X-Rays #AtoZChallenge

X-Rays – They Don’t Show Everything!     #AtoZChallenge

Whether we suffer an illness or injury, often one of the first methods to look at the structures inside the body is often an X-ray. This is regardless of whether the suspected injury will show up on an X-ray or not. There are many forms of radiological studies which physicians can use to evaluate the nature of your particular complaint, illness, or injury. Let’s use a simple example to expand upon this concept.

You manage to trip over a toy when walking through your living room. Your ankle and foot hurt, but that’s understandable because you felt it roll as you tripped. You do everything you should have done, and applied ice and elevated it to reduce swelling. You stayed off it as much as possible for the next day or so, but to no avail. So after a few days, you wind up going to get the injury evaluated.

An X-ray is ordered. You think that this shall provide an answer. While you may be lucky and it will, the physician already explained that his exam has him fairly convinced it is a soft tissue injury as opposed to a fracture. But to be thorough he ordered the X-ray. Of course, the x-ray did not show a fracture. Given that soft tissue injuries are extremely difficult to discern on a standard radiograph, this isn’t entirely reassuring. The physician orders an MRI of the injured area, prescribes some anti-inflammatory medication, and crutches. He explains not to put weight on it until after the MRI and tells you to follow-up in a few weeks if it isn’t better. He states you can call for results of the MRI if his office doesn’t call you within a few days of the test.

You go home and attempt to schedule the MRI as your doctor ordered. However, the earliest appointment you could get is nearly two weeks away. So you attempt to resume as normal a life as possible while you await the date of the MRI appointment. It isn’t feeling much better at all. In fact, it feels worse, and you still can’t bear weight on it beyond just resting your foot on the floor. Thankfully you at least have a job that you can sit at your desk, as opposed to a physically demanding one where you need to be on your feet, else you wouldn’t even be able to work.

The afternoon before the day of your test, you receive a telephone call from the MRI facility. Apparently, they attempted to get approval for your MRI from your health insurance, and it was denied. The insurance company insists that you get a CT scan instead. After leaving messages three days in a row the nurse at your doctor’s office returns your call inquiring if the doctor would write a prescription for the CT scan. She explains that the doctor said that the CT scan will not show what he needs to visualize, and insists on the MRI. You explain (again) that the insurance denied the MRI. The nurse says she will talk to the doctor again and get back to you.

The following week you finally hear back from the doctor’s office. They inform you that the insurance company denied the MRI. “No, really, ” you think to yourself as you bite your tongue. “Now what?” you ask the nurse. She proceeds to explain that you must get the CT scan. She said she argued with the insurance that the CT scan will not show the suspected injury the physician wants to see. They essentially said that’s fine. But you cannot get an MRI without first getting a CT scan.

So you schedule the CT scan and wait only a week longer for this test to be done. After waiting a few days for the report to be electronically sent to your doctor’s office, you decide to call for the results since you haven’t heard from them. Of course, it takes a day or two until you hear back. When you do, you learn what the physician already expected. The CT scan did not show anything out of the ordinary. He told the nurse to reorder the original MRI scan and see if it will be approved this time.

When you call the MRI facility they inform you that it should be approved since you did the requisite CT scan the insurance demanded prior to an MRI. However, they will not actually attempt approval for it until the day before the test, as is their normal policy. The first available appointment is nearly three weeks away this time. You are beginning to get understandably frustrated that it has been many weeks and you till have no answers. You still cannot tolerate putting any weight on your foot and ankle, and the pain and swelling have increased.

Three more weeks go by, and you finally get the MRI that the doctor ordered mere days after the original injury. A few days after the MRI, you get a phone call from the nurse at your doctor’s office, and she informs you that you need to go see an orthopedist to determine if you will need surgery to repair the damage done to the soft tissues in your ankle. That’s all she tells you other than the first available appointment with the surgeon is another four weeks away since it is not an emergency.

What is the point of this story you may ask?  Well, it’s actually quite simple. The decision-making ability regarding appropriate medical care, including diagnostic imaging, has been stripped from them by a system supposedly designed to save money for the insurance companies. Your doctor knew what he suspected the final diagnosis of the injury to be, and knew precisely what imaging was needed to achieve visualization of those structures. Yet the insurance company denied the test.

To add to the frustration and senseless process, they demanded you receive a test that would not adequately visualize the suspected injury within. When those results came back they finally agreed to the MRI, which was significantly delayed due to their supposed cost-saving policies. Instead of saving themselves money, they mandated a test known not to show what needed to be examined by the ordered radiological study.

This costs not only the insurance company money, but you incur the cost for anything beyond what is covered by your insurance. And in a realistic sense, they cost the facility providing the CT scan money in unnecessary wear and tear on their CT scanning equipment, wages for the radiology technicians to provide the test, and the fees for the radiologist to read the test. All this in the name of saving money?

In the abstract sense, it is also causing you, as the patient, more money yet. Delayed diagnosis can often lengthen recovery time as injury specific treatment often can’t be prescribed until the diagnosis is ‘official’ which couldn’t be achieved until the MRI was completed. These unnecessary delays can significantly lengthen not only adequate and injury appropriate treatment but can aggravate the original injury, resulting in lengthy recovery time. Physical therapy may take significantly longer to yield positive results as the injury was immobilized for two ((??)) months while playing the insurance game.

If you had a job that required you to be on your feet and did not have the flexibility to permit you to sit down to do your job, you likely could have lost all the income during the time you fought with the insurance company.

I realize that, in theory, these practices have been put in place to assure cost-effective treatments and avoid the overuse of expensive imaging studies like the MRI. However a claims adjuster is not examining you, nor are they often qualified to determine that a test is not appropriate. They simply consult the company flowchart of approved tests for a suspected injury or even more generally just approved procedures and in what order they can be done. Instead of saving themselves money, they are in fact increasing their expenses.

It is high time at least a little bit of the diagnostic and other clinical decision-making ability be returned to the physicians that actually see, examine, and treat us.

Wheelchairs, etc. #AtoZChallenge

Wheelchairs, etc.     #AtoZChallenge

Often the use of a wheelchair is equated with someone being unable to move or use their lower limbs in order to stand and ambulate. While this is certainly true for some people and some situations, it is not a hard and fast rule. There are many legitimate reasons one may be relegated to using a wheelchair without being paralyzed. In this post, we will discuss just a few such instances.

A chronically ill person, especially one with significant chronic pain or ambulation issues may frequently need the use of a wheelchair or any number of assistive devices. A person like this must often conserve their energy in an attempt to ensure that they can accomplish the task at hand. Many such people may be able to walk a varying level of short distances. However let’s imagine for a moment you are only able to walk twenty feet before becoming extremely fatigued, but yet you must go to the grocery store for the week. You may avail yourself of a wheelchair or one of the little electric scooter type buggies while at the grocery store. For after completing your shopping, you must be able to drive home, make it into the house, and unload all those groceries. So every little bit of energy conservation you can perform while out equates to a longer duration of overall activity.

If you use crutches it may be rather obvious as to why you may be using a scooter or wheelchair. But let’s say you are without physical deformities, you may well be judged by others either to your face or behind your back. You may feel extremely self-conscious in using it. However, none of those factors should deter you from using any assistive device that improves your ability and quality of life. Remember, you must not justify your use to anyone other than yourself. Okay, maybe to your physician(s) and medical insurance provider, but to none other.

I personally have been relegated to the use of a variety of assistive devices over the years including a single point cane, a walker, a wheelchair, and even for quite a while a powered wheelchair. While I’ve been lucky enough not to need the power wheelchair in well over a decade, there was a time and place where it was not only a viable assistive device but absolutely necessary. Without it, I would have been relegated to being housebound. I would not have been able to go to the doctor without at least one person assisting and accompanying me, which was not always a possibility.

The fact remains that people are judgmental of what they do not understand. Even if they see you in a wheelchair with crutches across your lap, they may pass judgment. But when there are no obvious signs of a disability that, in their mind, would justify the use of a particular device, they are more apt to pass judgment. The same is true of disability parking placards available (typically) from your state’s department of motor vehicles.

I was legally parked in a handicap accessible spot at a local department store chain one day. I was on crutches at the time. I came out of the store to find that someone had called the local police complaining that I was parked illegally. While the police were extremely professional in verifying my legal possession of the handicap parking placard, (we are required to carry a companion wallet card to prove we are the person it was assigned to), it was a totally unnecessary thing for someone to do. Not only did it create a source of stress and embarrassment for me, but it tied up the police officers who responded from attending to a potentially more serious request for assistance. It was just a general waste of time and resources.

Upon talking to members of various police departments around my area at the time, it became apparent that this type of call was becoming more and more common. While we do not know why they are becoming more common, I can tell you that it is sad that we as a society have come to distrust our fellow citizens so much that we will make false accusations. While I do not disagree that there are likely abuses, to call the police on a vehicle with the appropriate license plate or placard legally parked in a spot reserved for handicapped accessible parking, is an abuse in itself. If there is a vehicle parked there without apparent license plate or placard designated for this purpose, then I can understand questioning the motives of the driver of the vehicle.

While this particular discussion focuses on wheelchairs, the same concepts apply to almost any medical or assistive device you could imagine even something as simple as a cast, brace, or bandage. Have you had any experiences with using assistive devices yourself or with someone you care about? Share your insights with us below.

Vertigo #AtoZChallenge

Vertigo     #AtoZChallenge

During the month of April this blog has focused on a number of general topics as they relate to chronic illness. Today we are going to touch on a specific issue, because all of the other topics I chose for the letter V just didn’t sit well with me. So in order to remain relevant and in an attempt to touch on something new each day, we will delve into the dizzying world of vertigo.

Vertigo can be an illness in its’ own right. It can also be a symptom of many other illnesses, and even a side effect of some medications or surgeries. I’ve experienced vertigo on many levels throughout my life. I’ve experienced severe disabling vertigo many years ago as a result of what I was told was Meniere’s Disease.

To this day I’m not sure what was worse, the vertigo itself or the side effects of the medication. While the medication is specifically designed to treat vertigo, the dosage had to be titrated to such a high and round the clock dosage that it made me feel similar to what I suppose a zombie feels like. I was so groggy all the time and felt like I was living in a deep and all-consuming fog. Add to that the fact that it didn’t eliminate the vertigo and it was not a very pleasant time. Eventually after lots of time and physical therapy it seemed to resolve itself. Although to be honest, even my physician could not explain how or why.

Several other times I experienced acute onset vertigo as a result of what I’m told was an inner ear disturbance. After receiving specialized therapy at a local physical rehab hospital to treat what they called crystal formation in my inner ears, it too eventually resolved. Each time I experience it I forget just how debilitating even mild vertigo can be. Driving is nearly impossible. Just getting out of the recliner to walk to the bathroom can be a nearly insurmountable task.

Most recently, after major neurosurgery to repair a spinal cord injury in may neck, I once again experienced vertigo. More moderate this time than the severe vertigo of many, many years ago. But still significant enough to further affect my balance and ability to be mobile under my own power. Every time the therapists would try to get me up out of the wheelchair to attempt walking with the walker, I would get severely dizzy. Sometimes to the point of things beginning to get dark and I would be placed safely back in the wheelchair until it passed. Other times I could counter it with relatively low doses of the medication, and techniques taught to me by my therapists. Needless to say it made recovery a bit of a challenge.

Add to the dizziness, fatigue from the medication, and I think the very worst part besides mobility being affected, was the nausea.  Unrelenting, spontaneous, and severe nausea. I can’t count the number of times my nurse had to be summoned to the physical therapy area to give me a drug to attempt to counteract the nausea. This too didn’t always work, but at least it helped.

The point is that vertigo, regardless of the cause can be anything from a minor nuisance to a debilitating problem. If it is in conjunction with another illness or injury, the effects of vertigo can be greatly enhanced and even more troublesome. While there are medications designed to alleviate the effects of vertigo, it may be so severe that you wind up having to ingest multiple medications to counter it. In the process it is a known risk that you can compound the side effects of many of these medications, further complicating treatment and your quality of life while battling vertigo.

Have you or someone you know suffered from vertigo?  What seemed to help mitigate the effects of vertigo? How did you cope with the vertigo and associated side effects of the medication(s)? Please share your story with us below.

Uncertainty #AtoZChallenge

Uncertainty     #AtoZChallenge

Much to our dismay, when we are faced with a chronic illness or worse yet multiple chronic illnesses, we often find a world of uncertainty. To our surprise, physicians are not the all-knowing omnipotent beings they were purported to be a few years ago. As diseases progress it sometimes seems more common to wind up with a diagnosis of exclusion rather than a diagnosis based upon a factual evaluation.

While there are frequently standards for diagnosing an illness or disease process, they are most often strictly defined by the insurance or regulatory agencies. Some diseases may not present identically across a population. It is my opinion that while guidelines for diagnosis are understandably necessary, we have systematically removed the ability of our physician providers to draw their own conclusions based upon symptomology and assessment.

This regulation in the field of diagnosis is necessary to protect us and guide our physicians from making false or unsubstantiated diagnoses. However, by requiring such stringent diagnostic criteria we have removed their ability to individually evaluate and treat us. It has become more common for a physician to tell us that while they think we may have a particular diagnosis, they are unable to conclusively make the diagnosis. This is because we may not meet the stringent criteria set forth by some regulatory commission or agency.

Over the last year to year and a half, I have been told I have a very serious neurological condition, that is likely progressive. I’ve been told this by numerous physicians. At least one specialist was absolutely unequivocal of this diagnosis. I was referred to a very large teaching hospital who specializes in this disease. After a few months, it was time for my appointment. After traveling over an hour to get to the appointment, I thought I was finally going to get the answers and treatments I was repeatedly told I needed.

Much to my dismay, I was very, very wrong! The outcome was that while it could, in fact, be that suspected illness, this specialist was hesitant to make the final determination. While there are concurrent factors that could influence the diagnosis, there were not any that would preclude the diagnosis. Or so I had been told previously. After an interview with a Nurse Practitioner, she went to consult with the physician.

When he came in the exam room, he was extremely pleasant but proceeded to crush my world. He proceeded to explain that while the symptoms and diagnostic studies could be attributed to said neurological illness, that he was unable to make the diagnosis at that time. He went on to explain, that essentially, we had to wait six to twelve months, then re-evaluate the diagnostic studies to see if things had gotten worse consistent with the suspected diagnosis. At that time, if things had progressed to a severity required to make the diagnosis, we could begin treating it with medication. I was so flabbergasted I could barely speak.

Please do not misunderstand me. I do not want this diagnosis. But I had been told for nearly a year that it had to be what is wrong with me. That was after well over a year of uncertainty. Multiple physicians, some specialists, had told me I had this disease. Yet none were willing to make the official diagnosis in order for me to start the medication which has been proven to slow the progression in some patients. I was crushed because the medication has been studied to be most effective in the first two years after onset. I am already past the two-year mark. If I wait another six to twelve months, I will most certainly be further behind the eight ball than I was. What does that mean to my prognosis?

Because I did not meet the “gold-standard” of required items to solidify the diagnosis, he would not make the diagnosis. Gave me a bunch of things that must be ruled out over time. Things that other physicians had already told me were ruled out. While the gold standard is a guideline, not a hard and fast rule of diagnostic criteria, I was informed that there is no room for judgment in the clinical criteria. Isn’t judgment the definition of a doctor’s evaluation of your situation? It is the physicians’ judgment as to what is wrong with you. It is their judgment as to how to best treat your illness.

So I left the appointment with even more uncertainty than when I arrived, and near hopeless in terms of finding a diagnosis and achieving effective treatment. So now I get to sit and wait in limbo. Without a clue when and if I will get an official diagnosis and treatment. Unsure of whether that treatment will even be effective. Uncertain of a medical profession that has determined I must get much worse before finally making the diagnosis so many have told me they feel is the culprit.

One long, slow, uncertain day at a time. I’m not necessarily hopeful that I will get better, but I am absolutely hopeful that I will not continue to get worse. Sadly by not getting worse, I will ensure that they will not be able to make a diagnosis, which effectively means I will eventually get worse as the culprit will be left untreated.

Have you encountered uncertainty in your care? How do you handle uncertainty? What is your story of uncertainty? Please share with us in the comments below. We would love to hear your story!

Terminal Illness #AtoZChallenge

Terminal Illness     #AtoZChallenge

Typically when we think of chronic illness we don’t think of terminal illnesses. However many illnesses that end in a terminal condition can, in fact, be a result of a chronic illness. By definition, a chronic illness can be one that lasts more than three to six months. There are many terminal illnesses that would also be considered a chronic illness.

Several members of my extended family have battled cancer over a number of years. Some are still fighting the battle, keeping it at some sort of bay. Others are not so lucky. I have other family members who have battled kidney disease, one of who even had a transplant. Many times in my life I have encountered those who were so ill that it was deemed by them and their physicians that hospice care was the most logical path.

Sometimes the decision is made to forego further treatment in order to improve the quality of the limited time they have left. While this can be a controversial topic, I believe everyone has the right to determine their own best course of healthcare. Sometimes the treatments we may endure may not definitively prolong our lives and may leave us extremely sick or weak as a result. Maintaining a good and open rapport with your physicians is imperative in understanding where in this treatment process you may find yourself.

A relatively new change healthcare that could potentially cause concern, is the involvement of palliative care physicians early in your treatment. Palliative care has typically been thought of as an end-of-life option. However, the palliative care physician has evolved in many areas. Well before my brother reached a point in his cancer care that things were deemed to be terminal for him the palliative care team was involved in his care.

The first time we met with them in the ICU they explained to us that their role is expanding. In today’s healthcare system they are taking a more proactive role, with the express hope of decreasing suffering while increasing quality of life. This treatment can take many forms depending on your particular medical scenario. They also continue to make themselves available in the more traditional role of hospice and end-of-life care.

For those who are facing the decision as to whether to continue battling a seemingly never-ending battle with a disease process, this is a very difficult and personal choice. To some, it may sound like giving up. A better way to look at it is that the person is coming to terms with their situation, and choosing to embrace the time they have left and doing their best to ensure it is quality time with those they love.

Sense of Self #AtoZChallenge

Sense of Self     #AtoZChallenge

What is a sense of self? Typically it refers to how we perceive ourselves or in more simple terms it refers to self-image. How does our sense of self influence our lives? How does our sense of self transform when we are suddenly faced with a life-altering diagnosis?

When we are healthy and are able to do things we wish to do, including an occupation where we feel good about going to work each day, our sense of self is easy to identify. We can feel good about our chosen profession. We can feel good about our circle of friends we have built. We can feel good about our family and how close we feel to them.

When we find ourselves presented with a life changing illness or injury, we can face a whole new set of challenges in addition to the present medical situation. Suddenly we may find ourselves facing the very real losses associated with such a sudden change in our health and abilities. We may be unable to work either temporarily or worse yet permanently. We may face fluctuations or even losses of friends and family who are either unable or unwilling to accept our newfound limitations.

When we were able-bodied we often identified with our chosen profession. Without that label, we may struggle to determine who we are without it. Frequently when meeting someone new, one of the routine questions we may face is “What do you do?”. This reference to our occupation can be very difficult for someone who is seeking to identify who they are after finding themselves unable to work.

The key to finding yourself and your newly discovered sense of self is not always a simple one. The most important thing, in my opinion, is to cut yourself some slack! Give yourself some time to adjust physically to your new situation. Give yourself some time to mourn your old sense of who you were. Your injury or illness is not a sign of weakness!

As you begin to adjust to your situation, give yourself some credit on what you are able to do. It is important to recognize those things you are still able to so, or that you have accomplished despite your illness. We are often harder on ourselves than those around us may be. It is time to change this and improve how you feel about yourself. As you adapt to your new life, it pays to focus on the positive things, rather than to dwell on what may be outside of your reach.

As things progress, find things that you enjoy. Find things that make you feel good about yourself. Set goals that are both realistic and attainable that you and your care team can assist you in achieving. This could begin with something as simple as going outside. Enjoy the fresh air! Maybe you previously were a workaholic who spent most of your time inside in an office. Take the time to enjoy the outdoors. Even if you start simply by sitting on your front porch for a few minutes a day.

As time goes on, continue to find the things that bring you joy. It doesn’t matter how small and seemingly insignificant these things may be. No goal is insignificant if it brings you joy or helps you to feel better about yourself. Continue trying to keep things as positive as possible. Each little thing you do can improve how you perceive yourself. Share your experiences with others. Write in a journal so that you can look back and see the progress that you’ve made. This often helps one to keep things in perspective. This is especially true when we feel we may not be making any progress at all.

A true sense of self is often elusive, even to those who may not be facing challenges. It takes effort and time to find a true glimpse into who we feel we are after a major illness or injury. It is imperative that you give yourself the time to adjust and figure out who you feel you are or who you wish to become within the limits of your situation. There is no easy answer or guaranteed steps to accomplish this as it is a variable process based primarily upon your particular situation. There is also no regular time frame in which you must determine the answer to who you feel you are after diagnosis.

Do you have a story about how you adjusted to your new self? Have you found something that helped you improve your own sense of who you are?  Please share with us in the comments below. We would love to hear from you!

Resentment #AtoZChallenge

Resentment     #AtoZChallenge

It is not uncommon to experience resentment when facing a long term illness. Don’t beat yourself up if you encounter it. How you manage the resentment will make all the difference in your ability to work through it. Regardless of whether you resent yourself or think a loved one is feeling resentful towards you, you can conquer this!

When you feel as if you have lost your sense of self due to a chronic illness or injury, it is not at all unusual to feel some sort of resentment. Resentment towards life in general for the hand you were dealt. Resentment towards the person who just walked by you in the grocery store with apparent ease. Resentment towards medical professionals who you feel may be dismissing your symptoms. Or even resentment towards yourself for a perceived weakness in succumbing to whatever challenge you are facing.

Conversely, you could be the target of resentment. Friends may be resentful that you can no longer participate as actively in your friendships and activities. Possibly the family member or loved one that is your primary caregiver is resentful towards you for the additional burden on them. Maybe you feel that your children resent your illness and the fact that you may not be able to participate in activities with them as you once did.

Resentment can take many forms and go both ways. I think the most important tool towards dealing with any perception of resentment is open and honest communication skills. Second to that is the ability to step back and look at the issues surrounding the feelings of resentment as objectively as possible. Often these feelings may be perceived as opposed to real. If they are real, then it is up to you to initiate a discussion on how to change or resolve these potentially devastating feelings. There are no easy answers, but you can work through these feelings!

Do you have a story about feelings of resentment that you would like to share? How do you manage perceived feelings of resentment in your life? Share with us in the comments below!

Quality of Life #AtoZChallenge

Quality of Life     #AtoZChallenge

If you are chronically ill or care for someone who is ill, you’ve likely heard the term quality of life. Do you really know what this means? As a normal healthy adult, we may take the concept of quality of life for granted, as many people do. You have the ability to work and play without necessarily have to plan around any physical or medical limitations you may have.

As someone with chronic illness, regardless of whether your challenges are medical, physical or both, you no longer have that ability. You likely have to plan each and every aspect of your day. You may no longer be able to work. You may not be able to spend time with your children and grandchildren as you would like. Simply taking a walk with your significant other while hand in hand may be nearly impossible.

Quality of life is a fluid, multi-faceted, assessment of a huge host of factors. These factors may include such things as mental and physical health, satisfaction of life, independence, social interactions, our acceptance of our limitations, and our own perception as to what constitutes a good quality of life. These factors frequently change depending upon your current situation and abilities.

Evaluating your quality of life should not be based solely on one specific factor, rather a broad overview of many aspects of your life. Despite being in pain, confined to a wheelchair, or only able to work part time, you may feel as if you are happy with your quality of life. The determination of what comprises a good or even acceptable quality of life is a complex and subjective process.

One example of how to be realistic in determining what you wish to change to improve your quality of life follows. Once, during a particularly bad episode of low back pain and sciatica which made it nearly impossible to walk without a cane, I was prescribed physical therapy. The therapist was exceptionally forthcoming and yet upbeat. She explained  that we would not be able to correct the underlying problem but that we would likely be able to improve it.

She specifically asked what I felt would be realistic and attainable goals in order to improve my quality of life. I explained that I knew we would not be able to fix it, or even necessarily eliminate it, but I wanted two simple goals. At that point in time I was unable to wear anything but very loose fitting clothing seeing how a belt aggravated the low back and leg pain. I wanted to be able to wear regular pants with a belt. Secondly I wanted to be able to pick up my infant grandson without having to worry about dropping him due to me falling. We accomplished these goals by mitigating the pain and adjusting my actions to compensate for my limitations.

While the above example may sound super simplistic, improving your quality of life does not have to be a life changing alteration. Sometimes just learning to live within your limitations successfully can greatly improve your quality of life.

Have you discussed what you feel to be an acceptable quality of life with your medical team? Do you have a plan to ensure you can achieve your desired quality of life? What are some simple changes you can work towards to attempt to improve your quality of life?

Share your story and comments in the section below. We would love to hear from you about your thoughts on quality of life.

Pain Management #AtoZChallenge

Pain Management     #AtoZChallenge

In keeping with yesterday’s post regarding the use of opiates in treating pain, I thought for today’s post I would focus on non-narcotic alternatives to address your pain. Please realize that as with everything I write, the things I share are in no way personalized medical advice. You bear full responsibility for any actions you take regarding the information you read here. Furthermore, I suggest that you discuss any idea with your physician prior to implementation.

There are a variety of pain management techniques and tools that one could use as opposed to strictly pharmaceutical options. These alternatives can also be used to complement pharmacologic therapies in order to better manage your pain and hopefully require less narcotic interventions.

Biofeedback, cognitive-behavioral therapy and even psychotherapy are just a few tools that anyone with chronic pain can use to manage their pain more effectively. Along the same line as meditation and relaxation therapy also provide a means with which to retake control of the pain in your life, or at least manage it more easily. Some more advanced treatments that have been said to be effective in pain management are the use of Betar tables, Eye Movement Desensitization and Reprocessing (EMDR) and acupuncture.

While EMDR was originally designed for managing the stress of a traumatic experience, it has been shown to also help with pain management. Realistically speaking pain can very well be interpreted as a traumatic experience. the Betar table uses sound and magnetic waves to promote positive psychological and physiologic change, including pain management.

Gentle forms of physical activity can reduce stiffness and aid in alleviating pain. These can include yoga, Tai Chi, or even some of the low impact martial arts. Pool therapy is very helpful in permitting movement despite painful conditions when conducted in a warm pool. Medical massage can also be extremely helpful in managing pain associated with muscle spasms and many other disorders.

Some of the more controversial techniques to manage pain can include therapeutic touch, reiki, and the like. For the more scientific types among us, techniques such as these can be challenging as we desire to see scientific evidence in the aspect of a cause and effect relationship between a treatment and a cure. We often feel uneasy about things that are both unable to be seen and unable to be understood.

The most important goal of pain management is to find what works for you as an individual. What works for your friend or family member may not work as well for you. No two human beings are exactly alike. As a result, we often respond differently, even if only a subtle way, to the same medication or treatment. Regardless of what others think, find something that works for you, and stick with using it. If you are able to find a regimen of multiple treatment options that work for you, and you can alternate between them to find the best approach to manage your pain and improve your quality of life.

In closing, I would like to share a quick personal experience. Many years ago I was seeing a psychologist who specialized in treating those with severe pain. I was open to trying many things, including EMDR and the Betar table (amazing results!), but for some unknown reason, I drew the line at trying acupuncture. At one visit I was suffering from severe shortness of breath due to pneumonia. As I wheeled into the office he practically begged me to permit him to use acupuncture on me to improve my breathing. I was so ill that I reluctantly told him he could use one needle in each ear, and if it didn’t help he could never ask me again. (He specialized in auriculotherapy, which is specifically the use of acupuncture on coordinated body points in the ear.)

He carefully placed one very thin needle in each ear in what he told me were the lung points. To my complete and utter amazement, within a matter of three to five minutes, I was breathing as if I wasn’t ever even short of breath. I could take a full breath and had no more pain while doing so. The raspy sound of the fluid in mu lungs was incredibly reduced, almost nonexistent. Mind you I had been to my primary care physician just hours before and had refused to go to the hospital, as I wanted to try yet another outpatient course of antibiotics first. To this day I don’t understand precisely how or why it worked, but it most certainly did! As a result, after that, I permitted him to further explore how much acupuncture could do for me, which was a lot!

Unfortunately, acupuncture, as is true with many so-called alternative treatments was not covered by insurance and by itself prohibitively expensive. As life goes on, and he became unable to provide this therapy under the original circumstances, I found myself looking to alternative electronic acupuncture therapies, that while they may provide some relief, they most definitely do not provide the same level of relief that traditional acupuncture uses.

Have you found an alternative treatment that helps you manage your pain? Have you ever experienced something that to your surprise actually helped you better manage your pain? Please share your story in the comments section below. We would love to hear your experience!

Opiates in Pain Management #AtoZChallenge

Opiates in Pain Management      #AtoZChallenge

The debate over the use of prescription narcotics in the management of pain has long been a controversial topic. This topic has come more to the forefront of late as the debate heats up in both the media and the healthcare industry. There are arguments both for and against the use of opiates. In this post, I will share my knowledge and experience as they relate to the use of narcotics in pain management.

I have had numerous experiences with both acute as well as chronic pain. I have, at times, been on extremely high dosages of narcotics in an attempt to manage the pain, at that point chronic and increasing in nature. I was on such a high level of narcotics that it was determined that it was safer and more effective to implant an intrathecal pain pump to dispense the medication directly into my spine.

This required significantly less medication to achieve the same, even better, results. Doing this enabled me to manage the pain in order to undergo intensive physical therapy towards a better quality of life. Eventually, I made the difficult and personal decision to discontinue the medications to remove the side effects and further increase my quality of life.

More recently, I had undergone multiple major neurosurgical procedures in an attempt to relieve a spinal cord injury in my neck. While in the hospital, just a day or two after the surgeries, I was informed by a pain specialist that they would only treat my pain for a maximum of two weeks. After that, I would no longer receive any pain management whatsoever.

After five days in the hospital I was transferred to a spinal cord injury unit in a local physical rehabilitation hospital. While I have become accustomed to managing a great deal of pain in my daily life over the years, I was extremely grateful to find that the rehab hospital was not subscribing to the two weeks and done philosophy dictated by the pain practitioner in the hospital. I spent many weeks recovering from the surgery and performing several hours a day of various therapies in order to improve and ultimately hopefully restore functions affected by my spinal cord injury.

It is now four months post surgery and I’ve managed without pain medication for roughly two months now, by my own choice. I’m not going to lie to you, some days like yesterday are absolutely horrible. It is a personal choice and one that only you and your properly trained healthcare provider can make together after weighing all the options.

Having worked in the healthcare field as well as having been a patient, I will admit that there can certainly be abuse of prescription pain medications. But I do not think that a blanket rule of a set number of days of therapy is the best approach. Pain is an extremely individual issue that should be handled on a case by case basis by properly educated persons. There are many factors that affect pain from the nature of the initial injury to injuries of surrounding tissues and especially nerve damage.

As medical science, the study of pain, and technology improve there are more and more interventions becoming available that can decrease the need for opiates in pain management. However some are infinitely difficult to find, and like nearly all medical treatments, are not without their own risks. Nobody should be forced to live in pain due to stigma, fear of being labeled a drug-seeker, or fear of addiction. There are plenty of ways to mitigate these risks while mitigating at least some of your pain to improve your quality of life. Many times chronic pain will never be relieved entirely, but there are a wide variety of ways in which you can improve your life either with or without the use of narcotic medications.

What are your experiences with the use of narcotics in pain management? Would you  like to share your story with us? We would love to hear from you! Please remember to be respectful as everyone experiences pain differently and we all should be treated with respect. Reply in the comments below.