Thursday, July 2, 2009

Pain Management: Week Two (& Thursday Week One)

The pain management course is taking up almost all of my energy right now - it's great, it's helping me a lot, but it's also very exhausting.

Thursday Week One

Thursday sessions start with group psychotherapy, then hydro again, lunch, a half-hour 'education' session on various topics, physiotherapy, then relaxation.

The group psychotherapy last Thursday wound up being largely an introduction thing - Kon talking about what the therapy is about, getting to know us, us knowing him. He introduced the 'helpful thinking' concepts, and the underlying concept of CBT.

That concept is: events happen. How we think about these events affects our emotional reactions, and our behaviour. For instance, if you miss the bus, you might think 'oh my god, I'll be late for work, I'll get fired, then I won't be able to pay the rent and I'll end up homeless'. Or you might think 'oh well, no big, I'll have a few minutes to relax now and I'll be in a better state for work when I do get there'.

Same event, different thoughts. Of course, if your boss really is going to fire you, the second set might need to be modified slightly! Possibly to 'well, this guy was crap to work for anyway, maybe I'll stop in at the newsagent and check the job ads while I wait'....

So. Next was hydro - still a lovely warm pool, I still really like it. My side was aching somewhat by the time I finished, but the reason for that was probably hormonal. The ladies will know what I mean ...

After lunch was a talk about sleep, and 'sleep hygiene' - all pretty standard stuff if you're familiar with the 'sleep hygiene' thing. If you're not, a quick Google search showed a couple of .edus that talk about it. Sleep Hygiene from the University of Maryland and Sleep Hygiene from Stanford

Physiotherapy was more difficult than it had been on the Tuesday, but again, it was due to hormonal cramping and not the physiotherapy itself. I mentioned the problem, and Justin pointed out that this is still a pain issue, even if it's not my major pain problem. So we treated it as an opportunity to find out what my exercise tolerance is while in pain.

The relaxation session was very, very welcome. The techniques they're using are all ones I'm accustomed to, but the regular and extended relaxation sessions are doing me good. I need to make a point of doing this myself.

The drive home, however, was pure torture. The cramping was very, very bad, and every expansion joint, crack in the asphalt, speed bump, or other non-flatness in the road jolted the cramping muscles and caused a spike of pain.

This, along with anxiety attacks and continued cramping over the weekend and on the Monday, meant that by Tuesday, I was a mess.

Tuesday Week Two

I'd had a panic attack on the Monday night, was in pain, and was in a state where I could barely think. All I wanted to do was curl up in bed and pretend the world didn't exist.

But I went to the course. I was terrified that they'd tell me to 'buck up', 'keep a stiff upper lip', or even accuse me of 'putting it on' or 'acting sicker than I was'.

All of these, of course, are the usual responses I get. Even from family members (not Feldie and Tateru, though!).

I didn't get them from the pain clinic people. I was so relieved. In fact, they were very pleased I was there, and pleased to be able to actually see the difference between me-normal (Tuesday week one) and me-sick (Tuesday week two).

The OT (occupational therapy) session was on shopping, and quite frankly I remember very few of the details about it! But shopping, when you look at it from an OT point of view, is a massive task! It's also one that is very difficult to pace - to divide up into smaller units and take rest breaks between the units.

You have to dress, which itself can be a considerable effort. Travel to the shop. Select a trolley which won't make things worse for you (they recommend bringing your own shopping trolley!). Then you have to select the goods, which includes a lot of bending, lifting, even carrying. And a fair bit of walking, which is strenuous for some. At the checkout, there's concentrated bending, lifting and carrying. Then bagging (sometimes), and getting the things to, then in the car, going home, getting them out, more lifting and carrying, and finally putting the cold stuff away. Then collapsing on the couch while the nonperishables wait for you to have energy again.

Online grocery shopping can be a godsend.

So. After that, hydro - I didn't even have the energy to play in the water. I just did the exercises, had a shower, got dressed, and collapsed for lunch. The physios supervising the hydro kept an eye on me, I think they were a bit worried.

I also rested in the relaxation room after I ate lunch. I think I slept.

Justin and Erika (Catherine was away) controlled the pacing of my physiotherapy, sending me for regular rest breaks. And I was not to worry about trying to get the whole program done - anything would be good enough.

The relaxation room was very, very welcome.

I think I was almost incoherent at poor Kon (my psychiatrist). I don't remember much of what we talked about, except that he very carefully probed to figure out whether my depression and anxiety are most likely to be biological (anatomic or neurochemical), circumstantial, or simply lifestyle based. (As in, if you don't put yourself in positions where happiness is possible, you're not going to be happy.)

He's talking to my pain doctor, and they're going to work on appropriate scripts for me. He's pretty damn sure that at least some of it is biological.

I don't remember much about the trip home on Tuesday. I may have fallen asleep while Feldie was driving me. Maybe not. I was drained. Not just exhausted, but I had nothing left to give.

Thursday Week Two (today)

After the sleep Tuesday night and a fairly relaxed Wednesday, I felt a lot better. Though Feldie points out that I did a lot of housework on Wednesday. And I baked.


I love baking. It's very relaxing, and it produces yummy goodnesses. And since we moved into this house, we've not had an oven. The one that came with it is, quite frankly, so old and rusted we're sure it's dangerous and have never dared use it. The grill is equally off limits, being part of the same unit. One of the stovetop burners, we've taped over the dial to prevent us from forgetting and using it, the other three we do use - but carefully.

But now we have an oven! It's a little benchtop unit, and it was on sale for something like half price. And I love it! And I made my special recipe - passionfruit bikkies (cookies for the Americans). Anyway, I took some with me today, and shared them around.

Okay. So. Psychotherapy, we continued with the Helpful Thoughts thing. Hydro was lovely, and I spent a bit of time relaxing, and a short bit of water-play, as well as my exercises.

After lunch we had a session with CRS - Commonwealth Rehab Services. They're the government-run thing for getting disabled people back into the workforce. They might be helpful for after the program, or maybe someone else would be better. I don't want to be pushed into work too soon for my body. :(

Then physiotherapy, and Justin and Catherine were delighted that I hadn't had a pain flare after Tuesday! And Catherine gently scolded me when I went through my program too quickly - I must learn to pace my stupid body. Give it enough rests between bits of work.

Relaxation again. And then home. And once again, I napped shortly after I got home.

The Passionfruit Biscuit/Cookie Recipe

125g butter or margarine
1/4 metric cup of caster sugar (finer than table sugar, coarser than icing sugar)
1 egg, beaten
1 1/4 metric cups of SR flour (or plain flour + baking soda, to make it rise)
1 or 2 passionfruit OR 1 small tin passionfruit
Milk (optional)

Baking tray
Extra butter/marge or baking paper to grease/line the tray
Wire cooling rack
Sieve & bowl
Scales if possible
Measuring cups
Mixing bowl
Powered blender (ideal) or fork (and patience, and strong stirring arms)
Oven! (You'll want it at 180C or so)

  • Grease a baking tray with a little bit of extra butter or margarine, or paper it with baking paper.
  • If using a tin of passionfruit, put the contents into a fine sieve, catching the syrup in a bowl and the seeds and pulp in the sieve.
  • If the butter is hard, put it in the microwave or in a bowl in some warm water, until it's soft. Not liquid, just soft enough to beat easily.
  • Beat the butter/margarine and the sugar together until very, very fluffy. You want them thoroughly mixed, with no lumps of butter.
  • Add the egg, and beat until that's thoroughly mixed in too.
  • Gently fold in the flour. Just tip a bit in, stir it through, repeat until all the flour is in. It will become a rather dry dough, and tend to be lumpy, but try to get all the flour mixed with some butter/egg mix.
  • If you can't get all the flour blended with the butter/egg stuff, add a little bit of the syrup from the tin, or milk if you aren't using tinned passionfruit.
  • Tweak the dough mix slightly: if you tend to like 'soft' cookies, add a little bit of milk or a bit more syrup (a teaspoonful). If you tend to like 'dry' cookies, add a tiny bit of flour (a dessert-spoonful). As you get experience making this recipe, you'll learn to tell how it'll turn out by how the dough looks at this stage.
  • If your oven is slow to heat up, preheat it now. You'll want it at about 180C - tweak according to how 'hot' or 'cool' your oven is.
  • Take a teaspoonful (or slightly less) of the mixture and roll it into a ball. Place the ball on a greased or papered baking tray. Repeat, leaving a bit more than a centimetre (or half an inch) between balls to allow it to spread.
  • With a clean thumb, or the back of a teaspoon, put a dimple into the top of each ball of dough. Drip just enough passionfruit pulp and seed into the dimple to fill it - between three and five seeds works for me.
  • Bake in the heated oven for 15 to 20 minutes, until they're a lovely golden-brown. Again, practice with the recipe will tell you when to take them out - a shorter time leaves you with a softer cookie, longer gives you more crispness.
  • Place them on a wire rack to cool. Cover them with a teatowel, and ban any cookie-thieves from the kitchen!