It's a common worry for workers coping with a chronic illness — the fear that frequent absences or poor performance could lead to being fired.
The anxiety might make you drag yourself to the office even when you're feeling terrible, or perhaps do work that isn't your best.
The urge to soldier on may be even greater now, with the unemployment rate still high and expected to top 10 percent by the end of the year. Yet that's exactly why you need to be sure your health and job don't sabotage one another.
"You want to address it before it becomes a performance issue, where you're falling asleep at your desk or failing to show up," said Paul Gada, director of personal financial planning for Allsup, which provides Social Security disability services.
Dealing with a health issue at work may be easier than you expect. Your boss and co-workers may turn out to be understanding, and there are often laws or company policies that may protect you and help relieve your anxiety.
Here are some ways to cope:
You have every right to keep your illness private, but consider letting people know if your condition could interfere with your work.
Ask to speak to your supervisor privately, and explain exactly how your illness affects your job and what accommodations you need. If you require weekly doctor visits, for example, tell your boss the days you might need to come in late or leave early.
"The error a lot of people make is that they assume the employer will know how to accommodate them," said Thomas Golden, associate director at Cornell University's ILR School, which focuses on labor policy and issues.
Go in with a strategy for managing the situation. Spell out how you'll make up missed time, or suggest co-workers who would make good substitutes on the days you're out.
If you're not comfortable approaching your boss, start with your human resources department. Your supervisor will likely need to know about any accommodations, but you can request the matter be kept private.
The Americans with Disabilities Act requires employers to make accommodations for people dealing with chronic conditions. And a disability doesn't have to be obvious, such as being confined to a wheelchair. Conditions such as arthritis and cancer are generally protected too.
"It's really designed to protect people with enduring conditions," said Susanne Bruyere, director of Cornell's ILR School.
Accommodations might include special equipment, a flexible work schedule or hourly rest breaks. The Job Accommodation Network offers suggestions on accommodations for a range of conditions at www.jan.wvu.edu.
Remember that the ADA is based on the assumption that you can still perform the essential functions of the job; your company isn't required to create a new position for you. The ADA applies to employers with 15 or more employees, but the state where you live might have laws to protect employees at smaller businesses.
In addition to the sick days employers typically offer, many also have short- and long-term disability plans.
According to the consulting firm Mercer, 78 percent of companies provide short-term disability while 80 percent offer long-term disability. Pay is often at a reduced level in either case.
Short-term disability is designed for illnesses lasting between a week and five months. Benefits such as health insurance and 401(k) contributions usually are continued.
Under long-term disability, 60 percent of pay is the most common level of coverage, according to the Mercer survey. Benefits are typically continued, at least for a fixed period.
However, you could be laid off once you enter long-term disability. This would mean you'd no longer get benefits such as company-sponsored medical coverage.
The Family and Medical Leave Act also lets workers take up to 12 weeks off in a year. The leave is unpaid, but your health insurance coverage will be maintained. The law applies to companies with 50 or more employees; workers are eligible after being employed for 12 months.
Those covered under the ADA can also request additional leave, even after they've exhausted their standard days off. The employer does not have to provide the additional time off if it would cause an undue hardship.
As a final option, you can apply for Social Security disability insurance if you're no longer able to work. Anybody who has paid taxes on earnings can apply.
The compensation varies depending on your past earnings, but the average monthly payment is about $1,060 for an individual. The maximum monthly benefit is about $2,000.
Be aware that filing can be a complex process that takes years. About two-thirds of initial claims are denied by the Social Security Administration, although claimants disputing a decision can appeal to an administrative law judge. The agency estimates there are nearly 750,000 people waiting for a hearing, and some wait years to resolve their claim. About 61 percent of those who appeal are ultimately approved for benefits.