 Welcome to Happiness Isn't Brain Surgery with Doc Snipes. This podcast was created to provide you the information and tools Doc Snipes gives her clients so that you too can start living happier. Our website, docsknipes.com, has even more resources, videos and handouts, and even interactive sessions with Doc Snipes to help you apply what you learn. Go to docsknipes.com to learn more. Welcome back to Happiness Isn't Brain Surgery with Doc Snipes, practical tools to improve your mood and quality of life. We are continuing with part two of Living with Pain and Chronic Illness. In this section, we're going to review the effects of pain and chronic illness, including grief, self-esteem problems, and circadian rhythm disruption, which we've already talked about a little bit. And we'll explore what I keep referring to as mitigating and exacerbating factors, or what makes it better and what makes it worse. Effects of pain and chronic illness can include grief. Now, grief is something you're like, well, that's a simple thing. Well, no, unfortunately, grief is a bunch of emotions, kind of like an onion, with lots of layers, maybe not like an onion because people bounce back and forth between different layers. I'll find a different metaphor. It's important to understand that in the grief process, you go through denial, anger, bargaining, depression, and acceptance. So if you're diagnosed with a chronic illness, your first reaction may be, I want to get another opinion. That can't be right. That's denial. The second may be anger. Why is this happening to me? Bargaining, some people go through it, some people don't. Depression is that sense of hopelessness and resignation to, well, this has happened. I don't know how to deal with it, and I haven't figured out how to integrate it into my life narrative right now, because it's not, this person with this condition is not who I am. So that may send you back into anger because you're like, well, that's not who I am. That's not who I want to be. This isn't fair. And then you go back to depression and you bounce back and forth for a while. That's normal. Acceptance is the stage at which you are able to integrate it, if you will, into your life narrative. And, you know, I know that sounds kind of hokey. But basically, you have taken whatever that diagnosis is and accept it. It's part of who you are. And you've accepted, all right, this is the way it is. It's like having brown hair and brown eyes, just the way it's going to be. So how do I deal with it in order to live the highest quality of life? I can't. It takes a while. And even after you've reached acceptance, there may be days that you bounce back into anger or depression, and that's OK. Understanding it, identifying it, and instead of fighting against it, going, you know, today's a bad day. What can I do to make it better? Is going to be how you can deal with your grief once you get through it. But it's going to be important to address those thoughts you're having that are making you angry and address those thoughts that you have that are making you feel depressed and hopeless and helpless. A lot of times you can counter those thoughts with very positive empowering thoughts, because like I said in the last presentation, there are millions of people with chronic conditions that live extremely high qualities of life. You may not be able to do everything exactly the same way as you did before, but you can. And it's not a chronic condition, if you will, but aging. I'm a runner. I love to run. And I started running again. I had taken a little siesta from it for a while or hiatus. And I went back to running and I'm not as fast as I used to be. And I got frustrated about it. And I started working like crazy on my speed and on my distance at the same time. Because, of course, I'm going to try the same training plan that now that I'm almost 50, that I did when I was 20. And my husband just shakes his head. He's like, you realize you're not 20 anymore. And I got a little missed at him. I'm like, that doesn't mean I can't run. Like I did when I was 20. He goes, yes, it does. And it took me a while to come to acceptance of the fact that, you know what? I'm not going to run anymore like I did when I was 20. So it's just coming to an acceptance of whatever is. And instead of fighting against it, figuring out how you can work with it now that it's happened. So interventions work through the stages of grief for each of the losses because of the pain. Now losses. Yeah, when you have pain or chronic illness, you're going to lose things. Just like I said, even just with aging, I've lost the ability to run like I did when I was 20, I am not 20 anymore. And I wasn't ready to give that up yet. When you have a chronic condition, you may have to identify some physical things that you've lost, like your endurance or your stamina or whatever it is, any physical abilities that you used to have that you can't do anymore. You may have some self-concept losses because this is who I am. I'm, you know, a competitive runner. Well, yeah, I can still be a competitive runner. But for example, if I had to have a knee replacement, I might not be able to be a competitive runner anymore. So that would be taking away that part of who I always defined myself as. Does it mean I'm less of a person? Does it mean I'm less lovable? No, it just means I'm an ex-competitive runner. But coming to acceptance of that, you have to grieve every loss. You have to go through that denial, anger, bargaining, depression and acceptance for every loss. It doesn't matter if it's somebody dies or a part of you or a part of your self-concept dies or is taken away. If you lose your job, maybe you can't do the job you used to do. I knew a lot of cops when, you know, over the years, my husband was in law enforcement for almost 20 years. And I knew a lot of cops who ended up having to retire because of certain physical injuries. I've known a lot of soldiers who have had to retire because of injuries and not having that job anymore, which has been a huge part of their life for, you know, 15, 20, 30 years can be extremely devastating. So going through the stages of grief, looking at everything that you might have lost or you think you might have lost because of this condition and dealing with it, working through your anger and your depression, your frustration that you can't have that back. And then figuring out how you're going to accept it. So, OK, maybe I can't be a patrol cop or maybe I can't be a soldier on the front lines anymore, but can I stay in the military? Can I still work in law enforcement in a non-sworn position? What can I do instead? Other things that you may lose are even things that are a little bit more vague like your dreams. Maybe you was always hoped that you were going to be able to run a marathon and then suddenly your diagnosed with fibromyalgia and that's not going to happen anymore. Accepting the fact that that's not going to happen and maybe figuring out, all right, well, I'm not going to be able to knock that off my bucket list. What can I do instead? And redefining what the future looks like with this new caveat to it. I mean, when we have kids, I think most of us before we had kids had this whole grand scheme laid out. And then when we had kids, it changed a little bit. Sometimes, you know, well, in my opinion, always for the better. But, you know, there are some things that I thought I would do when I was before I had kids that I know probably isn't going to happen now. That dream had to go away. I had to choose. Now, what I replaced it with, you know, being a mother is so much more fulfilling or at least as fulfilling that it doesn't it's not a big deal to me. But I had to come to the realization that I can't do everything. There's just not enough hours in the day, so I have to choose. So when we're talking about pain and chronic illness, again, look at what's making you angry. I won't be able to. I can't do this anymore. I am whatever and start dealing with those feelings and figuring out, OK, that's how it is. What can you do now? How can you direct that energy that you would have used for that to do something positive, just different? Self-esteem is the way you feel about yourself compared with who you feel you should be or who you want to be. People with high self-esteem, you know, kind of think they're all that in a bag of chips. They're like, I am a good person. You know, people should like me. I like myself and that's a great place to be. But when you start getting if you have symptoms of a chronic illness, whether it's fibromyalgia or chronic fatigue, and maybe you can't get out of bed and do all the things that you used to do anymore and you feel exhausted all the time. Your self-esteem may take a hit because you may start feeling guilty. You know, we talked about that that guilt feeling. You may start feeling guilty about not being able to do the things you think you should. And there's that should word again. So redefining your self-esteem and focusing on the things that are awesome about you. So make a list of the positive things about you. Identify one or two goals you can work toward. You know, maybe you've got chronic fatigue syndrome and you can't go to every single play and game and meet that your kids have because you've got three kids and they're all involved in extracurriculars and you just don't have that kind of stamina. OK, so maybe you can go to one of those each week and rotate which child you show up there for. And then the kids whose presentations you can't go to, you do something else special instead. Maybe somebody records the game and you're able to watch it at home with them. Is it the same as being there? No, not necessarily. But does it demonstrate that you care and that you want to be there and you're there in spirit? Certainly. Celebrate small things, you know, congratulate yourself if, you know, maybe you go an entire day without needing to lay down and take a nap. And for some people, that's a huge milestone. And silence the inner critic. Just tell him to shut up. The inner critic is that heckler that's in the back of your mind that is always telling you you're not good enough or you should have been able to do that or anybody else would have. Fill in the blank. Just honestly, it's not really all that complicated. Just tell him to shut up because that's not what you need to hear. Those are the thoughts that are going to keep you stuck and anxious and arguing with him and saying, well, trying to justify why you did something that you're in a losing battle because you're fighting with yourself. So when you have those inner critical thoughts, one of the easiest things and first steps to do is just don't go away. Circadian rhythm disruption can happen if you don't get out of bed. And some days you can't. When I was on bed rest with my with my daughter, you know, I wasn't allowed to get out of bed and, oh, boy, I never knew how tired you could get staying in bed all day long. So not getting out of bed can throw your circadian rhythms into just a complete tizzy. And your brain's not sure when it's supposed to eat, when it's supposed to sleep, when it's supposed to be awake. So you're just kind of in this fog all the time. Think of it like perpetual jet lag. Staying inside in the dark, even if you can get out of bed, if you stay inside and watch Netflix marathons all day long, keep the blinds closed and just try to avoid the world. It's probably going to monkey with your brain chemicals and your brains again, not going to know when it's daylight. We want 14 hours a daylight a day and 14 is a good kind of round number, you know, in the winter, people start getting depressed. Well, the days are so much shorter. You get up, you go to work, it's dark out. You leave work, it's dark out. And if you work in a building with no windows like I have for many years, you don't even really realize when the sun comes out or if it comes out. So your brain again, doesn't know if it's supposed to be awake or asleep. Now, sometimes you can't avoid that. So staying in a well lit area at least 14 hours a day is really helpful to kind of keep in your rhythms stabilized. This is not the same as light therapy. Light therapy uses much brighter lights and it's much more intense for a short period of time each day. And you can talk with your doctor about that if you think that would help. What I'm talking about is just not going into an office and having a single 40 watt bulb illuminating the entire office. You know, keep it bright, keep it obnoxiously bright if you need to. And it really does help a lot of people. Try to get out of bed at roughly the same time each morning, even if you don't feel like it. It doesn't mean you've got to get up and jump into the shower and head off to the gym. It means you need to get up and start moving. Get dressed in your day clothes. I encourage people to do try to get dressed in your day clothes, you know, within an hour of getting up each day. This is one of those cues, one of those things we do that tells our body it's time to be awake and it's time to get started with our day. The same kind of cues we use in the evening when we set our sleep routine, telling our brain, OK, it's time to start winding down. After I had both of my children, I had really bad postpartum depression with both of them. And there would be days that I would never get out of my jammies. You know, it was just get up, feed the baby, you know, watch the baby, play with the baby, feed the baby. You know, it was just kind of go on on autopilot. But I would never get dressed in my day clothes. And I kind of never felt like I woke up. I was in a fog. And there's a lot more to it than that with postpartum depression. Don't get me wrong. But getting up and getting dressed in your day clothes can help trigger your body to say, all right, it's wake up time. Let's secrete some cortisol so we can get some energy. Turn on lights and sit in front of a window or get outside to get your day clock started. I encourage people to get as much sunlight as they can during the morning and the evening to wake their brain up and then so their body can see the sun starting to go down. Try to sit by an open window when you can. If you can sit out on a covered porch, that's great. You know, I know a lot of people have concerns about skin cancer. You don't have to be outside and getting, you know, hours and hours of sun each day. They found that 15 minutes a day is enough to really set those circadian rhythms. So 15 minutes before nine in the morning and after four in the afternoon, 10 minutes each time, pretty easy. If you must take a nap, try to keep it under 45 minutes to avoid messing up your sleep schedule. Once you get past 45 minutes, you start to get into a deep sleep cycle and then that can trick your brain again, not knowing when it's time to actually go to sleep. This may be different for some people based on your chronic condition. So again, always run it by your doctor and see what they think about it. So exacerbating and mitigating factors, exacerbating factors make things worse. So whatever your condition is, if it's your diabetes and your blood sugar, if it's chronic pain, if it's chronic fatigue syndrome, whatever the condition is, what emotional factors make it worse? For a lot of us, for the majority of people, stress, anxiety, anger, and to a certain extent, depression will tend to make the condition worse or at least seem worse. Mental factors include having a negative attitude or focusing on the pain or the condition itself and obsessing about it. Physical exacerbating factors can be poor nutrition, not getting enough sleep, having poor ergonomics. If you don't sleep well, if you don't have a good mattress and a good pillow, you're probably not going to sleep as well, which is going to have ripple effects. But mattresses and pillows aren't where ergonomics stops. If you work at a desk all day long, make sure you have a proper desk setup for your posture to prevent pain and minimize fatigue. When you're sitting in your chair or on the sofa watching TV, and I know some of us do that for a couple hours a day sometimes. If you're doing that, again, make sure you're sitting in a way or laying in a way that is supportive of your body and you're not all kind of kinked up, leaning your head on the dog's thigh or whatever it is. Sometimes I'll use my boxer as a pillow and that's probably not the best idea. But pay attention to what makes your situation worse. Environmental things that make your situation worse can be environmental things that increase your stress or just things like, like I said earlier, if you notice that when a rain front is coming in or a cold front is coming in, you start to feel a little bit achier. Even if there's no scientific evidence behind it, know that when those days happen, there's going to be a period where you're feeling a little less well. So how can you accommodate that? If you're not on your A game, what can you do to be kind and compassionate to yourself? Oh, my gosh, there's a concept instead of fighting against it. If something happens and you can't control it and it makes your condition worse, say, all right, I'm not on my A game. Let's drop back and punt and figure out how I can work with this. You do it at work all the time. Think about it. You go to do a project, you go to run a group or you go to do whatever you do in your job. And does it always go as planned? No, I can't believe that that's true. So when it doesn't go as planned, you think to yourself, all right, well, that didn't work. What am I going to do now? Maybe you run a store and your inventory didn't come in. Well, that's kind of a big problem because you can't stock the shelves. How so what are you going to do to work with it? Because you can't just magically make inventory appear. Do the same thing for yourself. If you're having a bad day, say, all right, not operating on all cylinders today, how can I be compassionate to myself and do the best that I can with what I got? And social exacerbating factors. Yeah, social can your friends can be great buffers against stress, but they can also stress you the heck out. So if there are people that make you feel guilty, if there are people even in their best, you know, they're trying their hearts in the right place to urge you to get out of bed but or do something and you're just you're not up to it. That can add additional stress and increase your feelings of guilt and resentment and frustration. So improve your communication with those people so they understand what's helpful and what's not. And then there may be some times that you just need to avoid certain social situations so you're not put into that position. If you're working with, maybe you've got kids at home like the example I gave earlier and you're feeling guilty about not being able to make all of their ball games or whatever it is, talking with them, saying, this is the situation. This is what I've got going on. I really want to be there. How can I help you feel like I'm there in spirit on the days that I can't be there physically and make a point of focusing on that and communicating with them so they don't think that you're just ignoring the games and they don't feel left out and you don't feel guilty. Win-win. Mitigating factors. These are things that make you feel better. So you want to do more of these. Emotionally, do things that make you happy. If you're happy and you're laughing and you're relaxed you're probably going to have less symptoms of whatever the condition is. Mentally, focus on the positive. Try to look at the silver lining. Try to find alternatives. Something happens. All right, can't change that. What can I do instead? Physically, some people like exercise, some people like yoga, massage, hot tubs, cold packs. Work with your care team to figure out what things you can do physically to help yourself feel better. Environmentally, what things reduce your stress in the environment? For me, a clean house, prefer that. Having it smell good, I've got a really sensitive nose so I don't like smelling dog all the time even though I use him as a pillow. So environmentally, what things can you do to reduce your stress? What things can you do in your environment that help you feel better and more optimistic? And socially, who can you bring in? Who can you bring around you that can help you feel better? And they may not be able to make your symptoms go away but they may be able to show up and help you distract yourself because sometimes when you've got chronic pain there's nothing you can do to make it go away or any other chronic condition. So you can either focus on it and dwell on it or you can invite a friend over and you can distract yourself from it for a little while because there's nothing you can do to change it. Grief is a complex emotion that accompanies any type of loss. It doesn't have to just be death. There can be loss of dreams, loss of physical abilities, whatever. Not everybody goes through all the phases. Some people skip that whole bargaining phase and that's okay. Many people jump back and forth between anger and depression. So it's important to understand you may go through it once and then go back through it a couple of more times and that's okay, that's normal. Acceptance doesn't mean liking it. It means just figuring out how to incorporate it into your life narrative. So you're writing this story, you're writing a book about your life and all of a sudden this event happens. What do you do with it through the rest of the story? How do you incorporate it into the storyline? Self-esteem can fall when a chronic illness or pain keeps you from doing things that are important to you. So focusing on the things that you can do and alternative things. What can you replace those other things with? So you feel good about yourself. Circadian rhythm disruption can happen whenever you're sleeping too much or too little or your body isn't getting the wake-up signals. So pay attention to your sleep hygiene. Exacerbating factors make your problem worse can include poor ergonomics, poor sleep, reducing opiates. We didn't talk about that. When you're on opiate medications for pain, when you cut back on them, a lot of times your body doesn't kick in with its natural opiates right away. So for a short period, you may feel a little bit more pain and that's normal but eventually your body catches up and produces its own natural painkillers. Obviously talk with your doc and stress. Stress will make just about any condition worse. Mitigating factors, things that can help include yoga and stretching, frequent movement so you don't kind of seize up if you will. Massage or heat and ice, heat or ice, whatever you prefer. Make sure to talk with your care team. See what interventions will work best for you. There are a lot of others out there and we're gonna talk about some of those interventions in the next segment. Happiness isn't brain surgery, is an educational podcast and not a replacement for medical advice. All health decisions should be made in conjunction with your healthcare provider. If you like this podcast, subscribe on your favorite podcast app. Join our Facebook group at docsknipes.com slash Facebook or join our community and access additional resources at docsknipes.com.