How I Use Pacing to Make the Most of My Day

When I moved across the province at the end of October, I did NOT do a good job pacing myself. Granted I had help for the physical moving but not the packing or unpacking or the putting together of furniture – that was all on me. I started out with the best intentions. I actually started packing by pacing. It was more the last minute stuff, the physically carrying items in the truck, and then everything after that was a disaster. And of course, that caused a flare (luckily it only lasted a week or so). However, that’s not what I normally do. Normally I pace myself, which is part of the reason why I can consistently be as active as I am.

Definitely explored my new neighbourhood as soon as I could.

What is pacing? Pacing is doing the same amount of activity everyday – whether it’s a “good” day or “bad” day. Now, this doesn’t mean you’re not listening to your body. There are of course days that Chronic Illness Warriors are going to need more rest. What it does mean is not over-exerting yourself on the good days and therefore creating more bad days. For example, I go for a walk everyday. It’s about an hour long. Even on days where I feel a bit more tired, I get my walk in. I also try to do some yin yoga everyday. It’s definitely movement that is easy to get in on days I don’t feel as good, because it is slower movements and stretching. But let’s say that I didn’t go for a walk today. Maybe I cleaned the house and did laundry instead. It’s about the same amount of activity – and maybe it’s more necessary or I have the thought that it’s more reasonable, depending on how I feel. Get what I mean?

Back in the summer, my pacing allowed me to be able to have a great visit with my friend.

There is A LOT of evidence that pacing works. Not just for me, but from other chronic pain and illness warriors. I’ve interviewed a ton of people on my podcast and have noticed that many of them use pacing. I attended the World Pain Summit earlier in the fall and 2 of the presenters, who were both people with lived experience (not healthcare professionals) talked about pacing and how it’s helped them. Heck even look at these search results on Google Scholar and you can see all the academic journal articles written on the subject. Pacing works – even with fatigue.

We did this by alternating activity with rest.

But how do you figure out what your pace is? Here are some key suggestions when it comes to pacing:

• Plan your day. We all have an idea of how we’re feeling when we get up in the morning, so having a plan of what sounds manageable for the day is a good place to start.
• Break up your activities and alternate at rest. For example, if you decide to clean the house, just do 1 room at a time and take a short break (30 minutes) in between.
• Prioritizing your activities. I align this with Values-Based Living. What is most important for me to do today? Why is it important? For me, my health is important (yes, even having a chronic illness) so doing some kind of movement that will keep me active and ultimately decrease pain (I’ve done many posts on movement for pain management) is essential.

Values-based living is engaging in activities that align with your values.

Even if you’re having thoughts that pacing seems impossible, just note that those are just thoughts. There are many people who can help you get started with pacing (occupational therapists, psychotherapists/counsellors, physical therapists, etc.) and the whole point is to improve your well-being so you can keep making the most of it!

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Daily Mindfulness: Notice Your Hand

This mindfulness practice is a good introduction to meditations and mindfulness in general, especially if you have a hard time with some of the more formal practices. It can help you get present just by focusing on one part of your body – your hand (alternatively you could use any part of your body that you can see fully, including using a mirror to do so). Mindfulness is mentioned by Dr. Richard Harris in this podcast episode as being beneficial for chronic pain and illness.
For all of my meditations, subscribe to my YouTube channel.
Be mindful, and keep making the most of it!

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How Did I Prevent a Flare?

Plus who is this blogger and why should you care what I have to say?

I think that I sometimes give off the impression that I’m 100% fine 100% of the time, which as anyone with a chronic illness or dealing with chronic pain knows, is simply not true. What is true, is that I’ve learned several strategies over the past 5 years to improve my well-being, even on my days of struggle. Let’s take this morning (Saturday) as a write this. I had some pain in my hips (both of them). I live alone and needed groceries and don’t have a car, so I walked to the grocery store. My arms killed on the way home because I accidentally bought more than I could carry. Then the apartment building door whacked my right hip (the less sore of the two) which obviously caused more pain. And then I became angry. Like swearing, yelling, grumbling, angry. I got text messages and was annoyed at the people texting me even though they weren’t saying anything bad. Then I noticed what was happening. Was this anger helpful? No, if anything it was making my pain worse. So I took a moment, watched my breath flow in and out of my body, and calmed down mentally… and then it helped my body to calm down physically.

These are my favourite days.

So… who am I? I’m Kelsey. I’m a person with lived experience. I have diagnoses of undifferentiated connective tissue disease, fibromyalgia, and glaucoma. I’m also someone who meditates daily (over 100 days in a row – my longest streak). I’m someone who has bad days, and good days. I make it my priority to have way more good days than bad ones. I’m a person who went to psychotherapy among other treatments (physio, chiropractor, naturopath, massage, etc.) and found it helpful for my anxiety and ultimately my pain. And then I became someone who went back to school to get my Masters in Counselling psychology, which I have now completed, despite the fact that I was working full time and in pain. I am someone who is committed to helping others who are struggling. And I am someone who wants to share what I’ve learned – and what I’m still learning – with all of you. I am me.

Just waiting for my final mark, but it looks like a therapist now!

Why should you listen to what I have to say? Well, there is no particular reason and it’s completely up to you! What I can say, is that I try to bring my personal, lived experience, with research (yes I actually do a ton of reading of scholarly journal articles for my posts) and clinical experience so provide you all with different ways to improve your well-being. Take me this morning for example. Would it have been helpful to stay angry all day? Likely I would’ve had to spend it in bed and probably wouldn’t have written this post. I’ve found this to be helpful for me, so it just might be helpful for you. Along with this blog, I have other resources too. Like my podcast and YouTube channel, which you should definitely check out if you haven’t yet.

On Halloween I was a badass like Buffy.

Okay, so I thought we’d end on a fun note. Two truths and a lie. I’d love to hear in the comments which one you think is a lie.
1. I have spent the evening hanging out with a celebrity.
2. I recently got a new puppy.
3. Pineapple is my favourite fruit.

My podcast topic this week was utilizing your authentic self, and next week is about evidence based treatments for chronic pain. My YouTube channel has a new video for building self-awareness (which is how I knew to calm myself this morning!). Until next week, keep making the most of it!

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The Body-Mind Connection

There is such a delicate balance between the body and mind and how they interact with each other. At the core, our mind… or more specifically our brain, controls everything from our thoughts and feelings to our pain levels to basic functions such as breathing. It sends the signals to all the body parts. Our bodies can also let our brains know when we’ve been injured for example. But what happens when there is too strong an influence of one over the other? This often happens in chronic pain, when the pain signals are amplified much more than they should be. Another common problem is the influence of our mental health on our chronic pain. For example, if you have higher anxiety or depression, you might notice that you have higher chronic pain as well. This is part of why I’m specializing in chronic illness as a psychotherapist. The balance is delicate and all parts of health need to be looked after in order for us all to live our best lives.

Image from: https://neurologycentretoronto.com/the-mind-body-connection/

Let’s look at fibromyalgia as an example, because it is a fairly common chronic pain condition. According to medical research, depression and pain share receptors in the brain. So it’s common for people with fibromyalgia to develop depression (less common the other way around but still possible).^{Dr. Ananya Mandel (news-medical.net)} So treating depression and chronic pain at the same time can be beneficial. A number of antidepressants have found to be in treating both. If you think you’re already on a lot of medication and don’t want to take anymore, then therapy for depression, may also impact chronic pain, especially if you’re clear with the therapist that you’re looking to treat both simultaneously. An even more interesting example is anxiety, which often feeds chronic pain, making it feel worse. Anxiety can increase how sensitive we are to pain, and therefore make the pain worse than it would be without anxiety. ^{Dr. Ananya Mandel (news-medical.net)} That being said, having pain can lead to anxiety, and so it is a vicious cycle. In this case, it might be more beneficial to treat the anxiety rather than the pain. As anxiety decreases, pain should decrease as well. Whether it’s pharmacological interventions, or psychotherapeutic ones (though for anxiety best results are always a combination of the two), if you have a lot of anxiety and a lot of chronic pain, it might be time to get a referral to a mental health professional!

I have a diagnosis of fibromyalgia (along with UCTD) and I used to have anxiety. While I do still have chronic pain, it is much less intense than when my anxiety was bad.

Let’s quickly talk about stigma, because while it’s decreasing, I want to recognize that some people still struggle with it. You are not crazy if you seek out mental health help. You’re not abnormal. A lot of things people tell me are normal, or do make sense given their circumstances. Mental health help is not just for the severely ill, it’s for everyone, because everyone struggles. If it’s a family member that is playing into the stigmatization for you, get them to read this post, or heck the millions of other posts and articles out there on mental health and stigma, and who is seeking services for what. And if that doesn’t help, remember that you have to do what’s best for you, not for other people.

Image from: https://www.twinkl.com.br/resource/t2-p-304-mental-health-is-everyones-business-a4-display-poster

If you have more questions about the body-mind connection, I am going to be doing a podcast episode on it in the near future, so feel free to email or DM me (on Instagram) some questions and I’ll answer them on air! Until then, keep making the most of it!

Chronically Living and how to make the most of it – new episodes every Monday!

Treating Depression

Depression is one of the most common mental health problems (right up there with anxiety). It also commonly co-occurs with chronic illnesses. If you’re feeling depressed, or have been diagnosed with Major Depressive Disorder, it’s really important you are treating it in some form. As a therapist-in-training, I see many clients with depression – some with both depression and anxiety, some with perinatal depression, some with depression and chronic illness – and there are a lot of evidence-based treatments out there. It’s really important to know that you don’t have to suffer alone. So I thought this week, we’d talk about some common treatments, and some up-and-coming ones for depression. I also have an entire podcast episode dedicated to depression and chronic illness this week, which you can access here.

This week’s podcast.

For chronic illness, depression most frequently occurs in people with Alzheimer’s, autoimmune diseases of all sorts, cancer, coronary heart disease, diabetes, epilepsy, HIV/AIDS, hypothyroidism, and Parkinson’s. I got into the criteria for major depressive disorder in the podcast episode, so definitely check that out for more information. When it comes to treating depression, the two most common routes are anti-depressant medications and psychotherapy. Anti-depressants most commonly come in the form of SSRIs (selective serotonin reuptake inhibitors) that alter our brain chemistry because it is implicated in depression (our brains are not the only thing that is implicated though). There is a lot of research that supports anti-depressants in treating depression, though research also shows that it works as well as a placebo. In other words, if you believe it will help it will. Now don’t get me wrong, I fully support someone taking medication (unless you’re pregnant or breast-feeding and can’t – thus why I see many perinatal moms in my practice), however what a lot of people find is that just taking medication isn’t enough to see significant improvements in their symptoms, and many people don’t want to rely on medication forever.

Depression affects about 20% of the population in their lifetime.

That’s where option 2 comes in: psychotherapy. As a student, I see about 10 clients a week plus I co-facilitate a group for 2 hours a week. There is a lot of research that supports the use of psychotherapy. My podcast episode on anxiety, which you can access here, breaks down how much your therapist and you each contribute to your outcomes in therapy, which is important to know. As for what type of therapy, there are many to choose from and they all have good outcomes. CBT (cognitive-behavioural therapy) and it’s third-wave counterparts (DBT, ACT, SFT, etc) are the most common. Typically this involves a combination of talk therapy, where you tell your therapist about your thoughts and feelings, and then the therapist giving you some things to try out in session that you can also practice between sessions (some people call it “homework” but I don’t like that term). Another option for therapy is psychodynamic, which involves talk therapy plus the therapist often makes interpretations. And then there are the therapies that rely mostly on talk, utilizing the therapeutic relationship, such as person-centred, existential, etc. All of these can help and are something I highly recommend. There is also evidence that different lengths of therapy are beneficial as well, from one session of drop-in counselling to short-term (10-20 sessions) of CBT or long-term (more than 20 sessions) of person-centred therapy.

Our thoughts and feelings can be like quicksand. Our natural tendency is to struggle, but that only makes us sink deeper in. The actual way to get out of real quick sand: be a still and flat as possible and let yourself float to the surface.

If you are in immediate crisis because of self-harm, abuse, trauma, and suicidal thoughts/plans, then please contact your local help line. I’ve put some numbers in the show notes for my podcast on depression. A quick Google search can help you find them in your country. If you don’t like talking on the phone, there are some organization that offer texting services. I volunteered for Kids Help Phone in Canada which had switched to primarily a texting hotline since many young people prefer to text. You are strong for reaching out because it is not easy to.

Canada.

In terms of other treatments, a few are available for treatment-resistant and severe depression. Electroconvulsive therapy (ECT), which used to be called “shock therapy” can be helpful for people with severe depression, though there are some potential harmful side effects, and psychiatrists don’t commonly use this unless necessary. Transcranial Magnetic Stimulation (TMS) is another option for treatment-resistant depression where magnetic pulses stimulate the nerves in your brain. Newly approved in Canada (and how I got the idea for this post) is the use of Ketamine for treatment-resistant depression. Ketamine is a dissociative drug that has a lot of research supporting its use for depression. It activates your glutamate, dopamine and serotonin receptors in your brain. It takes effect much quicker than anti-depressants and has shown to decrease suicidal ideation. So far research shows no long-term side-effects, though because it is a psychedelic drug, there is the chance of substance dependency.

Great video for anxiety and depression.

Whether or not you have chronic illness, if you have depression there is hope for recovery, and lots of options available. Talk to your GP, your psychiatrist, a psychotherapist or whomever else is or could be part of your mental health care team. That way, you can keep making the most of it.

How Do You React to New Symptoms and Side Effects?

What do you do when you have an expected new symptom? Or weird side effect from a drug or surgery? Or a better question, how do you feel, not just physically but also emotionally? It’s tough having a chronic illness. It’s tough starting a new medication or having a surgery. And so many chronic illnesses are invisible, so it’s difficult for others to understand exactly what is going on with us.

This is what invisible illness looks like.

The inspiration for this post came from my experience on Saturday morning. I had a hip arthroscopy two weeks ago, and on Saturday when I woke up and started to hop around on my crutches, my foot turned purple, as if all the circulation was cut off. I had a friend staying with me, and honestly, her reaction heightened my anxiety about it. I managed to keep a somewhat level head, emailed some of my practitioners and texted my brother’s partner who happens to be a doctor. Apparently this is a normal reaction after lower body surgeries. Basically I have to keep my foot elevated (at least at heart level) as much as possible. I did also go to the walk-in clinic that my family doctor works at. The doctor I saw looked at my foot and double checked that there were no blood clots, then suggested elevation and compression socks and sent me home.

Purple foot – Saturday morning surprise!

There are a couple of reactions we can have in situations like these, which, let’s be honest, happen often when you have a chronic illness. One, is fear, which, like I mentioned, is easy to be drawn to. It’s the fight-flight-freeze response, with flight or freeze usually taking over. It can be scary, overwhelming, anxiety-producing, even upsetting. It can also cause depression and sadness, because of course, something else stupid and terrible has happened to you. These are normal reactions, and short term responses like this are totally fine. The problem develops when these feelings take over, especially when you have a chronic illness because these situations, these stressors, are going to keep happening. If you are feeling like this more often than not, it’s time for some professional help. Seek out a therapist, because you don’t have to feel this way forever.

Image from: https://www.chconline.org/resourcelibrary/fight-flight-freeze-anxiety-explained-for-teens-video/

The second reaction kind of goes more with the “fight” part of the fear/anxiety response. This reaction is one I often go with which is “how am I going to solve this problem?” I do research (I will literally read scholarly journals online as well as just reddit threads – I need all points of view). I will ask the professionals I know, and the other Warriors I know. I will buy anything I need, whether I have the money or not. I will ask for help (I mean like I needed a ride to the doctor after all). This is a proactive response. The problem with this response is that it can ignore emotion. So, if you’re like me, it’s good to take some time alone to reflect, maybe use some mindfulness, get inside your body and your emotions and let them be what they are. Holding it in can make things worse in the long-term. Mindfulness will be your friend.

This is what I got with my proactive approach – a elevation pillow.

A third reaction is acceptance. It doesn’t mean you don’t experience the short-term emotions of fear and anxiety mentioned above. It doesn’t mean you don’t do some proactive things so you can take care of your body and your symptoms in the long-term. It just means that in the present moment you can understand that this is a thing that happened. It is not a reflection of you. It is (usually) not unsolvable. We all have to deal with acceptance when we have a chronic illness. I did a whole podcast episode on illness acceptance (which I will link below). This is something I strive for always. Can I be accepting when something I don’t anticipate or like happens? I would say for myself, the answer is yes. I do tend to be proactive first, then I try to use mindfulness to experience my emotions, then I try to accept reality. Is this always a perfect process? No. I do have people in my life to help me – mainly a psychotherapist and a naturopath – who are specialists in this kind of work.

Image from: https://www.smartliving365.com/the-problem-with-accepting-what-is/

I hope everyone has a great week. Reminder, I have a premium blog post coming out on Saturday, so if you’re not signed up and you want some more work on self-care strategies, it’s only $5/month and it’s well worth it. Remember everyone, keep making the most of it.

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Disappointment, a necessary part of life

Let me start off by saying that I’m doing a series of posts this month for a link-up. My understanding was to pick 3 prompts and do a post on each. I just found out this morning from the link-up coordinator that you are supposed to do three prompts in one post. If I had known that, I probably wouldn’t have done it. To me, that makes the blog more like a journal. While, I definitely share my personal experiences in my posts, I always set out to make this more of a self-help journey we can all be on together, with hopes that people can take something away to apply to their own lives. I also prefer to do a “theme” of the week (as you’ve probably noticed) rather than a hodge-podge of random information. Since I technically broke the rules of the link-up, I won’t be allowed to participate in any future ones, which is honestly fine with me as I never need writing prompts… I just thought it would be fun to connect with other bloggers.

I know you’re getting a photo of him every week but I miss him.

Anyway, on the topic of disappointment, I know that 2020 has been a s*** show for most people, and we’ve probably all seen our fair share of disappointment this year. The last few months have definitely been that way for me – first my dog being put down, and now, well, current circumstances, which have left me feeling depressed, which is not normal for me (thankfully I have a therapy appointment today). I’m going to share my current disappointment with you in a moment, I am also going to (try to) set myself up (and you too) on the right path to move beyond disappointment, because it is a necessary part of life.

Image from: https://www.walkinmyshoes.ie/library/podcasts/2015/august/coping-with-disappointment-and-failure

As you may know, I am doing my Master of Arts in Counselling Psychology (future therapist here!). What you may not know is that I am excelling in the program (literally have never had a 4.0 GPA and mine is actually higher than that – yes, I’m bragging a bit but I usually eat a lot of humble pie). What you also may not now is that Covid has f***ed practicum opportunities in Canada. We have to acquire our own practicums, and the university told us if we live in a major centre to contact at least 30 sites. I reached out to 63 in the city I currently live. Of these, only three confirmed they are taking students this year (1 I didn’t qualify for based on experience, 1 I interviewed for and didn’t get, and 2 I applied to but didn’t get an interview); 16 places never responded at all, and the rest said they weren’t taking students because of the pandemic. As a result, I also applied/contacted to 5 sites in a neighbouring city (all of which decided not to take any students); 5 in my hometown (2 never responded, 3 said they aren’t taking students); 1 in a city my older brother lives in (had an interview, didn’t get it), and 15 in a city my younger brother lives in (applied to 3, didn’t hear from 3, and the rest said they aren’t taking students).

My school I.D. photo lol

Okay, so that’s the backstory. The thing is, one of the places in the city my younger brother lives in actually accepted me as a student at the end of September. So, though I still had to do an application process through my uni, I did get some initial excitement going about living near family again and moving to the mountains! I have been in contact with my site supervisor, and have almost all my forms ready to go for school – the package is due Nov 1. Then yesterday, I hear from the university (who had initially sent off my application as the site is with a health authority) that the site has decided they took on too many students and cancelled my placement. While they didn’t say why mine was the one that was cancelled, it can be assumed it is because I currently live in a different province, as the health authority itself stated it prioritizes in province students. Here’s the thing, the site supervisor said he was still willing to supervise, and the whole thing is of no cost (at least monetary) to the site. It’s hard not to feel like I’m being penalized for the pandemic/living in the wrong province apparently. I know a lot of other students have had to defer their practicum until May but I’m already 35 and just want to get my career started. Thus disappointment. By the way, the health authority did tell the university they could submit my application to some of their other sites in the same region, so they did yesterday, but it sure puts a time crunch on the whole thing for me if there is a yes out there (fingers crossed).

Where I was supposed to move to… and hopefully still will.

So how do we work through disappointment? First and foremost I think it’s necessary to live in the emotions we feel. For me that started as stress and anxiety and has lead to deep sadness. I can only really move on if I fully feel these emotions, and so I will. Second, it is important to talk and process with someone. Like I mentioned, I will be having a session with my own therapist today (and yes, therapists do often have therapists) to do just that. If you don’t have one (you should!) then with a family member, friend, or partner also suffices. What I like about an impartial person to do this with is that they can get you to do more exploration and problem solving than someone who is just going to reiterate your own feelings and concerns back to you, or blame someone/something else for your disappointment (not saying the disappointment is your fault). Third, is to be proactive with what you can do. Apparently my decision could not be appealed by my site supervisor or the school, so I found a contact form and sent it off to the site explaining the situation and asking for a decision-maker to contact me. I also had the university send off my application to the other sites. I will continue to work on my school work (paper due this week) and try to keep myself busy and distracted while I wait to hear. Finally, I look at the worst case scenario. For me that is differing my practicum and doing in it May. Is that ideal or what I want? Nope. But will I survive? Yes. As I said, disappointment is a part of life, but it is the choices that we make when disappointment arrives that determine what our futures will be like.

I must live by my mantra now more than ever.

Thanks for reading, and keep making the most of it!