Making Relationships a Priority When I’m Tired and Everything is Important

Posted on June 6, 2016 by MSAA

By Stacie Prada

I didn’t worry about needing to consider my social life as it related to my health before I was diagnosed with MS. The downside was I also pushed myself beyond my limits and consequently averaged two exacerbations per year. Unknowingly I was adding stress to my body and accelerating my MS disease activity.

Spending time with friends and going on adventures were something I believed I should be able to do, and I didn’t see fatigue as a symptom of something larger and more serious. I still believe I should be able to spend time with friends and experience adventures, but I now weigh and budget the energy it takes with the joy I’ll experience.

The Harvard Study of Adult Development tracked men for 75 years (and counting) and showed that people with good quality relationships with family, friends and community are not just happier than people without good relationships, they are also physically healthier. They experience less memory loss, pain doesn’t affect their mood as much, and they’re generally more resilient.

As such, I see my relationships as imperative to my future health. Investing time in my social relationships is not optional. MS symptoms like fatigue can make it more difficult to build and maintain those social connections. When work, bills, housekeeping and everyday tasks take more energy than a person has, it’s easy to turn down invitations to social gatherings and become isolated.

Rethinking beliefs:

I grew up believing that school came first and only after you get all your work done can you get the reward of playing with friends. As an adult with a chronic condition that affects my energy level, I’ve learned that this approach feels like constant punishment. It also neglects the human need to have more in life than work. I’ll never have enough energy to do enough of the good stuff I want to do after all the work is done. To compensate, I pace myself on things I need to do, reduce the effort it takes to do them, and save enough energy for the good stuff in life. Among the good things are spending time connecting with other people.

I’ve heard the saying that to be rich, a person can make more or want less. I translate that as to be more energetic, I can make more energy or use less energy. I can do things that recharge my energy level, and I can conserve my energy by reducing the effort it takes to do things.

I boost my energy by exercising, eating nutritious food, being organized, pacing myself and resting. I’ll conserve my energy by streamlining, prioritizing, and delaying or delegating tasks. Doing these things allows me to feel confident that I’m doing the best I can, and it allows me to feel justified in placing a high priority on fun and relationships.

Prioritize Joy and Relationships:

A terrific method to maximize joy with limited energy is to double up on the benefits by combining things that need to be done with social interaction. I’ll go for a walk with a friend to combine exercise, social engagement, time outside getting fresh air, and time not eating or doing other things I should limit.

If I need to do some shopping, I might go with a friend who can drive and help me find what I need. I make sure to allow time to rest before, during, and after the excursion. It often changes the experience from one that can be draining to one that is invigorating and recharging.

I’ll reduce the effort it takes to participate in social events. I’ll shorten the length of time I’ll stay, but I’ll still show up. Sometimes I choose events that are easier to do and less physically taxing. Other times I’ll choose events that may require a lot of energy but are rewarding and worth the effort. If I love it, I make sure I streamline and reduce other activities so that I can have enough energy to do the one that’s a big deal.

The level of effort it takes to engage socially vastly ranges. I can choose how I want to connect at any time based on my level of energy and the relationship I want to maintain:

Text
Write an email
Write a letter or send a card
Call them on the phone
Skype
Meet for coffee, lunch or dinner
Go to a movie together
Exercise with a buddy: Go for a walk, hike, bike ride, swim, etc.
Go to an event: Attend a concert, museum, or dance
Plan an adventure
Take a trip, visit family, explore new places with someone

It also helps to explain to the people in your life how MS might limit your activities and that you’ll do your best to stay connected. While talking on the phone with my sister one night, we were having a very engaging and fun conversation when I hit the metaphorical wall. I interrupted her, “I’m sorry, but I need to go now so I can go do nothing.” We laughed at the time, and I still crack up that I could say that to her without being rude and without her feelings getting hurt. It’s important and empowering to recognize when to push myself to be socially engaged and when to quit while I’m ahead.

*Stacie Prada was diagnosed with RRMS in 2008 at the age of 38. Her blog, “Keep Doing What You’re Doing” is a compilation of inspiration, exploration, and practical tips for living with Multiple Sclerosis while living a full, productive, and healthy life with a positive perspective. It includes musings on things that help her adapt, cope and rejoice in this adventure on earth. Please visit her at http://stacieprada.blogspot.com/

Monitoring MS Symptoms and Trying To Avoid Relapses

Posted on March 21, 2016 by MSAA

By: Stacie Prada

Most of my energy is focused on managing my health with the goal of avoiding relapses and disease progression. Since fatigue tends to be my earliest symptom when I’m headed for a relapse, I monitor my fatigue level and adapt my activities and schedule to treat fatigue seriously.

By the time I was diagnosed with MS, fatigue had become a constant presence in my health. I felt I had no choice but to push through it and only stop when I physically could no longer do any more. Just because I could push through it at times, it came at the price of relapses. In the span of a little more than a year after learning I had MS, I had three exacerbations.

Fortunately my MS is relapse remitting, and my body has responded well to disease modifying medication and lifestyle changes. It’s now been four years since I’ve felt like I had an exacerbation, and my MRI scans support the conclusion that I haven’t had a relapse in that time. Please know that I know I’m lucky this is working for me, and someone else may do everything they can and still have relapses. What I’m doing now may not work forever, but I’ll keep doing it as long as it works for me.

Specifically I listen to my body and take it seriously when my energy level dips. I track my fatigue level and adapt my activities based on that level. When fatigue overwhelms me or I’m having an exacerbation, I prioritize self care above all else. The hard part about self care is that what I think I may need in the moment might not be helpful for me in the long run. A good example is sleeping during the day. Sleeping more than an hour or so during the day usually upsets my sleep hygiene and keeps me up during the night. Once that starts, it can take a week or so to get back on track and sleeping through the night again.

If I’ve hit the point where I realize I need to stay home from work or other activities, I’ll clear my calendar. I’ll prioritize obligations and only do the top of the list based on mandatory items and those that will support me the most. The threshold for a mandatory item is really high at this point, and they’re things that absolutely can’t wait to be done differently.

Following these guidelines helps me make good use of my time for physical health recovery and mental health maintenance:

1. Look into yourself. What do you need most right now? The answer will be different from moment to moment. Check in frequently.
2. Rally the troops on standby. Let people know who care that you’re managing your health and this is a normal part of your life. Promise to let them know if there becomes cause for worry or a need for assistance.
3. Reduce input. Focus on one thing at a time. Limit technology as it can make your eyes tired and tax your brain.
4. Wear comfortable clothes, but still get dressed and groomed if possible. You’re not sick; you’re maintaining your health!
5. Move your body. Stretch, move each part of your body if possible. A slow yoga sun salutation can stretch most muscles in the body, raise your heart rate and lift your spirit. It takes energy, but the physical and emotional reward is tremendous. If you don’t feel up to much movement, just move from the bed to the sofa or a chair. Any movement helps!
6. Don’t move your body. Lay down. Close your eyes. Meditate. Make yourself so comfortable that there is nothing else you’d rather be doing in this moment.
7. Nap only if necessary. Maintaining a regular sleep cycle is important, and napping can disrupt nighttime sleep for days to come.
8. Open the drapes or blinds. Let in the daylight. Rest somewhere other than bed if possible.
9. Stick to regular routines for meals and snacking if possible.
10. Do something productive. Journal, learn something new, research a topic, declutter, organize, write a thank you note, or make a healthy dish. Limit it to the level of your energy, and don’t push too hard. Intersperse these activities with doing absolutely nothing.
11. Be responsible and responsive. Know your work and social commitments so you may cancel or postpone them proactively. Or go in to work for an hour or so and do the absolute minimum that can’t be postponed or canceled. Leaving colleagues and friends scrambling to cover for your commitments will understandably cause frustration and resentment on their part, guilt on yours, and more tension in your life.
12. Seize opportunities to pause. An unscheduled hour or two during your work day may be ideal for taking some personal time off from work. This may help reduce the instances of needing to take a full day off from work and the impact to your colleagues.
13. Congratulate yourself for having the strength and good sense to listen to your body’s signals and adapt your schedule to accommodate them!

I wrote about my Pause Approach during a particularly difficult week years ago, and I still refer to the guidelines I created for myself when I’m feeling vulnerable to an MS relapse. It reduces time and energy spent trying to decide what I should do, and it helps me give myself permission to take care of myself. That’s the best I can do for myself as a person living with MS.

Relationship Changes: How an MS Diagnosis Can Change Relationships

Posted on February 12, 2016 by MSAA

By: Stacie Prada

The personal growth that can come after an MS diagnosis affects our relationships drastically. In facing our fears, the unpredictability of MS, and grieving the future we envisioned, our relationships can’t help but change. The experience reveals the dynamics that no longer support our mental and physical health or the future we now need. A friendship or marriage can blossom, or it can crumble from the magnitude and pace of change. And the outcome doesn’t dictate the value of the relationship, determine the efforts taken to maintain it, or judge each person’s character.

I may have been on a life path where my way of interacting would have evolved this way without an MS diagnosis, but I think the diagnosis definitely accelerated my need to take care of myself.

I don’t relate to people exactly the same anymore. I strive to notice when I’m contributing to a poor dynamic, own my words and actions, and distinguish between my issues and other people’s issues. It allows me to have some control over my life instead of unconsciously reacting to circumstances. It also reduces the stress that comes from feeling responsible for other people’s feelings and actions and trying to fix everything.

Some people saw this as rejection or abandonment. Others embraced it, and our interactions flourished. To me it felt like I was supporting them with new behaviors that weren’t at my expense and inviting them to join me.

I appreciate all of these relationships regardless of where they are today. These people are all a part of my life and history. I want to support them in their own life paths that are best for them whether our paths continue to cross or not.

New Year Goals and Designing My Life

Posted on January 18, 2016 by MSAA

By: Stacie Prada

My approach toward New Year resolutions is to just pause, think about things I want to accomplish or do in my life, or stop doing for that matter, and make a plan. It’s less about making resolutions than focusing my energy toward goals I’d like to achieve and living a life I’ll love. I think of it as designing my life and using a new year to motivate me to consider and organize my priorities.

Articles online say people fail their New Year’s resolutions within a very short time into the New Year. I’d rather commit to change and effort than to a specific task-based resolution that isn’t always achievable when health issues or life obligations interfere. It’s also easy to get sidetracked. If I have a plan and a mechanism for remembering what I’d like to accomplish, I’m more likely to succeed.

This approach was very successful for me last year when I signed up for a marathon. I stretched a 20 week training plan to 36 weeks. It allowed for plenty of setbacks without the pressure of failing. It also helped keep it fun. See my post, “Adapting to My Limitations and Doing a Marathon Anyway.”

Considering my MS disease progression will likely include mobility issues in the future, I prioritize being active. I think about things I want to do in my lifetime that I will enjoy and that I may not be able to do if I lose my mobility. My goal is to try to do them sooner than later. If I don’t do some of these things, it won’t ruin me. But I want to be conscious of them and incorporate them into my life now if possible. I enjoy planning and doing them now, and I will enjoy them in the future while reminiscing about them.

None of the changes I want to make are done in the first month of a new year. Instead, my intention is to prepare. I’m not setting up resolutions to do things perfectly all year long. I’m creating a plan with routines to make progress toward living a life I love while enjoying my life as it is today.

Making and Preserving Memories

Posted on December 28, 2015 by MSAA

By: Stacie Prada

As we embark on a new year, I think about the highlights of the past year. What makes me grin, what am I proud of accomplishing, and what was meaningful to me? How can I memorialize these things so that I can enjoy them in the future? I think it’s important to mark the passage of time, celebrate our successes, and keep our years from merging into each other without distinction.

When asked what one thing people would save in case of fire, they often say their photographs. I think this is telling for how important memories are to us, and I think this is helpful information for us to proactively add joy and meaning to our lives.

If we lose our photos, we will hopefully still have our memories. But what if we lose them with MS disease progression or aging? I may never reach a point in my life where I experience the extent of memory loss that people with Alzheimer’s and dementia experience. Still I think it’s helpful to look at the extreme cases and learn from them. People with dementia are sometimes able to recoup some memories through music, stories, and photographs, and this can improve their quality of life.

Creating Memory Triggers: We can work to improve our memory, but I also think it serves us well to create memory triggers that help us retrieve memories. I like to preserve memories physically through photographs and mentally through tying them to other things like music, people, food, and aromas. I try to enjoy the moment, feel it, and store it away in the subconscious. These are some ways I enhance my experiences and create memory cues:

• Take photographs. I love my camera and tripod attachment that will allow me to take a time delay photograph of everyone in the room – no need to have one person take the photograph and be left out of the photo. Have someone take action shots of you doing things you love. These will help you remember how you felt while doing them.

• Put photos in an album either in hard copy or digital format. Just make sure they’re accessible to look at. If you can add notes about the photo, all the better.

• Pay attention to music. Buy the soundtrack to a movie you enjoyed. Make a playlist of the songs you heard for the first time this year or are meaningful to you at this time in your life.

• Journal about things you care about. This is a terrific way to remember your thoughts and how you felt at a specific time in your life.

• Relish the taste of foods you love. Tell people in your life your favorite foods. It’s pretty incredible how people tend to remember other people’s favorite foods.

• Take time to smell things and register them. Think about how a baby smells fresh from a bath, how a forest smells after a rain, or how baked goods smell fresh from the oven. Take a big whiff if you like something, and pause to appreciate it.

Preserving my memories is not a solely selfish endeavor. My memories involve my friends and family, and compiling them is a gift for them to share with or without me. My mother kept a scrapbook for our family when I was young, and the stories she wrote to accompany photographs truly tell a lot more beyond the photographs. She’s been gone many years now, but seeing her thoughts preserved in her handwriting brings her back to us in a special way. My sisters and I treasure them, and things we may have known at one time but hadn’t remembered are available to us now.

With MS, other neurological diseases, and just aging in general, cognition and memory can be something that declines. The idea of losing my memory is scary, but it’s less so when I can actively do things that may improve my life now and for years to come.

Resources:
• Music & memory is an organization that provides iPods with personalized playlists to people with Alzheimer’s and dementia that improves those people’s quality of life. https://musicandmemory.org

• StoryCorps’ mission is to provide people of all backgrounds and beliefs with the opportunity to record, share and preserve the stories of our lives. They have an app that allows anyone to record their stories. https://storycorps.org/

Responding To Comments That I Need To… (Fill In the Blank Here)

Posted on November 23, 2015 by MSAA

By: Stacie Prada

It personally bothers me when I read online articles telling people “What every person needs to do…”and presenting it as fact. They don’t know me, and what may work for the masses may not be appropriate for me.

A simple example of this is kale. Kale is very nutritious, has a lot of health benefits, and I feel good when I eat it. People with hypothyroidism or taking blood thinners need to avoid kale. What’s good for many people is not good for every individual.

It’s common for me to explain to people suggesting I take immune boosting products why I don’t. People think that because they’re successful avoiding or recovering from colds by taking immune boosting products that I should take them too. I’ll nicely explain that I take a disease modifying drug to suppress my immune system because it works too well. While I want to maximize my health, intentionally trying to trigger my immune system to start fighting isn’t good for me. I also explain that eating foods with anti-inflammatory properties does work well for me. We’re all different.

So while it bothers me to have someone tell me they have the answer to my problems, I respond to it the same way as if they’ve just made a suggestion. I’ll honestly let them know whether I’ve already tried it, I’m doing it now, I’ve tried it and it didn’t work for me, or that I’ll look into it. I have a mental list of things I want to try but am not ready to do yet. Some of them like doing yoga and seeing a naturopath took me years before I was ready to try them. When I did, they were a huge benefit to me and I wished I’d tried them sooner. I followed up with the person who’d made a suggestion and thanked her. I let her know I’d finally done it and loved it.

Response Tool Box: I like to think of communication as a toolbox with tools that we use regularly and others that don’t come as naturally. Sometimes we use our standard tool and it works great. Other times it takes three or four tries with different tools before we convey our message. I’ve found that the following methods have worked in response to comments that make me uncomfortable, that seem hurtful, or that I’m not up for answering in the moment:

The blow off: If a comment is too ridiculous or mean and you don’t want to address it at all: pretend you didn’t hear it. Focus on something or someone else and continue the conversation.
Incredulous silence: If you want them to know it was inappropriate or hurtful, a paused look of shock can work. And move on to something else.
Honesty: Say their comment is hurtful or too personal for your comfort level and you’d rather not discuss it. And move on to another topic.
The improvisational approach: Consider the comment as valid, build on it to the ridiculous and humorous conclusion, and laugh it off. It works best if your response really is funny and doesn’t embarrass the person who made the initial comment.
Find an advocate: Turn to a friendly face in the group and ask what they think about the topic through eye contact or explicit words.
Connect: Find the kernel of accuracy in what they’re saying, and comment on how that is true before explaining more about your experience.
Insight: Someone has said something completely foreign to anything you’ve thought before. Say that’s interesting and you’re going to think about it.
The delayed response: Sometimes a comment sticks in my head long after the conversation is done. I allow myself permission to bring it up later after I’ve thought about it. There’s no time limit to letting someone know that something they said made an impression on you.
Reschedule: If my energy is low or the event isn’t really conducive for the conversation and I really would like to discuss it another time, I’ll tell them.
Defer: There is a lot of information on the web about this topic, and I’m still learning all the time. I know some terrific websites and articles that can explain it much better than I can. If you’re interested in them, I’m happy to send them to you.
Question: See if you understand their questions accurately. Ask them if your understanding of their question is correct. Ask them to tell you more about why they’re asking. Sometimes people ask leading questions because they want to tell you something. Let them.

Talking About MS

Posted on November 20, 2015 by MSAA

By: Stacie Prada

Over the years, it’s gotten easier and easier for me to talk about my MS and respond to questions and comments. When I was newly diagnosed and didn’t understand how MS affects my body, I felt a little anxious when people would bring up the subject expecting me to have all the answers. And sometimes I was just too fatigued to have the energy for thoughtful discussion.

I went from knowing nothing about MS to being an expert in how MS affects me. It took a lot of time and effort, and it’s helped me to manage my health better and be able to respond to questions and comments. Now I think of MS conversations as more of an opportunity to connect than a list of pat responses.

Lose the guilt: I think a lot of my anxiety in these early conversations was due to me not wanting to accept that MS will affect my life. I wanted my will to override the physical restrictions MS was placing on me. It took time for me to fully accept that I can’t control or outsmart my body and do everything I used to do or want to do. While I was holding on to the feeling of inadequacy, I couldn’t discuss my MS without feeling a little shame or guilt. And that mindset makes every conversation uncomfortable for all parties. Accepting I can control some things and not others allows me to talk about my MS with confidence. MS is not a character flaw; it’s a medical fact about how my body functions.

Assess the situation: Think about the event and make a goal. Is it to get through the occasion? Is it to have fun and avoid drama? Is it to connect with certain people and have long, meaningful conversations? Each situation will lend itself to a different response.

Determine their motive: Why are they saying what they’re saying? Are they trying to be mean and judgmental? Or are they seeking assurance that you’re okay and they don’t need to worry about you? There’s a difference. A person genuinely trying to help deserves compassionate response. On the other hand, a miserable person that enjoys drama and putting people down is always going to win at their game. They’re too good at it. They’re not reading articles about how to get better at dealing with people they want to make feel bad. If you don’t feel comfortable talking to these people, avoid them if you can. Solicit someone to be with you that can help you cope, by either sticking up for you or diverting the conversation. Lashing out or trying to make the person feel hurt like you feel won’t help in the long run.

Consider the source: Is the challenge how that person interacts with you, or is it the topic that worries you? There’s a big difference. People that are consistently aggressive or love to put you down because they’re “just kidding” can be dealt with differently than people that are trying to be helpful but are pressing your buttons.

I try to remember if I’ve ever had a good interaction with this person and what made it good. It sometimes gives me some ideas for how to deal with future conversations. It’s also helpful to consider how informed this person is. Even if they know a lot about MS, I know they don’t know my body or experience as well as I do.

Know yourself: When we’re at the top of our game, we might be able to roll with an insensitive comment easier than when we’re tired, feeling overwhelmed, and experiencing MS symptoms. We all have certain things that make us uncomfortable. Knowing and accepting my triggers allows me to get through situations better.

Stay true to yourself. Be you. Be the person you like being. The interactions I’ve regretted have been the ones where I felt baited to respond in a way that doesn’t align with my core. Don’t let another person’s comment dictate your mood or change how you feel about yourself. This can be tough when you’re feeling low or frustrated that you even have to deal with MS at all. The guidelines I aspire to may be different than yours, but I’ll include them here as an example:

Be genuine and sincere. Coming from a place of anger allows them to diminish your feelings with justification. Coming from a place of curiosity and connection may not always succeed, but at least you can feel good about how you behaved in a stressful situation.
Be funny. Be willing to laugh at your situation if you’re able, whether they’ve made the joke or you have.
Lead by example. You teach people how to treat you by how you react and how you treat them.
If you blow up, make amends when you can, and forgive yourself.
Remember it’s a conversation and not a pop quiz or Q&A. The focus doesn’t have to stay on you. You don’t owe anyone a response to a question that makes you uncomfortable.
Remember you don’t have to be perfect, and neither does anyone else.

Invite Connection: Some people are worried about saying the wrong thing, and they may need you to give them permission to talk about your MS. When someone like this asks how you are, answer them honestly. And simply tell them that you’re happy to answer any questions they have. It lessens their anxiety and invites conversation. It also reduces the burden on you to figure out what they want to know.

Ask them what their experience with MS is. Have they known people with MS? What’s their knowledge about it? I didn’t know anything about MS when I was diagnosed, and I knew of one person socially that had MS. I’d seen her once with a walker and visibly struggling, and a year later saw her looking fine. Given my extremely limited knowledge of MS before I was diagnosed, I can relate to people that have no concept of MS or other chronic illnesses.

I’m glad when people have an interest in learning more, and I want to encourage them. Being a safe person to ask questions builds compassion and empathy on both our parts. I’ve learned a lot and come to a greater understanding about myself and others through these MS conversations. Even better, I’ve received a lot of support, felt good about myself, and enjoyed a LOT of laughs.

Stay tuned for part 2 to read about tips for responding to questions.

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