Tag Archives: pacing

Boom & Bust

Following on from my post about pacing, I want to talk about boom and bust.  I have a lovely friend with severe M.E. and on her Facebook page recently she wrote (and I’m paraphrasing): “The differences in what I can do physically and mentally day to day are shockingly drastic. The other day, I folded clothes while talking on the phone, ordered food online, hoovered one room (for the first time– I was having a good day), did some light cooking, wiped down some surfaces in the kitchen, carried a tall lamp from my upstairs bedroom into the living room and watched tv with my husband — all without getting neuro symptoms or taking a nap.  Today I’m back in bed before even having breakfast and I had to rest in total silence and darkness for hours before even being able to write this because my brain is struggling in molasses”.

I love her to bits but I did want to grab her and shout arrrrggggghhhhh really loudly in her ear’ole 😉  This is a classic case of booming and busting.  In other words, doing all sorts of activities on a “good day” then wondering why you’re poleaxed for the week that follows.

If you had triple heart bypass surgery you wouldn’t expect to get out of bed the next day and hoover your lounge room carpet.  You would take things easy, gradually doing little bits and gauging your symptoms.  If your pain got worse you’d realize you’d over-done it and cut back, taking months to gradually build up your strength and tolerance to activity.  Yet people with M.E. think that the second they wake feeling even marginally human they should be able to go about their business like they’re not sick at all, then wonder why they feel like they’ve been hit by a train as a result. It’s a bit nuts when you think about it logically.

I speak as one who, for the first 6 years of her illness, thought that one day I’d just wake up better and be able to resume my life like nothing had happened.  I was in complete denial that I would never be well again and that my old, healthy and active life had gone forever.  I was no longer the person that I had always been and when you finally realize that you seriously want to slit your wrists.  However, your old life is dead and just as with any kind of grief you have to work through pain, anger and despair before coming to terms with your situation and finding acceptance.  It’s hard to do this alone and that’s where a trained professional may be useful.

After you’ve worked through your grief and denial and finally accepted that you have a new life you have to figure out the rules of that new life.  This is where pacing comes in.  I’m no expert and can only talk about my own experience, but I did get myself from being almost totally bedridden for 10 years to being able to live independently and I think routine was the key.  I had the same schedule every single day.  I don’t care if I woke feeling like Usain Bolt I stayed in bed and rested, doing no more on a good day than I did on a bad day.  Sounds easy doesn’t it?  But you have no clue, like seriously no fucking clue, how hard it was.  When I hadn’t been out of bed for three months and suddenly woke feeling if not exactly well at least like I wasn’t dying and not being able to use that precious day to do something other than staring at the same four walls of my bedroom – the same walls I’d stared at for the entire previous year.  Or to chat to my best friend for a whole hour on the phone after not speaking to a soul all week. Or to walk to the shops and be surrounded by people after months of total isolation.  Or to go out to dinner when I’d lived on cereal and frozen meals for one for the past six months.  The temptations faced by Jesus in the desert are nothing in comparison to the temptations faced by M.E. patients who are having a ‘good day’.  However I thought of my schedule as rehab and, just like the bypass patient recovering from major surgery, I needed to allow my body to heal before gradually increasing my activity levels.

The worst part is that, despite spending years solidly pacing and denying myself any kind of pleasures followed by thirteen years of continued pacing and only allowing myself the odd pleasures, I am still not well.  Not by any stretch of anyone’s imagination.  In fact, I don’t know of any patients who have had severe M.E. that have fully recovered, which is a bitter pill to swallow.  I have no more energy than any other M.E. patient.  What I do have is stamina and it’s that which allows me to do activities.  I also no longer wake each day feeling like I’m dying, or so sick I wish I were dead (and I did both for nearly a decade).  I still have pronounced symptoms including brain fog, feeling fluey, pain, muscle weakness, insomnia, nausea etc, but they only stop me doing things if I don’t stick to my pacing schedule and, on the rare occasions I take a calculated risk and over-do it the exacerbation in symptoms only lasts a few days not several weeks/months like they used to.

I still have a glass ceiling beyond which I can’t reach without risking a relapse.  I live a very structured life.  I haven’t been on holiday since 1996, not because I’m unable but because my body would rebel.  It’s unrealistic to live 50 weeks of the year in gentle, quiet, routined isolation then expect my body to cope with planning, packing, travel, vibrations, motion sickness, changes in climate, food, water and routine.  Not to mention stupendous amounts of stimulation in the form of noise, people, bustle, chatter with my travelling companion, scenery, things to do and the utter chaos of the outside world.  I wouldn’t expect a triple bypass patient to cope with all that the day after surgery and I don’t expect my sick self to cope with it either.  Ditto going to the cinema.  Or out in the evenings when I’m at my lowest ebb in terms of stamina.  Or reading.  Or cleaning the bath.  Or hoovering.  Or painting the Utility room, even though it desperately needs doing and my pre-illness self was perfectly capable.  And 1001 other situations I still avoid like the proverbial plague.

M.E. patients all want to get better but we want a quick fix.  A diet, a pill, a therapy which is going to instantly cure us.  Most can’t accept that currently the only way to improve our symptoms is years of dedication, hard work, deprivation and isolation.  And to be fair you can’t blame them.  But this is the hand we’ve been dealt and we have to be savvy about it and make a life that is as good as it can be.

I am never going to be well and able to do the things I could pre-M.E. and I have to make a conscious effort not to dwell on that or the grief, even 23 years down the line, would overwhelm me.  This is not the life an energetic, intelligent, bubbly, passionate, independent, hard-working woman would ever choose and I fought against it for years, with every ounce of my character, strength and determination…………and lost.  M.E. beat me every single time.  So I had to call a truce.  Had to give up some parts of my old life in order to keep some parts of my new life.  And at least I now have a life, when for ten years I had none.

 

 

 

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Mistakes, I’ve made a few

Following on from one of my recent posts, I thought I’d share my experience of pacing.  Managing energy expenditure is important for many EDS patients and absolutely vital if you have M.E..  I’m going to talk from an M.E. point of view, because my EDS tiredness and my M.E. “tiredness” are leagues apart and respond to different techniques but I hope EDSers will still gain insight from my ramblings!

When I first got M.E. 23 years ago nothing was known about the disease and there was zero advice on how to manage the condition.  I had a very busy and active life, including a full time job with a two hour commute, being in the middle of renovating a three story Victorian town house, hobbies (aerobics, horse riding, weight lifting, tennis), friends, a boyfriend and an active social life.  When I first had symptoms I struggled on at work for six months until I became so ill I couldn’t get out of bed in the morning, let alone do a ten hour working day.  Looking back, this was my first mistake.  If I knew then what I know now I would have stopped work immediately and rested.

Having been forced to give up work I had a lot of boring time on my hands during the day, so for the odd few hours I had some energy I thought it was a good opportunity to catch up on all the jobs that needed doing in my house including pulling down and replacing the ceiling on the landing and getting on with doing up the top floor of the house.  I felt horrendous but I was a really hard working, motivated young woman and illness wasn’t going to stand in my way.  Mistake number two.

I had no intention of letting my disease interfere with my social life either, so on Fridays and Saturdays I’d lie in bed all day feeling like death warmed up then at 6pm drag my leaden body out of bed, shower, do my hair, put my slap on and get glammed up, ready to go out with my friends or boyfriend for a meal, to the pictures or out round town.  It used up my energy reserves for days but I needed to keep up the pretence to myself that this sickness thing was just a blip and wasn’t going to stop me living my life.  Mistake number three.

Of course, I got more and more ill and my relationship with my boyfriend began to suffer.  Scared I was losing him I agreed to go on holiday to Kenya and to cut a long story short this is where I got Meningitis and ended up nearly coming home in a coffin.  I lived, but developed very severe M.E. as a result and lost my boyfriend anyway.  Humongous, life-changing mistake number four.

Now I didn’t have the choice of pacing or managing my energy.  For the next four years it was all I could do just to breathe in and out and blink my eyelids.  In fact, I went through a stage where I was so weak I couldn’t even blink my eyelids and my GP said that ideally I needed to be on a ventilator to give my lungs chance to rest.  Instead I wasn’t even hospitalized and just left to lie on my own in my bed without medical care for 23 hours a day because back then M.E. wasn’t treated or taken seriously and on the odd occasions I did see a  Consultant it was a psychiatrist not someone who could actually physically help me.

After four years I came to terms with the fact that my old life was gone forever and even if I was going to be bedridden for the rest of my life I was still alive and needed my days to be as good as possible.  And this is when I started pacing.  There was still no advice on it, I just instinctively knew that my body was in total disarray and I needed to do something to help it to stabilize.  So I devised a schedule, breaking my day up into activity and rest (and by rest I mean lying down in a dark room with no radio or mental stimulation).  Make and eat breakfast, rest for one hour.  Talk to a friend on the phone for 10 minutes (I had a timer), rest for one hour.  Make and eat lunch, rest for one hour.  Have Mum visit for 10 minutes, rest for one hour.  Be on computer for 15 minutes, rest for 90 minutes.  Eat tea, rest for one hour.  Watch tv for half an hour, sleep (or try to!).  I’d have a bath once a week when everything else had to go on hold because bathing floored me.  And on Wednesdays I employed a nice lady to clean my house and do my shopping, so had extra rests that day because just her mere presence in the house killed me.

I kept this schedule up for an entire year with no improvement in my health whatsoever.  Everyone moaned about it.  My Mum struggled to come at the time I needed her to, my best friend wanted to chat on the phone longer than ten minutes, friends I’d made online wanted me to reply to their emails or chat on a forum I was on, and I was so bored when resting I was scared I’d literally lose my mind.  But I stuck to my guns and carried on with my plan.  And slowly, slowly it started to work.

After about 18 months I started to see symptoms I’d had for years lessen.  I started to feel like I had a little bit of stamina, if not energy.  And this carried on for the next 6 years with baby step improvement.  I was able to increase my activity times and decrease my rest times and eventually made it out of bed, if not really out of the house 🙂

A decade later I am now moderately affected by M.E. not severely and can have some semblance of a normal life but only because I still pace.  I’ve discovered that I have most mental energy and clarity first thing in a morning, so that’s when I do all my blogging, computer stuff and paperwork.  I have most physical energy between 11am-3pm, so that’s when I visit my parents, do my shopping and take the dog out (paying someone to take him out first thing in the morning when my physical energy is low).  I crash every afternoon, so am in bed from around 3.30pm to 7pm.  I no longer have to lie in a dark room, but if I want to nap I do, or I listen to a talking book, or maybe check Facebook.  Evenings I have another spurt of mental, if not physical energy, so I stay in bed but tend to edit my photographs at night or email friends.

I still only bathe twice a week because I still find it absolutely knackering and I lose a week every month to my period, when I’m in bed much more and can’t do much of anything else (which is why I’m finding peri-menopause difficult, not knowing when Aunt Flo will arrive).  In the winter I go to my Camera Club one evening a week, but make sure I rest more during both that day and the next.  I also meet my bezzie for lunch once or twice a month, but again this involves planning my energy, resting more the day before and two days after.  If I’m having a crap day, which I usually know the second I open my eyes in a morning, I make sure I use my mobility scooter more that day, sit with my feet up more, or lie down more instead of sitting – all things which help conserve energy.  Planning and pacing have become second nature to me and are still absolutely vital in keeping my M.E. stable.

Pacing doesn’t just involve mental and physical activities though.  I’ve had to change who I am as a person.  I’m inquisitive and passionate and when I was well I used to get involved in debates and follow politics and was active in various charities, but all that has had to stop.  Emotions, be they good or bad, kill me.  Laughing is exhausting, arguing is more so.  My best mate also has M.E. and when we meet up for lunch we inevitably start discussing the state of the world, but after twenty minutes we both decide we need to stop because we’re absolutely exhausted (I can literally see the colour drain from my friend’s face).  I have to curb my naturally bubbly nature and try to keep my emotions on an even keen, which to be honest I finally really hard!   Stress is an absolute no no and can have very serious consequences for my health, which is why I don’t tolerate bullshit here on my blog or in my private life.  There are no second chances – you stress me out you are not in my life anymore, end of story.   It’s a matter of survival.

Sadly there are things I can no longer do no matter how hard I try.  Exercise, obviously.  And read.  I’ve always loved books and they saved my sanity as a child, but reading is so exhausting and taxing it’s no longer enjoyable or feasible – I miss books more than words can say, though talking books fill the gap a little bit (and are massively more expensive 😦 ).

Of course, there are times when you have no choice but to push through the energy barrier, eg. to attend a wedding or funeral, or if something goes wrong in the house, or if the electric goes off, or if one of my parents is sick, but during these times everything else goes on hold.  I’m not on Facebook, I don’t blog, I often don’t bathe at all, I don’t keep up with the washing and ironing, I eat solely out of the freezer …….something has to give.  Nevertheless, crises or extra events always, always rob me of energy and I then need a period of extra rest and recuperation afterwards to regain my equilibrium.

Statistically, children who develop M.E. are more likely to recover than adults and, while this may be partly down to the fact that their immune systems aren’t fully developed, I personally also think it’s down to the fact that they can rest fully.  They don’t have to worry about finances, don’t have to cook, shop, clean or do laundry.  Don’t have to apply for welfare benefits or deal with leaking roofs or broken boilers.  Other than being socially isolated they don’t really have huge worries or stressors and this does tend to improve outcome (though of course sadly not for all kids).

I often see questions about pacing from newly diagnosed people on the ME Association’s Facebook page and think it’s pointless replying.  When you’re first ill there is no way you are going to pace effectively.  You haven’t twigged that you are going to be ill for years and that your life is changed forever.  Haven’t realized what’s involved or the extend to which being chronically ill is going to change not only you but everyone around you.  That knowledge and acceptance only comes with time and experience.

 

 

 

 

 

 

 

Hard Choices

I come from a working class northern family who are opinionated and not afraid to speak their minds.  There are no discussions.  Instead there are conversations where the volume gets louder and louder and my Dad inevitably ends up blaming  “bloody immigrants” for everything from climate change to Brexit and my Mum and I just look at each other and roll our eyes ;-).  I have, therefore, never been shy in expressing my thoughts on any given subject (shocker I know 😉 ) even if I  have no idea what I’m talking about.

There was a paragraph in my last post about not knowing what to say to people who disagree with my opinions which my best mate and I discussed recently.  When I was younger, and before I was ill and had energy galore, I used to find the words “I disagree….” or “you are wrong….” an opening for a good debate.  Myself and the other person would then spend a happy hour fighting our respective corners on the subject, it might get quite heated cos we’re never going to change each others minds, and in the end we’d have to agree to disagree.  Wash the conversation down with a bottle of Chardonnay and it made for a good night.  And then I got sick and everything changed.

I don’t have the energy now for a good debate and I find fighting my corner stressful.  That’s not to say I never have conversations with people who share an opposing view to me, my best mate included, but I throw in the towel really quickly because I’m going to need the energy to drive home, cook my tea or put a load of washing on.  It’s too precious to waste arguing the toss about stuff I can’t change, or trying to justify or compare my own experiences to someone else’s.

My lack of energy is the reason I don’t follow research like I used to a decade ago, I’m not on any forums, I can’t read other blogs and don’t engage in lengthy discussions here on my own blog.  I need that energy for other stuff, like keeping myself alive, helping my parents and looking after my lovely Bertie.  I’m baffled by my friends with M.E. on Facebook who follow every political debate, read every newspaper, follow all the research and activism, and are constantly riled up about the state of the planet, Government policy, Brexit and just about everything else.  Where the hell do they find the energy for that?  I can barely brush my teeth most days and I have no clue how they find space in their foggy brain for all that noise.

My friend said “you can’t expect people to never disagree with you” and of course I don’t expect that, but neither can other people expect me to enter into discussions with them I don’t have the energy for.  I see my blog as an online diary on which people can comment, rather than some kind of advice site or forum and I don’t have the energy for it to be anything else.  And I know I have dozens of followers who read all my blog posts but never comment, because they’re too sick to – I, of anyone, get that.

I miss arguing the toss over a nice glass of wine and it’s actually weird to be forced to be mellow.  When my parents are talking shite about a subject (usually politics) I’m desperate to jump in and correct them with my superior knowledge, but these days I just have to keep my trap shut.  Maybe that would have come with age anyways, who knows.  I’ve definitely found as I get older that I care less and less about stuff that used to get me well and truly riled.  It’s not that I’m disengaged, but more that I’m weary of politics and the M.E. world – I’ve heard the arguments for five decades now and nothing ever changes.  If I’m going to use some of my precious energy it won’t be reading a 10 page research document or extrapolating my genetic raw data – it’ll be having lunch with a friend or walking the dog down by the river on a sunny afternoon hoping for a glimpse of the Kingfisher.

Pacing and conserving energy are vital for keeping my health stable.  There’s a lot of information out there about how to pace but it doesn’t really tell you how it’s done.  It doesn’t inform you of the fact you might have to change your entire personality in order to keep your body alive.  It doesn’t tell you that watching Peter Kay on the telly and laughing so much your stomach hurts can rob you of energy for the next 48 hours to the point where you have to live on toast cos you’re too knackered to cook a meal.  It doesn’t tell you that you’re going to have to sit and listen to your dad talking shite about immigration because correcting him uses up energy you’re going to need for a bath later.  It doesn’t tell you that you’re going to have to dumb down your inquisitive mind because you no longer have room in it for information on the mating cycle of Dragonflies because that doesn’t help you get through the day.  THIS is the reality of living with an energy robbing disease and why most people fail spectacularly at pacing, which has been the hardest thing I’ve ever done or will ever do.

 

 

Pushing Through

A blogging friend over at The Walking Allergy  made some interesting observations about illness management on a recent blog post of mine, and it’s made me think about my own experience.  Pacing is the best way to manage chronic illnesses like EDS and M.E. but it’s not always achieveable and when it’s not should we ever push through our symptoms?  The rest v activity debate is complex and is a very very fine line to tread.

I have to manage my EDS and my M.E. in different, often diametrically opposed ways, which makes for an interesting life.  I am in pain from my EDS every second of every day so I have to push through it otherwise I would never leave my bed.   However, I don’t push through blindly – I strap and brace injuries so as not to aggravate them and I only use my TENS machine to mask chronic pain signals, ie the type of pain with no obvious cause and which I simply have to live with – it would be madness to mask and ignore acute pain signals.   Eventually though there gets to a point in the day where the pain ramps up to such an extent that it forces me to stop and rest and the timescale for this happening is different every day.  Some days it gets to lunchtime and my back is screaming at me to lie down, other days I can get to the end of the afternoon before my body imposes forced horizontal-ness.  Sometimes I can rest for a couple of hours then get back up and carry on, other days that’s impossible.  Some days I can walk, other days it’s just too painful.

The fatigue from my EDS is something I admit I totally ignore.  I have an extremely busy life and there are things I have to get done every day no matter how exhausted I feel.  In fact, it’s only 7.45am and I am already so tired it’s like I’ve never been to bed.  But today, as every day, I have stuff to do so I just have to push through the tiredness and crack on.  It’s really hard, but do-able.

The “fatigue” from my M.E. is in a totally different league.  When I was severely affected I didn’t get dressed, or clean my teeth, for 4 years because I was simply unable.  I had so little energy I had to use it for really vital things like breathing and crawling on all fours to the loo.  However I lived alone and only had help for one day each week, so staying in bed wasn’t an option.  If I wanted to survive I had to get up and I had to make meals and drinks, I had to pee and poop, I had to bathe once a week (because if I didn’t I got crazily itchy), I had to answer the doorbell and the phone, I had to write shopping lists, I had to pay bills (no internet banking then!), I had to arrange tradesmen when my boiler broke or my roof leaked, I had to put the bins out……….and all the other stuff we have to do in order to live.  The consequences of this activity were legend – I would have a 10 minute chat on the phone and literally puke with exhaustion for the next hour.  I could make beans on toast for lunch then be so ill from the effort I couldn’t actually eat it – I’d have to rest for an hour first, then consume it stone cold.  I would write a shopping list for my Carer, then have a seizure from the effort of so much thought.  At the time, however, I had no other choice than to push wayyyy past my boundaries.

You would think that this would make me much more ill than my peers with severe M.E., and maybe for a time it did.  But, and it’s a BIG but, I’m the only one in my M.E. circle from the early 1990s that has made any significant recovery.  So I ask myself why.  It is because I didn’t have the option of staying in bed?  No matter how ill I was, and I genuinely was so ill I nearly died, I had to make myself get up and do things.  If I couldn’t walk I crawled.  If I passed out on the kitchen floor I had to damn well get back up again and finish making my breakfast, then try and actually eat it.  Did that make the difference?  I have no idea, but it’s the only thing which appears to separate me from my peers, who were all cared for by spouses or parents and had the option of remaining in bed.

So the question remains – to push, or not to push, through your boundaries?  It’s individual for all of us.  I live in a permanent state of pain and exhaustion so I have to push to some extent or I’d lie in bed forever staring at the ceiling.  But you have to know when to push and when to rest and that only comes with experience.  There are times when I’ve had to push on regardless and it’s been detrimental, no question about it.  There have been other times when I wonder whether having to push on regardless has actually been beneficial in the long run, regardless of the fact it was detrimental at the time – I’ll never know the answer to that.

Of course, our illnesses change over time and I’m as sure as I can be that in the future pushing through my pain will become impossible and I will become both wheelchair dependent for walking and carer dependent for cooking (bearing in mind I can no longer eat microwaveable ready meals as I did when my ME was severe due to my Mast Cell Disease/HIT).  My boundaries are ever changing and living within, or without, requires constant reassessment and daily choices.