Do you second guess every career move you make - or don't make?  Do you think twice, maybe three times, with every chance for something more - whether to ask for that raise, seek the promotion or look for a new job -because you're unsure if you can do it?

Chronic illness puts up all sorts of roadblocks --pain, fatigue or disabling symptoms -- while you're trying to live your life.   For some, it's natural to stay upbeat and positive about the world, not matter what shows up.   But then there are those who think that life is out to get them.  They figure it's best not to try too hard rather than deal with more disappointment.

But it's not like chronically ill people have cornered this market.  There are many reasons people behave like "fools".  In one of his last great movie roles, Nobody's Fool, Paul Newman (who sadly died recently) plays Scully, a  "healthy" man who spent his life gaming every system. Determined not to be played for a fool, he managed not to engage too strenuously in life, altogether.  Never quite "losing" , he's no winner, either.

That can happen easily when you live with illness.  Have you lost the energy (desire?) to take any risks at all?  Maybe you're one of the many who are bored, underemployed or treated poorly but you tell yourself you're satisfied you show up and keep your job.  Or maybe you're unemployed and tell yourself you'd rather be unemployed than be miserable at work.

Understandable.  But how's it going?

Every once in a while, it's a good idea to take a good look at how we're living our lives, how we're fulfilling our intentions, how we're playing the hand we're dealt  (for more on this topic, download my article, Playing the Hand You're Dealt, cicoach.com).   This means knowing your strengths and your limitations and then searching for the opportunities that exist if you can only see them.

Can you take this day, today, to take a good, clear look at your beliefs and behavior regarding a career?  Are you wondering how you can be sure you're not fooling yourself?  You can't.  But asking the question is a good place to start.

Building on her experience living with chronic illnesses, including multiple sclerosis and ulcerative colitis, Rosalind Joffe founded the executive career coaching practice, cicoach.com. Dedicated to helping others with chronic illness develop the skills they need to succeed in their careers, Rosalind firmly believes that living with chronic illness does not preclude living a full and successful life.

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Is the health care reform bill a step toward ensuring that anyone living with chronic illness will receive "adequate" medical treatment?

Or,is it just more help for the healthy?

I don't have the answer.  But I'm delighted that in the increased attention on the burden that chronic illness places on individuals and society when the chronically ill don't receive the health care they need.

I'm no political sage. I  don't understand  the  fine print in the new health care plan.  But I've heard  horror stories from chronically ill people --  clients and others - - who can't afford a specialist or pay for expensive medications. These are folks who are working and have some health insurance!

As I described in a recent post, you can be fired or lose insurance benefits if you don't disclose a medical condition before being hired.  You can also not be hired or lose your job if you do.  Sorry if I'm stating the obvious, but we can't expect legislation to prevent unfair practices from happening.

The Massachusetts health care reform program is cited as a national model but there's the good, the bad and the ugly. Unfortunately, universal coverage does not entitle the chronically ill to good or even adequate health care.

Back to my question.  Is this a step toward better health care protection for those of us living with chronic illness - whether working or not?  At the least, we are justified in hoping so.

Will it prevent people from being fired when they disclose a chronic illness - or even not getting health insurance?  I doubt it. There are only so many battles we can fight and much slips through the cracks.

Living with illness gives you the perspective that the unexpected and unpredictable happens.  That's not necessarily a negative.  It can be a point from which to expand and keep hope alive.  I feel more hopeful today.  Do you?

Building on her experience living with chronic illnesses, including multiple sclerosis and ulcerative colitis, Rosalind Joffe founded the executive career coaching practice, cicoach.com. Dedicated to helping others with chronic illness develop the skills they need to succeed in their careers, Rosalind firmly believes that living with chronic illness does not preclude living a full and successful life.

Phyl Rubin is talking but not about furniture. Phyl and Bernie  own a New England furniture store chain.  No, Phyl is talking about a secret she's kept for 40 years:  living with multiple sclerosis.

40 years of silence?  Why?  She didn't have to worry about losing her job or a demotion.  Did she think it would hurt sales?  She's quoted  saying she didn't talk about it because she's a "private" person.  But she's been in the "public eye" for decades.  Why did illness have to be private?

I think there's a problem with the fact that people don't talk about their illness and work in the same breath, don't you?

I know they fear that this will negatively affect how others perceive them.  But as Phyl's husband, Bernie, said, people were noticing that she wasn't the same --  and making incorrect assumptions about her.  When illness becomes debilitating, it's noticeable.

The reality is that the overwhelming majority of people with chronic illness do not disclose their illness at work, which means supervisors and co-workers are unprepared about what to do when it comes up.

I'm not talking about complaining to anyone who will listen that you're sluggish or have some pain. But there's the point when you're having trouble doing the work and your performance is suffering.  There are some who can't understand what chronic illness - unpredictable, waxing and waning, and often invisible - means. You might get negative responses or a subtle (even not so subtle) put down.

You have to be strategic talking about illness when others are depending on your deliverables.   It also takes confidence and clarity.  You can get some tips in my blog post and more  strategies in my booklet, Talking About It.

The fact is that more than 40% of American workers live with at least one chronic illness. But talk with human resource professionals about this issue and they typically say it's not a problem for them.  Of course, not.  No one talks to HR about this - at least not until they file for disability.

Many come to me when they've hit serious roadblocks after disclosing their disease at work.  But when we dig deep, disclosure isn't the root problem.  Sometimes they can no longer do that job -- or in that place.  Sometimes they need to make adjustments.  You can find assessments in the Working With Chronic Illness Workbook .

I don' t have an answer for this but it's clear that saying nothing until you have to leave work altogether isn't it.   It's not easy to let people know how hard your day is when you look fine.   Or more importantly, why you can't meet that deadline or make that meeting.  But unless you do, they'll have no idea what your problem is or what or who might help you.   And you have no chance for improving the situation - - until you leave on disability.  

What do you think?  What have you done about this and how did it go?

Chronic illness, complicated as it is, leaves many searching for a simple answer.

Lately, a tantalizing headline has gotten much press in the social media 'disease' community (yes, I'm on twitter and you can tweet me @WorkWithIllness): "Exercise can Quiet Anxiety that Comes With Illness". 

Help me, please.  What's the news here?   That people who live with illness also experience anxiety?  That exercise can help alleviate that anxiety?

I felt a particular sense of annoyance with this research when a client told me about an email she got from a  co-worker.  The email writer sent a link to this study with a note saying that since my client must feel very anxious about her multiple sclerosis symptoms, this is great news.  Exercise is the cure.

My client lives with symptoms that are periodically difficult to manage and puts in a minimum of 45 hours/week on her job.  She said that although the email writer's a "jerk",  she wanted to talk about her guilt for not exercising and her paranoia that other co-workers would conclude that multiple sclerosis must be her fault.   Can you relate to this?

I read several articles about this research and from what I can tell, the findings say:

• Exercise decreases anxiety for those who had not been exercising at all.
• Exercising at least 30 minutes a day is optimal.

But even if you can carve out that 30 minutes a day, that's not the only challenge.  You've got to figure out what to do and where.  Vigorous exercise is rarely an option with debilitating symptoms  (cross off that spin class).  And with changing symptoms, some days even mild exercise can be a problem.

Additionally, for  those who need a class or  teacher to stay motivated, there's the cost.   True, running or walking outside doesn't cost a dime but weather,  like illness, is unpredictable.  Extremes of any kind - heat or cold - can aggravate many health conditions.  And there's ice.  Nothing like waiting all day to take that long walk after work but icy streets and bitter cold, especially in the dark, present real danger for you.  Not exactly  an anxiety reducer, is it?

Consider this.   When you're given suggestions or "solutions" about your health that you didn't ask for, you've got some choices:

1. You can respond angrily that they don't understand.
2. You can wallow silently in self pity and guilt.
3. You can think about the suggestion, consider the source to decide if you want to respond, and consider the suggestion to see if it fits for you.

For more ideas about talking about chronic illness symptoms at work, check out my Career Thrive When You Live with Chronic Illness Series.

Tell me, what do you do?  How is that going?

On another note, a colleague has asked  me to post this request: Women business owners: Have you experienced a past personal crisis while running your business and lived through it to tell the tale? If you would be willing to share your story, we would like to interview you for an upcoming book, tentatively titled “When Life Happens.” Your experience and lessons learned can help today’s women’s business owners navigate similar life events. If you are interested in being interviewed, email chris@prioritywellness.com.  Put “Share My Story” in the subject line. Chris will respond with an initial questionnaire to assess whether your story is a match for the book. If so, either Chris or her co-author Elli will contact you to schedule a 1 hour phone interview.

If you live with chronic illness, you've probably realized that:

• Symptoms can come and go when you least expect it;
• the intensity and how it impacts you can vary. This can reek havoc on your job.

How do you explain the changes?  Yesterday you were able to get to work and do your job just fine. But today you've got pain,  fatigue or some body part isn't working and you'll be a few hours late or maybe won't be in at all.

One solution is to work "virtually". Virtual work does not guarantee flexible scheduling - unless you work for yourself or it's built into the nature of the job you do (e.g., such as writing, research, web design.)  But it does cut out a commute and in many cases,  it can mean that you have more flexibility to shift your work schedule around your health needs.

I've worked with people who have transitioned their jobs from a brick and mortar office to working at home.  What I've seen is that the  key piece is to  make sure that there are good reporting and communication systems in place. Expectations  about what others can expect and when must be clear to everyone involved. Communication trails have to be documented.   In fact, you have to be more precise than when you were in the office.

One client in my Just In Time Career Coaching program found that her supervisor became really difficult when she stopped coming in.  But when she explored this further, she learned it had nothing to do with her performance.  Her supervisor missed the personal interaction!

I've worked with others who found that after they went "virtual", they were working even longer hours because  systems weren't in place.   You can get some good ideas for communicating while working virtually .

I work virtually but for myself.  For 17 of the 22 years that I worked in large and small operations, I lived with debilitating diseases.  My career skills meant I only had full time and physically demanding options.   With two young children, neither my body nor soul were up to it. To keep working, I had to  "reinvent" myself.  My priority was to work at home.  I didn't intend to work for myself but it happened.   As with everything,  I can see that there have been positive and downsides to working this way.

The upside:

• I  develop relationships and network, market my services,  and work with clients worldwide without leaving my home.
• I don't waste my energy commuting, dealing with bad weather or worrying about finding myself in situations where I'm physically challenged.
• I take the breaks I need when I need them to take care of my body and I don't worry how this might affect how I'm perceived.
• I design and take charge of my time and energy with no one to thank or blame but myself.

The tough stuff:

• Studies show that working promotes health because it gives you a sense of purpose, creates a schedule and gives you social interaction.  But working virtually can be isolating, especially if you're solo. If you're struggling with illness, you can lose your sense of purpose and drive without the support of others.
• When I'm not well,  I'm alone in this body.  Mostly it's a relief but sometimes it's weird and it would be nice to have people contact.
• I miss being around people. Although my days are busy talking on the phone and emailing -  people who work for me,  colleagues with whom I work on projects, and clients,  I often miss having that face-to-face interaction.
• Although I don't miss getting "dressed" for the office, there are days that I'd like a reason to wear a suit.  Go figure.

I'm sure I've missed some points here.   Another perspective is at The Pros and Cons of Working Virtually.  Are you a virtual worker?  What have you found?

Living with chronic illness can leave even the toughest person feeling vulnerable.  You just wish that other people could "get it", don't you?

I know from personal experience how hard this is in a marriage  (How a Marriage Survives When One Person Gets Sick, MORE Magazine) .  And marriage is all about the relationship,  where two people have declared that it's for better or worse, sickness and health, etc.

But what can you expect at work where the goal is to produce products or deliver a service?  No doubt, positive relationships make work go more smoothly.  But we have to remember that no matter what we might wish for, relationships aren't the endgame in the workplace. At best they're a tool for effectiveness and worst, they're a by-product.

I thought about this when I was speaking with my client, Ann (not her name).  Ann, who lives with  Lupus, is a graphic designer. She worked on a team in which, although everyone worked independently, all the parts contributed to the whole on a consistently very tight schedule.  If one person slipped, the ship went down.

Ann's unpredictable and debilitating symptoms meant that the tight deadlines became a disaster.  A few weeks ago, she asked to be 'demoted' to a job with less responsibilities and reduced pay.  Which is why she's in the job hunt.

Ann had created a "needs" assessment  for her next job (using my Working With Chronic Illness Workbook).  In our conversation, she told me that she wanted a supportive environment, where people care about her and how she's doing.  Heading up her "Needs" list was "support".

But when I asked her to describe what support at work means to her, she said, "People who respond positively when I say that I'm unable to meet a tight deadline alone but with some help, could get there. People who pitch in and help if I'm stuck. "

She was surprised when I commented that her description didn't mention illness. Nor did she talk about anything emotional.  I  said that it sounds as if she's looking for a team approach, rather than a gotcha' response.  Again, she was surprised.

As we talked, Ann realized a few things.

First, she has to be clear with language.   What does support at work mean to her?  Do you know what kind of support you need?

Second, Ann  would love it if people would empathize when she doesn't feel well, rather than behave as if she's just a problem for them --  or worse, that she's making it up. But she finds that's hard to predict.   Are there things you say or do that seem to work for you?

Finally, she has to be in a job that she can do.  If you're lucky and you're good at communicating, people can be terrifically empathic.  But if you can't do the job, you're going to be history.  If  Ann needs flex scheduling and/or team support some or all of the time, then she needs a job where that's the nature of the job.

Can you be successful in the job that you're in or does it require support that's simply not there?

Being unemployed and looking for a job can be demoralizing.  Living with illness can be demoralizing.  No doubt there are other difficult life events  but these would rank at the top of anyone's "life's bad events" list.

Naturally you'd want to avoid experiencing both of these at the same time.  But, unfortunately, that's not a choice.  If you're facing this, do you feel hopeless, think you have no options and you can't see what you can do differently?

How are you doing with that thinking?  Probably not great.

Let's face it, you can't change that you live with a chronic illness.  But a positive attitude of hope and seeing opportunity in unlikely places at the least helps you get through the day in a better mood.  (I know that because I live it.)

Do you find that you're getting more listless and unmotivated?  A positive attitude helps you move and interact with others.  It draws in others and encourages them to want to be around you.  All of which helps your well being and, need I say, your work status.

Are you thinking, easier said than done.  I can't change the way I feel.

True enough.  Constant rejection and negative feedback  - either in a current job or in a job hunt - plus living with disabilities makes it hard to hold onto positive.

What can you do if negativity keeps nipping at your heels, when you least expect or want it?  What do you do if you realize this is a problem but you can't help yourself?

That was true for me.  When I was young (and healthy!) I had a generally "glass half empty"  outlook about my own life.  But the truth is that bad health helped me realize that I couldn't afford that thinking or behavior.  I had to teach myself new tricks.

I'd love to tell you that there are 3 sure fire tips to developing a positive attitude.  It's not that neat but there are some well defined places to start.

• First, create your intention for yourself.  This is your big theme idea of how you want to approach your career and it's becomes like your north star, your guidepost.   You might not ever reach it but it's where you're headed.
• Next, set some goals for yourself with clearly defined desired outcomes.
• Now, identify the opportunities and what gets in your way of achieving them.
• Finally, identify where and how you can get support from others to fill in your gaps.

Maybe you're thinking, I'm too old to change or I've been this way forever.  But it's not true.  Forget what they say about old dogs.  My dog, not old but not a pup either, can learn new behavior.  Because his habits are ingrained, he needs more help from me to learn a new trick.  And then he needs reinforcement.

You can get that new training, new ideas and reinforcement by reaching out for help. Join online or professional professional groups for information.  One tool I've used often in my career is a mastermind team (more information is in this online booklet ).  A mastermind team is a terrific way to get ideas and feedback from like-minded people.

Another tool I rely on is to work with a coach.  Yes, it's a financial investment.  But when you find the right fit, it's the best investment you can make in your future.

You can stop repeating the same old tricks that keep you stuck in "half empty" mode.  Start today.

A reporter was interviewing me about chronic illness and working.  She was very surprised when I said, "The single most important factor that helps a chronically illl person continue to work is to work in a flexible environment."

She asked me what "evidence" I have to support this.   (Have you noticed how popular that word has become lately?  It seem that it's only true if it's "evidence-based".)  I responded that I have anecdotal evidence --   I've seen it myself and heard it from others.

No.  I haven't found any research linking people who continue to work while living with a chronic illness and the flexibility of their workplace. (Have you?)  Unfortunately, it's not something that seems to be studied.   (Anyone want to do this -- or fund me to research this?)

I told the reporter that I'd written about this issue numerous times (in my book, Women, Work and Autoimmune Disease:Keep Working, Girlfriend! and more recently, this post, Who Needs a Flexible Workplace?)   I'm not an expert nor a researcher.   Just a believer.

In the meantime, we'll  rely on our experience.  And, the studies that support flexibility for all workers (Making Flex Time a Win-Win).

FYI - I've just read a great book on "reinventing" your career, New Job, New You by Alexandra Levit.  I like that she offers good stories of people who've done this and has solid tips.  Although it doesn't touch on chronic illness issues,  you can do the translation.

When I'm working with clients who are changing careers or even their jobs,  I encourage them to make flexibility a top priority.  I've noticed that this isn't obvious to those experience the onset of a new disease.   It's hard to imagine how chronic disease waxes and wanes, requires periodic doctors appointments often during the work day and can have different symptoms that come and go.  But live with disease for a few years and you can see that this is one unpredictable beast that can upset any schedule.

Do you have any reason to think that this isn't important?  I'd love to hear it.

Yes.  We must have easy access to high quality health care.  But just as importantly, we must be able to find a decent job at a living wage that allows us to take care of our health.  And the code word here is flexibility.

There are just too many definitions for chronic illness to list ( google it for yourself) and many contradict each other.

But, no matter what the definition is, there's one thing you can count on in unpredictable chronic illness world.

Living with chronic illness will affect your quality of life.

What makes me so sure?  I've seen it daily  -- both  in my  life with illnesses,  and professionally, as a career coach to those with illness.

In  "Mugging Myself", Psychology Today, Alida Brill writes how she "mugs" herself as she lives with MS.   Been there, done that, I say.  How about you?  Do you get in your own way? Are you tripping over your own feet in spite of your best efforts to sail smoothly with illness?

It's easy to understand why. But do you have to accept this?  It's unlikely you can can change the disease course.  But, do you believe that you can change how you live with it?

If you're saying, yes, here's a starting point.  I've seen 3 traps that too many people fall into. And I've worked with  people to think about it differently and seen what works.  Try this.

Ask yourself:

• Am I behaving as if living with a chronic illness is a sprint rather than a marathon? (Even with sprinters, it's a marathon). If you are,  you're bound to run out of steam.  Chronic illness requires patience and planning. It requires endurance.  And, you need to live in a place of hope that you'll make it to the finish line. Even if you can't actually run a marathon, can you behave as if you are?

• Is there some part of me that lives in fear of being "stressed"? Anywhere you turn, the message is that stress is bad for chronic illness.  But according to Dr. Esther Sternberg  (Stress, Chronic Illness and You),  stress can be good for you, too.   Sure, avoid on-going toxic stress, when possible.  But rather than focusing on what to avoid, put your energy toward managing the source of the stress and learning to live with the stress.  Is managing the source and the stress a more pro active, empowering stance for you?

• Do I live life as fully as I can and allow myself to do the things that make me happy? Yes, symptoms can mean that you have to pare down.  But you can still reach for those stars that will bring your fun and fulfillment.  In Lemonade anyone?, I describe how a painful task created new opportunity.   Start with setting desired outcomes - rather than unspecific goals. And  create daily intentions to achieve them. Can you create lemonade for yourself?

But wait, you're saying, I'm too stuck or too busy to think about this now.   Really?  That's why this is the right time.

Unless you only work best on your own, ask for help (or pay for it).   Find someone who will encourage you to get and stay on track.  Yes, a chronic illness career coach is ideal (smile!)   -- or a life coach who knows about illness.  But it can also be someone you know who understands what you're up against.

Have you discovered ways to avoid these mind traps - or others?

Living  with chronic illness isn't easy, under the best of circumstances.

And working can seem like it makes it tougher.

But the alternative is usually worse.

It was a dear friend's 60th birthday party.  And, once again, my body was in revolt. I was feverish, tired,  nauseous --  with  numb feet and awful balance  (multiple sclerosis symptoms that get worse when I have an infection).  It was a kidney infection after too many urinary tract infections to count from living with multiple sclerosis for over 30 years.

When my husband, Jake, and I left early, they were rockin' to,  "Dance to the Music".   I was a sad puppy.  Yes, it helped to cry and vent to friends and family.  But I was still sick and my symptoms were still there.

Even though sleep didn't improved how I felt, without a reason to get out of bed, I'd have stayed there.  And that wouldn't have been good  - -  for my psyche or body.

Lucky for me, my job  "called", and my day had  structure.  There were client appointments,  articles to write and projects to develop.  Nope, I wasn't at the top of my game.  But I had enough to offer to make it worthwhile.  Mid week, the infection subsided and I returned to baseline.  Just another incident in living with chronic illnesses.

But I have no doubt that work, a schedule, things I had to do, created distraction and motivated me to keep moving. (I even exercised lightly!)

Is work a prescription for everyone?   Clearly not if the situation creates miserable pressure or the people are toxic.  But does that mean you have to quit altogether?

It is a key ingredient for better health, especially with chronic illness and waxing/wanting disabilities.  Not convinced?  This website,  return to work knowledge.org , offers evidence-based research that working promotes better health for the chronically ill.

And even if your situation is relatively good, it's easy to dream about not dragging yourself to work on the bad days.  Are you at the  "tipping point",  thinking, "Enough.  I just can't go on."   We explore just that in my book,  Women Work and Autoimmune Disease: Keep Working, Girlfriend! and describes how some people face this.

Over the past seven years as a career coach for people with chronic illness,  many people have hired me to help them get back into the workforce.  They left for various reasons.  But usually it was because they thought they were too sick to work or were in a difficult situation.   .  But  studies show that it's harder to go back to work once you've left due to illness.  And the longer you wait, the harder it gets.

Are you wondering whether or not to stop working? 

With the New Year approaching and resolutions on your mind, you might ask these questions:

• Do I want illness to be a part of my life  rather than all that I am?
• What is the "long view", a strategic approach, so I'm proactive rather than reactive?
  
• Is there something I can do now to be better prepared for what might be ahead?
  

What have you done to figure these issues out?  How is it going?

Are you looking for help in developing the skills and capacity to address these questions?   If yes, contact me to find out more about how I  work with people, like you.