This topic is about someone who has been living with a permanent ileostomy for 20 years and is now facing challenges with isolation, anxiety, and unemployment. After losing a job, dealing with joint pain that has stopped him from running, and lacking close friends or a partner, he is experiencing severe anxiety and is struggling with negative thoughts about past decisions. He is looking for practical ways to ease his isolation, find purpose, and manage these persistent thoughts.

Here are some suggestions and insights that might help:

1. Try to have daily human contact to reduce feelings of isolation. This could be through brief conversations at a shop, visiting a library, running errands, or participating in activities at senior or community centers. You might also consider joining MeetUp groups, engaging on Twitter, or visiting local thrift stores.

2. Structure your job search by setting a specific task each day related to finding employment, such as updating your CV or visiting an employment agency. This can help ensure that being out of work doesn't affect your self-worth.

3. If anxiety or depression continues to be overwhelming, consider seeking professional help from a therapist, counselor, or physician, just as you would see a specialist for physical health issues.

4. Explore alternative forms of exercise that are easier on the joints, such as walking, mall-walking, light gym work, or tailored resistance training. Accept that progress may be gradual and that setbacks are a normal part of rebuilding fitness.

5. Use mind-calming tools like Yoga Nidra guided meditation, practicing gratitude by listing positive things each day, or visualizing an internal "defrag" or "off" button to help manage rumination.

6. Consider volunteering or starting a group, such as a local ostomy association, if one doesn't exist. Running a support group can provide a sense of purpose and help expand your social network.

7. Engage with online communities, such as forums, social media, and disease-specific groups, where you can find empathy and support that might be hard to find elsewhere.

8. Practice self-compassion by recognizing the achievement of managing an ileostomy for 20 years. Understand that aging and reduced abilities are normal and not personal failures.

9. Accept that anxiety can appear unexpectedly, like a game of whack-a-mole. Try to manage it one day or moment at a time, rather than worrying about the entire future or past.

10. Remember that the strengths you've gained through hardship, such as resilience and conversation skills, are valuable and can help in building new friendships or relationships.

11. If weather or safety is a concern, consider walking in indoor venues like malls or grocery stores to stay active without the risk of falls.