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One of the things I deal with as part of my Long COVID recovery is struggling with daily tasks. The struggle may include exhaustion, dizziness, pain, shortness of breath, oxygen desaturation, chest pain, loss of balance, and more.
In Long COVID it is assumed that the Central Nervous System is dysregulated. The Parasympathetic Nervous System (the part that relaxes your body after times of danger or stress) is not working properly with your Sympathetic Nervous System (the part responsible for putting the body into action in times of danger or stress). This can cause a host of symptoms that vary from person to person and from day to day.
I don’t know if it’s true of everyone but in my case, the Sympathetic Nervous System is in overdrive and even the slightest stressor causes me to crash. I’m learning to learn what causes stress to me and how to minimize or mitigate it, as well as to find ways to prioritize tasks and activities that I can’t change the stress load of to have the least impact possible.
Evaluating the Demands of an Activity
At the bottom of this post I’ve attached the document I received from my speech therapist called “Evaluating the Demands of an Activity. This document is the property of Providence Health & Services and I do not claim ownership of it in any capacity.
This tool has been one of the most helpful I’ve received so far. It has helped me understand exactly what is involved in the different tasks/activities I do and why they may cause symptoms or drain my energy the way they do. It also helps me make decisions about how to approach these activities that may decrease the demands and so decrease the amount of stress they create.
The form looks at the following: Balance, Vision, Cognition, and Pressure. It asks some basic questions to give you an idea of what might be entailed in each of these areas. Because I am also sensitive to sound and smell, I include those when I’m evaluating a task.
I’m going to show you two examples of what the evaluation process looked like for me.
Example 1: Grocery Shopping
My rating for grocery shopping, without considering the changes I’ve made to make it easier for me is:
Balance - A lot Vision - A lot Cognition - A lot Pressure - A lot, usually Sound - A lot Smell - A lot, if I need something from a cosmetics, bath or cleaning section
With this in mind, grocery shopping not only requires a lot of energy but is very stressful to my body and nervous system, which makes the energy expenditure even greater and puts me at high risk for adverse symptoms during and after the activity.
In order to see what I can change, I look at each section individually and come up with ideas that may either decrease the impact of that section or may help me manage the impact of it better.
This process takes time and sometimes it helps to have someone talking through the options with you because they aren’t always obvious.
Balance
Could I use an electric cart? Would using a walker help? What could I do to help take make this less demanding balance-wise?
Using an electric cart would make me dizzy, increase the stress from a cognitive perspective (learning and paying attention), and require more sitting and standing which also adds to the amount of balance required. Using a walker is difficult when also pushing a cart and even though it would be helpful to be able to sit down when I need to, putting the walker in the cart and taking it out would be too much for me physically.
What does that leave?
Well, I can be more mindful about using the cart for balance, taking longer breaks when getting items that I have to bend for or reach for, walking slower, and focusing on my breathing. While balance will still be a lot, that is the nature of grocery shopping.
Vision
There are a lot of bright lights and glare, reading nutrition labels, scanning shelves for the right items, movement all around me, and lots of colors, shapes, and textures. In addition, stores move stuff all the time, which means there’s a lot of scanning shelves for products.
While there is not a ton of stuff I can do to change the visual stimulation of grocery shopping there are actually some things that can help.
I try to go to stores I am familiar with. This helps me get in and get out faster with less searching, which also decreases cognitive demand. I put my shopping list in order by the section or aisle the products are on whenever possible. This means I’m not looking around in places that don’t have what I need anyway.
Fred Meyer (aka Kroger) has an amazing app and, while it does increase visual impact because I’m using my phone while shopping, it also helps minimize the amount of scanning and searching I’m doing because I can enter my shopping list and it arranges it by aisle and section based on the store I’m shopping at. This is hugely helpful for visual, cognitive, and pressure.
When possible, I go to the store at off times. Fewer people means less movement around me, unless it is a time when the store is having shelves stocked, then it’s easier to navigate people than all the movement of employees and products. Since I don’t have a car and rely on someone else to take me to the store, and since I don’t know when different stores do their shelf stocking, this is not always in my control but it is something I consider.
I have not tried tinted glasses yet, but that is next on my list to try.
All in all, like balance, grocery shopping is highly visual, so there are only a few things I can do to change the impact.
Cognition
While cognition is a lot, there are many things I can do to help decrease this to a medium or a little.
Making a list or using an app for my list helps me to not have to remember items. This also decreases pressure. Going to a store I’m already familiar with also decreases the amount of thought required to navigate the store and get my items because I know where things are.
Using an app where I can also download coupons and see what my total will be, helps me to take advantage of sales and not stress about missing savings opportunities that are really helpful to me right now.
Pressure
Pressure is a lot for me right now, predominantly because I have to rely on someone else to take me to the store. If they don’t have their own shopping to do, I tend to feel like I have to rush to get things so that they aren’t waiting for me. This is something in my own mindset, not actual external pressure.
The pressure to remember all my items can be alleviated by having and using a list or an app.
Another place where I feel pressure grocery shopping is when I have to stop frequently to catch my breath or because I’m dizzy. I’m always wondering what the people around me are thinking and feeling and that actually makes my symptoms worse and increases the feelings of pressure.
There is also the fear that I will get dizzy or have my oxygen desaturate and not be able to sit down or stop moving long enough to recover.
While these things are real concerns, they are mostly in my own thinking and so that is something I can work on to decrease and probably bring the pressure down to a medium or a little over time.
Sound
Many stores are full of sounds – the sounds of people, employees, computers, door alarms, background music, cell phones ringing, announcements, equipment running, etc.
Probably the single best investment I’ve made so far to help with sound is Loop earplugs. I got the Loop Experience earplugs and I love them.
These earplugs reduce background noise while still allowing me to have conversations. Usually, I take one earplug out if I’m having a conversation or checking out at the grocery store but that is because I’m still not able to judge how loud or soft I’m speaking with both of them. My ability to hear others when they are speaking to me unless they are talking really softly is great.
The earplugs definitely take grocery shopping from a lot to a medium demand and it’s so worth it!
Smell
I’ve always been sensitive to smell. Even when I was a child, the fragrance section of department stores and the cleaning aisle in stores bothered me. Since having COVID, this has grown worse and I can actually develop a migraine or become very short of breath just by walking past the cleaning aisle or a fragrance aisle.
Since I sometimes need to go down these aisles or be in close proximity to them, I make these my last stop before checking out. Yes, it’s still a lot and yes, I still have symptoms but by making them the last stop, I put myself in a position to be outside soon after I’m finished and to be able to sit down relatively quickly.
I know these are the aisles that can make the difference between finishing my shopping and having to leave because I can’t breathe, so starting in these aisles is out of the question. In fact, whenever possible, I will order items from these aisles online to avoid them entirely.
As with a lot of the other items, this doesn’t change the demand, it’s always a lot if I have to go down those aisles but I have options and that helps.
Other Options
Obviously, there is not a lot I can do to move most of these items from a lot to something less impactful, and that’s okay. Knowing that I am able to make other decisions when it comes to grocery shopping.
For example, whenever possible, I order groceries for pick-up or delivery. I love using Fred Meyer (aka Kroger) because they charge the same prices for pick-up and delivery as they do if you’re shopping in the store. This is not a common practice. So, between the ease of using their app, the convenience of the app, the quality of their products, and the fact that there is no upcharge for pick-up and delivery, Fred Meyer has become my go-to.
Grocery Conclusion
That is how I evaluated grocery shopping. It took a lot of time and was something I actually worked through with my speech therapist. It gave me a good grasp of how the tool worked and how to use it for other tools.
Obviously, there weren’t a lot of things that dropped below “a lot” and that’s okay. The point is to build awareness of what your daily tasks require of you so you can make choices about what to do and when to do it. It provides valuable information that gives you more control but also allows you to think creatively about how to address these tasks and make them more manageable.
Example 2: Vacuuming
My rating for vacuuming, without considering the changes I’ve made to make it easier for me is:
Balance - A lot Vision - Medium Cognition - None Pressure - None Sound - A lot Smell - None
Balance
There is really no way to decrease the amount of balance required when vacuuming, that I’m aware of. I have to move my body and my head and to get ready to vacuum means I’m going to pick stuff up off the floor so it’s out of the way.
So, rather than reducing the amount of balance required, I reduce the amount of time I spend doing the activity. Instead of aiming to vacuum the entire apartment, I vacuum one part of the apartment instead and I base it on the need of the room and the amount of energy I have.
On a day I have more energy, I will vacuum the living room. The living room has several dog beds and toys, so preparing to vacuum takes more energy than vacuuming and requires additional balance. I only vacuum the living room if it needs it, sometimes that’s once every few weeks. This is where prioritizing a demanding task is valuable.
On a day I have less energy, and if it needs to be done, I will vacuum the bathroom, dining room, kitchen, or bedroom but only one of those rooms. Very rarely will I do more than one.
In fact, since I’ve been out of the hospital (12/1/2021) I have only successfully vacuumed my entire apartment all at once, 2 times, and only vacuumed it all in the same day with extensive breaks between rooms 2 or 3 times. It’s just that taxing for me.
Sound
Vacuuming is loud. This is one of those activities where my Loop earplugs really come in handy. No one is talking to me and I’m not talking to anyone else so I can leave them both in and just do what I need to do. The noise reduction really helps and alleviates the sound pressure in a way that is difficult to articulate.
Vacuuming Conclusion
Vacuuming requires a lot of energy but the stress demand from the balance required and the sound also plays a significant role. As a result, I choose to vacuum only when absolutely necessary and only one room on a given day. I have the latitude to make this choice and it works for me. Reducing the sound impact has been the biggest help to me in vacuuming.
How This Tool Has Helped me
While this tool has not necessarily helped me decrease the demand of all my activities, it has helped increase my awareness of what my normal activities actually require. Where I was feeling guilty and ashamed for not being able to do some of these things, this information allowed me to understand why I was struggling and gave me options for figuring out ways to either decrease the demand of the tasks or come up with creative workarounds when necessary.
In short, it has provided me with a sense of choice and control. I can clearly see what I can change and what I can’t and I can make decisions that are best for me at a given time based on that information. It also helped me better understand the concept of pacing, which I’ll talk about more in a different post.
The Handout
I did not create the following handout and do not hold the copyright. This was provided to me by my speech therapist at Providence Health & Services and they retain full ownership of the document.
Please note: Information on this site is my own personal experience and is provided for informational purposes only. I am not a medical professional and the information here should not be considered a replacement for medical advice. Please see my full disclosure statement here.
