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Finding peace on earth and goodwill toward men when you have crummy health

December 11, 2009

My credentials: 25 Christmases with fibromyalgia, about 18 of which have included arthritis flares;  this will be my third Christmas with Addison’s disease.  And I studied stress physiology in the course of earning my Master’s degree in public health.

Disclaimer: My life and my health are not your life and your health. My credentials might be worth the cost of the pixels you’re looking at.

Reality: Holidays are stressful for everyone. Chronic pain and illness are stressors. Logically, therefore, holidays are exceedingly stressful for people with chronic pain and/or illness.

Participation Stress: There are a lot of things going on; it’s stressful to participate in them, and it’s stressful to pass things up. You have to make decisions. Here are some guidelines I have used over the years with some effectiveness.

Get to know your energy timeline. Do you crash the evening of an event, or the next day, or the second day after? How long does it take you to rebound after a crash? What does your schedule look like for the days immediately following the event you’re considering? What are you going to miss out on if there’s a good chance you’ll be sick or exhausted?

Assess the relationships involved in holiday demands on your energy. Is a particular relationship worth the stress of getting together during the holidays? Is there another time you could get together? Whose hurt feelings are most important to you? What is your sense of well-being worth to you?

Consider potential venues. It is not necessarily more relaxing to be a guest than to be a hostess. Fitting into other peoples’ routines, eating other peoples’ food to which you are unaccustomed or sensitive, and foregoing your own routine and environment can be very stressful and can cause flares and illness.

Timing of events should be factored into a decision of whether or not to participate. Is your energy higher in the morning, afternoon, or evening? My energy is low in the evenings, and there is no way I can rest up to overcome this. With Addison’s disease, my hydrocortisone dose is timed to emulate the natural circadian rhythm of cortisol production. Normal people simply produce more cortisol to compensate for a stressful event such as a busy social evening. But I cannot take extra cortisol as a social drug. Generally, no one and no event is worth whacking out my system that much. Emergencies are different. Parties are not emergencies. Concerts are not emergencies. Fellowship events at my church are not emergencies. The primary criterion of an emergency is something for which you dial 911.

People, especially family and friends, can be stressful, especially under stressful circumstances. To repeat, holidays are stressful circumstances. If you thought you were alone in thinking this, you are not. Interacting with people under stressful circumstances can leave a person with compromised health wiped out for days. But the angst of feeling as if you’re letting people down or that you are missing out on life can also be very stressful. It’s a tough call, but over the years I have been less sorry to miss out than to push myself and wish I hadn’t. Prioritizing your values and setting your boundaries around them, gently and with love, is a very good exercise at this time of year. Doing this is giving yourself a gift that lasts, and you need not do it at the expense of family or social harmony. If people will not understand your need to limit your activities with them, they are, quite bluntly, toxic.

Travel is stressful. Dense traffic is not a soothing environment; nor is the airport drill in which you get to play the part of the suspected terrorist. But if these things are mere means to an important, valued, blissful end, then submit to them and leave time to crash (your energy, not your car or the plane) and revive before participating in all those important, valued, blissful things. Travel with recovery time at both ends or stay home.

When I was in graduate school in public health sciences, the Holmes and Rahe Stress Scale was all the rage.  The Scale assigned values to various life events. Death of a spouse was assigned the highest value, 100. The Scale included events like vacations, Christmas, change in financial circumstances, foreclosure, etc. The psychiatrists who developed the Scale came up with an index for the relative likelihood of illness according to the individual’s total stress score for a given year. The long and short of the Holmes and Rahe Stress Scale is, very simply, that stress makes you sick. Their research was very convincing to us as grad students, because grad school is very stressful, and certainly we all got sick.

Don’t blow your diet. You’re on it for a reason. Holidays are stressful. Holidays often mean eating food you do not ordinarily eat, as well as more food than you ordinarily eat. Unhealthy eating is stressful to your system. Unhealthy eating means what is unhealthy for you, not for the public at large. Compound holidays with unhealthy eating and watch yourself get sick.

Control your time. Lack of control over your own time, whether in the workplace, or in any other situation, is stressful. This, too, is a matter of asserting boundaries and of assessing with care the value of a contemplated event before deciding whether to undertake it. If there is something you really feel you must do even at the expense of your health, then allow yourself time to crash, and factor the possibility of getting sick afterward.

Finally, make changes gradually. Breaking a longtime tradition in order to save yourself the stress of being part of it this time might be just as stressful as being there. If you have been super-overdoing , then do less, not nothing. Total withdrawal after a state of high stimulation is stressful. Think of scales: balance and weigh. Be proactive, preserve your routine as much as possible, change what you can change for the better, and know the cost to your own well-being of everything you take on. In fact, like a lot of things about Christmas, this is a good thing to do all year round.

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