Pacing

Spot the mistake in this scenario:

I have a rare good day and take the opportunity to do all the jobs that I have been wanting to do while I've been stuck in bed or on the sofa. This causes pain and fatigue, along with other unwanted symptoms, and I end up back in bed, or even in hospital. While I'm laid-up, I spend my time thinking of all the things that I want to do when I'm 'better' and then push myself past my limits at the first opportunity.

Sound familiar?

I think that many of us with chronic illnesses push our bodies to the limit. This may be a result of frustration at spending so much time unable to do ordinary (or fun!) things, guilt that we can't keep up with friends, the children, the housework, or our jobs, or excitement that we feel well enough to do things. It seems utterly counterintuitive to me to restrict my activities when I feel good as well as when I'm physically unable to do anything.

This is where the theory of pacing comes in. The idea is to break the cycle described above by carefully restricting activities on good days to avoid the 'crash' days. It's hard, but the incentive is there - imagine not having those crash days, or having them only rarely. It wouldn't matter that I didn't get everything done in a single day (or single afternoon) if I knew that there was a reasonable chance that I would be able to function the next day or even the day after.

One way to start is to think about what you can manage on a moderately bad day. Keeping a symptom diary can be helpful for this. If you know how much you can lift, walk, drive or eat on an average/bad day then you can use this as your baseline. Try to restrict yourself to this initially, gradually building up the level of activity according to how much you can tolerate. Remember that mental activity can also be draining - it's not just the physical tasks that take their toll.

Things that can help:

• Taking regular breaks
• Taking regular painkillers or other medications
• Short periods of activity
• Switching between activities (this avoids strain from repeating one thing for too long)
• Prioritising your tasks
• Delegating to others
• Planning to do things at 'good' times of day

It may seem painful to have to give up tasks that you feel you 'should' do, but paying for a cleaner for a couple of hours a week, for example, may free your energy for other, more important, things. If it's a simple choice between having the energy to spend quality time with friends or spending every good day chipping away at a house that never seems clean and then crashing for several days, surely the answer seems obvious?

I have to confess that I'm bad at this. I'm stubborn and I'm proud. I don't like to admit that my body is failing me, but I know that my husband would rather we were able to go out to see a film or to hang out with friends than know that I had done all the housework by myself.

Hiring a cleaner isn't the only way to delegate tasks. Ordering groceries online and getting them delivered has given me back two or even three days each week. Good things to delegate are things that you don't particularly enjoy, that don't benefit from your personal input, or that cause you more symptoms. I'm not suggesting that you absolve yourself of all responsibility and spend your time watching Jeremy Kyle; far from it. People with chronic illness need activity to avoid deconditioning - doing a lot of nothing will reduce your exercise tolerance and may adversely affect conditions such as autonomic dysfunction.

So what do you do?

• Try to keep yourself looking nice: wash your hair if you can (if not, dry shampoo is pretty good) and use scent and a little bit of make-up if they make you feel good. Get your hair cut into a more manageable style if necessary
• Find a wardrobe that works for you. Suits and high heels are great, but loose tops and trousers may be more appropriate if you're not working. Please don't sit around all day in the same pyjamas that you slept in. If nothing else, freshen up and change the PJs
• Try to have at least one thing every day that you feel pleased to have done. It might be a yoga class, craft, writing, speaking to a friend on the telephone or doing the washing up
• Stay in touch with friends and family. They probably won't understand the extent of your illness - few people do, but they're still part of your life story, and they probably care about you more than you realise
• Try to make contact with people who do understand
• Stay as active as you can, working from your baseline
• Eat good food at mealtimes. Try to make meals an event, even if you're alone or struggle with eating. Eating straight out of the packet while lying on the sofa is depressing for anyone.
• Get outside as often as possible, even if it's just for a cup of tea in the garden (perhaps not in this weather) or a walk to a local bookshop
• Don't give up entirely on work - if you can continue your job (even if you need help with rest breaks or flexible hours) that's great. Otherwise, see if there's anything else you can do - part-time, voluntary, self-motivated. 

I'm certainly not an expert, but I'm learning and I'm trying!