the heart and put it at risk for further injury.

But if you’re ill and missing sleep because of discomfort, worry, or medications, the last thing you need is the added worry that sleeplessness is harming your recovery. That’s why it’s important to tackle the causes of your sleeplessness calmly and systematically. I have my patients write down how much sleep they are getting each night and what is interfering with it. Some causes might be pain, anxiety, hot flashes, or waking to use the bathroom. Then, one by one, we tackle these problems.

For example, Karen Horowitz, 55, a planned-giving officer with the American Cancer Society, couldn’t sleep during her breast cancer treatment for two reasons: shoulder pain due to complications from her mastectomy, and hot flashes. She was constantly tired and frustrated. It took only a few weeks of physical therapy for her shoulder, and a prescription medication for her hot flashes, to get Karen sleeping through the night. In David’s case, cutting back on coffee and alcohol—which can interfere with restful sleep—made a big difference. If you decide to take an over-the-counter sleep aid, be sure to tell your doctor, because these interact with many prescription drugs.

STEP THREE: GET YOURSELF MOVING

It may seem inconsistent to say that people who desperately need rest also desperately need to move their bodies around, but it’s the truth. If the benefits of exercise could be packaged as a pill, it would be the most popular prescription drug available.

Physical activity has a positive effect on what is called hemostasis: how the chemicals in the blood interrelate and work together. Exercise also improves the healing of muscles, bones, tendons, and ligaments. For example, it spurs the formation of collagen, helping injured tissues heal properly. In addition, it appears to decrease the formation of excessive scar tissue, called fibrosis. Exercise helps us heal better.

Exercise also helps us to heal faster. A 2005 study at Ohio State University in Columbus followed a group of people 55 and older for three months. Each was given a small wound—the kind you’d get from having a mole removed. Then half of the participants were put into an aerobic-exercise program. The results were significant. The average number of days it took the exercisers’ wounds to heal was 29. Among nonexercisers, the average was 39 days.

A soldier I know named Charley, who asked that his last name be withheld, knows just how important exercise is in healing. In May 2007 he went for his annual physical. As a very fit 50-year-old, he was expecting a clean bill of health. Instead, he was diagnosed with prostate cancer. Following multiple surgeries, Charley was having difficulty controlling his bladder and was physically quite weak. He began to get stronger first by walking and then by light jogging. “The first time I ran up the mountain that I lived on, I could only run a block,” he recalls. He would run as far as he could, then walk until he caught his breath. “After about four attempts in the following week or so, I was able to return to my three-mile route,” he says. “It wasn’t good form, but I did it—and recovered in the shower.” Within six months he was back to his usual regimen of running, sit-ups, and pull-ups, and strong enough to accept a one-year assignment to Afghanistan.

There are many ways to begin exercising after an illness or an injury, and it is always a good idea to check with your physician about this. But most people can do what Charley did and begin with walking. A fun and helpful strategy is to buy a pedometer (you can get one for less than ten dollars) and, for one week, tally the number of steps you take each day. The goal for active, healthy adults is 10,000 steps per day. My goal for my patients is simply to increase their level of activity gradually. Keep a log, and each week try to increase the number of steps you take by 500 per day (with your doctor’s permission).

If you have a medical condition such as arthritis, you can still exercise without hurting yourself. For instance, nonweight-bearing cardiovascular exercises such as swimming help to avoid stress on the joints.
You can strengthen the muscles around painful joints with isometric exercises that involve tightening and releasing muscles. Or you can try exercises such as leg lifts, which don’t stress the joints. If you aren’t sure how to start exercising, ask your doctor about seeing a physical therapist. Most health insurance plans will cover physical therapy that focuses on helping people recover.

You can strengthen the muscles around painful joints with isometric exercises that involve tightening and releasing muscles. Or you can try exercises such as leg lifts, which don’t stress the joints. If you aren’t sure how to start exercising, ask your doctor about seeing a physical therapist. Most health insurance plans will cover physical therapy that focuses on helping people recover.

Illness is an unavoidable part of life, but your body wants to heal. And you can help it do that, despite the obstacles. I learned a lot about what it takes to heal from my own recovery journey. I learned to be patient. I learned to measure progress in weeks or months rather than days. And most of all, I learned to have faith in my body’s ability to recover.

I also witnessed this quality in my patient Liz Frem. Having suffered a devastating stroke at 57, Liz came to see me for a consultation. She didn’t believe what her doctors seemed to believe: that her weakness, balance problems, and headaches were with her for good. Though it had been more than a year since her stroke—usually considered the time limit for neurologic recovery—Liz was determined to get her life back. And that she has. With a program that includes an exercise routine involving weightlifting, golf, and Wii Fit games, Liz has improved every year. She’s now a vibrant 61 and volunteers as a golf referee.

Serious illness and injury can force people to accept a “new normal.” But many people experience more pain, fatigue, and disability than they have to. In short, they accept a “new normal” too soon. If you’ve been ill or injured or you are living with a chronic medical condition, aim for maximum healing—and don’t stop until you achieve it.

Julie K. Silver, M.D., assistant professor at Harvard Medical School, has written several books on health. This essay is adapted from Super Healing (Rodale, 2007).

Putting Your Mind to It

Mental strategies that can boost your potential to heal

The body’s healing process isn’t entirely physical. Along with eating right, sleeping well, and exercising, the five mental and emotional tactics below comprise an eight-point plan for maximizing your powers of recuperation.

Reduce Your Pain Though pain may be a normal part of many conditions, it can interfere with healing by interfering with sleep or causing needless, recovery-delaying stress. If you are in pain, don’t be a hero: talk to your doctor and get some relief.

Consider Mind-Body Therapies Meditation, guided imagery, and progressive muscle relaxation are all risk-free treatments that can reduce stress hormones and strengthen the immune system.

Monitor Your Mood It’s impossible to be in a good mood every day, even when you’re well. But how you feel emotionally will have an effect on how you physically heal, so it’s important not to give depression or anxiety the upper hand. In one 1998 study of dental students at Ohio State University in Columbus, small wounds that researchers created before a big exam took 40 percent longer to heal than identical wounds created during summer vacation. Each day plan activities that make you feel good, such as calling a cherished friend or drawing a bubble bath. If you find that you are down in the dumps or anxious day after day, seek professional help.

Surround Yourself with Love When you’re ill, it’s easy to withdraw. But people who care about you can help your physical healing with their support. In a study published in 2005 in the Archives of General Psychiatry, researchers found that when wounds of the same shape, size, and depth were experimentally induced in couples, healing was much faster if the couples were loving toward each other rather than hostile. So, if you are ill or injured, embrace those who reach out to you. And if you find yourself alone, seek out shoulders to lean on, whether of friends, relatives, colleagues, or a formal support group.

Tap Into Your Spirituality Daily prayer or reflection can help you heal. Even if you don’t believe in divine intervention, the process of quieting your mind and connecting to something greater than yourself can enhance relaxation and the sense of control. This, in turn, directly affects blood pressure and other physiologic processes in the body. —J.K.S.

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