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Finding Your Envelope

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By Bruce Campbell
 
(From the series Pacing: What It Is and How To Do It.)
 

There are a variety of tools you can use to understand your limits. Earlier articles in this series mentioned the Rating Scale and the Energy Envelope worksheet, both available on our Logs, Forms and Worksheets page.

This article will discuss three additional approaches to finding your Envelope.
1 Charting Your Envelope
The Envelope Log, found on the same page, is a simple form that gives you a way to record how well you’re staying within your Energy Envelope. It takes only a few minutes a day to fill out.
 
To use the form, rate yourself on a scale of 1 to 10 for three elements:
 
                a) Energy level (available energy)
                b) Activity level (expended energy)
                c) Symptom level
 
On this scale, 1 represents, respectively, no energy, no activity or no symptoms, and 10 represents the energy of a healthy person of your age, a high activity level or the worst symptoms imaginable.
 
You can fill this out once a day or more frequently. Using it three times a day can help you see variations in your energy level and symptom level during the day. You might find, for example, that your energy improves and your symptoms decline as the day goes on or vice versa.
 
For a sample Envelope Log, see the article Learn to Predict the ‘Unpredictable. For insight into the benefits of logging, an example of the use of logging and ideas on how to get started with recordkeeping, see the article Health Logs: A Big Payoff on a Small Investment.
 
2 Finding Limits Using Experimentation
 
A good way to understand your limits in particular areas is by trying experiments and keeping records, focusing on one specific area at a time. The goal is to find how much you can do without intensifying your symptoms.
 
You could start with fixing meals, doing errands or housework, spending time on the phone or working on the computer. In each area, you would keep a simple record of time spent and symptoms.
 
For example, you may believe you can stand in the kitchen for 10 minutes while fixing meals. To test this idea, note your starting and ending time while preparing food, and how you feel during and after. If you find you are worse, 10 minutes may be too much. If you feel OK, you may be able to extend the time.
 
If you feel worse, it’s important to understand why. If you are feeling weak or lightheaded, you may have exceeded your limit for standing. In that case, you have learned something important that applies to many situations. If you are in pain, you may have exceeded your limit for repetitive motion or may have held a tool inappropriately.
 
I applied this approach in several areas, one of which was exercise. I wanted to exercise to reduce the fatigue caused by deconditioning, but I was unsure how much would be helpful but not trigger post-exertional malaise.
 
My solution was to experiment to find the length and intensity of exercise I could tolerate, and noting the results both during and after. Initially, that level was about 20 minutes of walking a day at a pace that raised my heart rate to 90 to 95 beats per minute.
 
You can use this approach to define limits is many different areas. For example, you could use it to determine how much time on the computer triggers nausea or how far you can drive safely.
 
Your limits will probably be tighter in some areas and less restrictive in others. As I mentioned in the last article, when I had recovered back to about 75% of normal overall, my exercise ability was about 35% of what it had been before I became ill.
 
Also, your cushion or margin of error may vary from one area to another. Some people find that even small mistakes in some areas of their lives bring on a severe, disproportionate intensification of symptoms. For example, if they stay up an hour later than usual, they are especially tired the next day.
 
Knowing your limits in different areas gives you the foundation you need for the second part of pacing: adapting to limits. We will explore part two beginning with the next article. For now, let me give you a preview by introducing you to Bobbi Brown, who describes her improvement from 15% of normal to 35% to 40% in the article 25 Reasons Why I’ve Improved.
 
Almost half the items she mentions are limits on how much she does in particular areas, including driving, time on the computer, time on the phone, sensory input, socializing, household responsibilities and travel. She first found her limits in these various areas and then gradually changed her daily life to live within them.
 
3 Gaining Insight From Logging
 
Let me say more about the power of recordkeeping or logging. I think it was one of the two or three most important techniques I used in my recovery. Most people I know who have improved significantly keep a log, which usually takes two to five minutes a day.
 
In my case, logging led me to many insights about ME/CFS. For example, my logs showed that exercising in the afternoon was much less likely to lead to higher symptoms than exercising in the morning. This realization led the general insight that time of day was crucial: when I did something could be as important as how much.
 
Also, I observed that I sometimes felt fine during the walk but experienced strong symptoms afterwards or had to take a nap later in the day. That experience helped me to recognize that the effects of activity might be delayed. From that I learned that to understand my limits I had to be attentive to how I felt later as well as during and right after an activity.
 
Seeing that the effects of exertion were delayed taught me that I could not trust my body to send a signal at the time I went over my limit. This recognition also motivated me to use logging to define how much exercise I could do safely, so I could avoid symptoms by stopping when I had reached my limit.
 
Finally, record keeping can help you recognize subtle links between activity and symptoms. For example, some people with ME/CFS and FM have observed a surprising connection between their activity level and sleep. They find that if they are too active during the day, they become hyper-alert (“wired”) and can’t fall asleep.
 
This is the opposite of what might have been true before they became ill, when lots of activity produced fatigue and a good night’s rest. Counterintuitive realizations like this often come to light only through detailed records.