Whenever a person with a chronic illness such as fibromyalgia develops problems with performing her job, it may be time to undertake a complete self-evaluation. This self-evaluation would provide a clear picture, not only of limitations based on her chronic illness, but also a better understanding of where she stands physically, mentally, emotionally, financially, environmentally, and support-wise.

What are your limitations? Today many doctors find it difficult to say that a person can or cannot perform all of the required duties of a particular job, generally because they don’t know all of the activities involved in different occupations. By breaking your job into the activities it entails, you and your doctor can get a better idea of just how much you can do.

Physical. Consider the following physical activities. Does sitting for prolonged periods at a desk or computer or in a vehicle cause pain or stiffness? Can you get up and down from a chair without problems? Are there limits to how long you can stand, how far you can walk? Do you have problems maintaining your balance? Do you need a cane, crutch, wheelchair, etc., in order to get around?

How well can you move your arms and legs, reach for items above your head, from the floor, or off to one side or another? How much weight can you lift safely, and can you carry it any distance? What about dexterity? Can you use all of your fingers to pick up an object, to type on a computer keyboard or calculator, to operate a piece of equipment? Do repeated activities cause you pain, e.g., the motions involved in using a computer keyboard; cash register; calculator; or tools such as screwdrivers, hammers, wrenches?

Have you had to restrict your normal daily living activities--in personal care routines such as make-up or hair style; in household chores such as laundry, sweeping, vacuuming, running errands--including buying groceries or other shopping? Have you given up any leisure activities because they cause you pain or fatigue? Have you had to quit your job or been laid off because of your limitations?

Mental/Cognitive. Do you have problems concentrating, are you easily distracted, or find it hard to motivate yourself? Do you have a hard time learning new information either in formal education or for a new job or skill?

The physical symptoms of many illnesses can also have an impact on your ability to handle mental, work-related functions. Chronic pain or fatigue can make it hard to concentrate when operating equipment or machines. Other typical mental functions involve understanding, remembering, and following instructions; using proper judgment; and responding appropriately to supervision, coworkers, and usual work situations--including changes in a routine work setting.

Emotional. Have you been diagnosed with a mental illness such as depression, anxiety, or bipolar disorder? It is very common for individuals with chronic illnesses, particularly those which cause pain and fatigue, to have problems with depression. Have you lost interest in activities you previously enjoyed or had a change in your sexual relationship with your spouse or significant other?

How are you coping with your chronic illness? Have you worked your way through the stages of grief to reach an acceptance of your chronic illness? You have a right to grieve for your loss, your health, your ability to do whatever you could do physically or mentally before you developed your chronic illness. How is your self-esteem? Regardless of the state of your health, you still deserve to have healthy self-esteem.

Do you have a good relationship with your doctor? One woman who responded to a questionnaire for my book indicated that she was told by her doctor that she was simply afraid to fail and so was creating her symptoms. When she told him she had just made a major book deal with a publisher, he then said she was afraid of success. This type of attitude does not help your emotional state, so you need to find a doctor who will provide you with the necessary support to cope with your illness and help you develop a plan of treatment.

Do you use your illness to manipulate others, perhaps laying guilt trips on family members in order to get your way? Unfortunately, there are some individuals who do this, but I believe there are more who strive to live the best they can without abusing family and friends. Having a chronic illness doesn’t make us all saints or sinners; it is up to each person to make the best adjustment possible without imposing unfair or unproductive conditions on those around him.

Financial. Your self-evaluation involves more than just your body because you do not live in a vacuum. How secure are you financially? How much and what type of debts do you have? Are you financially secure, or do you live from paycheck to paycheck? You must know where you stand money-wise before you can develop a plan of action for future work. Are you employed full-time or part-time, or are you self-employed or receiving disability income? What are the ramifications of receiving the latter? While the Social Security Administration has raised the level of money an individual may earn without losing disability benefits, they still acknowledge that the income that most people receive is not enough to survive financially. This plays a large part in the decision about whether to apply for such disability. Do you have adequate health care for your chronic illness?

If you have some money set aside, is it sufficient to pay for new training or education? Is it enough for you to take some time off from work and try to adjust to your chronic illness and perhaps recover some energy? If you are the sole support for your household, your financial alternatives may be limited, but you still need to know what options might be avail-able. There are a number of government programs which assist with education and training, but not all provide enough income for a family to live on while that education takes place.

Physical World. Where do you live? In a rural or urban setting? Do you live in an apartment, single-family dwelling, duplex, or townhouse? Are your options regarding your home restricted because of a current mortgage or a spouse’s job? Could you move if you had to for training or a new job? Is there something about your home or physical location that would lend itself to some form of self-employment?

How accessible is your home, both inside if you have any mobility problems and outside as far as access to adequate transportation? Can you get to work, doctors’ appointments, and shopping? If the answer is no to any of these questions, can you move to improve your situation?

Social Life & Support System. Do you take part in some form of social interaction with others? Family and friends can serve as both a social outlet as well as a support system. Do you have dependent children or parents? If you do not have family close by and you live alone, do you still get out and around others? Living alone with a chronic illness can isolate you and can often lead to depression or anxiety. By nature we are social beings and need to interact with others to maintain a healthy mental and emotional state. Even if you enjoy being alone, you must make the effort to get out, at least often enough to keep yourself centered.

Friends and family can also provide help when you need it. One of the hardest things I had to learn about living with my fibromyalgia was to not only accept help when it is offered, but also ask for help when I needed it.

There are also more formal self-help organizations, such as the ones who receive this journal. These organizations usually remind us that we are not alone in our illness and also provide current information on chronic illness.

There are many other things that an individual can look at in order to get a clear picture of life and how chronic illness affects it, or will affect it, in the future. I firmly believe that once you have taken the time to consider your life carefully, keeping in mind the limitations to your finances, you will be better able to make an informed decision about your current job and the future.

About the Author: Gayle Backstrom has been a writer for over 35 years, just about the same length of time she has had fibromyalgia. Most of her early writing career involved photojournalism and public relations, including her own PR firm. After receiving her diagnosis of fibromyalgia, she was frustrated with the lack of information on FM, so along with her Fort Worth rheumatologist, Dr. Bernard Rubin, she wrote When Muscle Pain Won’t Go Away, Taylor Publishing. The book is now in its third edition.

The article above was adapted from her latest book, I’d Rather Be Working, A Step-by-Step Guide to Financial Self-Support for People with Chronic Illness (Copyright 2002, AMACOM--a division of the American Management Association, New York, NY). In addition to self-assessment exercises, this book addresses the pros and cons of the Americans with Disabilities Act, dispelling many myths and misconceptions and showing how recent court decisions about the Act can help (or hinder) individuals in their efforts. It contains a wealth of information on resources like the U.S. Department of Labor, the Job Accommodation Network, the Small Business Administration, and sources for training, education, vocational rehabilitation--and the financial aid that can help people of any economic means get the instruction they need. Interviews with 20 chronically ill or disabled workers illustrate the tremendous diversity of backgrounds they come from and the challenges they face. Their stories represent a wealth of new perspectives and practical approaches to improving and increasing employment options. To order, phone: 800/714-6397, or visit the Amacom website at: www.amacombooks.org. The purchase price is $14.95.