Thrive in Relationships While Having an Addiction or Chronic Illness

Foreign. I'd like to welcome everybody. Today's presentation on thriving in relationships while having a chronic illness or addiction. I'm your host, Dr. Donnelly Snipes. Today we're going to explore the impact of chronic illness or addiction on people's relationship with other people as well as with themselves. We need to remember that relationships are intrapersonal with ourselves and interpersonal. And then we're obviously going to identify strategies to help people nurture these relationships and while having a chronic illness or addiction. So we're really embracing that acceptance and commitment philosophy. What is a chronic illness? And we talked about it a little bit last week. But I think it's important that we recognize that there are a lot of different types of chronic, chronic illnesses. And I don't have all of them listed here by any means. But recognizing cardiovascular disease is a chronic illness, it impairs people's energy levels and their ability to do things that they may have done before. Maybe they have to carry around an oxygen pack, whatever. Autoimmune issues, including diabetes. And some of you are like, what? Yes, auto diabetes type 1 has long been proven to have an autoimmune component, but they've also discovered that type of type 2 diabetes also has an autoimmune component, too. Chronic fatigue syndrome, dysautonomia. And dysautonomia is kind of like autoimmune issues in that it's a group of conditions that involve dysregulation of the autonomic nervous system. We've talked a lot about pots, but if you want to learn more about dysautonomia, you can just Google it. But it is a set of conditions that is exhausting and significantly impairs people's quality of life. Ankylosing. Ankylosing spondylitis, which is a basically a fusing of the vertebra. Migraines, Lyme disease, hiv, all of these can impact the person's ability to live the rich and meaningful life that they had once thought they were going to live. It doesn't mean they can't live a rich and meaningful life, but they may have to make adjustments mentally. Addiction is a chronic illness. Adhd, chronic illness, anxiety, depression, bipolar, schizophrenia, ptsd, cptsd. Yes, a lot of these things can go into remission, just like autoimmune disorders and dysautonomia can. People don't have migraines every single day. But it's important to understand that for most people, there will be symptomatic times. And helping them recognize those times and aim to reduce the intensity, frequency and duration of their symptomatic periods by taking care of themselves, by. By recognizing what they do have the power to control is really important in counseling. There is a significant portion of people with chronic illness or addictions that have attachment trauma. Well, let's think about it. We've talked about this back in the physical last week and in other videos. When people experience attachment trauma and it's not resolved, or any type of trauma for that matter. But today we're talking about interpersonal. When people experience attachment trauma, it is terrifying, especially if they are younger. But at any point in time it can be very traumatic and it can result in changes in their attachment style because they don't feel safe, they don't feel empowered, they don't feel supported, they don't feel like they can depend on others. Attachment trauma itself may contribute to dysregulation of the nervous system and the development of the chronic illness or the addiction. A lot of chronic illnesses, A lot of the chronic illnesses and addiction are contributed to, or I don't want to say caused by, because there are multiple causes, but exacerbated by chronic stress and inflammation. And the chronic stress and inflammation that is caused when somebody has an insecure attachment style contributes to dysregulation of their nervous system and potentially development of chronic illnesses. Emotional dysregulation that happens when our nervous system gets dysregulated. Then we see people experience more emotional dysregulation, flat to furious, flat to frantic. There's not a lot of in between. And when they do disregulate, it takes a lot longer to down, downregulate and to recover, to recuperate because it's exhausting. It's like they ran a 400 yard sprint in the time that some, somebody else may have, you know, walked 50ft. So they spent a lot more energy because they're nervous system reacted so much stronger. When we're disregulated, it's hard to communicate. So there's often communication difficulties explaining what's going on and articulating what they need. Partly because of they're in fight orf flight, but also partly because of the attachment trauma. People with insecure attachment, often we're taught that it's not safe to, to tell people no, it's not safe to set boundaries, it's not safe, whatever. So they may not feel like it's safe to communicate. Hey, I'm having a bad day today. I just can't do that. And again, poor boundaries kind of Goes along with communication difficulties. Because of that trauma, the person may have learned that other people are not safe. Either it's not safe to say no, or it's not safe to let anybody in. But either way, the person experiences more stress and low self esteem. And self efficacy. Self esteem is how you feel about yourself. Self efficacy is whether you believe you can do things, whether you believe you're empowered. And when people experience trauma, often it leaves them feeling unsafe and disempowered. And if they haven't resolved that trauma, then they're still feeling unsafe. Disempowered, non efficacious, if you will. And when people develop chronic illnesses or addictions, a lot of times that compounds their feeling of powerlessness, hopelessness, unsafeness. What can we do about it? First, educating yourself and others. If you've got a chronic illness, educating people about it. Chronic illness, physical or mental health issues, including addiction, are often invisible. Now, there are some that are visible. Yes, I get it. But a lot of them are invisible, which means other people may not know when you're having a bad day. Other people may not know what you can and actually cannot do. Without making a lot of assumptions, it's important to educate yourself about what's the progression of the illness, what caused the illness? Because a lot of people are like, well, how did that happen? Okay, we can educate them the progression of the illness and what you can and cannot do at different points in the illness, Whether it is when you're asymptomatic, when you're having symptoms, or as the disorder progresses, if it's a progressive disorder. When I say educate, there's no book that's going to be able to say you can. Early stages, you can do this, that, and the other thing, and mid stages, you can do this, that, and the other thing. It's going to differ for everyone. But you need to become mindful and educate yourself about what you can do. What can I do when this is happening? What can I do when I'm having this symptom? What can I do to minimize the number of episodes that I have in a given week, month, year, whatever? Even when the condition is visible, like multiple sclerosis or rheumatoid arthritis, many people do not understand the variability of how it impacts different people and even the same person on different days. Monday, you may be great. Tuesday, good day. Wednesday, you feel like you got hit by a ton of bricks. Okay. May not know exactly where that came from. And it's important that you understand as the person with the chronic illness and others understand as your support people, as the people that are in your mil, you, if you will. It's not a choice. It's not like you did something Tuesday night. Theoretically you did something Tuesday night and now Wednesday, you are just, you know, down for the count many times if you don't sleep as well and you may not have anything to do with that, it may just be something going on with you or the environment. You didn't sleep as well. So Wednesday a bad day, Thursday may be a bad day. You don't know when you're going to necessarily improve. And that can leave you as an individual feeling very frustrated and powerless. It's important as the person with the chronic illness to keep journals of how am I doing today? What is better? Even if it's just a little bit better, a little less intense, or it's lasting a little less time, what is getting a little bit better? People that are in my family who have chronic illnesses, they notice how much time can I spend up out of bed today? Was I able to take a shower without having to sit on a, on a shower chair? Was I able to cook my own meals? What was I able to do? And noticing those things that a lot of us take for granted is important for empowerment because it helps us focus on what we are able to do. It's also important for those that are in your circle to educate them and not to assume that they know when you're having a flare. They need to do this and you can't do this. Communicate, articulate. What is it that you need during this episode today? Facts in this concept, in this context at this time, or symptoms in this context at this time? When people with celiac disease get gluten, there are some symptoms that are very similar, but there are some symptoms that may be variable between episodes and how long it lasts, how intense it is, may be very different. So assuming that when somebody with celiac is exposed to gluten that it's going to be three weeks before they're better, that may be a go by, but it's not a hard and fast rule. Maybe a little longer, maybe a lot shorter, we don't know. And one of the things that we see with a lot of chronic illnesses is when people have an episode or breakthrough symptoms, whatever you want to call it, they start to feel frustrated and disempowered. They trigger that stress response and that activation of that stress response actually worsens the chronic condition and worsens the symptoms and makes it last longer. Radical acceptance is a big one. When you have a chronic condition, it is what it is. Radical acceptance is a big one when you've got kids too, so you may be able to apply this to that. But recognizing there are some things that are out of your control and trying to focus on the things that you can control, that is going to be very important. Educate yourself and others about your particular symptoms, about your particular triggers, and about solutions that are helpful for you and what you need to have done. You can. If you're living with somebody and they're willing to help out, hopefully maybe you have a list of things that they can help out with. When you're having a flare, when you're stuck in bed so you don't have to repeat it every time. A lot of people are very willing to help. A lot of people are feeling compassion for you when you're suffering, but they don't know how to help. Or sometimes they'll over help and it'll feel like they're hovering or they'll get frustrated because they see you suffering. They're not angry at you. They're angry at the fact that you're suffering. But the person with the chronic illness may take it personally and say, oh, they're angry at me. Being very clear and avoiding that cognitive distortion of it's my fault that don't personalize it. Ask them. I sense that you're really angry, frustrated right now. Is it because I'm. Is it because of me? Is it my fault? Is there something I can do? And differentiating them being angry at you for something versus being angry about the situation which they recognize is not within your control. Encourage people not to guess about what you can and cannot do because that takes your power. If they assume that, hey, she's having a flare so she can't get out of bed, she can't do any of this. They may be intending with the best intentions to help you out, but instead they're taking some of your power away and not allowing you to live your rich and meaningful life. I've shared before when a couple times when I had surgery and I got up and I wanted to do stuff and my husband was very adamant that, no, the doctor said you were supposed to stay in bed and you were supposed to rest for six weeks. And I'm like, no, we ain't doing this for six weeks. I'm fine. And it was a give and take. We were right. The last surgery I had, the doctor actually cleared me after four weeks and they had been saying six to eight weeks. So I did heal faster than Expected, which was wonderful. However, it was also important for me to do as much stuff as I could while I was recovering. And that's true for trauma as well. The sooner we can get back to our routine and feel empowered to be independent, the more control we have. Improving self esteem is another big issue for a lot of people with chronic illnesses. Especially if they have attachment trauma and they are fearful of rejection, or they have difficulty connecting to others because they have avoidant attachment style styles. It can be really hard to feel safe in relationships. And a lot of people who've had attachment trauma blame themselves for whatever happened. So they feel like it's their fault. They feel like they weren't good enough or they weren't lovable enough. They feel like they weren't powerful enough. They were disempowered because they couldn't make that person stay. They were disempowered because they couldn't make that person get better. And in terms of their own life, they may feel disempowered, not efficacious, and bad about themselves because they can't do the things that all the things that they want to do the way they want to do them, when they want to do them. And you know, a lot of us are like that. We want to do it the way we want to, when we want to, how we want to, and that's not always possible. Sometimes we've got to make modifications. All of these things can weigh on a person's self esteem. Where they may start feeling like they are not lovable, where they may start feeling like nobody wants to be around them because, you know, this episode's been going on for so long. Whatever they are telling themselves, they start feeling like they are not worthy and they're not lovable. I found in practice over the past, you know, quarter century that doing self esteem activities with people, having them write down things that good about themselves often falls pretty flat because they don't feel good about themselves. So they have a really hard time finding something that's good about themselves when they approach it directly. The thing that I found that works best in individual therapy is asking people, what characteristics do people generally look for in a friend? If you want, what do you look for in someone who you think is worthy of your time and your care? And we talk about it for a little while. A lot of times words come up like honest, dependable, compassionate, respectful of self, others, the earth, loyal, encouraging, supportive. I don't know about you, but I look for all of these in people. That's what I hope to project. But that's also what I look for in, in friends, in people I spend time with. And recognizing that is really important because none of these are about what you do. None of these are about whether you can go rock climbing. None of these are about whether you can cook a five course meal this Saturday. These are about who you are and core characteristics. Once we've defined those characteristics, then I ask the person, all right, let's go back over these. Which ones of these do you have? Most of the time, they can check off several of them, if not all of them. People with chronic illnesses may not feel like they are always dependable. And we can explore that from the perspective of being realistic. Nobody is able to be a hundred percent dependable all the time. Stuff happens, life comes up. Do you do your best to be dependable? And when you can't do something that you've said you would do, you let people know, do you communicate? You know, that's you can be dependable and have a chronic illness. You can be a dependable employee and have to call in sick. It happens. If you're calling in sick two, three times a week for months, that's going to be a problem. But most of the time, if the person looks at their dependability, they'll recognize that when they are asymptomatic, they're very dependable. When they are symptomatic, they're not as dependable. But guess what? It's not because they don't want to, it's because they can't. And it's not reasonable to expect yourself to be going to work if you are. You're in too much pain to even get out of bed. It's just what it is, purposeful action and exhaustion. A lot of people with chronic illnesses because their body is trying to fix the illness or because of the changes that happen in the body as a result of the illness. A lot of people with chronic conditions struggle with exhaustion. They may feel kind of foggy, exhausted all the time, or certain things may cause them to get exhausted a whole lot more quickly. Okay? Being mindful of your energy levels, of your exhaustion levels is really, really important. People with chronic illnesses and addictions often have limited energy or are more vulnerable to distress, chronic illness and addiction. Your brain picks up on that as a stressor, which causes the stress response, the autonomic nervous system to become dysregulated, which makes you more vulnerable to dysregulation. When something happens, it feels like it's a whole lot more overwhelming to deal with than if you were in remission or on your A game, whatever, however you want to call it, accepting that you are. Think of it as your friend who doesn't have the chronic illness is doing the same thing that you are, but you're doing it with a 50 pound rucksack on your back. You would expect it to yourself to get more exhausted carrying that around. Become aware of who and what is important in your rich and meaningful life and regularly reflect on that. I know I've said that so many times in different videos, but we only have so much energy. We only have so much time in the day and thinking in the morning about how am I going to spend my limited energy today to move toward my rich and meaningful life and what things am I just going to let go because they ain't worth my energy? That's important. People can ask themselves and reflect before they get ready to make a decision. If I do this, will it help me move toward my rich and meaningful life? And I have two very different examples here. Setting boundaries and setting boundaries takes energy and it doesn't always have the best results if you're dealing with somebody who has their own stuff. However, sometimes the people with their own stuff are the people you most need to set boundaries with and say, I just can't do this right now. Physically, I'm not able to do it. Emotionally, I just can't handle this right now. That is important. And if you set those boundaries, does it help you move toward your rich and meaningful life? Only you can answer that. However, you've got to consider keeping this person in my life or doing this thing for this person that is, I just don't have it in me to do right now. Is that a wise use of my energy? Or is taking care of myself so I can recharge and heal a better use of my energy to move toward my rich and meaningful life? Another example, going to a two day music festival sounds like a lot of fun. Your friends may be like, hey, let's go. It's going to be awesome. We have one here in Tennessee called Bonnaroo. It's kind of like the Woodstock of, you know, the, the 2000 and twenties or something. But it's hot, there's a lot of alcohol and probably other drugs. Is that the best thing? It may sound like something you want to do, your friends may be all about doing it. But is it the best choice for you in terms of using your energy and the environment in order to move toward your rich and meaningful life? Most of the time I would probably say no. Because being at a two day music festival, you know, you're not going to get adequate quality sleep, you're probably going to get dehydrated. If you are struggling with addiction, you're going to be exposed to all of the drugs and alcohol, which is going to be stressful and that's going to take a lot of energy. Is that a good use? Only you can answer it. Then the next and the next question to ask yourself is if I don't do this, how else could I nurture this relationship? What's the backup plan If I don't go to the music festival with my friends, which I'd love to do, but I don't think it's a good idea, what else could I do to nurture this relationship when they get back? Maybe we could, you know, fill in the blank. But doing something that is shorter in duration and less exhausting could be a compromise. I still want to spend time with you, but that's too much for me. And that is a reasonable, that's a very reasonable boundary to set. If you're in a relationship with someone and you don't set boundaries and they are, you know, of invading your boundaries, trampling all over them, is it possible to nurture that relationship? Is it possible to thrive in that relationship while they are invading your boundaries? How can you tolerate their boundary invasions and live your rich and meaningful life? And you know, obviously there are some relationships you don't want to completely cut off. I get it. So if I don't set boundaries with this person, how can I maintain my own health and sanity is basically what it comes down to. Dysregulation and communication are other issues that come up for people with chronic illnesses. It's difficult to communicate effectively when you're in fight or flight. Your brain is not in executive functioning. Think about it. Problem solving, planning. No, none of that. We are in run from the hungry lion and save yourself. Which means we're not thinking about the most tactful way to say things. We're not thinking about how to explain something to somebody. We're just saying get away. Stop it. Make it, make it go away. That's not really helpful. A lot of times it happens, okay, you may be in fight orf flight because of the current situation. Maybe you're going along. You, you've got a chronic illness. So you've got this, you ongoing low level of chronic stress. And then you get into a car accident and you disregulate. You go just completely freak out because you were In a car accident. All right, no doubt that was scary. That was stressful. It's important to understand that you're probably experiencing a surge of stress chemicals which will make it more difficult for you to communicate with the other person without going, you know, full on angry. It also could be things are going, going along, nothing major happens, but it's just this underlying chronic distress and it's grading on you. And that can cause you at certain times to feel resentful, to feel jealous, to feel guilty. And all of that increases your stress levels and, and may make it more difficult to be tolerant. Be patient, be compassionate with yourself as well as with others to help with this. Encourage people or you yourself. Improve mindfulness of your emotional state and vulnerabilities in each piece of life. Pay attention throughout the day. Not just first thing in the morning or last thing at night, but throughout the day. Check in with yourself. How am I feeling right now? And maybe you want to use one of those little emoji boards so you can pick out the face. Whatever works for you, that's fine. But paying attention to how you're feeling and what your vulnerabilities are. Remember, vulnerabilities are conditions that make you more likely to become distressed. When I'm sick, when I'm in pain, when I haven't slept well, those are three of my vulnerabilities. If those are going on, I know I am more likely to have a more extreme emotional reaction. I recognize that each piece of life. So your physical. Are there any vulnerabilities that are making you more irritable interpersonally, are there any vulnerabilities? Maybe you're an introvert and you're having to be at this big party for the, for the company and you really don't like those big parties. That's stressful. That's going to be a vulnerability. Maybe you have to be in a meeting with somebody that just gets on your every last nerve. Just recognize it. It's a vulnerability and it's going to take more energy to deal with, but it's also probably going to cause you to feel more defensive in that meeting. Okay? That means you're more vulnerable to dysregulation emotionally. Other feelings you've got going on that may contribute to dysregulation. If somebody's already anxious about something, other things in their life, they're just already anxious. And something else, some other stressor happens. Their anxiety meter is already up here. That may send their anxiety meter over the top. Okay, If I recognize that I'm already anxious then I will take steps to buffer myself from any more anxiety and I will be more mindful of not saying the first thing that comes to my mind until I've had a second to down regulate cognitive vulnerabilities and environmental vulnerabilities. Your environment can be very stressful if it's too hot, too cold, too smelly, too loud. All of those things can be really stressful for people who are already somewhat hyper vigilant. Learn how to get into your wise mind and assertively communicate your thoughts and needs. Sounds a lot simpler than it really is. But getting into your wise mind means down regulating. Slow your breathing, slow your heart rate, use those distress tolerance skills and take a beat to think about what is it that I need right now and how can I communicate it without being aggressive? How can I put my cards on the table, so to speak, without kind of forcing them in somebody's face. If you want to think of a, you know, a situation, develop secure attachment. And I've always used the mnemonic cares, consistency, attention, responsiveness, encouragement and safety. These are really important because it improves relationships. We need to be have a secure attachment with ourself. We need to know that we can count on ourselves to keep ourselves safe. As children, not so much children do rely on their adults. But as adults, we need to know that we can take steps to keep ourselves safe. Doesn't mean we have to be independent all the time and we can't count on anybody else. No, that's not what it means. However, it means we need to recognize that we have the wisdom to look at a situation and go, no, I'm getting out of that. That's not, not a good thing. So consistency in awareness and responsiveness to self and others. Be mindful of what's going on within you and around you and be prudent in how you respond. Prudence is a combination of patience, knowledge and wisdom. Getting that information, applying it to the situation, and figuring out what is the best response here, which means you've got to stop and think before you speak or act. Recognize what's going on, take a breath and choose how you're going to respond in the best way possible to use your energy to reflect who you are and move toward your rich and meaningful life. Consistency in responses also means. And if you're thinking, if you're being prudent in your response, you're going to be a lot more consistent. But consistency in responses means not letting some things go sometimes and not others, not being Jekyll Hyde if Somebody does something that you don't like, you're going to correct it every single time. If somebody does something that you like, you're going to reward it every single time that you're consistent. It's not Jekyll, Hyde, it's not hit or miss, it's consistent. Proactive attention is also important. Spending time with yourself, spending time in self care says self. You're worthy of this self, you need to recharge and I want to take care of you. Proactive attention is important. Even with our electronics, we do proactive attention. We do updates, we clean our monitors. We do have virus scans and stuff going on our computers all the time because we want to take care of our computers, but we don't even take care of ourselves that way. We need to, we need to take proactive steps to acknowledge ourselves as human beings and human beings worthy of care and attention. We also want to give attention to other people. Relationships will dwindle if they're not nurtured. Doesn't have to be a lot. Maybe it's a text, maybe it's a phone call, maybe it's going out to coffee, whatever you have the energy to do. However, connecting with those people that are important on a regular basis is going to help nurture those relationships. Responsiveness to distress and success in self, in others. A lot of times when we talk about responsiveness, we talk about a caregiver being there to help a child when they are in distress. And yes, that is super important. We also need to be there for ourselves when we're in distress, when we're having a flare of our condition, being responsive to that distress and saying, okay, self, what is it that I need to do right now to best use my energy? But there's the other part of it. We also need to be responsive to our successes. We need to recognize when we, hey, you did that. You got out of bed today. You were able to make dinner today. That's awesome. You know, you're making progress, celebrating successes, celebrating going a month or two months without an episode. That's great. That is mind boggling for some people and celebrating that, being responsive. So you're not just focusing on what's going wrong and what you can't do. Embracing those dialectics when things happen. I'm having a flare right now and you know, this, this stuff's not going so well and I'm able to do these things to best manage this situation. I do have power to manage some things. Charting can be really helpful. The frequency, intensity and duration of things that are happening. If you are reconditioning after being on bed rest for a while, charting how how long you were able to stay out of bed. That's not what you can't do. That's what you can do. You're like, hey, I went from not being able to be up for more than 45 minutes. Now I'm staying up for four hours at a time. You know, rock that. And it doesn't if you haven't had a chronic illness that made sound silly. But it is so empowering when you can realize, hey, I went all day without having to lay back down and take a two hour nap. That's amazing. Been there, done that. Burn the T shirt. Encouragement of self and others is also important. But we want to encourage with compassion. We don't want to encourage ourself when we're asymptomatic to push it too hard because that's going to cause a flare. We don't want to encourage ourself when we're having a flare to push through it anyway because that's just going to make it worse and prolong the flare. So we need to encourage ourselves to do what we can do based on the facts in that context at that time. We need to encourage others to also do what they can to help us need to encourage others to do what they can to live their rich and meaningful life. And that may mean, hey, you know, I really wanted to go hiking with you today, but I just, I can't. I don't have it in me or whatever reason I'm having a flare. But I know that you love hiking. Why don't you take the dog and go hiking without me and then I'll see you when you get back. Encouraging people to take care of themselves is also important and being safe and that means unconditional positive regard or upr separating what people do from who they are. And this kind of goes back to that self esteem thing. Recognizing that you're a good, compassionate, loving, loyal person, you know, whatever other characteristics you want to add, even when you can't get out of bed, even when you're in so much pain you can't do something that you really want to do, it doesn't make you any less lovable. It is just how it is. And accepting yourself as you are does a lot to reduce stress. Reduce stress reduces inflammation. Reduced inflammation reduces the generally reduces the duration of the flare. And perfects is another mnemonic that I use a lot in addiction recovery. Sometimes we call this good orderly direction. But it's a set of principles or go buys that we can use in order to nurture our relationship and be the person we want to be. Starts out with prudence again, patience, knowledge and wisdom. I have patience to take a step back to get the facts, to get the knowledge. And then I'm going to take that knowledge and I'm going to apply it to the situation to get the wisdom I need to tell me what should I do next. We need to be more prudent instead of impulsive in how we act and what we do. Especially for a lot of people with chronic illness, especially when you're asymptomatic. A lot of people, when they're in remission, they want to try to make up for lost time and they end up pushing it too hard and relapsing. We need to endure distress in when we have a flare in our relationships, in life. Recognizing that distress is part of life and instead of fighting with it and getting angry about experiencing distress, which Hayes calls dirty discomfort, enduring it, saying, all right, this sucks right now and this too shall pass. Respect for self and others. Doing to others or for others as you want them to do to you, and doing to yourself as you want others to do to you. That's really important. Respecting yourself. If your best friend had your condition and was having a flare, what would you expect of them? And are you holding yourself to that same guideline? Or are you expecting more of yourself? Are you expecting yourself to be the super person? Be respectful in your expectations, in your judgments, in your assumptions. Forgiving self and others is really important in relationships. Sometimes people are going to get mad. They had their heart set on going on this trip with you and you can't go with them because you're having a flare and they're going to get mad. They may temporarily be mad at you. They may definitely be mad at the situation. You can get angry at them for getting angry at you, or you can recognize that, hey, you know, I can see where that was really disappointing and frustrating from for them. And I can. I'm going to forgive them for getting angry at me. I'm going to forgive them for not being respectful and compassionate toward me for now. We'll talk about it later. But I'm not going to stay angry because staying angry is going to make my chronic illness worse. It's going to make it last longer, and it's not worth it to me to stay angry and fuel the fire of my current pain. Earnestness means acting with integrity and ultimately with earnestness. That means doing what you say you're going to do, when you're going to say it, when you say you're going to do it to the best of your ability when you go to work. Most people, when they go to work have good days and bad days. On their bad days, they're not as productive as on their good days, but they're doing the best they can at that time. They are pushing through, they are trying to do their very best. That's earnestness. With chronic illnesses, we'll have good days and bad days. And if we truly try to keep our promises and do what we say to the best of our ability at that point in time, nobody can expect anything else. You wouldn't expect more out of your children or your best friend if they are doing the absolute best they can given the circumstances. All right, great, I'll accept it. I will try to support you. Compassion for self and others is also important. We don't want to approach people judgmentally. If they get disappointed because we can't do something or if they get angry because they don't understand our condition, maybe we can educate, we can be compassionate. Putting ourselves in their shoes and going, okay, I wonder what's going on that is causing them to react this way to this situation. And trying not. Compassion is sort of the opposite of anger a lot of ways. Trying to be as supportive and non judgmental as possible. The same thing for ourselves, being compassionate with ourselves. When we're having a flare of our chronic illness, okay, we're having one, it sucks and there's nothing I can do about it. I am not going to judge myself harshly because I can't do things today that I was able to do yesterday. I know as soon as this flares over, I'll be able to do it again. Being truthful, authentic with self and others is also super important. Don't have that, as my mother used to call it, stiff up, stiff upper lip and just push through. That's not helpful most of the time. Being truthful with people about what you can and cannot do and what you do and don't need their help with is essential in nurturing these relationships. I said it earlier, I'm going to say it again. Most of the time. The people in your, in your life that are important, they want to help, they care, they have compassion for you. They may not know what to do. And truthfulness means telling them. Truthfulness doesn't mean waiting until they ask. There's lies of commission where you intentionally tell somebody something false and then there's lies of omission where you just don't say anything and you assume that they know. A lie of omission with a chronic illness is not telling anybody what's going on with you and that you may need a little help. So being truthful with those around you. I'm having a bad day today, or I'm feeling really run down today. This is what I need, or this is what I can do, or sometimes it's just I'm feeling really run down. Today's a bad day, okay? People are like, all right, I'm sorry. Let me know if there's anything I can do to help. End of story. It doesn't have to be a long discussion. And selflessness, offering support or resources to others in your relationships while respecting your own limits in a way that fosters mutual respect. While respecting your own limits, you can be selfless, you can be compassionate, you can give to others, you may do things for others like help them move that you really don't want to do. That's a selfless act when you can do it. But the key with selflessness is respecting your own limits. Because if you get burned out, worn down, or trigger a flare, then you are going to be. Not only are you not going to be helpful to them, but you're probably also going to need additional help from other people. So being selfless means recognizing what you can do and establishing that. That respect and people who matter don't mind. As Dr. Seuss said, when you communicate truthfully with them about what you need help and why you can't do something. Ideally, we try to create a win win. You know, I can't help you move this weekend. I'm just. I'm really struggling. I'll try to help you out next weekend. That's possible. Setting boundaries is also important. Being mindful and truthful about your boundaries demonstrates respect to self and others. It's important since insecure attachment is an underlying issue for a lot of people with chronic illnesses. And it is important to address those boundary scripts. What were you told or taught when you were growing up about saying no and about asking for help, evaluating whether those are accurate in this context at this time, or whether those were scripts that were formed in a dysfunctional situation and you want to have a more functional lifestyle. Types of boundaries. Go back to the peace mnemonic again. Physical boundaries, my person and what I can do, my energy. Interpersonal boundaries, how quickly or slowly I learn to trust you. Emotional boundaries, how I feel, Cognitive boundaries, my thoughts and environmental boundaries. That's my Stuff. Whether you're going in and rummaging through all my stuff, all of those are important. To know what your boundaries are with different people and be able to feel safe enough to maintain those boundaries. Maintaining those boundaries is telling yourself that intrapersonal relationship. I am worthy of feeling safe. I am worthy of being protected. And as such, I'm going to set this boundary. Being. Setting boundaries with others is respectful to them as well, because it says, you know, I really want to be in a relationship with you, or I want to hang out with you, whatever, and this is what I need to feel safe. So instead of making them guess and hit or miss and violate a boundary and offend you, and then you've got to make up or whatever, tell them ahead of time, you know, let them know what is and is not comfortable for you. If you have some boundaries that, that are hard boundaries, you know, no, we're not. We're not doing this. People with chronic illness or addiction often have more pronounced variability in their abilities and distress tolerance. Instead of having, you know, if I'm having a bad day, maybe I'm 10% off. Somebody with a chronic illness, when they, like colitis, Crohn's disease, when they have a flare, when they have a bad day, they may be 70% off. We're not comparing apples and apples. It's two different situations. And it's important to be aware and compassionate of that. If you've got somebody in your circle who has a chronic illness that flares, recognizing that their bad day may be a lot worse than your bad day, and not trying to expect the same out of them that you would expect out of yourself in different circumstances, Be mindful and truthful about your limitations helps demonstrate respect, compassion, and selflessness. Because being mindful and truthful, you're telling people, this is what I can and cannot do. Remember, respecting your limitations in order to foster mutual respect. And that is so important. Develop alternatives. If you can't do something. Maybe I can't think of a group activity right now, but crocheting. My carpal tunnel acts up really bad when I crochet for very long. But I love crocheting, and it's important in my rich and meaningful life for me to be able to crochet and get through all that yarn I've got down there in the craft room. But I can only do it for 15 minutes at a time. And so that's my limitation. Alternatives. If I can't crochet, what else can I do that helps me feel creative? Baking, you'll Find me either out in the garden or in the kitchen. Those are my Zen places. So, okay, there are alternatives. If my friend wants to go rock climbing, my carpal tunnel is acting up. There's no way I'm grabbing and climbing. It ain't gonna happen. Can't do that. How about if we go on a hike instead? Still outside and. But it doesn't require me to use the grip strength that I just don't have right now. So developing alternatives that you can propose. How about this instead? Can be really helpful. A lot of people with chronic illness find themselves isolated because others have reached out to them and they've said no so many times that people quit asking. And it's not that the people don't like them or don't want to do it anymore, but they figure, well, every time I ask, they say no, so why bother? When you propose alternatives, it communicates. Hey, I would love to do that, but I can't. I would love to do this instead. I want to spend time with you. And that is crucial at nurturing those relationships and people. Just like vulnerabilities, you can have limitations in all p each piece of your life. Your physical limitations, pain, energy, just your abilities. Interpersonal limitations. Your ability to trust people. Maybe you're just not at a place where you can trust people that much yet. Okay, communicate that. You know, I don't feel comfortable enough trusting other people to go to this big shindig for a weekend where I'm not going to be in my home. Home. Home base. Emotional limitations. I am grieving right now. I'm exhausted, I'm angry, I'm whatever. I don't have a lot of emotional energy to give right now. That's a limitation I have. And I would still love to do something else with you tomorrow or the next day, but today I just need time to grieve. After we lose an animal on the farm, I always need at least 24 hours, sometimes 48, to grieve and get my head on straight after that happens. And it's just the way it is. It's just how I am. Cognitive limitations. If something is too mentally overwhelming for you, mentally stressful chess, I'm sorry. I can play checkers until the cows come home, but I cannot wrap my head around chess. And it frustrates my son because he loves to play ch. Okay, we play checkers instead. That's my alternative. And environmental limitations. Communicating to people that I'd love to do that, but I'm too sensitive to the heat. My mother in law takes Thyroid medications that make her very sensitive to getting overheated. Easily acknowledging that, okay, so we'll do stuff inside that's, we'll find something else to do because it's not about what we do, it's about getting to spend time together. Chronic illness, including diabetes, cardiovascular disease, autoimmune issues, chronic fatigue, dysautonomia, migraines, PTSD, mental health issues, etc impact more than 80% of people in the United States. When you start going down that list of, of things in the, at the beginning of the presentation, recognizing that that doesn't even include all of the thing, all of the chronic illnesses, but when you start going down that list, I think you can check off, you know. Yep. No, no, somebody who has that know somebody who has that, somebody else has that. I even, I just went through my family and I'm like, yeah, 80%'s about right. Maybe my, my family may be a little higher actually. Developing healthy relationships with self in order to feel safe and empowered, which helps you reduce your stress and reduce your systemic inflammation. And developing healthy relationships with others who can be there to support you and encourage you and nurture you. These are essential in life, but require that all parties have an understanding of the illness and as it exists for that person. That both parties are able to effectively communicate and are willing to communicate, needs, understandings, etc requires unconditional positive regard. Acceptance of each person in the relationship or acceptance of yourself if you're talking about self esteem for who you are, not what you can do for for them, and determination to purposefully use that energy that you have, that very limited energy to nurture relationships that are important in ways that help you move toward your rich and meaningful life. Are there any questions? And BB that is a great way to approach things by saying, you know what, I don't want to make plans, then break them. So let's play it by ear. It's not that I don't want to spend time with you, but I never know on a day to day basis. I had a dear friend with Crohn's disease and she didn't know on a day to day basis whether she was going to be able to do certain things. Shyman I don't specifically have a video on menopause. I do have a video on physical aspects of aging and then I also have a couple of videos on hormones and mental health that address menopause and decreasing gonadal hormones as we age. So check those out. You can go to docsnipes.com AI whoops. And Ask my AI for input on what videos to watch. And just in general, you may be able to query it regarding your specific question about hormones, mental health and menopause. I'm sorry to hear that, Tom. It is very disheartening when you discover that your, your cancer is no longer in remission. And you're right, the new people that you meet are, are amazing. A lot of times those people are people who are going through similar things so they understand and they get it. And I found with cancer, one of the things that a lot of people experience is even when they go into remission, a lot of people distance themselves because in their mind they think that you could pass away tomorrow and they don't want to expose themselves to that grief. It's important, if you can, when people have cancer diagnoses, to be as open as others want with them about the progress of your disease, because it can be. My uncle lived with bladder cancer for 12 years before he finally passed away. And that was, you know, way longer. He was on therapies for it the entire time, but that was way longer than he was. He was supposed to live, quote, according to the doctors. And really embracing, encouraging others to help you embrace what time you have left can be helpful. And I know you know this. I'm telling. Speaking more for, for other people who haven't necessarily had to deal with someone who had cancer and was lucky enough to be able to go into remission for a little while. Okay, everybody, have a wonderful rest of your day and I will see you if you come to the Monday, ask me anything. I'll see you then. Otherwise, I'll see you next Wednesday. Including diabetes, cardiovascular disease, autoimmune issues, chronic fatigue, dysautonomia, migraines, PTSD, mental health issues, etc. Impact More than 80% of people in the United States. When you start going down that list of things in the, at the beginning of the presentation, recognizing that that doesn't even include all of the things, all of the chronic illnesses. But when you start going down that list, I think you can check off, you know. Yep. No, no, somebody who has that know somebody who has that, somebody else has that. I even, I just went through my family and I'm like, yeah, 80's about right. Maybe my, my family may be a little higher actually. Developing healthy relationships with self in order to feel safe and empowered, which helps you reduce your stress and reduce your systemic inflammation. And developing healthy relationships with others who can be there to support you and encourage you and nurture you. These are essential in life, but require that all parties have an understanding of the illness as it exists for that person. That both parties are.