Healing from cancer is not about pushing yourself to the limit without consideration for what tasks are important or how they will affect your body. Rather, healing well involves a thoughtful approach of setting goals and modifying your activities to achieve those goals. Although healing well does include physically challenging your body to improve strength and endurance, it also includes periods of relaxation and rest. In short, to heal well, you need to prioritize and pace.
Again, keep in mind that if you have a list of priorities and you refrain from doing what is not meaningful to you, then you will maintain a good quality of life despite any physical limitations. That is, you can probably do what you want to do as long as you avoid doing things that aren't very important. Thinking about it another way, here is your chance to unload all of the boring, mundane, and monotonous tasks that you never enjoyed doing anyway. The business community recognizes that over the past few years there has been a dramatic shift in what people want to do or not do, without regard to whether they are sick. As a result, many new services are designed to help people conserve energy. Ordering groceries online is just one. You can also have your dry cleaning picked up and delivered, as well as your medications.
You can have prepared food delivered to your home, or you can hire a personal chef to cook meals and freeze them. The personal-chef industry is booming, and many of my patients hire a chef, even if only for a short time. There are fees involved in many of these services, but they are often nominal. Of course, while you are budgeting to live within your energy means, you also must live within your financial means. If you can hire people to provide these services or to do yard work, laundry, and so forth, then do so as a good investment in your health.
Now is also a good time to let friends know how they can help. You can do it in a considerate way that will not burden people you are close to. For example, ask a friend to take your clothes to the dry cleaner when he takes his own. Or, inquire when your friend is next going shopping and ask whether she could pick up a short list of items for you at the same time. The suggestions I have made thus far are just that-suggestions. In order for you to have a good quality of life and optimize your ability to heal, you will have to decide for yourself what tasks are most important and how you can best accomplish them.
Although the terms activity and exercise are often used interchangeably, in this article I use activity to mean all the things that you do during the day that don't involve structured exercise. I am making this distinction to emphasize that activities such as walking from your parked car into the drugstore or doing yard work don't count as exercise. Exercise is a structured endeavor in which you work in one of three areas: flexibility, strength training, or cardiovascular or aerobic conditioning. My point here is that optimal healing involves structured exercise and not a series of activities that are tiring but don't improve flexibility, strength, or endurance. If you are struggling with fatigue and physical deconditioning, then you would be wise to prioritize what you do and pace yourself so you will have the energy to carry out a formal exercise program. Little spurts of activity here and there don't count -at least not very much. Even running errands all day doesn't count. This type of activity does more to wear you out than to help you heal.
Before you begin to seriously pace yourself, it is a great idea to spend three days keeping track of what you are doing. After all, one of the best ways to see how you can save "coins" is to first see how they are now being spent. In my clinic, we recommend that patients keep a three-day log of their activities. They write down all their activities and also document when they are experiencing pain or feeling particularly fatigued. The occupational therapist then reviews this log with the patient and rates the tasks with different highlighters. A yellow marker highlights the low-energy activities, a pink marker highlights activities that take a moderate amount of energy, and a green marker highlights high-energy activities. You can color-code your own log at home; it will be interesting to see how your log "lights up." You may think that you aren't doing much but then see that you have mostly pink and green in your log. Or vice versa. The point is that this is a logical place to start. You'll get a lot of good information from this exercise if you have the patience to do it.
There are a few basic principles when it comes to pacing. These may seem obvious, but as you read them, ask yourself whether you are following them. They are good tools to use in the recovery process. Here are the basics of pacing:
1. Organize and plan your day ahead of time. Doing this costs you energy up front, but it is energy well spent. We're looking at priorities again: ask yourself, What do I want to do? Skip the things that aren't meaningful or that make you overly fatigued. Include the activities that will help you with your recovery and the things you enjoy. If you need to do something that you know will be tiring (painting your home, doing your taxes, etc.), spread it out over several days or even weeks. Better yet, ask someone else to do it for you. Try to exercise early in the day when your energy level is highest. (This won't work for everyone's schedule; exercise is important to include even if you do it later in the day.) Keep in mind that exercising right before you go to bed can contribute to poor sleep.
2. Plan and take breaks (rest periods). A break is not necessarily a nap. I only recommend napping if you are sleeping well at night and still exhausted during the day. If you are not sleeping well at night and you nap during the day, a vicious cycle of poor sleep can result. Most people don't need to nap during the day and would do better with an earlier bedtime or a later wake-up time, or both. But planning breaks during the day will give your body and your mind a needed rest. You should find time to sit down in a comfortable chair and read, listen to music, meditate, or whatever you find relaxing. Depending on your energy level, stage of recovery, current treatment regimen, and work and family commitments, you may have to be creative about when and how you take breaks. But do it. Put your feet up and be good to yourself.
3. Use good body mechanics. Poor body mechanics cause a huge energy drain. Sitting at your computer in a chair that is not supportive and without arm rests is very taxing. Standing (and bending over) while doing household chores such as cooking, folding laundry, washing the car, and gardening is also very tiring. Don't mistake activities such as these for exercise. These tasks will do practically nothing to build your strength and endurance, so you should conserve your energy while performing them, especially during the recovery phase.
4. Perform activities in a comfortable temperature. I know people who take great pride in waiting until a certain predetermined date to turn on their air conditioning or heat, despite the outdoor temperature. It's great to be frugal and to be conscious of the environment. But living or working in an environment that is too hot or too cold will unnecessarily sap your energy. It is also wise not to exercise in extreme heat or cold.
5. Avoid straining or pushing yourself to the point of exhaustion. I tell my patients to listen to the "voice" of their body. What is your body telling you? Are your legs or arms getting tired? Are you feeling more pain? Are you having trouble concentrating? These are all warning signs that you are pushing too hard. Try to heed your body's warnings right away so that you don't reach the point of severe exhaustion or pain.
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