The Spoon Theory: What fatigue is like for the chronically ill

Photo credit: shopsweetlulu.com
Photo credit: shopsweetlulu.com

I’ll be honest:  Continual fatigue is a tough symptom for me to accept, because I have a hard time believing that I can’t/ shouldn’t completely ignore it and 100% push through it.  I mean, don’t we often hear about doing anything we want if we try hard enough and believe in ourselves and really, really want it?  This lie, the idea that we can control our destiny, is a trap I can fall into.

Just yesterday morning, I was tired of being tired and was letting all the recent media flurry about the dangers of sitting get to me.  I decided I’d walk around inside our house once or twice each hour of the day.  Good idea, right?  I mean, I’m practically going to be rocking “from the couch to a 5K” before we know it.  I decided to start with a bang and walked from our bedroom to the far end of our house and back, TWICE.  By the time I finished, my blood pressure was so low it was undetectable (probably 80/50), but I did it and didn’t feel too bad.  Yeah!  I’m on my way!

Three hours later, I was completely worn out and felt like I could hardly move. (Vat of caramel, anyone?)  I guess fatigue is a real symptom, one that I cannot simply outwit or ignore or pretend to be untrue.

Sufferers of MS, lupus, POTS, rheumatoid arthritis, cancer, Lyme disease, and many more illnesses tend to struggle greatly with fatigue.  I posted about fatigue here.  Now I want to let you in on a great way to understand chronic illness fatigue.

I hoped I could share with you the Spoon Theory in its entirety here but have not yet received permission, so far now, click here to read (it will open in a new window), then y’all come back now, ya hear?

The Spoon Theory is helpful for me to realize I won’t completely be able to do my pre-POTS normal activities, and I need to learn how to use and conserve spoons wisely.  I hope it’s helpful for you too.  All right, back to the couch!

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Fighting fatigue (POTS Symptom #4)

One reason I do this blog is so others with POTS, NCS, or other forms of dysautonomia won’t feel as alone. I have only met (in person) two people who have POTS, and both of them have different experiences than I do, along with some overlaps. To me, it’s helpful to know others are going through something similar and that I’m not (just) crazy.  Today, I am introducing another typical POTS and/or NCS symptom; for more, see here.

I recently asked members of a POTS Facebook group to describe fatigue. People posted a lot of great answers (at bottom).  My favorite came from Lea K.: “Fatigue feels like I am in a big vat of caramel. Everything is so heavy.” This resonated with me, and I think, many others.

Fatigue is a major problem for most people with POTS and/or NCS, as well as many other chronic illnesses. My husband helped me think of a helpful way to explain it. He had a cell phone that, when far from home, would constantly keep trying to find service and would run the battery out quickly. For me, my body is always trying (and often failing) to find equilibrium and getting exhausted in the process.

tired

I describe fatigue as feeling like I can only move my eyeballs—the rest of my body is too heavy to move, even though I may not necessarily feel sleepy. I do have fewer horribly rough days than I used to, probably thanks to my treatment, but fatigue definitely limits my activity level every single day. I often am quiet when very tired, and my face sometimes droops a little, almost as though even my facial muscles are worn out.  I usually don’t want you to know just how fatigued I am, because I want to be my old upbeat, energetic self, so I may use a good bit of energy trying to convince myself (and you) I’m not that tired, to varying degrees of success.

Thanks to others who contributed descriptions; some may resonate with you or help you understand POTS fatigue better.

Susie: For me, fatigue feels like 100 pound weights pulling me into the ground.

Toni: I feel like a potted plant.

Venus: I’m living in a stage of constant fog.

Emily: For me, fatigue feels like being run over by a truck .

Chelsea: Emily, that’s what I was going to say too! Except I was going to say like being run over by a MACK truck.

Jennifer:  For me, fatigue feels like not being high energy me.

Christina: For me, fatigue feels like dental anesthesia, except you’re not allowed to sleep it off.

Touching Lives: For me, fatigue feels like my body has been unplugged from its energy source but still expected to somehow function.  I always feel like the toy whose batteries are drained but you keep pushing the button to hear it make the dragging sound that it makes. I hope that makes sense- if not please just chalk it up to my fatigue!

Ellen: I lay there in pain, and I cannot move.

Jac: For me, fatigue feels like the protective heavy vest they put on you for dental procedures. One word? Heavy.

Donna: Like your brain does not have enough energy to even make your limbs move.

Colleen: It’s completely consuming. Resistance is futile.

The next few days, I’ll post a bit more about fatigue since so many can relate– sounds exciting, right?!?  I know…. You are yawning already.

Funny Friday: A trip with a view

Well, we all need a little laugh sometimes, so once in a while, I will post a funny Friday.  Here’s today’s story.

And, yes, I know it’s Thursday.  I just need a little jump on the weekend; how about you?

I told you a while ago that I am trying to learn how to have more fun in the midst of a  chronic illness.  On a recent weekend, our family found ourselves with several free hours one afternoon.  Wow!  This was exciting!  I told my husband we needed to grab fun.  He loves what he does, but his job is quite demanding, and a change of pace is a good thing; he is especially revitalized by time outdoors.  Knowing my limitations, I thought an hour-long drive to the mountains would be the perfect idea.

Just a drive isn’t so fun for three active kids, so I thought of a place we could go, one of the highest overlooks in our state, with views of surrounding mountains.  Off we set, and we had the best time driving up on that gray, misty afternoon, stopping to buy hot, fresh, boiled peanuts on the side of the road.  The kids and I were so excited to realize Mark was driving us through clouds as our van climbed higher and higher on the winding, tree-lined roads.

We made it to our destination, and I was elated to realize we could park in a handicapped spot, and I could use my stool to walk a short distance to this famed overlook.  Mark and the kids scrambled to the rail at the edge of the rocks, with me trailing behind, but finally I made it.  This was so exciting to know we’d feel like we were on top of the world!

And here’s the funny part.  This was our view.

Our view from the beautiful overlook
Our view from the beautiful overlook

Yep.  Just white.  Everywhere you looked.  It was like standing in front of a green screen for filming.  You could see NOTHING.  No trees.  No mountain views.  No birds soaring way up high.  Only solid cloud.  Just white.  And more white.

Umm… yeah.  I was more than a little surprised we could see NOTHING.  I had to crack up, though, when my husband, who has scaled many of this country’s highest mountains, said, “Yeah, I knew that’s what it would look like.”

I guess the beautiful, misty clouds we drove through on the cozy, gray day should have clued me in.

Have you ever been treated to an amazing view, or the lack thereof?

Promoting well being: My 100-day challenge to myself

Healing comes from God’s hand.  I can’t manipulate Him or trick Him into doing things for me, but He loves to work in and through me and you.  Even as I wait on Him, I am embarking on a 100-day challenge to myself, as I seek well being and nurture my body and soul.  This doesn’t mean I won’t or shouldn’t ever do any of these things after 100 days or that I never do them now; it’s just a concerted effort to discipline myself and soak up healthy nourishment.

Why am I telling you?  Because it will help me really do it, I hope. I’m great at thinking of ideas, so-so at starting them, and terrible at finishing them.  Here we go!

My 100-day challenge started Monday, September 15 (yes, I’m a week in!), and goes til Christmas Eve– that means we have fewer than 95 days until Christmas.  Get ready!

These 100 days, I want to be outside more, soaking up sun (or clouds!) and God’s restorative creation.  My goal is to spend 20 minutes alone outside,  at least 4 times each week. I think this will help me as I worship God and listen to Him and take in His goodness and love. I’m thankful a friend is leading me through memorizing the first half of Psalm 139 this fall.

Being outside alone is good.  Being outside with Mark is even better!
Being outside is a good thing!

I plan to take a 100-day break from overstimulating electronics.  For me, this means I will take a break from looking at Facebook (just checking once a week), electronically organizing photos (something I rarely do but intend to), checking e-mail as often, and visiting deal websites.  None of these is bad; I am just trying to decrease nausea and help myself choose more restorative (for me) activities for 100 days, since too much computer time makes me feel worse.

Dysautonomia, which includes POTS and NCS, has at its core problems with the vagus nerve originating in the brain.  I have read articles about restoring and strengthening the vagus nerve and would like to try to do that.  My goal is to do biofeedback with the EmWave system (used at the POTS Treatment Center in Dallas) for 20 minutes, at least 5 days each week.  Experts recommend choosing a consistent time; I would like to do this at 9 a.m. most days.

For 100 days, I plan to avoid certain foods to minimize inflammation and to address some recently diagnosed digestive issues.  I am even going to give up coffee.  I don’t drink coffee often and unfortunately have to stick with decaf due to side effects, but I do enjoy it.  However, I am highly suspicious of it as it seems to increase nausea.  Since I can’t seem to resist it (I love to try and retry favorite foods and drinks, hoping maybe THIS time, they won’t bother me), I am going to give it up for 100 days.

What else?  I don’t know of specifics at this point but am looking forward to a quieter fall.  I’m nervous about missing out on a few things, but I trust that God will help me.  Pray that I will “seek first the kingdom of God and His righteousness” and that I will “seek the Lord while He may be found [and] call upon Him while He is near” (Matthew 6, Isaiah 55).  Let me know, and I’d love to pray the same for you!

Have you ever gone through a self-set challenge?  Have you had a favorite one or an extra hard one?

Finding fun in the midst of chronic illness

In coming months, I hope to post more about ways to find fun in the midst of chronic illness.  It’s something I’m definitely learning along the way.  To introduce the idea, you are going to play “Where’s Kristi?” (à la Where’s Waldo) to find out the common theme that helps a person with POTS have fun.  See what you can detect in the following pictures.  The first one is super easy, to help you get started.

funcamping
Fun camping
funcornhole
Fun cornhole with family
funshower
Fun at my sister’s wedding shower
funbeach
Fun at the beach with kids and cousins
funlake
Fun at the lake

So, did you get it?  Did you figure out where I was and my secret to having fun in all sorts of situations? If you guessed, practically lying on the ground SITTING, you got it right!  Bonus points to all who found salty Gatorade, another help to those with POTS, in pic #4.  I am thrilled I can sometimes ride in the car somewhere and find the nearest seat to enjoy myself in a variety of situations– look for more fun to come!

P.S.  The chronically ill person might feel pretty yucky during fun (refer to pic #1), but when doable (and it’s not always), fun is a good thing for that person, friends, and family– and makes for some great memories.

Fall’s must-have accessory

I have that “it” item, that piece that everyone wants.  It’s almost always on me when I’m out and about, and it’s the perfect choice for parties, sporting events, or even a quick trip to the drugstore.

Upon seeing it, people always ask me where I got it and how they can get one.  They want to touch it, try it out, see if it complements them.  Young and old are eager to get their hands on my must-have accessory.

So what is this fabulous piece, you may ask?  A designer purse, a statement necklace, some unique artisan-made shoes?

No, it’s my trusty folding cane-stool.  Whether I’m sitting in line at a Redbox kiosk or at a doctor’s window, people LOVE it.  And I’m serious about young and old.

Not great for long-term sitting, but perfect for a quick seat anytime you need one!
Not great for long-term sitting, but perfect for a quick seat anytime you need one!  So light and easy to carry.

Young:  I used it at a frozen yogurt shop and the adorably-perky 16-year-old behind the counter went on and on about how much she wanted a stool just like mine.  I asked her why, and she said, “Oh, I take ballet and practice for hours at the studio, and during breaks, I’m just so lazy, I’d LOVE to sit down!”  Okay, I loved that.

Old:  I was sitting on it checking out books when the librarian asked me all about it and told me she’d LOVE to get one for her elderly mother, who was pushing 90 and really could use it, but her mom just didn’t want to be pegged as one of those sick people, you know?  I just have to laugh.

In the meantime, look for me out and about.  If I’m not in a wheelchair or electric scooter, I probably have my must-have accessory… and I’ll even let you try it out!

P.S.  In the meantime, do you have a must-have accessory?  Do tell!

P.P.S.  A friend gave it to me; she’d bought it for her late mother at an estate sale.  This, too, can be yours!  It’s on Amazon, here.

P.P.P.S.  I’ve never seen another of these in use anywhere.  Share the news if you have a sighting.

Ridiculous trust

You all are probably getting the impression that I like to DO, and you are right.  As I was getting sicker and sicker in 2012 and 2013, I slowly began to stop DOing.  I stopped freelance work, then stopped helping with a Bible study and community group at church.  I stopped picking up our kids from school, then eventually, for a time, saw most of my at-home jobs (cooking, cleaning, shopping, etc) come to a halt.  I just physically couldn’t do.

I remember multiple times crying out to God, “What should I DO?”  I didn’t know where to go or who I was, in some ways, without the ability to do.  I also didn’t know how I could live out my call with so little I could seemingly do.

I remember God impressing upon me, “Trust Me.  Just trust Me.”

Trust?  Isn’t that too easy? Couldn’t that be a copout?  Doesn’t that take absolute surrender and acknowledgment of my dependence?  Where’s the DOing?

A friend of mine has felt called to persevere in a particular frustrating, discouraging, difficult marriage situation.  She told me she really thought God wanted her to stay with it, but that it felt completely ridiculous to do so.  She spent the better part of a year studying the Bible to find all the ridiculous things God has had His people do.   Noah building that ark was absurd.  Moses keeping his hands raised during battle probably isn’t a time-tested war strategy.  Elijah probably felt completely ridiculous eating food brought to him by ravens.

To me, “just” trusting can seem a bit ridiculous…. But isn’t the wisdom of this world sometimes foolishness to God (1 Cor. 3:19)?  Doesn’t God sometimes choose what is foolish and weak to shame the world’s wise and strong (1 Cor. 1:7)?

What ridiculous thing is God calling you to right now?

 

Nothing in my hands I bring

Well, no sooner do I write about getting better, than I get knocked off my feet.  Saturday and Sunday, I experienced powerful presyncope that left me in bed most of both days. (I don’t know why this happened, but POTS is unpredictable.)  I am on the couch today, very faint but cozy at home, thankful for friends and a husband who cook, throw in laundry, bring the kids home from school.

I dislike the worse days, but you know what?  In some ways, I’m grateful to be reminded that I can’t do it all.  After the blackouts in vision, the surges of nausea, the body weakness, the tremors, the loss of speech, I know I must wave the white flag and admit to myself that I can’t always carry out my plans, my desires.  I’m unable to catch up on the laundry I’d let pile up, to drive the car– or even walk unassisted to get in it-, to make cobbler from ripe summer peaches, to sit at my son’s soccer game.  I can’t do any of the 5 on my Can-Do List for a couple days.

In bed, doing nothing
In bed, doing nothing… but I am sitting up!

Yesterday, before I’d fully come out of a presyncopal episode, I was in the church lobby, on a couch, hunched over, head resting on an ottoman, with one friend fanning me, another holding salty ice water near my mouth, and my husband trying to put a dose of midodrine in my mouth– I could not even lift my arm to take my medicine myself and the funny of the situation left me laughing so hard I couldn’t swallow it down.  I could do nothing!

It WAS funny, and my friends were happy to see me laughing, but doing nothing is also hard.  I want to be strong and independent and capable.  I want to find my worth in what I can do and am quick to try to run there as soon as I can do things like stand up while brushing my teeth.  So in some ways, I love that God, in His goodness, has chosen for now to let me live with POTS and NCS and reminds me that I don’t need to do anything to earn His love or find worth in His kingdom.  In fact, I can’t do anything.  “All our righteous deeds are like filthy rags”; but “God demonstrates His love for us in this:  While we were still sinners, Christ died for us.”  (Isaiah 64:6; Romans 5:8)

Like my husband and friends who practically carried me to the car, checked my vitals, changed my daughter’s sheets, picked up meals, cleaned our kitchen, and did our errands, God does all the work for me in saving me and delights in doing so.  “Come, everyone who thirsts, come to the waters; and he who has no money, come, buy and eat!  Come, buy milk and wine without money and without price. … Incline your ear, and come to me; hear, that your soul may live.” (Isaiah 55:1,3)  He simply calls me to come and to believe.

I do hope to post more about what I can do, but I hope I will learn to rejoice, too, in what I can’t do and to praise God that He is exceedingly able.

Treatments that have helped me improve with POTS & NCS

When I first developed POTS & NCS, I would google, “Does POTS go away?” or “improvement with POTS”  or “how can I get better with POTS?”  I wasn’t sure when, how, or if I would see improvement.

I recently posted a list of 5 ways I have improved since being treated for POTS (postural orthostatic tachycardia syndrome) and NCS (neurocardiogenic syncope); those of you with dysautonomia may be interested to know what has helped me improve.  Although I would say I am still not living a fully-functioning lifestyle, I am now far from bedridden.  YAY!

Spoiler alert:  If you are not that interested in POTS or dysautonomia, ignore this post and stay tuned for future posts more attuned to your interests.

Specific treatments* that have helped me improve are:

1) Beta blocker.  I take metoprolol tartrate, 25 mg, day and night.  This dramatically reduces my wildly racing heartbeat and enables me to stand more often and a little longer without my body getting as fatigued.    Several medical professionals have asked me if I have a pacemaker, because it does seem to keep my heart at an unusually stable rate.  My electrophysiologist prescribed this for me, and I noticed it helping right away.

2) Midodrine.  It took me over a year to see the full impact of midodrine’s help.  Midodrine constricts blood vessels and helps raise blood pressure.  I was seen several times at Vanderbilt University’s Autonomic Dysfunction Center, and my neurologist there outlined the timetable and dosage plan for midodrine for me. I started with 2.5 mg, 3x per day, then increased my dosage by 2.5 mg each time about once a month.  When I finally reached 15 mg, 3x per day, we increased my morning dose to 20 mg; the next month we backed off my afternoon dose to 12.5 mg, then to 10 mg, followed by the same for my midday dose.  My current dose is 20 mg around 7-8 a.m., 10 mg before noon, and 10 mg around 3-4 p.m.

I am shocked if any of you unaffected by POTS and/or NCS are still reading.  Those of you who have dysautonomia should know that this took about a year to find the right dosage level and really see how helpful it was.  Each time we increased or decreased, I felt quite rough for about a week each time.  For me, this proved to be worth it, because my too-low blood pressure is now higher and does not bottom out nearly as dramatically when I am upright.  I try not to lie down too much on midodrine (it can result in dangerously high blood pressure, although this is not the case for me) except for after lunch or on days my BP seems extra low.

3) Salt.  While most Americans seem to want to consume less sodium, I (and many dysautonomiacs) generally need to intake more sodium.  This is often one of the first treatments a doctor will advise someone with POTS (certain subtypes of POTS may not follow this protocol).  Salt helps thicken my blood and makes it more likely to “stick” around in the upper half of my body instead of pooling in the bottom half.

I aim for 5,000 to 8,000 mg of sodium per day.  This is not easy to get!  I generally have 1/2 tsp of sea salt in my morning tea, then repeat (definitely an acquired taste I built up to).  I drink tomato juice midmorning and then took a 1,000 mg salt tablet with lunch (not doing right now due to nausea).  Early afternoon, I drink an electrolyte-filled drink (coconut water, low-sugar sports drink, vitamin water-type drink, etc) with another tsp of sea salt.  Then I have more tomato juice before dinner.  I might sub or add chicken broth somewhere along the way. Whew!

Early on, I went through weeks of counting sodium like others count calories.  I have my rhythm down now and prefer adding salt to drinks instead of food because I don’t eat a ton during the day (again, nausea) and because I can measure it better and not be discouraged about the taste of my food.  Salty food is not a bad idea, but a serving of chips only has about 170 mg per serving– at that rate, I’d need to eat maybe 30 servings of chips?!?  I will sometimes load up on olives, pickles, chips (with extra salt) and salsa etc.  I don’t get much sodium from prepackaged or convenience foods (which can have super high sodium contents), because I rarely eat them.

As far as side effects, my blood pressure is still not too high; I haven’t put on weight from the salt; and (though this is not completely related), I have super low cholesterol.  Crazy!

If I am in a given situation where I am feeling weaker and more tired and faint, I drink a glass of water (or Emergen-C or something) with a tsp of salt mixed in.  This helps tremendously!  I carry salt packets with me at all times so I can add them right in for that extra boost.

4) Increased activity enabled by beta blocker and midodrine.  The combo of my beta blocker and midodrine (and salt) has helped me sit more, walk and stand a little more, get out of the house more, and do more in general.  That has made me stronger and a little more fit, then I am able to do more, etc.  Instead of a vicious cycle, it is a life-giving cycle!  I am not up to any real exercise yet (neurocardiogenic syncope rears its ugly head pretty quickly), but even just making myself do more helps me be able to do more.  I haven’t seen complete linear improvement with “just push through it and you’ll get better”– but a very modest pushing myself  has helped a bit over time.  Experts warn people with POTS not to lie down too much, because one can quickly become deconditioned.  While we sometimes just need extra rest (and should listen to our bodies), I see the wisdom in that.

5) Dietary considerations.  I love sweets but now rarely have sugar due to its effect on me– racing heart, wooziness, and increased fatigue.  Even too much natural sugar (like that in a Larabar) bothers me.  I also try to make my diet fairly veggie-heavy and generally avoid dairy, soy, gluten/grains.  I also rarely eat anything processed.  That may not sound too fun– and I certainly love indulging now and then or enjoying food someone makes for me– but I do think it’s helped me feel better.  It’s kind of a veggie-heavy, not-so-meaty Paleo approach; I often feel most energetic (though nowhere close to cured) when I’m following a modified Whole 30-type way of eating.

I have done plenty of other treatments (and hope to pursue more) and will try to address them on this blog over time.  Be on the lookout for information about cardiac rehab/ exercise, salt caves, compression stockings, fludrocortisone, anti-nausea meds, and much more!

Remember, everyone’s body has different needs and responds differently to different meds and treatments.  Let your medical professional advise you.

* Like Dr. Kent Brantly, a missionary to Liberia who was cured from ebola, gave all credit to God for his healing, I see my improvement as coming from God’s hand.  I am thankful He can work through doctors and medicines, as well as in supernatural ways.  Prayer, from me and His people, makes a huge difference in my day-to-day living and my emotional and spiritual wellbeing, as does His Word.

Kristi’s CAN-DO List: Ways I have improved, with POTS

Our town recently hosted a world championship of handicapped athletes for a particular sport.  I was at Whole Foods recently when in came a team from the Netherlands.  There were a dozen people in their fitted orange shirts, a third of whom were in sleek, tricked-out, sporty wheelchairs.  The whole group looked fit and strong, and I loved seeing their energy.

Dutch athletes, photo credit here

You all have heard me do enough moaning and grieving and Woe-is-me-ing about what I can’t do– and it’s true that there is much I cannot do, even belt out songs due to shortness of breath or take great pictures due to the lack of ability to stand long (or maybe the lack of ability to take great pictures).

Today you are going to find out what I CAN do, physically.  Maybe I’m not ready to compete in a world championship for disabled athletes (those of you who know me are allowed to snicker seeing as I was terrible at sports BEFORE I got sick), but I HAVE made physical improvements from this time last spring.  I have gotten stronger this summer and am so thankful.

Here is what I CAN often do now that I could not do last spring (2013), usually due to feeling too close to passing out, or to extreme fatigue, or to other symptoms becoming intolerable.

Kristi’s Top Five List of Can-Dos as of Late Summer 2014

I can (often)…

1. Brush my teeth standing up!  This is a vast improvement from months of draping myself over the bathroom counter or sitting on the toilet.  Maybe one day I’ll be able to blow dry my hair standing up.

2. Cook or put together a simple dinner for my family, more often than not.  I know some of you are thinking, “Wow! I can’t even do that!”  This is probably my main priority for significant energy use, besides picking up the kids from school.  Prepping little by little throughout the day, using a slow cooker, leaving dirty pots and pans for my husband (thanks, Mark!), etc, makes it more doable.  I am so grateful for the meals, gift cards, and Sister Soup (my amazing sister has sacrificially made and delivered us a pot of soup every single week in 2014!) that sustained us for so long.

3. On a good day, do laundry or sweep the kitchen floor or wipe the counters (probably not all three).  I am SO happy to be able to do the same chores that used to get on my nerves and seem so boring.  A little Pandora in the background and a challenge to myself to do 5 or 10 minutes enable me to do some simple cleaning now and then.  I am thankful for help in this area too.

4.  Do this blog… and even sometimes sit straight up while I do it.  This is huge for me.  I tend to compose posts in my head but am amazed that I can actually sit at the computer, pound them out, and post now and then.  If I can handle computer time, I might prep a few posts at a time, then have enough for a week or two when I’m not feeling up to it.

5.  Occasionally run small errands and,

my favorite,

wait for it,

you know you want to know:

DRIVE!

I’m pretty sure I’m more excited than a 16-year-old to be back behind the wheel.  Watch out– Swagger Wagon headed your way!

Okay, maybe I don't drive super far, but my husband ROCKS it, and I'm great at riding next to him, drinking salty tomato juice!
Okay, maybe I don’t drive super far or too often, but my husband ROCKS it, and I’m pretty good at riding next to him, drinking salty drinks. (Plus, I happened to have these pictures and don’t show him off nearly enough!)

Want to see what has helped me improve?  Read this post.