Indicators versus triggers - knowing about these can help you control symptom expression

In managing chronic physical health or mental health conditions, it is important to know the difference between indicators and triggers.  Identification of the two allows for increased control of symptom expression.

An indicator is something that often (or always) PRECEDES symptom expression.  A trigger is something that CAUSES symptom expression.

Allow me to provide an example from my life.  I have migraines.  When I am exposed to an allergen such as the chemicals in someone's perfume, that TRIGGERS a migraine.  In other words, I have no migraine symptoms, encounter the chemicals, and develop a migraine.  Often, migraine intensity is linked to how much I was exposed to the allergen.

Once or twice a month, I have a random migraine.  This migraine is not tied to ANY trigger I can identify.  However, each time one of these migraines comes along, I feel really, really happy for 48 hours prior to onset of migraine pain.   While I am typically content and positive, I rarely am happy to the point of giggling.  So, I watch for giggling and out-of-my-ordinary happiness.  When that happiness occurs, I can increase my sleep amounts, make to to be extra careful in avoiding triggers, and start taking preventative medication.

Knowing triggers and indicators can allow you to reduce symptom expression.  Another example, for someone who has bipolar disorder, tracking stimulus for several weeks/a couple of months will often show a pattern of how much stimulus results in mood switching.  When I have worked with people who have tracked stimulus, the people typically find that a certain level of "good stimulus" (eustress) and a much lower level of "bad stimulus" (distress) will result in mood change.  With this information, the person can then plan events to reduce likelihood of mood switching.

Specifically, if John Doe can tolerate 2 eustress activities (like going to dinner with friends, and staying up late to watch a movie), but can only tolerate 1 distress activity (finding out he has work that is past due), John can plan to take care of the work over the weekend.  To avoid mood switching, John will have to change the evening out to another weekend.

Sometimes using mood tracking, the person will be able to link intensity of stimulus to length of mood change.  For example, when I was working with a person who had bipolar disorder, that individual found it was possible to predict the length of depressive episodes by tracking how much stimulus was being experienced.  Using this information, the individual was able to attend a week-long, highly-important-to-the-individual event.  The person planned self-care activities throughout that week to reduce stimulus.  And the individual understood the level of stimulus would likely result in a 3 week depression afterwards.  The depression lasted 2 1/2 weeks.

When processing the entire chain of events, the individual was able to state unlike previous depressive episodes, having an expected time frame for the depression and understanding that the depressive episode was part of how his body and brain worked resulted in the individual being able to resist suicidal impulses.  Prior to understanding how the individual's bipolar disorder worked, the individual would self-harm while depressed.  With the tracking tools and education the individual was able to use planning, self-talk, and understanding to reduce anxiety about depressive episodes.

There are excellent tracking applications, websites, and files on the internet.

• Psychologytools.org has multiple worksheets.  
• PatientsLikeMe.com has some lovely possibilities.  
• Latuda (medication for bipolar disorder depression) has a great mood tracker on its website (http://www.latuda.com/bpd/treating-bipolar-depression.html).    
• SparkPeople.com lets you track food and exercise.
• It is also possible to track triggers and indicators just using pen and paper.  

I would suggest, if you are looking for indicators as well as triggers, to track activity, food intake, weather patterns, and as much detail as you can in your life.  Sometimes it can be a combination of things that result in triggering symptom expression.

Sometimes indicators are subtle and hard to identify without enough information to track down the indicator.  For example, one individual identified moon phases as her trigger for symptom expression,  The day after a full moon, she experiences increase in symptoms, with this increase lasting about 72 hours.  The couple days before the full moon, she feels very tired.  The fatigue is an indicator.  The full moon is a trigger.

My Personal Adaptations for Chronic Illness - Some of my Facebook Posts

• Laura A Collins Hiking poles - when out walking on uneven ground. 20 bucks for 2 of them at wal-mart. 
  
  face mask - stops the asthma. (side benefit... for the warped sense of humor people - can make toddlers scream! and worries the heck out of walmart managers) 
  
  VERY little in purse - or a purse that is a back pack. For trips, a waist bag - so maybe I look like I am pregnant (overweight with a bag hanging off my belly/side)... but it does NOT hurt my shoulders, arms or back AND can carry 2 waterbottles. 
  
  Little step stool for shower days when standing is difficult. Sit on it and since it is plastic, dries easily. Also -TMI warning - use it for a foot prop to prop up feet when on toilet (reduces incidence of hemorrhoids)
  
  Re-arrange cabinets - often used stuff in standing height - no reaching required. Re-arrange closets, drawers, etc... Either you can WORK to fit your environment or you can make your environment WORK TO FIT YOU!
  
  Slip on shoes (Birkenstocks) - drop and slide in feet, no stooping needed. Bras that can be fastened before putting on and then pulled over head. Pants that are stretchy so can just pull them up (even when they are zipped so no need to struggle with fingers in the morning).

  10 minutes ago · Like
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  Laura A Collins Necklaces with toggle clasps - so no need to struggle with little fasteners when hands are stiff. 
  
  Pens with extra large barrels - reduces stress on the wrist. 
  
  Split keyboard - reduces stress on wrists when typing.
  
  Place to prop up feet when at desk, better ergonomics for body. Chair that fits body - prob sat in 40 or so before I found "the right one".

  8 minutes ago · Like
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  Laura A Collins Lots of tote bags that have shoulder straps. I RARELY carry things in my arms. Instead, I put them in the tote bags and make a couple trips. No large packing of ANY type. Heavy hurts.
  
  Memory foam topper for my very firm mattress - the best of support and no poking places - soft enough for sensitive joints.
  
  Shampoo (I make my own) in easy to use flip top container - no messing with tiny lids when still half asleep.
  
  Meds in week long keepers - set up a month in advance. (4 keepers). Last one a different color - so when get to that one, call in the refill. Pick up before the end of the week.

  4 minutes ago · Like
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  Laura A Collins One set of migraine meds in a container that FEELS different - so I can get my meds even if I cannot see properly.
  
  Extra epipens and meds in multiple locations (work, travel bag, bedroom, bathroom). Never know when anaphylaxis will hit. Got to be prepared.
  
  Portable nebulizer (battery operated). Take care of asthma where-ever I may be - including hiking or on the road.
  
  List of all meds and medical info in car, at work, in medic alert account, and medic alert bracelet. ESPECIALLY ALLERGIES.
  
  wrist strap on cell phone, recorder I use at internship, and camera. Tendency to drop things is fixed when they are ATTACHED to the body.
  
  Keys on a carabiner. Attaches to purse strap WHERE I can see them - so do not lose them as often.
  
  Calendar on Door of bedroom - so I always see my appointments - every morning before I get dressed, every night before bed. No forgetting. Color code the calendar so it is OBVIOUS even when my brain is half gone from fatigue what is happening the next day.

A Thanksgiving hope for those with Chronic Illness

A Thanksgiving hope for those with Chronic Illness

by Laura A Collins (Notes) on Thursday, November 24, 2011 at 1:38pm

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A Thanksgiving Hope

For the last several months, as I have struggled with maintaining my path into health, as I have listened to others and their struggles, as I have learned about obesity, I have come to some conclusions.  Allow me to tell you a story. 

I experience chronic illness.  Like many others who experience chronic illness, I have learned that management is a huge part of achieving a modicum of wellness.  This fall, I was overwhelmed with tasks and responsibilities in my life.  Therefore, I started to ignore those things which I KNOW help me with wellness.

 I know I need 8 hours or so of sleep a night.  I was getting less than 7.  I know that daylight savings time (light change) is a very difficult period for me to transition.  I did not prepare this year by increasing sleep time by an hour, changing my light bulbs, making sure I was exercising.  Instead, I was existing in a frantic state of trying to put out fires faster than they were starting.  I know that I need to eat on a regular schedule.  Instead I was eating too much or not eating at all – and so dropped out of ketosis.

As a result, I developed severe bronchitis/mild pneumonia – and took 2 weeks to recover from it.  I developed a 4 week migraine, 2 weeks of which were totally debilitating.  I caught a cold.  Still working on getting over that!  Not preparing for light change, meant that my seasonal depression was fairly severe – I slept away the better part of a week.  I still have limited energy (about 10 hours per day and I am done!!).  My glands became swollen and I started to bruise easily again – which likely means the Epstein Barr Virus (think Mono) is active again in my system.  It flares up every time I get run down, and has since I was 13 years old.

Now, let’s talk about guilt and accountability.  Guilt is, to my mind, a way of saying, ”I did this thing, but I am not going to do anything about it.”  Accountability is, on the other hand, a way of saying, “I did this thing, did not like the consequences, so I will plan to not do this again.”  One takes energy, but accomplishes nothing helpful.  Instead, it becomes a way to flagellate ourselves… without having to commit to changing the actions we are lamenting.  The other takes the same energy, but helps us to grow.  It is based on acceptance of the previous action, evaluation of the results of that action, planning future actions, and determination to grow in a way that we choose.

Chronic illness is a lifetime lifestyle.  It does not go away.  It has ebb and flow.  Those who experience chronic illness are NOT AT FAULT for having the illness.  There is no blame there.  They are not at fault for when the illness flares and causes complications.  While it is true that the individual can act in such a way to help REDUCE or INCREASE the RISK of flare, the occurrence of flare is beyond control.  We control our own, human, actions.  We have no control over life events or the cosmos.  We are not God.  Therefore, if our actions are causing an increase in risk that is not worth that cost, then see the discussion of guilt and accountability.

Western (American) society emphasizes being “The Best”.  However, there can only be one who is “The Best”.  By default, all the others are not.  Eastern societies emphasize being better today than yesterday.  The difference is the measure of improvement.  The Best is only the best in comparison to other people.  Better today than yesterday is a measure of personal change.  One is concerned with winning, regardless of growth.  One is concerned with growing, regardless of the contest. 

I have come to the conclusion that obesity, in the case of people who experience biological imbalance in carbohydrate metabolism, is a chronic illness or condition.  It is something that will be with us for all of our lives.  We will never be blithe about what we eat or able to be inattentive to our eating actions and choices.  However, as has occurred with my personal journey through other chronic illness, I expect that as time passes, and as I learn more about this particular condition (having only started learning about this 157 days ago), the knowledge will become habit, and the habit will become almost unconscious.  Similar to driving, what was complicated in Driver’s Education is now second nature.  However, will all new skills, I expect this to take time to become integral to my life.

Therefore, my Thanksgiving hope for us all is that we accept our actions, we move quickly through the grief process of giving up the “person who can eat without consequence ideal we all had in our minds”, and that we learn to be better today than yesterday as we grow into wellness and health.

Laura Collins

An Introduction

I have never posted a blog before.  I have friends who post blogs and their continual creativity awes me.  How they find daily postings within themselves confounds me.

I have posted recipes, thoughts, and other work to my facebook page for the last several years.  However, my facebook page is locked and private.  And, as time passes, I find within myself the urge to share my recipes and thoughts…  and so… a blog.

Over the next several days/weeks, I will post the backlog of work from my Facebook page.  And then, as I create new recipes, have a thought here or there, or take photos of spring flowers, I will add to this blog.  I welcome your comments.  You are free to share anything you find here provided you attach my name to it and do not use it for your own financial gain.

Who am I?

That may be important as well – if you are deciding to follow this blog.  

I am an emerging counselor.  That means I am in the last bit of my Master’s of Mental Health Counseling Program.  Right now, I am an intern at the local Free Clinic.  So, much of what I think about is the state of mental health and trying to make sense of how different reality is from the myriad books I have read. 

**HOWEVER, any information posted on this blog is for educational purposes only and is NOT meant for diagnostic or individual counseling purposes.  If you feel you have mental health needs, please consult a qualified mental health professional or go to your local emergency room.

I have multiple allergies/intolerances..  I am allergic/intolerant to wheat, corn, coconut, millet, all grains, bananas, and lots of other things.  Someday I will post about those.  I participate in online support groups for corn-allergies.  I have fibromyalgia, but when I control the allergies, I am able to reduce or eliminate almost all fibromyalgia symptoms.  My theory is that allergies cause underlying inflammation... and it is this inflammation which triggers fibro symptom expression.

I am the single mother of a 16 year old son.  Family relationships and being mom are topics of interest. 

I am overweight.  Weight control and weight loss are topics I return to.  Often, these are tied to the Prochaska model “Stages of Change”.  Between allergies/intolerance, weight, and a lifetime love of food – I create a lot of recipes.  

I have a small (25-30 pound) dog.  Inky is neurotic, but lovable   He is a rescue dog and has taken quite a while (over a year) to recover mostly from his previous home.  He still has lots of anxiety.  His hips have damage and he also has hip dysplasia.  He takes medication daily.  

I have my own mental health issues.  I am OCD.  It took me years to learn to control the OCD.  Now, I am organized, and adapting to change takes me effort, but it possible.  I no longer have lists of lists nor do I obsessively arrange things.  However, I can organize the heck out of any schedule or event.  I have some degree of depression or cyclothymia.  This is controlled with 20 mg daily of Prozac (which lets me sleep), cognitive methods, and practicing of wellness.  We’ll talk about that on occasion as well.  Wellness is extremely important to me.  Wellness allows me to channel my mental health issues into strengths (like organization, accomplishing projects when have the energy boost of low level hypomania, etc.)  I have a holistic view of wellness and like to incorporate multiple domains.

I am a liberal in most political aspects.  That is something that will on occasion be a topic of conversation.  So will religion.

Pretty much – this is a blog where whatever comes to mind will find its way onto the screen.  Hopefully, there will be bits and pieces you enjoy or can use.  And, when something neither appeals to you nor applies to you, you are most welcome to skip that post or comment on your own point of view.  

I hope you are looking forward to this as much as I am.

Laura