Looking for a Big Payoff on a Small Investment? Try Keeping a Health Log

By Bruce Campbell

If you’re looking for a coping strategy than can give you a big payoff for a small investment of time, consider record keeping. A few minutes a day spent filling out a health log can help you in at least four ways. You can use records to:

Controlling Symptoms

A health log offers a way to understand the fluctuations in your symptoms, giving you a tool for discovering what makes your illness worse and what helps you feel better. For example, records can help you learn how to pace yourself. One person, after noting that her symptoms were proportional to her exertion, used her logs to divide activities into categories of light, moderate and heavy, based on how much energy each activity required and how much it increased her symptoms. She used that information to plan her days so that she could alternate light activities with moderate and heavy ones. She reported, “I can do more now and have lower symptoms.”

Other people report that record keeping helped them to recognize that many different factors contribute to their symptoms. One woman, for example, used record keeping to discover that her mental activity was affected greatly by the time of day. She found that if she read in the morning, fibro fog set in after 15 minutes to half an hour. When she kept records for a week, she found that her mental stamina was much better in the afternoon. By studying during that time, she was able to read for two 30-minute sessions with a 10-minute break and could retain the information. Over time, she increased her total study time to two hours a day. Keeping records showed her that when she did something was crucially important. Logging can also reveal how symptoms are affected by factors such as stress and social activity.

Records can reveal the cumulative effects of activity, showing the importance of looking at periods longer than a day. Some people find that they can maintain a consistent activity level for several days, feeling tired only at the end of the period. Having records helps them think about what level of activity they can sustain.

Records can also help you become aware of the effects of mental and emotional events. Many people with CFS and fibromyalgia find themselves easily tired by activities that require concentration, like balancing a checkbook, reading or working on the computer. Conflicts with other people and emotions, such as worry, anger and depression, can be especially tiring. A health log can reveal that mental and emotional events, not just activity, can intensify symptoms.

Motivating Yourself

Records can also be an important source of motivation and inspiration. Seeing written proof that activity level affects symptoms can provide a stimulus to stick with pacing. Records of progress can provide hope. For CFS patient JoWynn Johns, both factors were important to her learning to live within her energy envelope, as she described in an article posted on this site. After recognizing that mental exertion and emotional stress provoked her symptoms just as much as physical activities, she concluded that she would need records to remind herself of those causes of her symptoms.

I needed to make this information visible to prove to myself the effects of mental and emotional exertion, as well as physical activity. I also wanted concrete evidence of the effects of staying inside my envelope. Because limiting my life in this way is so very hard for me to do, I had to show myself that it was worth it.

Getting a Reality Check

Records can also function like a mirror, offering a reality check. One person in our program said, “Logging brings home to me the reality of my illness. Before logging, I didn’t realize that most of my time is spent on or below about 35% functionality. This false perception that I was better than I am led me to overdo things, but now I am less ambitious.”

Another person uses a visual record keeping system to help her pace herself. She rates each day and records her rating on a calendar using colored dots. Green means a good day. Yellow means caution. Red means stop: intense symptoms, time to go to bed.

A third person reviews her records to see where she might accept more responsibility. “At the end of each week, I look at my activity log and write a short summary at the bottom of the page, commenting on good experiences, symptoms I had that were not my fault, and symptoms I had [that] I could have had some control over.”

Explaining Your Illness & Documenting Disability

Lastly, you can use records in discussions with physicians and in substantiating a claim for disability. Health records can document your functional level and show changes over time.

How I Used Logs in My Recovery

I used a variety of logs during the time I was sick with Chronic Fatigue Syndrome. Most took only a few minutes a day to fill out, but I felt deeply rewarded by the effort. I was encouraged by seeing that some days were better than others. This observation motivated me to search for what I was doing that created good days, so that I could increase their frequency. (The keys proved to be getting adequate rest, having a consistent activity level and avoiding stress.) Record keeping also taught me other valuable lessons. It showed me that my CFS was worse in the morning and better in the evening, and that the effects of exertion were cumulative during a week. Also, logging helped me recognize the connection between standing and symptoms, documented how much exercise was safe, and showed me my vulnerability to stress.

My records helped me to recognize that I often experienced delayed effects from activity. For example, if I walked somewhat more than usual, I would feel no increase in symptoms during my walk, but had a higher level of symptoms later in the day or even the next day. The experience taught me that I could not trust my body to send a signal at the time I was active to tell me that I was doing too much.

By documenting the effects of my actions, my logs helped me hold myself accountable. When I was tempted to think that increased symptoms were just part of the illness, my records often proved that I had been more active then usual. The evidence was there in black and white. The records also provided positive motivation by showing me how much better I felt when I lived consistently within my energy envelope.

One experience above others drove home to me the value of logging. At the end of 1998, I spent two hours trying to understand the relapses I had experienced that year. (I defined a relapse as symptoms so intense that I spent at least one day in bed.) Going over my records for the year, I found eight relapses almost all of which were associated either with travel or with having a short-term illness. Recognizing the causes, I developed strategies to minimize the effects of travel and secondary illnesses.  The result: zero relapses since. (For more on how I used logging, see the chapter on record keeping in the story of my recovery.)

Getting Started

If you are interested in keeping a health log, you can use an existing form or create one for yourself. You can download for free all the forms we use in our program. They are available on our Logs and Forms page. If you would like some further background on record keeping, plus three sample logs, see the article titled Learn to Predict the Unpredictable.

As you proceed in your record keeping, I suggest that you keep three guidelines in mind. First, make your log easy to use. You are more likely to fill it out if the task seems manageable. A common rule of thumb is that a log should take only a few minutes a day to keep. Second, your log should be meaningful to you. Use logging to help you answer questions that are important to you, not because you think you should or to please others. Whether you use an existing form or develop your own system, make sure the records fit your situation. Third, set aside time regularly to review your logs. Plan to spend some time each week or once a month going over what you have written to look for patterns and connections. If possible, ask someone to go over them with you.

If you decide to log, I hope you make discoveries that help you manage your illness better. If you do, write us so we can include your examples in the next article on record keeping!

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