It was only after my heart attack and subsequent cardiac complications that I had to learn the fine art of p-a-c-i-n-g, a skill I’d never bothered to master until then.
In fact, many freshly-diagnosed heart patients tell me that they feel reluctant to embrace the concept of pacing themselves to minimize symptoms or protect dwindling energy reserves. Some prefer instead to focus on returning quickly to “normal”, whatever that is. . .
Deciding to pay attention to pacing can feel to these people like they are giving in to the diagnosis. So it may help to reframe this need for balance following diagnosis of a chronic and progressive condition like heart disease. We tend to grieve the loss of our former self – the one who could happily run around all day with her hair on fire. I sure used to miss that version of my former self! But I now know that when I pace myself, I’ll be more able to enjoy each day. When I don’t pace, I don’t enjoy.
Because I live with the often-debilitating cardiac symptoms of coronary microvascular disease, I now describe my days as “one outing” days, or “two outing” days, or (rarely) “three outing” days – each outing followed by periods of exhaustion and recuperation. Some outings feel big (like doing a presentation or a live media interview) and some feel small (like walking downtown), so recovery times can vary – but it’s all built into my pacing schedule. On a bad day, my “three-outing” plans may evaporate entirely, so flexibility is also a useful skill to work on.
Compare this to my pre-heart attack life, when I could easily knock off several outings on the way to my first outing.
Author Toni Bernhard, in her recent essay called 19 Tips from 19 Years Sick, had some advice on learning to pace ourselves:
“As I wrote about in my book, How to Be Sick, pacing is my go-to treatment. I admit that I need to do a better job of sticking to this tip myself but, when I do, I’m less likely to feel ‘trashed’ at the end of the day. Even stopping to lie down for 10 minutes can help me make it through the day. My wish is that all of you who are reading this are better at pacing than I am!”
I especially liked Toni’s tip that she calls the “50% rule”:
“Given how you feel on a particular day, you decide what you can comfortably do – and then do only 50% of it. I also recommend that you think of that unexpended 50% as a gift you’re giving yourself to help you feel less sick and in less pain.”
Smart pacing always starts with smart planning.
Toni, for example, is a person who had always loved to host lively dinners and parties for friends or family, but she worried that her entertaining days were over once she became ill. But her husband, an enthusiastic cook, readily offered to take over all the prep and try out different plans. Forget large late-night dinner parties – why not scaled down morning brunch events for those (like me!) who tend to feel better early in the day compared to later on?
Toni also had to make an advance plan about when she’d be able to join her guests. She knew she wasn’t well enough to stay from start to finish. She could either be early to greet the guests as they arrived and chat with them a while before excusing herself to go lie down, or she could rest during the early part of the gathering and then come out later for desserts and to say goodbye when their guests were leaving.
She was realistic. She unapologetically accepted that she couldn’t stay up for both, but planning ahead for a partial visit meant that she could pace herself, and that meant she and her husband could still have company over. And just because she’d always entertained her guests a certain way before didn’t mean she couldn’t still do what she loved – but this time, in a modified way.
Planning ahead must also mean taking a hard look at our calendars.
Like Toni, I cannot have an appropriately-paced day ahead of me if my calendar is as jam-packed as it used to be, pre-heart attack, when my busy-ness seemed a cause for perverse pride:
“Hey, Carolyn! How are you doing?”
“Oh, you know how it is. . . crazy-busy, as usual!!!!”
I had morphed, almost overnight, from bragging proudly about how “crazy-busy” my life was, to a state where almost every outing or activity required resting beforehand, and recovering afterwards. Post-heart attack, even taking a shower required a 20-minute lie-down just to recuperate!
At first, I couldn’t figure out what was happening. Why couldn’t I just pull up my socks and snap out of this? I felt so distressed about my reduced stamina that I mentioned this sudden change in my ability to function to my (now former) family doctor, who then asked me:
“Can’t you just push through the pain?”
Well, in fact, I couldn’t. That’s what made it so distressing!
Planning a heart-healthy calendar page means making thoughtful decisions. Which outings or activities mean the most when you can no longer say yes to many? Take a moment to think about how you truly want to spend that precious hour of your life. And then practice learning to say “No!” – no explanations or apologies needed. Remember, dear reader, that“NO!” is a complete sentence.
I have had to learn the hard way that planning ahead and carefully counting my “outings” could mean the difference between having a flare of awful symptoms and being able to enjoy myself relatively symptom-free. Yet unlike the very wise Toni Bernhard who knew her limitations and made self-care plans in advance to carefully protect her health, I used to just soldier on, saying “YES!” to many outings in the early days post-diagnosis just because I’d been invited!
Sometimes, an invitation is so attractive or so important to me that when I weigh the pros and cons, I do agree to go, despite knowing there’ll likely be harsh consequences for saying “Yes!” – but that’s a choice I’m occasionally willing to make.
I’ve learned in general, however, how brutal the consequences can be when I don’t respect what my body’s trying to tell me. And I’ve also had the rare but fantastic experience of having lovely outings precisely because I’ve done some planning ahead to make sure I was rested, fed and watered enough to truly enjoy it.
Saying “No!” to some things may in fact mean saying a more whole-hearted “Yes!” to even better things.
I recently discovered new U.K. guidelines about pacing for people recovering from COVID-19 (courtesy of Homerton University Hospital in the London borough of Hackney). These common sense pointers are useful for heart patients who are learning new ways to pace themselves, too. For example:
“Once activities are planned, then pacing allows people to sustain an energy level until a task is completed:
- “Allow plenty of time to complete activities and incorporate frequent rests.
- Perform tasks at a moderate rate and avoid rushing. Although a task may be completed in less time, rushing requires more energy and leaves less ‘in the bank’ for later activities.
- Breathe easily during activities to decrease shortness of breath.
- Rethink activities with rest in mind. For example, sit instead of stand if you’re feeling tired.
- Allow plenty of time for rest and relaxation. Take a morning or afternoon nap prior to activities or outings to build up energy.“
Landscape image: Enrique Lopez Garre, Pixabay
NOTE FROM CAROLYN: I wrote more about how heart patients can learn the fine art of p-a-c-i-n-g in my book, “A Woman’s Guide to Living with Heart Disease”. You can ask for it at your local bookshop, or order it online (paperback, hardcover or e-book) at Amazon, or order it directly from my publisher, Johns Hopkins University Press (use their code HTWN to save 20% off the list price).
Q: What activities or outings have you learned to say “No!” to that you used to do routinely?
– Another essay from Toni Bernhard: “Pacing: The Chronically Ill Person’s Best Friend.”