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Should We Push Ourselves...?? How Far???

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I was talking at one point to a fellow who said we needed to "retrain" our autonomic nervous system so we should try as best we can to keep as active as possible. I have POTS but my hr is pretty manageable on toprol...altho I still feel very crummy!

I really try to do this but some things I really can't do....i did some vacuming the other day and then started with the diareha, had to lay down...etc. I feel just awful when I really push myself. it is like a backlash of sorts; I feel ok so I reallly push and then am so sick I can't function.

What is the thoght on how much activity we should try to do? This really doesn't feel like building stamina....is that what we should try to do?



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i have been pushing myself the last few days. The only reason why i am really physically pushing myself is because i know if i don't i will be a hermit and my life will be empty. It might still be this way even with pushing it but its worth a try to get better and back to normal. I worked out yesterday and today i have brain fog/head ache/confusion, but im ok with it, it ***** but atleast i got something done yesterday and trained my muscles. Might as well push it and feel sick than rather than not live at all and be a little more comfortable and probably still feel sick anyway. I think the hint here for people with illness like us is baby steps. Ive been slowly intensifying as much as i can each day.

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I just learned something really interesting at my lasted psychiatrist appt.

He asked me how I monitored/paced myself. I said I wasn't very good at it. It's hard to know when I'm overdoing, etc. and if I'm having a good day, I tend to overdo.

What he said was that it's important to find a way to do what I can on good days and try to find a way to stop before I push TOO far and crash. On bad days, back off.

What I found so interesting was his comparison to people in chronic pain who overdo on a 'good day' and crash with pain for 1-3 days afterwards.

This is pretty much what I do (and a lot of us here do). We push hard and then crash out.

He said that doing this can create fragility. Whereas if we pace ourselves better and don't push to the point of serious crashing we can build endurance.

It was a different perspective for me. And even after 10 years I still over do. I guess this gave me a different reason and motivation to pace myself better.



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I think pacing is really important, but I also think a small amount of pushing myself has actually made me a little bit better. Marginally better, but better.

For me, "pushing" myself to do a certain type of difficult things - standing for a long time, walking great distances, going to long social events where I have to talk for a long time and/or stand up for a long time, doing too much in one day, doing too much housework, working too many hours at my job - NEVER helps me. These things always set me back. I do as much as will make me tired (everything makes me tired) but not exhausted. Because with these types of activities, I find if I "push" myself there is no benefit.

But, if I "push" myself to do activities that are challenging but healthy - taking a walk for exercise (not too long or too fast), doing a little weight-training, pushing myself to go for a little bike ride even if I'm tired - I find these things help me long-term. I push myself to try and do some form of (light to light-moderate) exercise five times a week. I've been doing this for a year, and I do feel a little bit better now. But there are some weeks I simply can't do all five days, and this has by no means cured me. But I think it's a good example of how moderate "pushing" can actually be beneficial.

I think it's important to have some social life, even if it's a quiet social life like having a friend over for tea or going to a movie. I do push myself to do these things -- again in serious moderation -- because otherwise I get too depressed. I don't push myself to do things like house cleaning or more work than I have to, because these things wear me out with no real emotional return. I think with a chronic illness, you have to pick and choose -- do I push myself because I'm going to benefit in some way? Or am I pushing myself because I hate admitting I can't do this, because I want to be "normal"? Am I pushing myself to do something just because everyone else can do it, or is it something I really want to invest my limited energy in?

Definitely a hard balance to find!!!

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Very well said, Jump.

I tend to crash about 2 days after a strenuous or stressful event. There are some stressors that can't be avoided (like spending all day upright yesterday while my mom was having a hospital procedure) and some stressors I don't want to avoid (like staying up late with friends I rarely see). And there are so many factors that can affect how we respond to activity/stress like the temperature, seating, and if there is time to totally rest for the day or so following. Sometimes I feel horrible and can't think of anything I did to cause it!

I know each of our illnesses affect us in different ways and to different degrees. For me, I have to look at the big picture and figure out what makes me really happy. If I have to push myself to accomplish something that I'd regret not trying to do, then I do it and prepare for the aftermath of worse symptoms. Only you know your body and what your limits are. It's good to push to your limits on a regular basis, but only you can decide when you push too far.

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It's the $64million question!

I always used to push myself (with my cardiologists backing) and spent a lot of time feeling very ill. Over the previous 2 years I pushed myself so hard at work that I pushed myself into a deep pots hole where I really couldn't function and had to give up work. I have now been off work for 8 months but I still push myself too hard. I have energy to do things like go out for coffee with friends or take a short walk but I always need to rest afterwards.

Only 2 weeks ago I went away for 2 days. I felt well on returning home. The next day I drove to pick my sister up from university (something that I do fairly often and usually causes no problems). However this time the combo of going away and then doing 5 of hours driving pushed me too far and I ended up having to rest completely for 5 days, not even having the energy to check my e-mails.

I saw a physio for the first time last week. She could see how tired I was an actually asked "are you a boom and bust sort of person?". She is referring me to occupational therapy to teach me how to conserve energy and learn how much is too much pushing.

Now if only our POTS and symptoms were the same every day or predictable then pacing would be so much easier!


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I wish we had a little "health units" monitor so we could see how close to empty we were! HHHHHH

I know that when I push to exercise, I am DONE with everything for the rest of the day. Every time. But if I do it consistently, the recovery time gets shorter and I feel better. But if I miss a week, and then go back to it, I am flat-out crying on the mat and DONE for a day or two. The gains are so transient. I feel a bit of a cold coming on and am under a great deal of stress right now, so I know I am losing "health units" quickly! If only I had a recharge cord......... :unsure:

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A recharge cord!! That would be the best med ever!! I'd love to feel good for even one entire day and not have to suffer for it the next day or two.

I've never learned how much is too much. On a fairly good day I just want to keep doing what I want to do. Not good!

Mary P

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Guest tearose

About 10 years ago I came up with what I call my energy point system. In the morning, usually as I nibble on an early morning snack with hydration, I try to plan my day and I allocate points to every activity. You can create a system too! Just try to figure out how you feel on that morning and then spend your energy points wisely. If I overspend...it means I am using tomorrows points so I'd better be careful. As is usually the case, if I have overdone one day then inevitably, I do need an extra nap the next day.

Real lesson about the importance of NOT pushing too much:

When I was only about 5 years into this syndrome (before energy point system), I was trying to set up a garden. I was not deconditioned but I was frustrated that I just could never do consistent physical activity without relapse or need for naps...this was not what 38 year old woman suffered with so I refused to "give in" to my tiredness and POTS. I love to garden and I decided to "push through" my profound fatigue and aches and pains and heartrate variability...I hoped I would just build more strength and endurance. That is not what happened!!! Instead, I so damaged my insides that the pelvic region collapsed and I tore muscles internally!!! I believe that since I was not getting adequate blood supply to my internal muscles and organs, things just deteriorated. I wound up needing full pelvic reconstruction and the surgery took nearly 7 hours. I needed two transfusions and it took a year of recovery including the need for occupational and physical therapy.

I had to learn to go just to the peak of my ability and NOT push beyond that.

To illustrate,... I know I am not able to walk a few miles every day, I would just burn out. I can't seem to build endurance. I seem to spend it, then need to replenish it. However, with proper planning, I am sure I could run and win a few mile race but it would most likely take me two weeks to recover. I would not be able to do anything else during those two weeks either.

One important thing I have to remind myself every day of...I struggle every day to just take care of me, my ADL's and body...most people don't think about their digestion, elimination, heartrate, temperature, hydration, rest,.... I only have about 4-5 productive hours a day. Most people have many more than that. I now allow myself to be very selective how I spend those precious hours.

Learning how to recognize what is enough is hard but achievable. Learn to trust your intuition.

best regards,


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I push myself hard only for very special occasions. I think progress depends on gently pushing yourself and I've improved slowly by increasing my activity slowly over time. But we're only human and sometimes we get carried away or lose track of things and go overboard.

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This quote says it all for me:

'He said that doing this can create fragility. Whereas if we pace ourselves better and don't push to the point of serious crashing we can build endurance.'

Ive had a major POTS crash since October last year and i was finally seeing the daylight at the end of it two weeks ago. My protocol was to do what Ive done the last two times. Walk each night - start small and gradually increase it. After the six month period ive been feeling ok. Not 100% but significantly improved.

i went on a trip camping and rested and was very careful. Felt fine. Went shopping and was OK. Then i did something really stupid. I went to the pool and had a swim. And I did too much - my heart was pounding and I kept pushing.

The reason I did this was because after my last relapse I had pushed myself much harder - and it had made a big difference in that i was able to walk long distances, then ride a bike and i was back out of the POTS hole very quickly and i was the best ive ever been with POTS for two years after that.

But this time my body seems much more delicate. After the swim i nearly fainted on the drive home, slept the rest of the day and now three days out each day has been worse - i feel terrible today - the surges are back and im dizzy just sitting here typing now on the couch... My wife is annoyed at me as well as she was glad to see me feeling ok again...

My boss was great again thank god about it. But ive got no sick leave left now...

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I am so glad to have found this support system. I agree with most of you that pushing myself too much backfires and then I feel bad. I push myself to work at my job but usually work 25 to 35 hours a week. I also agree that pushing to do something fun within reason helps so I do not feel as depressed about having POTS. Someone wrote of wanting to just feel normal for a day or a few hours. I have been lucky enough to have some times where I feel normal for a few hours in a day, but it was interesting to read that someone else besides me thought of it that way as well, if only to feel normal again.

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When I first joined these forums a member wrote a post that has affected my whole mentality on my illness:

Imagine that everyone on earth has a certain amount of energy that can be thought of as a "budget". Let's pretend that the average person has $1,000 in a day to spend and the average cost of energy per activity is $5, big activities are $40 and little activities are $1. It would take that person ALOT of strain to spend their whole budget so they never have to worry about it.

Now let's say I only have a budget of $10 because of my POTS. This means I can do a few small things in a day, but if I overdo it I have to borrow into tomorrow's funds, meaning if I spend $15 bucks, I only have $5 the next day. Or let's say I spend $20...then I have NO energy the next day and have to rest. If I spend $25 then I suffer the next 2 days with bad POTS symptoms.

If I budget my energy then I can have enough energy per day to do things I want, but if I have to do something major (let's pretend I go to a wedding) then I suffer the next day to pay off my energy debt. Even if I have a really good day, I still remember that there is a budget that I have to stick to.

By using this mentality I've been able to avoid many many crashes, as well as predict crashes. I have the choice to go into energy debt or to save energy for a big event. I just listen to my body, and when I feel tired, I rest. I'm not sure if I explained that well at all, but learning to budget has been my best survival tool so far. Hopefully the philosophy will help others as it's helped me.

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