Helping women with chronic illnesses

There is so much I want to do.

There is so much I want to say.

My body, however, won’t cooperate with my wishes… and that’s OK.

No matter how much there is to do.

No matter how much there is to say.

It will all have to wait for another day.

Right now… all I am concerned with is getting some sleep. No matter how much I’d rather be doing a number of other things, I need to listen to my body. It is screaming out for sleep. So, I am going to listen. Off I go to do just that…

This post was written by Jeanne at http://chronichealing.com. Copyright © Jeanne — chronichealing.com. All rights reserved.

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RT @jeanneendo: "Sleep, Sleep, Sleep…"

My online time has been extremely limited due to many factors. The primary reason is that I’ve been unbelievably busy in this way…

Just kidding! I know… It’s a wee bit early for April Fool’s jokes, isn’t it? Seriously, though, even if I were an ice-fisher-woman (which I can assure you that I am most definitely not), I wouldn’t be out fishing now. No way! I’m lucky if I can walk to/from the car without my fibromyalgia and Reynaud’s announcing to me who’s boss. Trust me… they are the bosses!

In fact, the single-digit windchill temperatures have been wreaking havoc on me as far as fibromyalgia pain is concerned. So, the last thing I’ve been dreaming of doing is ice-fishing!

In addition to pain in every possible corner of my body due to a fibromyalgia flare-up, I have been dealing with migraines that have been forcing lots of time in bed to get extra sleep. It has been extremely frustrating to get further and further behind on everything but I couldn’t have forced myself to be online more if I had tried. I am now in what I call “basic functioning mode”. That means much of what I like to try to keep up on daily has gone out the window indefinitely.

So, I just wanted to take a few moments to surface long enough to say that I am not really fishing, I am not on vacation (hahaha… I’m full of jokes today!), and I am not ignoring my wonderful online friends. I am sleeping far more than usual, coping with incredible pain, and trying to be as productive as possible at a time when my body protests at nearly everything I try to do.

For example, one of my biggest accomplishments today was (gasp!) taking a shower. My husband located the shower chair that was stowed away in the basement (due to my history of falling and/or fainting in the shower at times like this). Thanks to that chair, I did it. Who knew taking a shower would ever be such a massive accomplishment? Three cheers for being clean!

When I’ll be up to writing again remains to be seen. As frustrating as it is to me when I am bursting with ideas to write about but unable to do so, I need to give my body time to recover from the holidays and adjust to the weather changes that are causing a sharp increase in fibromyalgia pain. I am dealing with the migraines as best I can. One day at a time.

This post was written by Jeanne at http://chronichealing.com. Copyright © Jeanne — chronichealing.com. All rights reserved.

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RT @jeanneendo: "Basic Functioning Mode"

This post was written by Jeanne at http://chronichealing.com. Copyright © Jeanne — chronichealing.com. All rights reserved.

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RT @jeanneendo: "Happy 2012 New Year!"

Music has always been very healing for me. I decided to share some video clips of songs that I like. Perhaps you’ll find them soothing and/or pleasant too. For those of you celebrating holidays at this time of year, I hope you enjoy them and that your symptoms are as manageable as possible.

For everyone… I am sending peaceful thoughts your way!

This post was written by Jeanne at http://chronichealing.com. Copyright © Jeanne — chronichealing.com. All rights reserved.

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RT @jeanneendo: "Music For Healing…"

This week, I came across an abstract that riveted my attention:

Endometriosis-associated Serous Borderline Tumor and Endometrial Stromal Sarcoma of the Ovary: A Report of a Rare Lesion in an Infant

[Trigger alert: Before I proceed, there are some photos of young children in a video clip at the end of the post. I just wanted to let those who are struggling with infertility know that before you scroll down any further].

Personally, I think that this child’s case could provide endometriosis researchers important clues. My hope is that the researchers will continue to follow this child with long-term studies. I believe doing so may benefit not just the child mentioned in the article but the endometriosis community as a whole.

Having never heard of an 18 month old child diagnosed with endometriosis, my curiosity was immediately piqued. As it turns out, this is the first such case ever reported. Prior to reading the actual article, the first thought that popped into my head having seen the abstract was, “I wonder if the fact that this child is in Hong Kong has anything to do with it since that area is known to be very high in dioxin”.

The article did not mention dioxin. The thought that popped into my head was simple wondering on my part that was rooted in the fact that I have read about and seen videos clips over the years regarding waste management practices in China (and the sad fact that many countries ship their toxic garbage there illegally).

Since the medical community has not agreed upon “the cause” of endometriosis (and since I personally suspect there are many causes), I don’t think anyone can say why this 18 month old girl has endometriosis.

The case report titled, “Endometriosis-associated Serous Borderline Tumor and Endometrial Stromal Sarcoma of the Ovary: A Report of a Rare Lesion in an Infant” was published in the International Journal of Gynecological Pathology (January 2012 – Volume 31 – Issue 1 – p 98–102).

The full article can be accessed here and the authors are: Ronnie S.L. Ho, M.B.B.S., Godfrey C.F. Chan, M.D., F.R.C.P., Shau Yin Ha, M.B.B.S., F.R.C.P., and Philip P.C. Ip, M.B., Ch.B., F.R.C.Path.

From that article:

“There was no maternal history of endometriosis and the mother herself did not take any hormonal medication either prenatally, or during the 1 week of breast feeding after the child was born. On physical examination, the child showed no evidence of precocious puberty or thelarche.”

Back to the topic of endometriosis in general… There is no established cause of endometriosis. There are numerous theories (and some of them make sense to me). In my opinion, there may never be a sole cause of endometriosis that is agreed-upon by the medical community. I suspect that there are causes (plural) of endometriosis. There is some research that points to things that are linked to endometriosis and they may well be determined at a later date to be within the multiple causes I suspect are behind endometriosis.

One thing that has been linked to endometriosis is dioxin.

For those who are not familiar with the studies done on rhesus monkeys regarding endometriosis and dioxin exposure, click here for more info. That link goes on to say:

“Based on animal studies and observation of wildlife, impaired fertility is a result of exposure to endocrine disruptors. Infertility affects approximately 40% of women with endometriosis”

From Greenpeace:

There has been much attention to the topic of toxin emissions in Hong Kong:

Again, on a hopeful note I really do think that this case of the 18 month old diagnosed with endometriosis could provide endometriosis researchers important clues. Obviously, my heart goes out to the child and her family. I cannot imagine what it would be like to have an 18 month old child be diagnosed with endometriosis. I certainly don’t mean to be insensitive to the child or her family when I suggest her case may provide hope for the endometriosis community and possible clues for researchers. I just think that the mere fact that an 18 month old child has been diagnosed with endometriosis throws a total curve ball at the notion some doctors have had (the theory some doctors speak of as if it’s a/the cause: retrograde menstruation). Obviously, retrograde menstruation was not behind this child’s case of endometriosis!

As I indicated earlier, the question I posed initially wasn’t really a fair one. To my knowledge, no one can definitively answer the question I posed up front…

Could Endometriosis Diagnosed In 18 Month Old Be Related to Toxins?

Closing on a sober note…

In the course of searching online about dioxins in China for this blog post, I came across the following video clip. I’ve seen videos before about waste management practices in China and the high rates of dioxin there. This segment tied that together with discarded goods that are illegally shipped to China. What are your thoughts on it?

(I apologize in advance for any ads that may appear within the following clip. I don’t have any control over the ads CBS includes).

This post was written by Jeanne at http://chronichealing.com. Copyright © Jeanne — chronichealing.com. All rights reserved.

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RT @jeanneendo: "Could Endometriosis Diagnosed In 18 Month Old Be Related to Toxins?"

When I speak of mountain climbing here, I am not referring to the literal climbing of mountains. (Though I must say that it may feel literal to those living with chronic illness!) Instead, “mountain climbing” (as used here in a figurative sense) refers to the various obstacles, challenges, and difficulties that face people living with chronic illness/pain. Following up on what I wrote recently here, this can be an especially challenging time of year for people living with chronic illness(es) and chronic pain.

Ask any person living with chronic illness(es) whether they sometimes feel like they are “climbing a mountain” and I think the odds are good that you’ll get an affirmative response. After all, there are days when simply getting out of bed in the morning feels like climbing a mountain. For others (who are bed-bound due to their illness), getting out of bed each day isn’t even an option at all. So “mountain climbing” (both the mental gymnastics required and the physical concerns that must be dealt with) seems like a good way to sum things up for many chronically ill patients I have gotten to know.

While I know that some people who read this blog don’t celebrate holidays at this time of year, I know that many other readers do. So, I wanted to take a moment to talk about some of the special challenges that this time of year can sometimes hold for those living with chronic illness.

For some, this time of year involves extra activities or changes in routine such as buying/making gifts, baking, sending greeting cards, traveling, operating on less sleep than usual/needed, and attending gatherings where people may be wearing fragrances that trigger symptoms (i.e. for migraine or multiple chemical sensitivity patients).

So, how can a patient best deal with the extra stress that can crop up at this time of year? Well, that obviously depends upon the person. However, there are some general ideas that I have discussed with fellow patients over the years that may be helpful to some. There is nothing particularly profound here. These are just a few general suggestions that some might find helpful as they work to strike the balance necessary to participate in various festivities/traditions without compromising their health in the process. These may also get people thinking of other ideas for reducing stress (at holiday time and beyond).

(Image by Cool Text)

Fragrances: For many patients (especially those who experience migraines or multiple chemical sensitivity), attending gatherings where people may be wearing fragrances that trigger symptoms is a major problem. While it may be difficult, try to educate people about how such fragrances affect you. If may be awkward to discuss this (i.e. people can get very defensive about their fragrances) but the payoff will be well worth it if it means someone avoids wearing fragrance to such a gathering where you will be present.

If you are exposed to a fragrance, it makes sense to consider the option of leaving early (as unfortunate as that may be if it happens). Multiple chemical sensitivity patients often avoid entertaining in their homes to prevent fragrances from entering their homes (i.e. their “sacred zones”). For most MCS patients, home is the only place that’s a safe zone.

I’ve never climbed a mountain in the literal sense. In years past when I was healthier, I did a bit of hiking but certainly nothing that would qualify as mountain climbing. In the figurative sense, though, I’ve been “mountain climbing” every day since I was 13 years old. “Mountain climbing” is tiring. It can be frustrating. It can leave you sore. However, with some planning and organization “mountain climbing” can be easier than it would be otherwise. Don’t forget to rest when you can and ask for help when you need it. Overdoing can cause very undesirable results.

Just as the spectacular view from a mountain’s summit can be a great reward for the effort expended to get there, so too can it be very rewarding to be able to attend a gathering or maybe even travel to a destination to spend time with loved ones and friends. With some planning (and luck!), holiday-related stress can be reduced and out-of-the-ordinary experiences can work out quite well.

This post was written by Jeanne at http://chronichealing.com. Copyright © Jeanne — chronichealing.com. All rights reserved.

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RT @jeanneendo: "Mountain Climbing Time!"

Bouncing back can be difficult. This post is about recovering after activity that is unusual (i.e. in type or amount) and which triggers and/or worsens symptoms – including pain and fatigue.

Following up on this, I’m talking here about dealing with the fallout that can occur for a person living with chronic illness who has:

Found oneself in situations resulting in feeling hurt/misunderstood by those who don’t “get it”

Basically, I’m talking about recovering from being more active than usual and/or from being exposed to circumstances that may cause significant stress (such as interacting with people who don’t “get it”). Holiday gatherings may involve foods that trigger symptoms and it may be difficult to avoid them entirely. There are many factors that can set a patient up for exacerbation of symptoms after the holiday or special event has passed.

Any chronic pain patient can tell you about the “crash” that inevitably occurs after the unusual activities. Typically, only those living in the same household as the patient get to witness these “crashes”. It is very common for friends and loved ones who see a patient functioning at his/her peak to be oblivious to the fact that there will almost certainly be paybacks later. (In other words, just because I joined you for an all-day gathering doesn’t mean I won’t be bedridden tomorrow as a result)!

OK. Let’s face it. If you’re reading this chronic illness post, you may never be quite this bouncy!

This post is about bouncing back from challenging events such as holidays. For people living with chronic illness and chronic pain, events that are taken for granted by others can be absolutely challenging and exhausting. It’s that time of year when there may be more triggers than usual.

For a person living with migraines or multiple chemical sensitivity, fragrance worn by others can serve as a trigger for symptoms. For those living with infertility, the holidays can bring gatherings with young children or babies; this can be very difficult. For a person living with interstitial cystitis, vulvodynia, or endometriosis it can be painful to sit in the car (or plane) for extended periods of time. The list goes on.

Many chronic conditions can result in extra exhausting times around the holidays due to physical and/or emotional stress and a multitude of potential triggers.

Let me state the obvious here – because sometimes it just helps to hear the simple tips that we already know. (There is some overlap between the following categories).

REST: The importance of sufficient rest cannot be overstated. Unfortunately, some of the same factors that can lead to the need for extra rest (travel, more time than usual involved in challenging activities, stress) can make it difficult to sleep (being away from home, having extra pain from overdoing things that makes it hard to get to sleep ot stay asleep). It isn’t always easy but doing whatever you can to get enough rest is key.

Catnap, anyone?

COPING MECHANISMS: These can vary widely from person to person. For some people, coping mechanisms may actually assist in the process of getting to sleep or staying asleep (to get the rest already mentioned). Coping mechanisms can range from taking more frequent breaks during activities to talking with a friend or loved one who “gets it” to one of my personal favorites… listening to music.

Tori Amos’ music is often one of my first choices.

LIGHTENING THE LOAD: When attempting to bounce back after having been extra active, it can be helpful to cut back to the absolute minimum amount of activities for awhile. Rather than trying to “get back to normal” (whatever that is!) , it can be helpful to do less than usual while recovering from a period of increased activity. The body gets a chance to “catch up”.

Try not to get loaded down with more than your body can handle.

DON’T BE TOO HARD ON YOURSELF: Many people I know of (who live with chronic illnesses and chronic pain) go through periods where they “beat themselves up” about what they can’t do in general (or what they couldn’t do when faced with activities that are not within their capabilities at this time). Self-induced guilt trips only complicate matters. If you find yourself focusing on what you can no longer do, try to shift your thoughts to what you can do. Rather than focus on the losses, try to focus your limited energy on appreciating the things that you can do.

HUMOR: Never underestimate the power of humor. Whoever said “laughter is the best medicine” was right. When I am feeling drained, depleted, and exhausted, one thing that can sometimes perk me up is watching a really good comedy or listening to my husband crack jokes (which sometimes include gallows humor).

Humor has helped get me through some very TRYING times!

It is easy to feel exhausted, drained and frazzled any day of the year when chronic illness is in the picture. To add the extra stress and commotion that the holidays can bring on top of it can really be overwhelming. Trying to pace yourself and to have realistic expectations of what you can and can’t do (and in what time frame) can be very helpful. If you have done more than your body would have liked, it’s worth it to take the time out to replenish your energy. Trying to run on empty only takes a person so far. Eventually, the body will make its displeasure abundantly clear!

I realize there really isn’t anything that novel/unique in this post. Much of what is listed above falls into the category of common sense. However, it has been my experience that a great many patients take comfort in knowing they are not alone in these struggles and find it reassuring to give themselves “permission” to rest and recover after overdoing. Sometimes it’s easier to give oneself such “permission” when the obvious is stated. Sometimes it just makes it easier to give oneself that time to bounce back after periods of extra activity or travel or very busy schedules. It is OK to take the time to get rejuvenated… whatever methods work for you!

This post was written by Jeanne at http://chronichealing.com. Copyright © Jeanne — chronichealing.com. All rights reserved.

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RT @jeanneendo: "Bouncing Back: Five Tips To An Easier Recovery"

Today, I thought I would write about holiday suggestions for people living with chronic illness. Obviously what is helpful for one patient may not be for another. After all, each person is unique. However, I tried to include some themes I have seen arise for me personally and for many of my fellow chronically ill patients.

If someone doesn’t understand (or listen) when you try to explain a change of plans or the need for rest, accept the fact that you tried your best to communicate the situation to them. Ultimately, you can’t control what others will think.

While we all try our best to be thankful throughout the year, this time of year brings added “pressure” (for lack of a better word) to express gratitude. Don’t get me wrong. Gratitude is a wonderful thing. The trick for many chronic illness patients, in my estimation, is that it can sometimes be difficult to focus on gratitude when pain and suffering are so significant that they make it challenging to focus on it.

I will try to avoid including platitudes that may be less-than-helpful… or tips on how to tap into your gratitude. Anyone reading this more than likely has a good idea of how to tap into that. My hope is that anyone who happens to be reading this (regardless of which country you reside in or whether or not this is a holiday week for you) might come away from this post feeling a bit more confident about setting appropriate boundaries, knowing when to say no (i.e. not accepting jobs/activities/duties that are likely to be detrimental to one’s health), and knowing when to rest.

Also, I believe that no matter how serious one’s health problems are and no matter how stressful the situation may be… there is virtually always something to be grateful for. If you are struggling to identify something, start with the most basic things. Every day on which we each wake up and start with a new slate is a gift. No matter how much pain and suffering one is experiencing, odds are, statistically, that if you’re reading this post you are relatively unlikely to be homeless or suffering from hunger at this time.

Does that mean there aren’t any people reading this who are really suffering in those ways (struggling to meet their needs… not just wants)? No, not at all. I know that quite a few of my readers experience plenty of suffering (of all sorts… including serious concerns about having safe housing and enough food to eat) – as many of them have shared their situations with me “off the blog”. After all… overwhelming medical bills can lead to debt, to difficulty paying for basic needs (such as food), and it can even affect the ability to find affordable housing. So, I don’t mean to gloss over these issues – because I know for a fact, from talking with many of my readers “off the blog”, that these challenges can be alarmingly close to becoming reality (if not already so) for many.

Having nearly lost our house a few years ago (following crushing medical bills for my care), I remember the fear and anxiety that we felt while struggling to save it. Quite literally, I cannot put into words the degree of stress and anxiety that resulted. So, I most definitely do not wish to minimize the emotional pain involved or to dismiss what anyone else is experiencing.

My thoughts and best wishes go out to everyone at this time. Most especially, my thoughts are with those who are homeless. When the temperatures dip as they have already this year, I can’t help but think about those who don’t have shelter or enough food to eat. This Thanksgiving, I will be sending out positive thoughts and energy to those in need.

Finally, I would also like to thank my online friends for the support, information, validation, insightfulness, courage, and humor you display every single day. It is awe-inspiring!

This post was written by Jeanne at http://chronichealing.com. Copyright © Jeanne — chronichealing.com. All rights reserved.

If you’re like me, you find online shopping a helpful alternative. Thank you for supporting my blog by using my Amazon ads. I appreciate your support!

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RT @jeanneendo: "Holiday Suggestions For People Who Are Living With Chronic Illness"

This post was written by Jeanne at http://chronichealing.com. Copyright © Jeanne — chronichealing.com. All rights reserved.

If you’re like me, you find online shopping a helpful alternative. Thank you for supporting my blog by using my Amazon ads. I appreciate your support!

New to blog commenting? Just click “comments” below post. (If you set up a Gravatar, your picture will show when you comment).

RT @jeanneendo: "International Survivors of Suicide Day – 2011"

If you’re like me, you have read before about the topic of judgment in the context of chronic illness and chronic pain. Perhaps you’ve read about people who were unfairly judged in the workplace. Or maybe you’ve read about people being unfairly judged by their very own family members and loved ones. I personally can’t think of anyone who appreciates being judged by others in this way.

The emotions that may spring up in conjunction with being judged can compound the challenges faced by patients since it can add emotional pain to the physical pain the person already experiences. Sadly, it is not unusual for chronically ill patients to find themselves in such situations. In fact, I daresay anyone who has lived with chronic illness and pain for any length of time can relate. Feeling misunderstood by people in the workplace (assuming the patient is even able to continue in the workplace) and feeling misunderstood by loved ones are all-too-common (and often maddening) experiences for a great number of people living with chronic illness. No one wishes to be misunderstood.

Today, though, I’d like to focus on a different type of judgment (than that of workplace people or loved ones judging the patient). It’s a type of judgment that I have experienced firsthand. Many patients I know have experienced it as well. It’s another form of judgment that can wound deeply and leave emotional scars as remnants.

Judgment from people we thought were “safe”:

What happens when we are judged by fellow patients?

While this isn’t the most pleasant subject, I decided to write about it today because I’ve seen it play out in the lives of many people who live with chronic illness. Yet I don’t recall ever seeing it written about. Not in books, not in magazines, and not in blog posts… I’m sure someone out there has written about this topic. I myself just haven’t come across any writing pieces that focus specifically on judgment of chronic illness patients by chronic illness patients.

What happens when judgmental, critical remarks are made by fellow patients? This scenario can induce a different type of pain.

When patients feel judged by other patients (based both on what I have experienced firsthand and what I’ve seen with chronically ill friends of mine) the sense of betrayal can have an especially potent sting. Most chronically ill people that I know are especially caught off guard by judgment/criticism aimed at them by fellow patients. Each patient is unique. What works for one patient may not work at all for another. No patient is in a position to judge another’s choices or treatment plan.

Judgment can mean many things depending on context. I may have chosen the gavel photo above as a visual but I’m obviously not writing about judgment in a legal context here. The “criticism or censure” mentioned in this definition of judgment is the best for for what I am talking about. The phrase “sit in judgment” listed there (under part b for “to assume the position of critic”) is what I am referring to. Essentially, the notion of criticism is key to what I would like to discuss. I’ve seen fellow patients become downright bossy regarding what they see as the proper course of treatment for me. (Never mind that it’s my body and that I don’t like it when people talk to me as if I don’t know how to advocate for myself). What patient likes to feel like she’s expected to obey a fellow patient regarding treatment options for her own body? Certainly not me!

How many of you have ever experienced any of the following (from a fellow patient)?:

Implication (or outright statement!) that you should disregard the medical advice from your own physician/s (and instead follow that person’s idea of how to treat your medical condition/s?)

Personally, I think when one person feels “bossed around” in this way by another, it can be poison to the relationship. Unfortunately, it is not all that uncommon for people living with chronic illness to judge and/or criticize one another (whether overtly or in a more subtle fashion). Clearly this can be hurtful for the patient who feels he/she has been judged by someone who had previously been viewed as a “safe” person in whom to confide. Helpful ideas/suggestions are one thing. Unsolicited advice is another (especially when there seems to be an expectation that the person being “judged” really “should” take the advice).

Some examples of categories of people who may engage (however unintentionally) in “judging” fellow patients:

Advising others to disregard medical advice: As virtually any person living with chronic illness is well-aware, doctors are not perfect. They make mistakes like any other human beings. Sadly, there are some doctors who are corrupt, misinformed, arrogant, and/or ill-equipped to diagnose and treat the illness(es) at hand. However, no patient is in a position to give advice to other patients along the lines of “ignore what your doctor says”. It’s one thing to diplomatically raise concerns for the well-being of a fellow patient. It’s quite another to leave that person feeling like you’re telling him/her to disregard what their doctor has advised. (This brings up liability issues as well). The notion of strong-arming an online acquaintance into ditching advice from his/her physician/s when the person suggesting doing so has never even met the patient in question (and when the person making the suggestion is not a health care professional) is risky. Suggesting a person explore options (such as getting a second opinion) is one thing. (That can be a very helpful suggestion). Telling someone (in so many words) “your doctor is incompetent” is another.

Here’s the million dollar question… What do you do when a fellow patient appears to be sitting in judgment of you? What do you do when comments (be they subtle or blunt) are made that make you feel uncomfortable? I have had numerous conversations with people who live with chronic illness who have experienced these scenarios. I have found myself in the position of having been judged. What I’m wondering is how many of you have experienced this and how did you handle it? I would love to hear your feedback. Please take a moment to leave a blog comment. I think this is an important topic that affects many people. How can patients living with chronic illness/pain avoid falling into the trap of judging fellow patients? How can patients who feel judged articulate how it makes them feel when other patients judge them (perhaps without even knowingly engaging in judging anyone)?

How can we encourage compassionate support between fellow patients and speak up for ourselves when we are uncomfortable with comments we perceive as judgmental and hurtful (if indeed we determine that it is worth speaking up in a given situation?)

Your feedback on this topic is much appreciated. I believe it is crucial for patients to support each other (whatever personal choices they may make for their own bodies and lives) and avoid passing judgment on each other. Sometimes, there can be a fine line between diplomatically worded suggestions and judgmental/critical remarks that hurt fellow patients. What are some ideas for how to word suggestions so that they are not mistaken as/perceived as “orders”? If one has concerns about another patient’s well-being, what are the best ways to convey that concern without coming across as bossy or condescending?

This post was written by Jeanne at http://chronichealing.com. Copyright © Jeanne — chronichealing.com. All rights reserved.

If you’re like me, you find online shopping a helpful alternative. Thank you for supporting my blog by using my Amazon ads. I appreciate your support!

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RT @jeanneendo: "Collision: When Judgment Meets Chronic Illness And Pain"