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One of the hardest calls to make as a runner is when to resume training after illness.

If you're used to training every day at a moderate or high intensity, missing a few days can be as much of a mental challenge as physical. Sure, when you're sick you don't want to exercise, but it's that fuzzy recovery phase that can be tricky to negotiate, especially if you're on a training program.

 

In fact, sports physicians agree that athletes need special attention when it comes to managing exercise post-illness.

 

James Lawrence, a Sydney-based sports medicine specialist, says athletes are generally attuned to their bodies and have a good sense of when they are sub-par. But reining in their enthusiasm to train at high intensity can be difficult.

 

"It's a contentious issue and there's been very little research in the area of returning to training after illness," Lawrence says.

 

"Athletes who are familiar with their resting heart rate can use it as a guide for returning to exercise. Otherwise, the rule of thumb that's generally applied is the 'above the neck, below the neck' check."

 

Above the neck symptoms include a mild sore throat, stuffy nose and headaches. It's generally OK to train lightly with these symptoms.

 

 

Below the neck symptoms are fever, chesty phlegmy cough, aching body and very sore throat, plus things like vomiting or diarrhoea. If you have these symptoms, it means the bug is still in your system so there's a risk of inflammation of the heart occurring, which is potentially deadly.

 

So not only is it unhelpful to train under these conditions, it can be downright dangerous.

 

Sports physician Sharron Flahive, the chief medical officer of the NSW Waratahs rugby team, says the worst thing you can do is 'yo-yo' your comeback.

 

"You feel fabulous, you go out and do too much, then the next day you feel terrible again," Flahive says. "It's so frustrating when people yo-yo, they come back three weeks down the track and say they can't shake the 'flu.

 

"I tend to use the equation that for as long as you've been out, you should take that long to get back to the level you were training at before. If the 'flu keeps you in bed for one week and then you felt well, then it'll take you another week to come back at that level."

 

Flahive says advising athletes in this area is about their mentality as much as their physical issues. If you're used to spending a certain amount of time training each day then it's a good idea do something, but it might just be a brisk walk to start with.

 

"You might return at 60-75 per cent of your usual effort levels. If you normally do a 5km run, you might start with a 3km walk/run. Or you go on a brisk walk first and see how you feel and step it up from there. It's better at the end of it to be able to say you could've done a bit more."

 

Flahive says there could be a link between a premature return to training after illness and chronic fatigue syndrome.

 

"Anecdotally patients will talk about going back too early after illness and maybe that's why they developed chronic fatigue. I'm not sure how strong the science is on that, but it seems fairly logical."

 

Another red flag to be aware of when returning to training from illness is the heightened risk of past injuries reoccurring. Flahive says any absence from training, including holidays, carries the same risk.

 

"When you have an injury you go to the physio and do all the strengthening work on it," she says. "Often its recurrence is a consequence of muscle disuse. Any area where you've had an injury or a niggle would be more susceptible after a break in training."

 

So the post-illness message is: don't panic.

 

Use the enforced downtime wisely: do that yoga or stretch class at the gym that you never get around to doing in your usual state of wellness; revisit some of the physio exercises from a previous injury; get outside and move your body but finish the session feeling like you could have done more.

 

Increase the intensity gradually. Before long you'll forget you were ever sick.

 

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Joan Rivers had two great joys in life aside from her family: making people laugh and plastic surgery.

 

So much so that, in a tribute to the star who died on Thursday, writer Lena Dunham mentioned it.

 

"Joan is gone but a piece of her lives on: her nose, because it's made of polyurethane," she tweeted cheekily.

 

Rivers would be having a uproarious chuckle at the joke.

 

Her acid wit spared none, herself included.

 

"I've had so much plastic surgery, when I die, they will donate my body to Tupperware," she once joked.

 

Rivers' first surgery is believed to have been an eyelift at the tender age of 32, the same age she rose to fame on The Tonight Show Starring Johnny Carson.

 

In the nearly 50 years since then, she had, among other things, two facelifts, at least one nose job and so much Botox her plastic surgeon would send her away.

 

"He will say 'You don't need anything. Go home'," she said in 2007.

 

But that was of little concern to Rivers, who continued to have procedures up until her death.

 

 

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"I want to look nice," she's said. "No one wants to look ugly!"

 

When asked by television presenter Anderson Cooper if it was true she's had 734 procedures, Rivers cried: "No," in mock outrage, "739!"

 

"She has a punch card," daughter Melissa chimed in.

 

"Every weekend I just go in and I do something," Rivers added. "You get a tenth one free. It's like coffee so you just keep going."

 

While she was (hopefully) joking, Rivers admitted she gets Botox every "five or six months".

 

How she would have aged naturally is anyone's guess, including Rivers'.

 

"I wish I had a twin so I could know what I'd look like without plastic surgery," she once quipped.

 

Despite the witticisms at her own expense, there was deep sadness underlying the procedures that made her, as once described by the New York Times, a "plastic-surgery cautionary tale".

 

"My husband killed himself. And it was my fault," she once joked. "We were making love and I took the bag off my head."

 

Rivers' husband and father of her daughter, Edgar Rosenberg, committed suicide in 1987. The night he died, Rivers was having liposuction.

 

As always for Rivers tragedy was not off limits. Nor was her own belief that she needed so much surgery because she was "ugly".

 

"I was so ugly that they sent my picture to Ripley's Believe It or Not and he sent it back and said 'I don't believe it'," she has quipped.

 

"I believe in plastic surgery. Eventually," she said pointing to the journalist in one 2007 interview,"you will look in the mirror and you will know. You will hit 40 and say 'That isn't quite right' ...

 

"My motto is 'Better a new face coming out of an old car than an old face coming out of a new car'. Spend your money on you."

 

Rivers certainly invested in her surgery. To the extent that daughter Melissa once staged a surgery intervention.

 

"At one point I start to think the risk outweighs the reward, so I wanted my mom to know how I felt about it and I made myself fairly clear," Melissa told Anderson Cooper.

 

In the end, it was not a risky cosmetic procedure, but complications from a routine throat procedure that ended the 81-year-old's life. That said, with all the surgery, a part of Rivers will never die, and for that she will be pleased.

 

"I have a fantasy funeral where my daughter Melissa turns away all the sons of bitches that I don't like," she said several years ago. "It will be invitation only. But,I really don't know who I will still be talking to in 3007."

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'We decided to share the news as soon as we could': Jill Duggar reveals why she and Derick Dillard announced their pregnancy at just eight weeks

 

Jill Duggar and Derick Dillard revealed their pregnancy at only eight weeks, and it turns out that the devout Christian couple had a reason for the early announcement.

 

'Understanding that the majority of miscarriages happen within the first trimester, and believing that every life is precious no matter how young, we decided to share our joyful news as soon as we could,' Jill told Page Six.

 

The 23-year-old 19 Kids and Counting star, who is due in March, added that they purposely kept their engagement short so as not to tempt themselves into being unchaste before the wedding..

 

She advised married couples-to-be via Us Magazine: ‘You may not wanna push the wedding date out too far, as those natural God-given desires with too much time between engagement and marriage can make it harder to remain pure.

 

 

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‘If you are financially ready, and things are in place (which should be at the time the question is popped), we believe an engagement should only be long enough to plan a wedding!’

 

For further support, the devout Christians turned to praying. ‘Once we knew we wanted to get married, we didn't want to put off the wedding for a long time and provide a stumbling block for ourselves,’ explained Jill.

 

‘We purposed to save ourselves physically for each other within marriage (even our first kiss for our wedding day!), so we had a short engagement period.’

 

Now that they are expecting however, the attention has turned to other issues – including morning sickness. 'They should call it "pregnancy sickness" because it's all day, but I'm feeling good today!' the expectant mom told ABC

 

'I'm thanking God for this little life and the good signs. It's well worth it,' she added.

 

Jill, who married Derick, 25, in June, says that she's also had her share of pregnancy cravings.

 

'[Like my mother, I crave] things that are more sour to settle the stomach: dill pickles, lemon with salt or lemon juice with water or salt. I like cold things [too]. I don't like a lot of hot meals right now but I do try to get protein every two hours,' she said.

 

Though her parents, Jim Bob and Michelle Duggar, famously gave a name beginning with 'J' to every one of their 19 offspring, Jill says she's unsure whether she and Derick will carry on the tradition.

 

'We're still pretty early right now but we’re thinking we may not do a letter theme. Maybe we'll do some other kind of theme!' she said.

 

She also revealed that she plans to use a midwife when the time comes.

 

'I feel like it will be way more relaxing... and having the baby at home with a midwife provides more of that personal care. It’s more intimate for the couple as well, getting to be in your own environment,' she said.

 

The couple married - and shared their first kiss - in front of more than 1,000 family members and friends at the Cross Church in Springdale, Arkansas, on June 21.

 

In August, they revealed to People magazine that they're expecting their first child.

 

'We got pregnant a little less than two weeks after we got married,' Jill said, adding that she and Derick 'want to leave it up to God' to see how many children they have - 'whether it's two or 20.'

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