Managing Anxiety and Depression

It's difficult to not experience anxiety or depression at some point in life, particularly when dealing with a rare disease or other chronic illness. Such feelings at times are normal to experience but when they become long term feelings is when they can become more inhibitive or detrimental.

It's helpful to understand the cyclical relationship between thoughts, mood, and behavior and how they interact with one another. It doesn't matter where you start in the cycle, each segment will affect the rest.

For example, if I have the negative thought that my health will not improve leading to depressive feelings which may manifest in behaviors such as isolation and loss of interest in activities. These behaviors feed into new thoughts such as I'm never able to do anything which may make me feel more depressed and engage in increasing depressive behaviors.

Each part acts as fuel, reinforcing the cycle to continue. And so this is the same for other moods such as anxiousness or happiness.

The easiest way to change the cycle is to stop a negative thought in its tracks and replace it with a more positive thought. However, negative thoughts occur so automatically that we often fail to realize that we had a negative thought. It helps to know what kind of negative thoughts to look out for in order to start recognizing the occurrence of a negative thought.

• All or nothing thinking. Looking at situations as black and white with no middle ground. Either I can do everything or I can't do anything.
• Overgeneralization. Applying one experience to all future expectations. I can't do anything now or ever.
• Filtering out or diminishing the positive. Only recognizing the negative, ignoring the positive or excusing why the positive didn't count. I was able to do something this time but that's not how it usually is.
• Jumping to conclusions. Drawing negative conclusions or expectations without any evidence to be the case. I won't be able to do anything anyway, so why try.
• Emotional reasoning. Belief that what you emotionally feel is the reality of a situation. I feel like I can't do anything so therefore I can't nor will be.
• Expecting perfection. Holding yourself to a strict level of standards with no room for error or difficulty living up to unrealistic expectations. I can't do it the way I want so I can't do it.
• Personalizing everything. Taking others words or actions personally even if they were not directed at you. They didn't invite me to their activity because they don't care about me.

Familiarizing ourselves with the types of negative thoughts can help us to recognize when we have a negative or discouraging thought. If you have a bothersome feelings, ask yourself the following questions:

• What happened that is bothering me?
• What were my first thoughts about it?
• How did I feel when it happened?
• What did I do?
• What happened as a result?
• Am I satisfied with that outcome?

These questions will help us to understand our thoughts and feelings associated with an experience or situation. Once we understand what is going on behind the scenes in our mind, we can tackle the problem and work toward a more positive experience. This is particularly helpful by changing or reframing the identified negative thought when such an occurrence occurs.

Instead of thinking "I can't do anything because I'm sick", we can reframe this discouraging thought to "I'm not able to do as much as I would like to right now, but tomorrow I may be able to do more than I am today".

Negative thoughts are not easy to change over night. We engage in negative, discouraging thoughts so abundantly as human beings that it has become an automatic habit. But like with any habit, habits can be changed. It just takes continued effort and determination to create a new habit. So don't give up, it may take some time but it will be helpful for mental well-being to continue such efforts.

Changing behaviors can also help to enhance positive thoughts and emotions. Often when we are anxious or depressed we will isolate, decrease activity levels, over sleep or not sleep, and increase or decrease food intake. There are a number of behaviors that we can engage in to help calm the mind and those bothersome feelings.

• Here's a step by step guide to such helpful behavior exercises.
• Try out these additional tips to help manage stress and anxiety related to illness.

Fohm Cleanser: A Sponsored Review

Disclaimer: I have been given Fohm as part of a product review through the Chronic Illness Bloggers network. Although the product was a gift, all opinions in this review remain my own and I was in no way influenced by the company.

I have Short Bowel Syndrome which means I use the restroom 20+ times a day for loose bowel movements as a result of having my colon and part of my small intestine removed. My skin is sensitive due to the frequent restroom use and regular toilet paper can be harsh on such sensitive skin. To help combat skin irritation, I utilize Calmoseptine ointment after each restroom use. Not only is my rear sensitive but so is my vaginal skin that has only worsened over the years. For individuals like me, a wet cleanser can be helpful in mitigating the effects of frequent restroom use associated with GI issues. Typically, individuals think of wet cleansing wipes but a wet cleansing solution, such as Fohm can be a game changer.

Fohm cleanser is a touch-less dispenser system to replace wet wipes to not only help clean your rear but also prevent build up in your sewer system of excessive wet wipes that will also help reduce pollution and sewer line issues.

I was provided the touch-less dispenser and a bottle of Fohm cleanser solution that is marked to last 6 weeks. The cleansing solution is liquid and when activated through the dispenser turns to a foam. One can purchase Fohm on a subscription service basis or a single cleanser refill. The dispenser comes with a USB charger to charge the dispenser batteries to allow for touch-less dispensing of the cleanser on your existing toilet paper. However, it does not come with the USB cube so I had to obtain my own cube for charging the dispenser.

Upon first glance, the system didn't come with very detailed instructions although was simple enough to assemble. For those who suffer with pain or arthritis in their hands, this system may be difficult to assemble without some assistance from someone else. The cleanser bottle is made with a durable plastic that is not the easiest to squeeze for emptying the cleansing solution into the dispenser and the top of the dispenser was not particularly easy to screw on tightly to prevent spills. I would suggest charging the dispenser before adding the cleanser to the dispenser.

I placed the dispenser on the back of the toilet tank for easy access for cleansing my skin after using dry toilet paper. The downside of the dispensing system is that it is not portable for continued use outside of the home unlike hand sprays that may easily be concealed for use no matter where you are. For someone with regular bowel movements (i.e. with a colon who isn't having diarrhea), it may be suggested to only use toilet paper with the cleansing solution to clean the skin. However, due to my Short Bowel Syndrome, I found it cleaner and easier to clean with dry toilet paper first followed by the cleansing solution. The system dispenses a fair amount of foam solution when activated and can be changed to dispense 10 ml or 25 ml. I always fear using new cleansing products as ingredients may cause a burning sensation to already sensitive and irritated skin. This was not the case with Fohm cleanser though. It was comfortable on my rear and vaginal sensitive skin areas even at my rawest skin moments. 

With continued use I have noticed less irritation to my vaginal skin in particular. I have not felt able to stop using the Calmoseptine ointment on my rear though even with continued use of Fohm. Others may be able to forgo such ointment use though. Overall, I was pleased with the Fohm product and would recommend it to others with GI issues or who just want a more eco-friendly cleansing option.

Coping with Life Altering Breakups

The 27th will be the third anniversary of my divorce. I view this day as my independence day - the day I regained my freedom as an independent woman free from the confines of being legally tied to another person and the damage that legality can cause to a person when all is betrayed or jeopardized.

Although I still celebrate this freedom day, this year it comes with some heartache. Perhaps this is due to the ending of my last relationship almost six months ago. It was the first relationship since my divorce where I allowed myself to deeply love again and for a while I thought this relationship would be a forever relationship. Like my dreams and hopes pinned on my marriage were dashed, so it would be with this relationship as well.

Just like with the ending of any deep relationship, there are bouts of sadness and pain that creep in afterwards when you think you've fully healed. And so it is as my anniversary approaches. I am reminded of the life I once had and the life I have now. I had a good life then and I still do now - they're just different and honestly, in the long run it is a far better life now.

In my marriage, we were building a life together. We were planning to build our dream home on a farm I bought in the country and for years planned on surrogacy for a child of our own. He was trying to make his own side business work of his own passions and interests. We lived as partners and we had a great relationship and marriage - until we didn't anymore. I remember the day that my life began to fall apart, only I didn't truly realize it yet. My love for my husband and my optimism in us kept me in denial of the true level of pain that had been inflicted upon me and our relationship. In the end, the pain was too much and I couldn't get past it. Eventually, I realized that the level of security I require for my own well-being could only be obtained and protected on my own - outside of any marriage or legalities that would tie me to another person and their choices.

My life changed - there was no more plans for a deeply desired baby, I moved back home to my parents and eventually sold the farm. I didn't know what I would do or where I would live permanently. My mind frantically raced between all the possibilities. One moment I was going to permanently stay with my parents and provide for them as they age or I would build my own house on their acreage so that I would be near but separate. Or maybe I would go ahead and build a house on my farm or just move into my new boyfriend's house. The options were endless and I found myself able to advocate for every possibility. But in reality, I was still grieving. My life was different and there were too many options available. I didn't know what I wanted my life to become.

The times following our separation and divorce were truly freeing.
The weight of all the pain and

stress had been lifted from me and I had the whole world ahead of me full of adventures awaiting me. Sometimes I still am gifted the surreal feeling of my present life with all the freedom of opportunities that singledom provides - the never ending possibilities that lie ahead for me with no one else to answer to or interfere with my decisions or life. The world is open to me and I can choose any path I so wish. This surreal feeling has waned over the years but it refreshes itself periodically and I am left amazed at my life. I left a marriage that had unexpectedly turned harmful to my future security and I managed to pick myself up (albeit with the support of my parents and friends) and now I own my own home. I never would have suspected owning your own home could provide such joyous, prideful feelings within oneself. At times it is hard to believe I am where I am in life - that surreal feeling that I made it on my own.

My last relationship lasted a year, longer than it should have for my own mental well-being. We lived together and it was nice to share a life with someone beyond just the weekly date. It wasn't a partnership like I wanted but it was the closest I had come since my marriage and we shared a deep love for a while. After our break up, I had to become accustomed to being on my own again in my home. This allowed me to reacquaint myself with my home and that surreal feeling of it all being mine and mine alone. That surreal freedom I had lost while in this relationship.

I've rediscovered my freedom and the wonderfulness of my present life since then. Sure, I hope to find a partner to spend my life with someday. It would be nice but so is the freedom of independence. And so for now, I will savor this freedom and cherish the surreal feeling of my accomplishments and the adventures that await me.

Milestone Depression

I never was one to attach a lot of meaning to holidays or birthdays, they were just another day, another year. Sure I enjoyed celebrating with loved ones but they remained just another day. I even recognized birthdays as a milestone of survival. However, my outlook on holidays drastically changed over the last couple of years for two particular days - my birthday and New Year's. Now I enter a period of mourning around these days in anticipatory grief over what the future holds.

I have always wanted my parents to outlive me and there were times that this was nearly the case. I fear the real possibility of outliving my parents. And as I age, this fear has intensified. My birthday and New Year's have become to serve as painful reminders of this fear as I become another year closer to my fears becoming reality. I no longer enjoy these days, instead I become overwhelmed with fear and depressive feelings - spending hours sobbing while my mind is consumed.

As a child and teenager, there were times that my doctors were amazed at my survival of times that I wasn't expected to live through. Afterwards, I was convinced that I would not live past age 21. When I turned 22, I was overcome with feelings of bewilderment and grief at passing 21. I had come to accept my death and was prepared for it. I didn't know what to think about continuing onward with life when I was utterly convinced I wouldn't see 22. My health was still precarious enough that it wasn't unreasonable to think my life was limited. Age 21 has come and gone and now, I find age 40 to be a prime limit to my life. At 40, my parents should still be living and they would be recipients of my life insurance policies that would allow them to be taken care of financially and medically in their older years. My parents' comfort and security is more important and means more to me than a long life for myself nor do I want to endure the loss of my parents. As selfish as that may be, their loss is a tremendous fear of mine and I truly believe they would handle losing me better than I would handle losing them.

And so for the day of and a few days past my birthday or New Year's I am overcome with mourning for another year added to my age and my parents' ages. This state doesn't stay for long but it is long enough to remove any joy these holidays may have held for me in the past. I try to remind myself during these days to enjoy the time that we do have together and no one knows the future. After a couple of days the intense feelings extinguish themselves until the next year when they are renewed with acuity once again. The fear remains with me on a daily basis in the back of my mind, however, not as acute as on these particular holidays. Most days it is easily manageable as I practice reframing my bothersome thoughts and distract myself with activities. It's important to focus on the present so that we don't get lost in the fears of the future.

What We Need From You

Chronic illness is a challenge, period. It's a challenge for those who live with the illness on a daily basis, for caregivers of the ill person, and for those who are involved with the person outside of the home. Chronic illness often leaves those in its wake feeling frustrated and helpless. The ill person struggles to live daily life with the symptoms of chronic illness and friends and family are limited on what they can do to help the ill person. To make matters worse, those of us with chronic illness are often hesitant to ask for help from others due to feeling burdensome and are frequently at a loss ourselves as to what may be helpful. To help all of us, here's a list of things we need from you due to chronic illness.

We need you to be available.
Chronic illness can be extremely isolating at times, particularly if it is a rare disease. Depending on the diagnosis, it can be difficult to identify and communicate with others with the same illness. Social media has helped close the distance among individuals with the same illness but in person visits remain different from online communications. We are further isolated due to difficulty to physically leave our homes except for our medical appointments. Even when we want to visit with others we may not physically feel up to visiting regardless of the communication form. We frequently experience hospitalizations and may only experience encounters with medical providers. Your presence in person, on the phone, or online is a tremendous support to us when we are able to do so.

We need you to listen and encourage.
Due to the elevated risk of isolation among those with chronic illness, we are at higher risk for depression. We easily become frustrated, discouraged, and depressed regarding our health issues and daily struggles. Your willingness to listen to our concerns and to encourage us along the way has an immense impact on our mental health.

We need you to be understanding and forgiving.
Changes in our health and abilities often causes us to feel angry and frustrated as we are adjusting to chronic illness. Furthermore, when we don't feel well we may be ill tempered. We don't mean to direct our frustrations and anger toward others. A gentle reminder when we are acting unfair will help us to realize any damaging behavior and allow us the chance to correct any harmful behavior. Your understanding and forgiveness is paramount in this process.

We need you to help us feel accepted and loved.
Chronic illness typically means changes to our bodies and abilities that may not be visible to others but we remain acutely aware of such changes. We may have difficulty accepting such changes and become insecure and self-conscious of our bodies, symptoms we are experiencing, abilities, and our self-worth. We all want to be accepted by others and this desire may be heightened by chronic illness. Your acceptance helps us to accept ourselves when we are struggling with self-love and acceptance.

We may need your physical assistance.
Chronic illness is high maintenance requiring ongoing medical management that includes frequent medical appointments, tests, procedures, medications and more. These tasks are demanding physically and mentally. As abilities are challenged by chronic illness, we may require your physical assistance in the form of transportation to appointments, assistance obtaining and taking medications, household chores such as cooking, shopping, and cleaning. Changes in our abilities often leaves us feeling as a burden on others resulting in our hesitancy to ask for physical assistance even when it is greatly needed.

We may need you to help us find assistance.
Chronic illness can easily create financial difficulty due to inability to work temporarily or permanently. Our finances may easily be overcome with medical expenses. Locating appropriate resources is not an easy task when one is sick. Therefore, your assistance in locating and applying for resources may be of great service to us during a time that we are having difficulty physically or mentally functioning.

We need you to help advocate.
As a patient, we benefit from advocating for ourselves but your advocacy on our behalf would also be advantageous. We may not always have the physical fortitude to speak up or we may forget questions to ask. You can help us by attending appointments with us and listening to the information presented by medical providers. Additionally, advocacy efforts on a larger scale directed toward public awareness and legislation are stronger with participation by patients and loved ones.

We need you to help us enhance our physical comfort.
Chronic illness often is exacerbated by physical symptoms that are distressing and even painful. We've learned little tricks to help ease our discomfort such as using heating pads, rubbing a painful body spot, or even taking a nap. When you are near, you can help by handing us objects such as a heating pad or our medication so that we may limit our movements, particularly when movement is painful. Sometimes a gentle rub on the afflicted body part or even something as simple as playing with our hair can be soothing. We often fight fatigue that negatively affects our sleep schedules. In such cases, helping us limit our nap time will help us maintain an appropriate sleep schedule while boosting our energy.

We need you to take care of yourself.
Lastly, we realize that providing care and comfort to a chronically ill person can be difficult on others and want your well-being to be taken care of as well. Caregiver burnout can be detrimental to all involved and the last thing we want is our illness to be harmful to you. We understand that one cannot provide around the clock care for us and maintain one's own well-being. Self-care is important for everyone, not just those with chronic illness.

We may not say it enough but all your efforts to support and assist us in the walk of chronic illness is greatly appreciated and we are far better off with you in our lives than without you. We thank you for all your efforts.