After an illness, serious or not so serious, have you ever felt "down for the count"? It is not uncommon to feel that way after an acute illness, whether it was an opportunistic infection or something as mild as a cold or the flu. This period after the illness is the recuperation stage. How you approach the recuperation stage can be important in determining how quickly you bounce back from the illness. You have to take into account the complications associated with HIV (alone or in combination with hepatitis B or C), the effects of medications and other treatments, and other health issues going on currently (heart disease, cancer, diabetes, etc). Recuperation from an illness is never easy but with so many variables involved it is important to take it one step at a time.
Some of the steps you can take towards a quick and healthy recuperation include: getting your physician's OK to resume normal activities; feeling up to resuming normal activities; taking the time you need to gradually work your way back up to your normal activities and not trying to do too much too soon; taking the time to rest whenever necessary; resuming normal activities and exercise; making sure you are eating properly; following the directions for taking your medications and not missing doses; and having the social support necessary to work back into your normal daily activities.
By following these simple steps, you should be able to resume your normal activities and get back to enjoying life much more quickly. These steps are important components to recuperating from any acute illness. No one likes to feel bad or sick, so take the time to do it right and you may feel better sooner.
Often seen as an inconvenient part of the process, getting your physician's permission to resume normal activities is important because he/she may know something about your acute illness that you are not aware of. For instance, side effects from an antibiotic you are taking to help with an infection may cause you to run a slight fever or cause gastrointestinal (GI) distress or perhaps they discovered that you are insulin resistant, which can slow healing time. It is great that you feel good enough to resume normal activities, but get a physician’s approval first so you do not experience a relapse or other complications.
Feeling Up to the Task at Hand
Once your physician has given you clearance to resume normal activities, then it is up to you to get started. The most important thing to remember is to go slow. Do not try to do everything the first day or the first several days. If you are working, get back into the swing of work for a few days. Then if you still have energy, start adding in activities outside of work such as exercise and hobbies. However, do not try to start your workouts and hobbies at the same level you did before getting sick.
Sometimes you feel ready to resume activities before your physician, family, or friends, think you are ready. It basically comes down to you and your body. No one else really knows your body the way you. If you feel up to giving it a go, then by all means try to resume your normal activities but be prepared for some fatigue if everyone else thinks it is too soon. One gentleman I work with was an athlete before becoming ill. He has been hospitalized a couple of times over the past two years. Each time he was hospitalized he had more trouble gaining back his pre-hospitalization weight and his energy level seemed lower than ever.
The first thing I noticed was he was trying to go right back to the level of activity he had participated in before he got sick. He was playing basketball every day, running between three and five miles two to three days per week, jumping rope several times per week, the list went on. He told me when he felt ready to return to activity he would play ball and jump rope, and he would feel great but the next couple of days he was so exhausted and sore that he had not done any activity for the last three weeks. I told him that initially he needed to set his sights lower. Start with walking around the block, doing some stretching, and maybe some light weightlifting. If that did not exhaust him, then he could do it again in a couple of days and gradually build up. I think that with enough time he will be back doing these activities that he really loves but he needs to start slower.
Generally, most people know when they are ready to resume normal daily activities. However, sometimes we are not given a choice in the matter. Often your physician says you are ready, your family and friends say you are ready, and your job says its time to get back to work but you do not feel ready. This can be for a variety of reasons, including fatigue, drowsiness, depression, and anxiety. While it is important to feel ready, with all of this outside pressure you will have to figure out a way to express to everyone else whether or not you are ready. Often these outside influences help you realize that you are ready. It can feel good to get up and go do something, get into a fresh environment and be around people. It’s a tough call at times to figure out if you are really ready or if you are being forced to be ready whether you are ready or not.
Time and Rest
Take the time to let your body heal from the illness and get plenty of rest. Nothing slows the recuperation process like rushing it. It takes time for your body to bounce back after any illness and it takes even more time to mend when it is battling HIV, and even more time with co-infections like hepatitis B or C or other conditions such as diabetes or heart disease.
Do not rush the process. Take small steps. If you are going to go back to work then start with half days if you can. If you have the option of working from home, try that for a few days before heading back to the office for full days. If you are talking about exercise, it is especially important that you not over do it. Start with small increments for both strength training, cardiovascular, and flexibility training. The most important thing to remember is to take the time to make it work. Do not rush it. If you push too hard too soon, you will get frustrated and feel exhausted.
Getting plenty of rest is probably the single most important factor to recuperating from an illness. Rest can include sleep as well as sitting and resting. Getting enough sleep is important to the recovery process. Sleep is the time when your mind and body do a great deal of regeneration. Without sleep, your mental and physical processes suffer. It helps to go to bed at the same time every evening and get up at the same time every day. Even on your days off or days when you are not planning on doing anything, you will find that getting up, moving around some, and changing positions around your home will help speed the recuperation process. It will also make the transition back to work and normal activities a little easier.
During this recuperation phase, it is also important to rest without necessarily sleeping. Too much sleep can also slow down the process. Periods of inactivity can be spent watching television, reading, talking on the phone, or visiting with friends but the important thing to remember is to not do anything that is strenuous or taxes the body. Adding some light activities during this time can help the process of recuperation as well.
Once you resume your normal daily activities, it is important that you continue to get plenty of rest (both sleep and times of inactivity). Generally, your body will tell you when you need to rest. As some of you know, there are times when fatigue just overwhelms your body and your body shuts down. It is literally possible to fall asleep in the middle of a sentence or in the middle of an activity. This is often a sign that your body is not really ready to resume your normal, hectic schedule or that you have overdone it in some way or another. Give your body a break and give it the sleep and rest it needs.
Activity and Exercise
Activity and exercise is another of the most important things you can do for your physical, mental, and emotional health. Resuming these activities is a good way of telling yourself that you are getting back to where you were before you got sick. These activities can be as simple as walking your dog, taking the stairs, playing with your children, or going to the art museum. This may be a good time to try some of more gentle exercise routines such as yoga, tai chi, Pilates, and simple stretching regimens.
It is important to make sure that you resume your regular exercise program as soon as you are able to. Lean body mass is an important factor in maintaining your health so your exercise program should remain a priority in your life. Remember to go slow. For example, for aerobic exercise, you perform short cardio bouts (five to ten minutes, gradually increasing the time) or you could do what is called interval training by walking for a minute then resting for a minute then walking for a minute then resting and so on. For strength training, start with the lowest weight setting and do a few reps (8-12) and gradually increase as you feel stronger. If the lowest weight is too heavy, then start with just going through the motions that the machine would take you through with no weight at all.
Be active and be involved. Try to find activities that you enjoy and know you will continue to do. If you enjoy dancing, go dancing. Resume your volunteer activities when you are ready. The most important thing is to get your body and mind back to its normal activities as soon as you can.
Diet and Nutrition
This is another important component of recuperation from an illness. Often when we are sick we do not feel up to eating, so we do not eat or we do not eat very well. This is especially true if you have to prepare your own food. If you can get someone to help you with meal preparation and shopping, this can help ensure that you are eating and eating well. You should resume eating a healthy diet as soon as you have the energy to eat. If you do not feel like eating, find ways to get the nutrition into your body. Eat foods that sound good or are comfort foods.
It is important for you to communicate with your physician and dietitian. Your dietitian is specially trained to help you with your nutritional needs. There are special dietary recommendations for most major illnesses, as well as any other conditions you are currently experiencing. They should have suggestions for helping you to eat no matter what the illness involves. If you are experiencing weight loss and wasting, you should consult your physician and dietitian immediately. They may recommend a nutritional supplement or other options to help maintain your weight during and after your illness.
If you are having GI problems, then you will do best by eating a simple diet -- broths, crackers, and clear juices for a while. You will also want to drink plenty of water but if you are having bouts of diarrhea you should drink even more water and some sports drinks, which will help with electrolytes lost (diarrhea can cause severe dehydration). Avoid spicy, high-fiber foods and dairy products for the time being. As your GI tract starts to return to normal, then you can slowly add these foods back into your diet, but again go slow. The suggestions they have to offer are limitless, all you have to do is ask.
As you start to feel better and can tolerate foods then slowly resume your normal diet. Make sure you are getting adequate calories, protein, vitamins and minerals. If you do not know how many calories, how much protein, or what vitamins or minerals you should be taking you should consult your physician and/or dietitian. Generally, most people with HIV need more calories, protein, vitamins, and minerals then the average healthy person on the street.
Medications -- Adherence
As everyone with HIV has been told over and over again, a key to your health is taking your medications and not missing a single dose. This is true even when you are sick. Yes, it is hard to remember to take your medications when you do not feel well, and sometimes they are hard to swallow, let alone keep down. If you do not practice adherence to your medication regimen, however, you run the risk of developing resistance to the medication and/or getting sicker over the long run. The same is also true when taking antibiotics for infections: finish out the prescription until they are all gone. Do not stop taking your prescriptions just because you are feeling better.
It's great to have a good group of friends and family around during the good times, but it is even better to have these supportive people around when you are sick. They are the ones who help you out in so many small and large ways. They get you to the doctor. They help you to eat right. They include you in their activities and social events. They remind you to take your pills. Without this support, recuperating from an illness is even more difficult. It does not matter if they are your best friend, your neighbors, your biological family or your own created family. These people are a a big help to the recuperation process.
It also helps having access to your peers who also have HIV, with or without co-infections.
These are people you can count on to ask and answer questions, share experiences, and sometimes just be there. We may not always agree with everything they say or do but we do have this disease in common so it is important to be there to support each other in times of need. One way of having access to peers with HIV is by joining a support group, such as those run by Body Positive or by other AIDS service organizations.
Recuperating from an illness is a multifaceted task. It involves you, your medical staff (physicians, nurses, pharmacists, social workers, and dietitians), your family and your friends. It involves taking your time, getting plenty of rest, resuming your normal activities and exercise program, eating right, and consistently taking your medications. Most of all it takes you feeling up to the task at hand. If you are able to get control of all of these factors, with the help of your family and friends, then you will be ready and able get back into the thick of the things before you know it.
Glenn R. Preston, MS, RD, LD is the CEO of Real World Fitness, Inc. in Kansas City, Missouri. HIV-positive since 1985, he is a registered dietitian and combines fitness and nutrition with personal training for people with HIV and other chronic medical conditions.
Back to the March 2001
Issue of Body Positive