On Fridays I will address a question related to depression and find the answer from an expert. If you have a question you want answered, please ask it on the combox of this post, and I'll try my best to do some research and feature it in an upcoming Friday post.
Today I have the pleasure of interviewing one of my favorite therapists, Elvira Aletta, Ph.D., on a very important topic: chronic illness. I say important, because it now pertains to me (and thus is important), and I need to learn some coping techniques ASAP before I fall over, into the Big Black Hole of depression.
Dr. Aletta is a clinical psychologist, wife, mom to two teenagers and blogger, seeking the balance in upstate New York. She is working on a book "How to Have A Chronic Illness So It Doesn't Have You," and would love to hear your story about how you or someone you love thrives with chronic illness. Write to her at draletta@explorewhatsnext.com. To learn more about Dr. Aletta, check out explorewhatsnext.com.
Question: I know that you have dealt with chronic illness personally and professionally, and this is an area of specialty for you. Do you have five good rules for living with both chronic illness and depression?
Dr. Aletta: Yes, I've had my share of chronic illness. In my early twenties I was diagnosed with nephrotic syndrome, a rare kidney disease that usually affects young boys. Weird. Then in my thirties I came down with scleroderma. Never heard of that either. When we are young it is our God given right to take our health for granted. Chronic illness means getting sick and being told it's not going away, and that stinks. Our bodies have suddenly freaked out on us and we've lost control of the one thing we thought we could count on.
It's not depression if you are adjusting to a major loss. That's grief, which needs time to process. Allow yourself that time to mourn, to be angry and sad about what you've lost. You need time to accept the new reality.
Then at some point, we need to take action. If we don't, grief morphs into depression and that can make your physical illness worse.
Be aware that one or a combination of factors can cause lowered mood when you have a chronic illness:
➢ The situation. Loss. Grief.
➢ Changes in appearance, mobility, independence.
➢ The illness itself may have depression as a symptom.
➢ Pain and fatigue.
➢ Side effects of medication and other treatments.
➢ Social pressure to appear OK, especially hard if there's no diagnosis.
My five good rules to deal with it all? OK, here we go...
1. Be confident you have the right doctor.
When you have CI your relationship with your doctor is second only to your spouse or your parents. Being honest (and you must be honest!) with that person means you need to be able to trust them to hear you. If you don't have that kind of relationship get a second opinion. Shop around. In my CI career I fired three highly recommended specialists because they were jerks. Thankfully I've also had wonderful physicians who literally saved my life and my mind.
2. Define your circle of support carefully.
Isolation leads to depression and it is so easy to isolate when you feel lower then dirt. People may surprise you. Peripheral friends may step up and be terrific support while others you thought you could count on cave. If someone inside the circle asks, "How are you?" Tell them the truth. When someone outside the circle asks, lie, say, "I'm fine" and change the subject. Too often they can't handle the truth and they suck any energy you have taking care of them. A patient of mine found her mother would get hysterical at any medical news so it was better to keep her at arms length.
If someone asks if they can help say yes. Accepting help is a gift to them. Trust that someday you will be on the giving end. My patient's mother could do laundry for her and that made both of them happy. One big way someone can help is to go to doctor's visits with you. The extra eyes and ears take the pressure off you when the news is emotionally laden and important, even if the news is good.
3. Protect your health as you would a small child.
You are more than your illness. That part of you that functions well needs you to advocate for it. Of course there are the basics of getting plenty of sleep, exercise and eating smart. In addition to all that I suggest learning a new set of signals that are your clues for when you're wearing your health thin. For me it's lowered ability to concentrate, tension in my neck and shoulders, irritability and loss of my usually dependable sense of humor. When those yellow lights are blinking, it's time for me to stop, assess and make changes. When I ignored those signals I relapsed and looking back I can see where I ran the red lights. So be a fierce protector of your health. Set limits and find the courage to say 'No'!
4. Create a new measuring stick.
Our self-esteem lies in the standards with which we measure ourselves as we go through life. To thrive with chronic illness, throw out the old and rethink your standards. If you are used to defining yourself by your 50-hour workweek, for instance, you may feel lousy about yourself because now you can't manage it.
Finding a new standard can be tough. One technique I use with patients is to have them ask themselves what is reasonable? Is it reasonable to do it all yourself or is it more reasonable to delegate? Is it reasonable to register the kids in travel hockey or is it more reasonable to stay local? This is where a lot of courage is needed. Courage to address old pressures to be a certain way and to imagine value in doing things differently. In my own life and in my work I find that those who thrive despite chronic illness creatively find opportunity in their new reality.
5. Have dreams and strive for them!
You had ambitions to get a degree or promotion, to see the world or save it, to get married and have kids. Now you're thinking, do I have to give that up? No, you don't. It's imperative for your spirit that you have goals for living, big and small.
What might change with the reality of chronic illness is the path and timing. I wanted to have kids and was told for years, 'No.' I had to adjust to the idea of life without kids or adopting. Then in my late thirties, my doctor said, go for it. After a scary, thrilling journey, today I have two thriving teenagers.
As we reach for the stars let's appreciate the ground we stand on. Mindfulness has a real place in keeping depression at bay for everyone. Sometimes our dreams are right before our eyes.
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Dear Doctor Aletta,
My bedroom is full of stuff up to the ceiling. I have been trying to clean it for years, but I can't succeed. There is stuff on my bed also and I am sleeping in the living room. Please let me know how I can overcome this. I want to have a nice room to sleep in. Please help me. Thank you.
Best regards,
Anna
Mary Margaret: It sounds like you are balancing crying with joy and laughter. This may sound silly but have you tried Skype? Seeing a loved one as you talk with them can really be nice. A lot of people who are shut in because of health issues also use the social networks (facebook, twitter) to stay connected with friends and family around the world.
otherdeb: I'm so sorry for your nightmare. I'm glad if my article helped in any way. Keep up the very good work. I'm hoping it will get easier given time.
Susan: You describe a situation that's much more than dealing with chronic illness (which is problem enough). You have enough stress going on to kill an elephant! Plus you're saying you were practically born with low self-esteem. If I had you in my office I would have you write down in list form each stress point. Then I'd have you assign each a number 0-10, 0 being no stress and 10 being 'Holy Cow!' No fair giving everything a 10! This technique is called categorization and it's meant to get the thoughts spinning in your head out of your head. Then we put handles on them so we can move them around. Got it? Choose which item you can tackle easiest first. Try to get the number down from say a 5 to a three. That's called gaining mastery, a key to overcoming anxiety and depression and building self-esteem. I truly wish you could find a good counselor to help you with effective problem solving. You can use the Psychology Today web site find a therapist feature to find a counselor near you. Also if you're interested, I provide telephone & Skype consultations.
Everyone: The book Feeling Good, the New Mood Therapy by David Burns, explains a lot about treating depression. I recommend it to my chronically ill patients.
Dear Friends,
I intend to answer all of your concerns. My last effort was somehow swallowed up by the ethernet. I'm so sorry because a) I will have to try to duplicate quite a long reply and b) I don't want you to think I'm ignoring you. I'm not. You all ask excellent questions.
Thank you for your patience,
Dr. Aletta
PS. You might enjoy this. http://draletta.typepad.com/explorewhatsnext/2009/06/exercise-is-not-negotiable.html
In discussing a chronic illness, sometimes one also needs to remind the person involved of their right to expect support from the physician one chooses: that means one must not only feel comfortable with what the physician knows and does, but that should there be any questions, regarding such simple things as services, charges for those services, or some other small item that costs the patient money: when those expectations are not met, the physician you chose should support the patient.
Ex: I once had an IVP because of my kidneys (nephrosis); the nephrologist ordered the xrays to be sent directly to him. Instead they were sent to an reader who held them after reading and writing the report until my appointment time the next day. I had to get the report myself. When he read the report the radiologist completely, and I mean utterly and totally, missed a 2cm. kidney stone-it wasn't even mentioned in the report.
When I requested he include a note himself, to the radiologist about missing the kidney stone , to explain why the radiologist would not be paid by the insurance, or me, he refused-saying it was "unprofessional".
The radiologist wanted something like $400.00 for his services.
He was part of the rotation at a local hospital so neither my nephrologist, nor I had a choice or say in the matter.
It took me several weeks and serious threats at malpractice with the radiologist and his billing service (he had no office at all), including the threat to include the billing agency as an accessory to resolve the problem.
And yes, after the third day of getting now-where with the radiologist or his agency, I told my nephrologist about the problem his professionalism had caused me and openly fired him-Donald Trump style.
If you as a patient do not feel the support and concern you feel you need from your physician, get another, and stop wasting your money.
Any chronic disease can be dangerous if not treated on time this indicates findrxonline in their articles, in many cases the drugs are of great help to counteract the chronic pain, but there are other supplements that science should be regarded as vegetables and vitamin supplements, many consider the medicines are of great help to counteract the pain, especially opioids narcotics such as Vicodin, Lortab, hydrocodone, oxycontin, oxycodone, tramadol, and many others that exist in today's market, but I think we should also consider as an additional alternative to supplement the vitamins such as calcium, B complex, vitamin C, do you think it is a contribution to people with chronic disease?
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