Pain Management and Migraine Relief

Surviving the Holidays This Year

2008-12-09T14:00:00.002-05:00

Well it's that time of year again when folks are out in full force, pounding the pavement searching for that special gift for the holidays. With the economic crises being felt by many this year, the stress of maintaining the level of festivities one is accustomed to may be unrealistic.

With the colder weather and damp chills that come with the changing seasons, arthritis and other muscular-skeletal conditions can wreck havoc with normal everyday functioning. So how can folks get through the holidays this year?

Prioritize. Sit down and map out the important and necessary issues that need to be addressed. And spend money wisely. Paying on a bill is more important than buying holiday gifts. Consider cutting back and spending less. Shorten your gift-giving list if necessary. And limit the number of gifts purchased per person. Remember it is the thought that counts.

Some of the best gifts are those that were crafted or made by hand. The thoughtfulness and time that go into creations is a priceless gift. You can't put a price tag on the amount of kindness and love that is shown by the efforts put into making a special gift for that special loved one.

Another idea might be to offer your services to someone. Create your own gift certificates such as 4 hours of baby sitting to provide relief for a new mom. Run errands, assist with light house cleaning for a busy friend or loved one. Helping others in spite of personal pain and limitations can feel rewarding in itself so you benefit in more than one way by sharing yourself with others. And most important of all, remember the reason for the season. That should help you put things in proper perspective.

When you prepare to go shopping, plan your trips carefully. Don't overdo. If whatever you plan to purchase is big and heavy, bring someone along who can help manage the item. Make sure to have assistance from the store employees when necessary.

If walking is a problem for you and the trip will require a good deal of it, consider taking some medication before leaving the house. This will help keep you comfortable while you are out and about. Be careful however if you plan to take a medication that could cause drowsiness. Be sure to have someone else do the driving. And plan to take a little time when you get back home to rest for a short while with some ice or maybe some heat so that you can get a jump on any possible inflammation that might have occurred with the activities of the day. For acute conditions, one common course of treatment is to start with ice and then introduce heat after at least 24 hours. And perhaps one of your family members can provide a short massage to help relax tired and achy muscles.

These are some coping strategies that might help folks get through the stress of the holiday season. I encourage folks to share some of their survival tricks with us. Post them on either my Pain Management or Migraine board. Refer to "Surviving the Holiday Season" in the subject field so I will know your post is linked to this blog. Happy Holidays!

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Use of Placebos: Is It Ever Appropriate?

2008-10-28T12:00:00.002-04:00

I just read an article that said that nearly half of the doctors in a survey prescribe and give their patients placebos. "About half of the 679 US internists and rheumatologists questioned reported prescribing placebo treatments to their patients on a regular basis."[Tilburt, J.C. BMJ, online first edition, Oct. 24, 2008] And many do not tell heir patients they are doing so. I figured it happens, but I was shocked at the number of doctors who admitted to doing it.

I feel it is unethical for professionals to do this. There is a great focus on pain patients being labeled as seekers when they take meds that provide no relief and continue - in desperation - to try to find someone to help them. Now I am curious - how many of those instances can be tied to a patient being given a placebo? No wonder it wouldn't work! And yet the first to be scrutinized is the patient, not the prescriber. This would make for a very interesting and important research study.

Now these are my own personal comments and opinions on the issues around placebos. If you would like to share your comments, please visit either my pain management and/or migraine message boards and share your thoughts. Put the word "Placebo" in your subject line. Let's hear what people have to say about this controversial topic. Look forward to hearing from you!

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Changing Seasons - Comforting Images

2008-10-27T08:30:00.002-04:00

Well the summer is gone and fall has arrived. Some areas are experiencing that all too unsettled feeling when the seasons change and winter is around the corner. For some the temperature fluctuations can bring on cluster headaches. And the cold can often be felt right straight to the bones of folks who suffer arthritis.

During this time of added stress for many who have experienced financial upheaval and other stressful times, it is especially important to take care of yourself. Be sure to eat right and get rest. And if you begin to notice symptoms of a cluster, see your doctor and get on your meds promptly. It is easier to break a cluster if it hasn't lasted too long. Be kind to yourself. Take one day at a time. Seek out the help and support of others if you need to.

During this time of year many folks are preparing for winter - plastic on the windows, furnaces checked and fireplaces stoked. Thinking of images that bring comfort and warmth can be soothing during cold or stressful times. Maybe you can create some comfort images to add to your pain management tool box. Let's see how many we can gather. Post your comfort images on either my pain management or migraine message boards here on WebMD and let's see how many we can collect!

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Stressed and Worried? Build a Tool Box to Cope

2008-10-21T15:07:00.003-04:00

Whether it's reading the news or listening to frequent discussions around us, we can't ignore the state of our current economy. People reviewing investments feel the urgency and panic that go with the realization of hard-earned money being lost. People who live on those financial resources realize they are quickly reaching a point of "no available funds."

Retirement plans dwindle and Social Security funds are being eaten up quickly, leaving those who have yet to reach retirement age wondering if we will have anything to count on when we do. The most strategic retirement plans continue to leave people ill-prepared for retirement during the financial crisis. People all around are filing bankruptcy, losing their homes to foreclosure, and wondering where they will go and what they will do.

Coping with the stress and worry of life is hard enough for people in relatively good health. For those with chronic pain and physical limitations, it can lead to increased pain symptoms and decreased ability to cope with them.

I strongly encourage you to reach out to someone to discuss concerns. Find a close friend or join an online chat group of people experiencing similar situations and support each other. Start writing a journal, either online or in a notebook. Sometimes it helps to get your thoughts and concerns out on paper so you can visualize them. It helps to keep them from swimming around in your head all night long.

If you find yourself in a crisis situation, find a counselor to speak with. In the meantime, list your situation in your notebook. Ask yourself if there is anything you can do to help the situation. If so, start writing down the steps you can take. If not, then the issue becomes locating someone who might be able to help or some how realizing the situation for what it is and work with it. Call on family and friends for support and brainstorm with people about things. Sometimes people can suggest options we might not consider on our own. Try not to be hard on yourself. The economy is not your fault. It is what it is. The important thing is to do the best with what you have.

Photo Credit: German Meyer

To help with the physical pain and symptoms, try to be kind to yourself. Take a bubble bath. If the doctor says using Epsom salts is ok, add some to your bath water to help with inflammation. Pace yourself. Try not to overdo. Don't be afraid to ask for help when you need it. This is not a time for being proud and ego-centered.

Are there anythings you have found helpful in coping with the issues of life? If so, please share them on either my Pain Management or Migraine message board here on WebMD. Start your post with "Coping Tool Box" so we can find your post and respond. Let's see how we can add to our pain and stress management tool boxes together.

Most respectfully,

Indie

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The Value of Change...Getting Outside

2008-09-29T16:00:00.005-04:00

For folks who suffer chronic pain and limitations, the tendency to stay home and remain sedentary can be more harmful than good. The fear of making pain increase or symptoms intensify is very real and the fear in itself can be crippling if we are not careful. On those days when it is nice outside and you can manage, consider stepping outside into the sunshine. Sit on your porch, walk about your yard or grounds, take a short ride. The change of scenery, the feeling of fresh air, and the change of pace can change the way you think and how you feel.

Today I took my first trip to the ocean. My husband drove me down to Seaside to take a short walk. Just to be sure, I took a couple NSAIDS before we left and by the time I reached there I was doing fine. We took it easy, walked a little, sampled the boardwalk fare by having some ice cream and a slice of pizza, watched some sunbathers and took in the sounds and smells of of the surf and then headed back. We weren't gone more than about 3-4 hours tops, but it felt like I had taken a little mini escape and boy, did I need that!

The walk did me good. I recently had neck surgery so I focused on my posture, which not only helped that but also helped keep my low back in check as well. I used a fanny pack and carried little in it. So my shoulders and arms were free of any weight. I made sure to enjoy the ocean air and focused on relaxing as I sat briefly on a bench and I enjoyed the present. I didn't think about the stress or the worries that have occupied my mind. My husband and I shared nice light conversation about the ship traveling down the coast and the kids we watched building sand projects. And we saw some daredevils riding on a skyride and knew that would not be either of us...lol. It was an important time of sharing and relaxing - just living in the moment.

It is important to allow ourselves these times. They are important - they lift our spirits and help us through trying times. Fresh air and sunshine can help us feel better and cope easier. When was the last time you went outside, took a short trip, or enjoyed a change of scene? There is still some time... think about it. And when you get back, write and tell me about it on either the pain management or migraine boards. Label it "My Day Trip" or "Change of Scene" or something like that and I will know you are responding to this blog. I look forward to hearing from you.

~Indie

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Fear of Taking Meds

2008-09-18T07:15:00.004-04:00

While looking at posts on my Migraine and Pain Management message boards, I have noticed the fear of taking meds as a theme. The fear of med side effects is legitimate, and when people read all of the possible side effects and interactions, it can lead to significant concern and hesitation to try a new medication. Sometimes it comes down to weighing the risks against the benefits and remembering a few things.

Meds react differently with different people. What some folks experience while taking a drug does not mean everyone will experience the same negative or positive effects.

Every medication is a foreign substance taken into the body. Therefore there is a chance of reaction with any medication. However, if a patient takes a drug as prescribed and is monitored by a physician, any problems should be recognized and reported promptly. This enables drug doses to be regulated and side effects minimized if the drug is not stopped and another prescribed.

Medication is but one approach to chronic pain. To gain the best results, it often takes a multi-faceted approach to treat pain. In this case, having an open mind to various alternatives can be very helpful.

Some folks take herbs feeling they are harmless. Be very careful. Herbs if taken without proper research and supervision can be harmful and even deadly if taken in combination with other herbs or prescribed medications.

Some meds have temporary side effects that resolve as the body gets used to the drug. At the same time, it often takes time for the body to build a blood level that will result in benefits. Quite often people will start a med only to stop it too soon, thus losing the chance of realizing the full benefit the drug might have for them. Therefore, it is important to give meds a fair chance to work before writing them off as being ineffective.

These are some things to ponder if you find your doctor prescribing new medications for your condition. I hope they help you as you work with your doctor as a team to find the best combination of treatments and modalities for your individual condition. May you find the relief you need and so greatly deserve.

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Anterior Cervical Discectomy and Fusion: Healing One Day at a Time

2008-09-16T16:56:00.003-04:00

Recently I underwent an ACDF (anterior cervical discectomy and fusion) with hardware at C5-6. It was a last resort following conservative treatment with failed outcomes, deterioration in fine motor skills, and neuropathy in both shoulders and arms including hands.

The decision to undergo surgery was difficult at first. However, I realized the time had come. It needed to be done to save my livelihood - the ability to use my hands. Functionality is as important - if not more important - as pain at some points.

I am roughly two weeks post op and continue to have stiffness and pain when I turn my head to the right. And although my arms still feel very heavy, the tingling and pins and needles are less. I am thankful for that. I am trying to stay optimistic that with healing will come a decrease in pain and stiffness. I am currently using heat and also have meds for pain and spasms if I need to take them. They can be sedating, so I try to hold off and take them at night. I find myself up a lot at night and am looking at the possibility my pillow may be an aggravating factor. I am going to try a different one tonight to see if it helps.

My doctor said the problems with my neck didn't start yesterday and it would take time for the nerves to calm down following the surgery, so I know that being just two weeks it is not reasonable to be symptom free. The good thing is my surgeon performs a lot of these surgeries and everyone I talked to said I was in the best hands possible. So I feel good about that.

What I need to do now is focus on getting better. I am thinking as positively as I can that my chances for a positive outcome are good. Tincture of time can sometimes be hard to take. I am looking to reduce stress wherever possible because I know that this can drain my coping skills and waste my energy. Sometimes it is easier said than done. I must eat and rest and take it easy. Although it is hard for me, I am asking for help when I need it. I am fortunate to have a supportive husband and family to help me through this trying time.

I am hoping for a speedy recovery so I can get back to full time work with as few limitations as possible. And for now, I will work on it one day at a time.

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Gaining on Pain: New Treatment Breakthroughs

2008-08-01T10:00:00.003-04:00

Have you ever read WebMD the Magazine? If you have been in doctor's offices, you may have seen copies in the waiting area. In the July/August 2008 edition, there is a great article, Gaining on Pain: New Treatment Breakthroughs, by WebMD's own Michael W. Smith, MD and Scott M Fishman, MD, president of the American Pain Foundation.

This article, written in question/answer format, shares some exciting things about latest discoveries, new drugs,and experimental treatments for chronic pain. It brings out the point that chronic pain is a disease that requires a multi-faceted and holistic approach to treatment that includes focusing on the patient's physical, psychological, social and cultural issues effected by their pain and limitations.

In the article there is a very accurate description of the downward spiral often experienced by chronic pain sufferers. The impact can be devastating to victims and their families - especially if the person in pain is also the main breadwinner in the family. As a chronic pain sufferer myself, I read it with all too much understanding of the price that can be paid by victims of this condition.

But the article is not about gloom and doom. It is about accomplishment and hope. Research has revealed exciting discoveries and increasingly effective alternatives. New drugs are being developed and tested and combinations of known alternatives are showing promise toward combating the debilitation caused by some chronic pain syndromes.

WebMD takes the issues of chronic pain and education very seriously. They make sure all of their content is accurate by calling upon the expertise of recognized leaders like Michael W. Smith, MD and Scott M. Fishman, MD. When you read WebMD the Magazine, you know you are reading reliable information. So if you haven't yet seen this valuable resource, consider picking up a complimentary copy on your next doctor visit.

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Technorati Tags: chronic pain, treatment, WebMD the Magazine

Complimentary and Alternative Medicine for Pain Relief

2008-07-30T08:34:00.001-04:00

While recently reading the Spring 2008 edition of The Pain Community Newsletter of the American Pain Foundation, I was pleased to see the focus on complimentary and alternative medicine (CAM) for relieving pain. I am glad that people are beginning to consider the benefits of various alternatives. I remember years ago when I would talk about certain alternatives, people would laugh and call them bogus and fake. It is good to see that they are now being explored and tested more seriously.

The article, The Evolving Role of Complementary and Alternative Medicine for Pain Relief, includes a scale that shows back pain as the main condition being treated by CAM. The use of these alternatives for other conditions such as headache, recurring pain, and insomnia remains low. This is a very good article and I encourage folks to check it out. Share your responses with me on my Pain Management and Migraine message boards. What complimentary and alternative medicine approaches have you tried? What conditions were causing your painful symptoms? Did you find them helpful? I look forward to hearing from you!

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Reconnecting: The Importance of Friendships & Faith

2008-07-15T15:54:00.003-04:00

An opportunity to see a dear friend of mine presented itself this weekend. I hadn't seen her in over four years since she moved from New Jersey to Georgia. To see her, I needed to drive to Delaware where she was visiting family. I am so glad I had the chance to take that trip.

At first I was reluctant to travel due to a variety of issues, including physical limitations, but in the end I decided seeing my friend would be worth the effort.

My friend and I both suffer physical difficulties so we planned our time together with a lot of flexibility. We managed to travel into Baltimore Harbor and see some sights and enjoy some great food. We didn't push it. In fact, I was pro-active and put in an extra set of clothes right below my heating pad in my suitcase. I was determined to be prepared in case I needed to stay an extra night...and it turned out to be a good thing because I did indeed need to take the extra time and use it to relax with meds and pad after the events of the busy day. But it was worth it.

We had a wonderful time. Over the couple days, we talked like teenagers for hours about all the different things we had encountered over the past four years. We also enjoyed laughing at some of the crazy things we remembered as colleagues and coworkers. It was all good.

Our faith is very important to us and we found a place to worship Sunday morning before I headed home. While driving back, I had time to contemplate the importance of reconnecting with friendships and faith. All relationships take work. And it is important to make the effort to nurture them. I came home feeling refreshed. Although I may have physical discomforts, this past weekend was needed and deserved and I am thankful I made the right decision and went. It raised my spirits and added energy to my coping reserves which have been tested.

If you have a close friend or family you haven't seen in a while, find some way to reconnect. A phone call, a visit, an email, whatever way you can, reach out and make that connection. Perhaps your faith has been challenged. Seek to reconnect with that part of your life. Find positive people to be around and among. It will help you build strength and coping energy to deal with the painful areas and conditions you may have in your life.

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Formal Education, Regardless of Pain

2008-07-10T06:31:00.004-04:00

For one reason or another, many folks find the need and/or the desire to return to school. It may be that physical challenges and life events or disabilities require them to rethink and adjust their career. Maybe life has taken them down a path of reflection and the need and desire to grow in certain areas of life lead them to further education. Work and professional credential renewals may also mandate it.

A course or two or an advanced degree in a person's life is seldom met with isolation. More often than not these people already have busy lives and full platters and school becomes yet another item to juggle.

If you are a person who is juggling life, work, and school, I applaud you. If you are challenged by pain and physical limitations as well, I am inspired by you. And I thank your families for any support they offer you as you work your way down your life path and master your educational pursuits.

I started my summer semester toward my Ph.D. this weekend. It is the first time I am taking three online courses simultaneously. Some may think it foolish. And it may in fact prove to be more than I can bear right now, but I have my reasons and I pray I am able to meet my goal to complete them all successfully at the end of 10 weeks.

At this moment, I am faced with the reality that the time has come and responsibilities are now. I was initially filled with panic as to how I would manage on top of all of the challenges that I am personally facing and the sleepless nights of pain and worry. For a moment at least, the mountain seemed insurmountable at best. But this is not the time to belly up...

After a good look, a deep breath, and a reminder that I am not alone, I began to look at the big picture and break it down into manageable pieces. One thing I knew for sure - I needed to get organized. So I took the time to look at each course: assignments, special activities, projects, other requirements, etc. And I noted the due dates for these items on a calendar.

Once I noted the major features and requirements of each course, I took time to specifically review those assignments due this week. And I made copies of those things. I created folders for each course and I entered the information into each one. On the fronts of the folders I noted specific components: texts, journals, posting requirements and project descriptions for quick reference.

Next I noted all non-school responsibilities and events on the same calendar. For all entries I placed a tentative time frame so I could get an idea how everything was fitting together.

Probably one of the most important things for people with pain and limitations like myself, I made time for rest periods, noted usual times of heightened pain and discomfort and I made space for flexibility in my busy calendar. I noted the word "negotiable" next to these because they may change. I want to feel I can adjust my routine to accommodate them as needed. For people with pain and discomforts, handling busy schedules requires us to be sensitive to our personal needs and limitations as well as our strengths and ambitions.

I also printed out one last item before retiring last evening - the time line and deadlines for making enrollment adjustments. This is the first time I have ever attempted 3 courses simultaneously and it may prove to be too much for me. And that is okay. I won't know unless I try however, and I am willing to give it my best.

The one good thing for me is the fact these are online courses so I can take them from home. This helps a lot. I opted for this type of learning for a number of reasons. I can continue to work and go to school. I can work on my homework sitting in a recliner or laying in bed when I can't sleep at night if necessary, etc. I can use my heating pad whenever I want. The flexibility is of great importance and a necessity.

Get the most out of the technology you use. My computer has the capability of voice recognition and I am setting that up. I have neurological deficits in my arms making typing almost impossible at times. During those times, I will consider the voice recognition capabilities of my laptop to keep on keeping on if necessary. The investment in software to make learning easier is well worth it if a person plans to complete a degree online.

And don't forget ergonomics, especially for the person with pain syndromes and physical limitations. Be sure your study area is comfortable and accommodating. If you are most comfortable working with a laptop on a sofa or in a recliner with legs elevated, then consider doing so for brief periods. But make sure to stop, get up and move around periodically and stretch. If you tire, leave school work alone for a little while and go back to it later when you are refreshed. You will accomplish more in less time. Try to keep balance. Your school work is only part of your daily routine. Don't neglect other responsibilities to family, work, and community.

So if you have had a desire to explore the path of continuing education, don't let your limitations stop you from doing so. The key is to be flexible and organized with your time and energy. Don't allow yourself to over-tire or get so over-stressed you begin to feel ill. Be conservative at first. Try one course and see how it goes. Later on, you may desire to test your limits. And be forgiving if you find that you may have to step back and re-evaluate your plans and time lines. It is okay to do so. It is not a sign of failure by any means.

How many of you out there are online students or busy adults juggling with school on top of everything else in life? Let me hear from you! What have you done to make this workable for you? What advice can you share with others who need to forge on in the wake of other life challenges? Create a post with "School Challenges" in the title on either my Pain Management or Migraine message board and together let's forge on! I look forward to hearing from you!

~Indie

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Technorati Tags: chronic pain, education, organization, ergonomics, pain management

Celebrating Independence

2008-07-02T12:23:00.001-04:00

Well, here we are preparing to celebrate Independence Day when in fact many people struggle with the fact they no longer have independence. People with chronic pain and disabilities often long to experience independence they may never see.

What is independence for many who rely on wheelchairs or assistive devices and don't have the luxury to take a trip to the beach and walk along the sand? How about wading in water? Playing in the surf?

Some people may dream of cooking on a BBQ grill and having friends over for a picnic to celebrate the 4th of July but are unable to manage the tasks required of it. Some will try very hard but may hurt desperately later on. Others have too may barriers to even try.

This blog post starts out sounding rather depressing. However, it is important to try and think of the positives in life. And yes - people with chronic pain and physical limitations can continue to enjoy some independence in their life, although they may have to accept the support of others in order to enjoy it.

How about getting together with some true friends and watching fireworks at a public place? Most public places are required to be handicap accessible, so take advantage! Maybe you can't get right on the sand, but how about getting to a boardwalk and overlooking the sand and surf? Enjoy the sounds and smells of the seashore. Picture in your mind the sounds of seagulls flapping their wings and screeching at the people as they wait for food scraps to drop.

Can you enjoy a caramel apple or some cotton candy? How about some popcorn or a slice of pizza? Funnel cakes are one of my favorites.Oh they are messy - but that is okay...bring some moist towelettes along and use them to freshen up and clean up any sticky powder sugar and such.

What about using your backyard to host a few friends? You supply the grills and some food and they bring along anything they like to cook. Maybe you or some one in your family can make a great salad and assist with the side dishes while someone else runs the grill!

Be creative! Sure there maybe some things you will have to forfeit this 4th of July. But remember the things you can do and set out to do them.

To avoid the inevitable aches and pains that come with extending yourself, consider taking a little medication prior to events so you can feel more comfortable during and require less meds after. Put in a plan to rest briefly between major events like traveling and eating or eating and then watching fireworks. And how about planning that nice warm tub of bubbles to end your day so you can feel refreshed and relaxed when you do hit the sheets for the night.

If you travel, plan to break up the trip with short stops to get out and walk about rather than driving non-stop for hours. Plan your timing to help avoid the heavier travel hours. Give yourself plenty of time.

Even though you may need to be creative and cope with a few barriers, it is okay to get out there and celebrate independence. There is so much to be thankful for. Focus on those things. Try it! You may be surprised and pleased at just how great a holiday weekend you may have! I look forward to hearing about your holiday on either my Pain Management or Migraine message board here on WebMD.

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Technorati Tags: chronic pain, independence, holiday, positive attitude

Proper Body Mechanics

2008-06-03T06:45:00.002-04:00

This is just a reminder to always use proper body mechanics when moving, lifting, pushing, pulling, bending, etc. When lifting, be sure to squat down, bring item close to your body, lift with your legs and maintain good posture. If something is too heavy to lift, don't lift it. It isn't worth it.

Avoid bending over to place items on the ground. Instead of bending at the waist, bend your knees and use your legs - not your back. Don't be afraid to ask for assistance. It is better to be safe than sorry.

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Technorati Tags: back problems, body mechanics, lifting, pain management

Frozen Shoulder

2008-05-27T16:46:00.001-04:00

Frozen shoulder (adhesive capsulitis) can be so severe it can rob us of our quality of life. Sleeping with pain can be almost non-existent and it can cause a host of other problems.
Here are some options for managing this painful condition:

Muscle relaxation is important because relaxation means less guarding of the muscles in that area. Less guarding and relaxed muscles decrease the release of damaging and aggravation of inflammatory chemicals in the tissues that can lead to swelling and tenderness.

Cold compresses may also help decrease inflammation and improve comfort. At this point they are considered the gold standard of therapy/treatment for this painful condition.

Physical therapy is important because therapists have the ability to offer a varied approach to treatment that includes ultrasound, gentle range-of-motion as well as massage and specialized exercise programs to assist you as you heal. Constant motion is important in order to maintain functionality , decrease swelling by increasing circulation to the effected areas.

If you don't have a cold compress available, try putting uncooked rice in a sock and stick in the freezer. The result is a pliable pack that you can place across your shoulders for relaxing and comfort.

I never forget the potential for the use of heat as some folks find heat to be more comforting than cold. And if your doctor does not disagree, then I encourage its use.

Are there other folks out there suffering from the severe pain of frozen shoulders? Feel free to share some of the remedies you find to help you get through the pain and limitations of this painful condition. Post your responses on my Pain Management message board here on WebMD. I look forward to hearing from you and getting to know you!

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Air Travel - How Do You Manage?

2008-05-20T05:49:00.004-04:00

Last evening I returned from an educational trip. It started like most of my trips. Even though I am a careful packer, it is hard to travel with a light suitcase when you are going to be gone close to a week. I managed to fit everything into one big case and I put the rest of my items with my laptop in my backpack and took off.

When I arrived and finally made it to my hotel room, I noticed severe aching and tenderness in my shoulders and arms - mainly my right arm. It ached like a tooth ache and intensified around my elbow and down into my hand. There was tenderness but no signs of redness or bruising. I did feel like there was some swelling however. The interesting thing I noticed was that it intensified when I wore my backpack at the airport.

I talked to my husband the night before flying home and shared my concerns because I had a lot of paperwork I gathered at the seminars that I needed to bring home. The weight felt extremely heavy. He had a great idea. He suggested I ship some things home so I wouldn't need such a heavy suitcase. I could then transfer some items I didn't need to carry in my backpack to the suitcase and check it. There happened to be a business center/Kinko's located at the hotel where I was staying so I went down and purchased a box. I filled it with items that I didn't want to carry and I shipped it home. This enabled me to use my suitcase and lighten my backpack a little bit.

I cannot say that I had dramatic relief. However, my right arm is feeling less tender today. It is important for people like myself with chronic pain to be creative sometimes and do things like this to help ourselves when we need to. I may have to give up my backpack completely. I notice there are backpacks with wheels built right into them. I plan to invest in one of those in the near future.

Have you ever found yourself in a situation where you needed to be a creative traveler? How about sharing some of your ideas on either my Pain Management or Migraine message boards here on WebMD.
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Part VI: Total Knee Replacement Outcome

2008-05-16T10:04:00.001-04:00

During the last few months I have been sharing the experience of my husband's total knee replacement. We are pleased to say he is just about finished with his therapy and ready to go back to work.

His surgeon says he has a "state of the art" knee. My husband spent some time in a painful lull and then bounded forward with improvements. He can now go without pain meds. He walks without a cane and no longer limps. He walks longer distances than he did before but still finds some limitations when he tries to walk too far or push too hard. (Keeping it real).

But his overall improvement and outcome is more than we had hoped and we are both grateful. His doctor says the rest of the residual swelling should subside in the next couple months and he should return pretty much to normal range of motion. Since much of the swelling from behind his leg has been gone since surgery, his range of motion is already better than pre-surgery.

The next step will be for my husband to return to work and he is more than ready (smile).

Part 1: Total Knee Replacement - One Man's Journey
Part II: Total Knee Replacement - The Big Event
Part III: Coming Home!
Part IV: Healing Continues
Part V: Total Knee Replacement - And the Beat Goes On

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Technorati Tags: knee replacement, pain management

The Pain of Obesity...Bariatric Considerations

2008-04-30T13:07:00.002-04:00

Recently I attended a seminar with my daughter regarding obesity, weight loss, and surgical alternatives. My daughter has struggled all her life with weight issues and has tried many things to lose weight. At the age of 25 she has several co-morbidities that are most often seen in the older adult population, i.e.: high blood pressure, asthma, GI problems, arthritis, low back pain, and fertility issues. Three of her doctors have recommended surgery and will be providing statements of medical necessity for her.

The biggest challenge has been insurance coverage which has kept her from even considering this option in the past. Then she found an organization at one of the local hospitals that gives hope to the obese and support to the many that pass through their doors to get surgical assistance that might not only improve the quality of their lives, but may even save them.

I was glad to see this program requires all of the necessary pre-assessments prior to acceptance into the program. We don't foresee my daughter having a problem and pray that the insurance coverage will be sufficient. She emphasizes this is not a cosmetic move. She has a loving husband now at her current weight and she feels blessed. This is for her health and quality of life. She feels that once she gets the weight off, she will be able to pursue a different line of work and become more financially stable. She sees this as a new lease on life - the beginning of a new one in terms of eating and nutrition and other behavioral considerations that are so often linked to unhealthy eating patterns.

I am thrilled to see my daughter pursuing this alternative since she has tried diet after diet, prescription meds, and exercise (which usually leads her to a back spasm and PT). She needs to get some of the weight off so she can start to exercise regularly and continue a more active lifestyle. Right now she is exercising at home using a TV stretching and aerobic video because she is embarrassed to walk outside. She has lost over 50 pounds. However she has issues with an inability to keep the weight off once she loses it. And when it comes back, it comes with a few extra pounds besides.

My daughter is diligently researching the surgical procedure. She is talking to people who have had it done to hear their experiences and outcomes. She is linking up to networks to build her support group. She has looked into the dietary supplements she would need to take and also the protein supplements. Being lactose intolerant, we were concerned about her finding products to work with but she has at a local supplement store. The store manager has been supportive and willing to help her learn about the different products that are used for nutritional supplementation after bariatric surgery. She wants to have a comprehensive understanding about what it will take to make this a positive experience and a new lease on life. She is not looking for miracles. But like many of the close to 100 other people attending the seminar, one would be welcomed I think.

These past few days I have seen some positive changes in my daughter. She is brighter and more energetic. She is becoming quite educated on the subject of bariatric surgery and weight loss. She feels she may have found her only hope after exhausting all of the other less invasive approaches. I am proud of her for pursuing this. I am going to be her biggest fan as she finally begins to feel better about herself and her pain begins to decrease and resolve.

I told my daughter she is a beautiful young lady and she is...regardless of her weight. Being healthier and beautiful at the same time...It can't get much better than that.

I'll keep you posted.

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Part V: Total Knee Replacement - And the Beat Goes On

2008-04-16T16:20:00.000-04:00

Up until about a month ago, my husband continued working hard to recover from his total knee replacement rehabilitation at home. He spent a total of 6 hours a day on the CPM (continuous passive motion) machine in addition to other exercises his therapist prescribed. Then one day we hit a major road block that put a halt to the formal rehabilitation and threatened my husband's positive recovery experience.

Feeling proud of his accomplishments, my husband met with his surgeon for a follow-up. Expecting my husband to be using a walker and ambulating at a slow pace, the surgeon was surprised and very pleased to see him ambulate with one crutch at a regular pace. Watching him maneuver the exam table and sit with his knee dangling close to 90 degrees brought a big smile to his face. Significant swelling remained and pain continued to rise to a moderate level by the end of the day when there had been a lot of activity. But my husband remained very motivated to recover so he could get back to work. So the surgeon discontinued the home therapy and ordered an outpatient PT evaluation and treatment plan.

The next day my husband contacted a couple of outpatient centers in the area and gave them the disability/insurance information so they could set up the reimbursement process. Then the phone call came telling us that it was now over 6 months since my husband worked and both his disability and his insurance benefits had been exhausted! With mouths agape, we just stood looking at each other. Here we were with a need to finish therapy in order to get back to work - but without insurance and with no income, my husband had nothing to cover the therapy. He even asked about performing therapy at home and then going to the surgeon for a follow-up, but that was unacceptable. He was in a catch-22.

The first reaction was to panic; then we stopped. We needed to focus our energy on finding a solution. I had recently accepted a position myself and was therefore in the midst of benefits transfers. Now I needed to get my husband onto my insurance as soon as possible. Then he would need to find a therapy center and get going with the therapy. So I went to work on getting this switch to my insurance accomplished.

Two and a half weeks later, my husband was covered. Today he had his evaluation for outpatient therapy. The key to his ability to continue progressing forward in the interim was his unceasing desire to heal and get back to work. Every day - several times a day - my husband performed exercises to keep his range of motion. He practiced stretches using stairs and a chair; he walked up and down the flight of stairs a couple times or more every day without fail. Following each session, he iced his knee and when the going got tough, he took some meds and elevated his leg until he was back up and about. What could have been a set back in terms of regaining function did not because of the consistent and persistent exercise my husband did on his own.

This has been a learning experience for us, to say the least. Now my husband is prepared to work on continued therapy and strengthening. He is hoping to get back to work soon. Based on our experience, we encourage anyone who must undergo a surgery or problem that may lead to more than 6 months off the job, to file for social security temporary disability insurance benefits early. Don't get caught off-guard like we did.

Part 1: Total Knee Replacement - One Man's Journey
Part II: Total Knee Replacement - The Big Event
Part III: Coming Home!
Part IV: Healing Continues

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Technorati Tags: pain management, knee replacement, recovery, disability

Cool Idea for Your Pain Management Toolbox

2008-03-20T10:23:00.000-04:00

One of the things my husband has needed to do is ice his knee before and after using the CPM (continuous passive motion) machine or having the physical therapist work with his post op knee. This is what we were told to do:

Take paper cups and fill with water. Place in freezer. When needed, take a totally frozen paper cup and peel around the cup edge exposing the ice surface. While holding the paper cup, rub the ice around the knee area. You can either put the rest of the frozen ice back in the freezer to use later or toss away.

This tool can be used on many parts of the body that need icing. Use any size paper cup you want. The larger sizes are great for low back and large areas. For headaches, perhaps a smaller cup would be fine. It is an easy tool to create and inexpensive as well. Give it a try!

Part 1: Total Knee Replacement - One Man's Journey
Part II: Total Knee Replacement - The Big Event
Part III: Coming Home!
Part IV: Healing Continues

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Technorati Tags: pain management, ice, knee replacement, recovery

Part IV: Healing Continues

2008-03-17T22:13:00.004-04:00

It has been roughly 4 weeks since my husband's total knee replacement. He remains on crutches and finds challenges getting into and out of vehicles and managing stairs, but he has improved significantly. He is tired at times, yet his attitude remains positive. There are times when he feels extreme pain, but he sees the value in the continuous passive motion (CPM) machine and he continues his exercise regimen faithfully.

I am thrilled when he is blessed by his efforts. He finally walked around the house with his crutches feeling no pain which is something he has not experienced in years. And he is bending his knee further and further each day. Outpatient rehab comes next for further strengthening we are told. I bet it will be a short course.

My husband will be going for his post-op visit to see the surgeon soon. I hope he is as pleased at my husband's progress as we are. I will keep you posted!

Part 1: Total Knee Replacement - One Man's Journey
Part II: Total Knee Replacement - The Big Event
Part III: Coming Home!

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Part III: Coming Home!

2008-03-12T19:31:00.005-04:00

After three days in the hospital, we learned insurance wouldn't cover the level of care my husband needed following his knee replacement surgery. They decided to send him home and set him up for home care and home PT (physical therapy). At first I panicked because I knew he was going to be home alone about 12 hours a day and they seemed a little too eager to discharge him. So I went with him to PT and watched him walk with walker and crutches and manage stairs, etc.

I was literally trembling as I got into the truck to swing by the front of the hospital where they were bringing him. His pain levels were through the roof and getting him into the truck with the knee immobilizer on and the crutches was an ordeal. With sheets of exercise regimens in hand we headed home.

We got home and made it up the steps. He was a little off balance when the dog ran to greet him and I was glad to be there to support him and help him regain his balance. Just the ordeal of getting home tired him, so he settled into bed to rest. It is very difficult to sleep in a hospital and he was exhausted period.

From the start my husband had a very determined and motivated attitude. He was warned it was going to be painful, but he was not going to let it keep him from doing what he needed to do so he could get back to the business of living a "normal" life.

The first few days he slept a lot partly due to the pain meds and also because of the exercises he was doing throughout the day. He used the crutches and walked short distances around the house. He didn't push himself, but he exercised regularly.

Many nights my husband wakens with stabbing jabbing pains down his leg; and yet with so little restful sleep, he doesn't complain. He accepts it as part of the healing process. His visiting nurse and therapist feel he is really doing above the average in speed of healing in spite of the mess the surgeon found when he started his work. He did a wonderful job on the inside and out. We feel very thankful and blessed.

Part 1: Total Knee Replacement - One Man's Journey
Part II: Total Knee Replacement - The Big Event

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Part II: Total Knee Replacement - The Big Event

2008-03-04T15:42:00.008-05:00

The big day of the knee replacement finally came. Emotions were high and included apprehension and relief. For someone who suffered with this chronic pain as long as my husband had, it was a relief to know there was a light at the end of this tunnel. Apprehension came from the concern about any issues that might arise from having such a surgery.

We arrived at the hospital and went through all of the necessary paperwork. Our wait in the same day surgery area seemed endless, but finally my husband's name was called. He was escorted back to be prepped before I was able to re-join him. Soon my name was called and I went in to join my husband who by now had surgical gown on along with an IV line and multiple ID bracelets. Shortly after, he was whisked away to a holding area where I was unable to follow. My wait had just begun.

For the next four hours, I sat in a surgical waiting room while others came and went. Family were told when loved ones went into the OR, went to recovery, and when they were going to their room or preparing for discharge. I already knew my husband would be staying, so it was going to be a while before I would get to see him. I prayed often for him hoping everything was going as planned but after two hours and then three, I began to be concerned. Why I was not receiving notice of his going to recovery?

Four hours later, my husband's doctor came out to see me. He told me his condition was much worst than the x-rays revealed. He had a lot more work to do before he could replace the joint. He said there were also some issues with anesthesia; they had to switch to general anesthesia during the procedure. I was shocked that a spinal would have been considered when it was already confirmed my husband had a serious problem.

My husband remained in the post-op recovery room for four hours before he was assigned to a room and arrived there. That wait was endless. I couldn't concentrate on any reading. I went down for a bite to eat and quickly returned, eager to hear that I could see my husband.

The call finally came and I was directed to the orthopedic floor. My husband was awake and talkative. I figured that was due to the meds he received. He described the experience of inefficient sedation and remembered feeing severe pain and seeing his knee opened and bones exposed. He remembered people pulling his arms away from the surgical site before he "passed out"... I guess this is what the doctor was referring to when he described the need to use general anesthesia during the procedure.

Photo Credit: José Goulão

Before long, the nurses came in and gave my husband a pain med IV. He began to relax and get drowsy. He enjoyed some jello before dozing off. I quickly got his supplies taken care of and I decided to head home so he could get some rest.

During the night, my husband called me in severe pain and told me he was getting meds hourly that were not touching his pain. This bothered me. I called and spoke to his nurse directly to find out what he was receiving. The meds he was receiving should have held him except the nurse was not giving him a dose sufficient enough to address his pain issue. I discussed how she could better use the meds that had prescribed by his doctor. My husband later called to say he received a variety of meds and began feeling a little better. He even managed to rest a little. I was very relieved.

Stay tuned for Part III: PT and DC

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Total Knee Replacement - One Man's Journey

2008-02-19T22:16:00.003-05:00

Photo: Gary Minnaert

My husband's preparation for a total knee replacement started weeks before he finally received a date and time for the procedure. Being unable to work, he remained home on disability. This entire issue of seeking financial support was incredibly stressful and he suffered financially while he waited several months for a payment. Countless phone calls and faxes and emails went back and forth between his employer, union, health care providers, and insurance company. It seemed like no one wanted to help him.

His disability was actually canceled because they didn't feel that he really needed it. Yet he had documentation from doctors and consultants attesting to the extent of his limitations, pain, and suffering that he endured. Doctors even wrote that he needed a total knee replacement It seemed like the left hand didn't know what the right was doing and the stress of trying to keep on top of everything really limited his ability to cope with his situation.

My husband's initial injury to his knee occurred at the age of 14. He fought for years to try and have his joint repaired however no one wanted to do so because he was "too young"... So he suffered for over 30 years while his knee joint steadily declined in function and his pain levels continued to rise. He suffered and worked full time. As a commuter into NYC he walked city blocks from bus stations, ferry landings, etc. until his knee started buckling. He fell on numerous occasions and had many close calls. By the time he had surgery, his knee was buckling while walking in the house. Several falls and near falls led to minor injuries on top of the major problems.

I began to seek assistance for him to try and get him cleared for surgery. Here is a man who enjoyed his work and who wanted to work and maintain responsibility for his financial obligations and yet was made to suffer months without any money and a need to appeal decisions that were made using inaccurate information.

All the while the pain he experienced became severe and persistent, requiring heavy medications which often left him groggy and unsafe for travel or basic functioning. Like so many people, my husband feared drug addiction and refused to take pain meds for a long time. Finally I was able to convince him he needed to try taking meds to gain a level of comfort to sustain the ability to manage activities of daily living independently.

Once the dates were set for pre-op testing and surgery, my husband began focusing on strengthening muscles he would need to assist with ambulation and normal function. He wanted to be sure his legs were in optimum condition in hopes of a speedy recovery. He made sure to eat well balanced meals and rest frequently. He didn't want anything to occur that might delay his surgery any further.

I must add, my husband recently learned he was diabetic which concerned us with his ability to undergo successful surgery and proper healing. It seemed like something was always being added to the stress this man was already enduring. Thank goodness he maintained an optimistic view and relied on his faith to get him through.

Part 1: Total Knee Replacement - One Man's Journey
Part II: Total Knee Replacement - The Big Event
Part III: Coming Home!
Part IV: Healing Continues
Part V: Total Knee Replacement - And the Beat Goes On

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Technorati Tags: pain, knee replacement, disability

An Ideal Pain Management Plan - You Describe!

2008-01-29T07:02:00.000-05:00

I was recently asked why if I am a pain specialist, I write about loss, sadness, and other things that don't seem to relate to pain. This question enabled me to discuss the complexities and the interrelationships between physical pain and the many topics I write about.

I view pain in a very broad and comprehensive way. My personal/professional definition of pain relates distress of any kind in some or any aspect of life to the experience of pain. Pain is so much more than just a physical experience. It touches on the biopsychosocial and spiritual aspects of a person's life as well as effecting the life of those close to the victim.

To treat pain, it is vital to explore all of the areas of a person's life and take these into consideration. To prescribe treatment for only one aspect and neglect to investigate the others often does a great injustice to the patient who suffers.

If you were to define an effective treatment approach for victims of chronic pain, what components would it include? Please share your answers and comments on either my Pain Management or Migraine board. I look forward to talking with you!

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Sticks and Stones...

2008-01-23T08:52:00.000-05:00

The other evening I watched a TV show about a heavyweight teenager. She put up with a lot of ridicule and pain from her peers. But she also experienced a lot of ridicule from her own mother. The effect of this was very damaging to her. I was glad she became angry and determined to make something positive out of such a negative and destructive experience. It would have been so easy to turn her anger inward and become depressed. In that state, she might have tried to harm herself as a way to escape her pain; that would have been devastating. This girl made a lot of very important points about the fact that people link heaviness and obesity with ignorance and often use these victims as scapegoats to promote their own popularity.

I have been heavy most of my life. Pictures of myself as a kid showed I was a big kid for as long as I can remember. I remember being the brunt of other people's jokes on more than several occasions. I remember how it made me feel then and it hurts to this day when I think about it.

As a parent of a larger child, I made a point of letting her know on a regular basis how beautiful she was and how proud of her I was. She struggled through school and was also a victim of many cruel kids. Every time she came home in tears, I hurt right along with her. I wish for once people would stop before they speak and think about what they are saying.

One of my favorite sayings:

"What a person says about someone else, says a lot more about the person speaking than the one they are talking about."

~Indie

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Technorati Tags: teen weight, body image, healthy weight