Warning signs
How to know when an episode, attack, or flare is right around the bend.
Welcome to Solicited Advice, our weekly column that celebrates the helpfulness in health. Because in a world where strangers at the grocery store love to tell you that a specific brand of magnesium will indeed “cure” what ails you (it probably won’t, so sorry), we’re all about passing on our lived experience in a way that makes your life a little better. Are we experts? Nah, not really. But we’re great listeners who have perfected the art of pillow screaming. Let’s get into it!
I’m newer to this whole “having a chronic health condition” thing, and one part I’m still trying to figure out is if there are any warning signs I can look out for prior to things like a manic episode or fibro flare. I’m always shocked when they happen and I feel like I shouldn’t be. Tips?
Ash: I wish I had a better answer than there’s no one-size-fits-all for any diagnosis or person, so you’re going to find the answers by listening to your body, observing your symptoms, and noting your behaviors. A weird way this shows up for me: I know when I’m having a bad day or am close to slipping into a depressive episode because I will deprioritize putting on makeup. For me, spending even five minutes on makeup on days that I go out in the world or have video calls — because I don’t put it on for everyday wear at home unless I’m filming — is dedicating time to doing something just for me. It took a lot of time to notice that trend, but now it feels like a flashing warning sign when it comes up. That’s all to say, it’ll take a bit of self-reflection and time, but you will eventually find your tells.
Jess: Decades in, and this can still be a struggle for me too. I tend to know the signs, but then overlook them or don’t make the connection when they happen — brain fog is, frustratingly, one of my regular symptoms and also sometimes a warning sign.
About a decade ago, I was really pissed off that I wasn’t catching things before they knocked me on my ass. So, I made a list. I started listing every possible symptom I could recall experiencing, asked my partner and other close people what symptoms they remembered me mentioning, and went back through my notes and planner to find things I might have forgotten.
Then I opened a spreadsheet and started fussing with it. Days across the top, and then down the side I had a section for data like the weather, barometric pressure, sleep hours, movement, whether I took my meds, and so forth. If it was something I thought might have an impact, I added it. Below the data lines, I added all of the symptoms I had collected. I skipped a bunch of lines so I could add in more symptoms as I noticed them, and then included a spot at the bottom for adding relevant notes because I’m terrible at any kind of “rate your X from 1-5.” I can’t rate my stress level, for example, but I can write a note that says “car accident” or “cat got stuck up a tree and it took five hours to get it down” (yes, really) — and that’s information I can use later.
For months I tracked what symptoms I was experiencing on any given day. It was tedious, but ultimately really helpful for me to narrow down things I now know to be true for me — like how I’m basically a human weathervane. This means checking the forecast isn’t just a “weird” thing I do before making plans, it’s part of how I know if I’ll be functional for those plans.
Once I figured out the larger, overlapping patterns, I was able to dial in on the more specific condition tracking BFF Kat talks about below, which is part of how we learned I’m allergic to gluten and dairy. For those of us with multiple conditions (so many of us!) and/or who tend to spend a lot of time dissociated from our bodies (whoops) or minimizing our experiences (double whoops), I think the two-step approach can be extra helpful.
Kat: This is truly an art form, so be gentle on yourself. It’s taken me many years to get to a point where I can anticipate a flare or an attack, and that’s only because I’ve done a boatload of symptom tracking and discovered that my acute episodes follow a pretty predictable cadence.
The biggest benefit of identifying your own set of triggers or patterns is that you can get ahead of treating them through means such as medicating, self-soothing, coping mechanisms, or distractions. So, tracking is where I’d start. I recommend you choose what you want to track first (e.g., manic episode or fibro flare) — but try not to tackle both a mental and physical illness at the same time, because that’s where the lines get blurred. For instance, if I wanted to better predict my anxiety attacks, I’d make note of my mood throughout the day, how much sleep I’m getting each night, how much of an appetite I have (fun fact: I typically lose my appetite altogether when I’m in a heightened state of anxiety), what the weather’s like, and if there are any major stressors in the present moment or on the horizon for me. Ash’s most recent Trackers & Treats template would be great for this!
Learning my warning signs through and through is how I figured out that when I get a major case of the yawns, it means a migraine attack is coming. Once the yawning begins, I take my abortive migraine medication right away and about 50% of the time, I can nip the symptoms down to a really manageable level. Not an actual science, to be clear, but paying attention to those specific warning signs has been wickedly helpful with functioning from day to day. Sending you support!
P.S. Oh, and one more thing. Once you’ve identified those yellow lights of yours, definitely talk to your support system about them. I’ve found in the past that sometimes I’m way too insular with what I’m experiencing on any given day, that I don’t actually consciously take notice of what’s happening in my own body. For example, multiple days in a row of fevers and a full-body rash typically means a lupus flare is on the horizon. But because I have so many other conditions (and, well, life), it’s very possible I don’t put the pieces together — but your people just might!
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