Friday, July 17, 2009

Pain Management: Weeks Three & Four

Weeks three and four went by similarly to weeks one and two. Hydro and physio were very much the same - I increased resistance in the physiotherapy, and Justin has me walking the dog every day: not far, but far enough to count. To the corner and back. Relaxation was very much the same as the first two weeks - still something I know how to do. The key is to actually DO it.

The Tuesday OT sessions were cooking and craftwork (mosaic). Mosaic, apparently, is excellent for fine motor skills - for the rehab patients, it's a way of giving them fine-motor exercise without boring them to tears.

For us, it was an exercise in learning to pace ourselves, and reinforcing the various techniques we picked up in cooking. Bench height, positioning, looking down at our work by bending the neck, not curling the shoulders. Reaching for things by shifting weight, when possible, rather than having the arm at full extension.
Also, when doing kitchen work, open the cupboard and put your foot on the bottom shelf. This gives your body a more relaxed position to work in.
When kneading dough, use the weight of your body, rather than your arm muscles. And don't bother looking with your eyes - your hands know exactly where the dough is.

And a bunch of etceteras. Including:
* use pre-cut frozen veg, it's not only easier, it's probably been snap-frozen within hours or even minutes of picking. Supermarket 'fresh' food (even some greengrocer 'fresh' food) has probably been in storage for days or weeks.
* similarly, go ahead and use frozen pastry rather than making your own, unless you particularly enjoy it.
* prep your food over the whole day, don't try to do it all in a burst all at once. It won't hurt the carrots to sit in the fridge chopped for a couple of hours.

Individual psych on Tuesdays continues to be ... interesting. I'm not sure if it's helpful or not, but based on the mood I'm in on the Tuesday trips home, it probably is. We're digging out stuff like how I feel about my body, and he's giving me 'helpful ideas' about my body that are TRUE.

You know how self-help books and counsellors and psychs say stuff like 'don't think negative thoughts, think useful helpful ones'? Well, my psych listened to me talk about that, and pointed out that you have to believe the helpful thoughts you think, otherwise you're just going to get cynical about your own thoughts.

So he agreed with me about some things about my body: it's broken in a lot of ways. It's not fair. It's hard to do things I want to do.
Then he gave me true things to think about when those things creep into my mind. "Yes, all that is true, BUT:"
* But my body enables me to hug my pets, and Tateru, and Feldie.
* But my body enables me to help Feldie with her hair and makeup.
* But my body enables me to type to my friends, and write tutorials, and so forth.
* But my body enables me to take Vi (the dog) on walks. Albiet short ones. And the physios and I are working on that.
.... and so on.

The Thursday group psych sessions are a bit less helpful to me than the individual stuff, since a lot of it is stuff I already know. However, like the relaxation stuff I already know, it's a matter of putting it into practice.

Thursday education session on week 3 was on community services and supports - neighbourhood houses, TAFE short courses, respite services, disability pensions. Nothing entirely new to me, but some of the specific places were new to me. After the course, I'll sit down with the sheet and start calling around. If I can control the anxiety. :(

Week 4, it was on relapse prevention. Which, essentially, amounts to 'make sure you keep doing this stuff, and when-not-if you have a slack day, or a slack week, or even a slack month, forgive yourself and keep going'. It included techniques like making appointments with yourself in your diary, and letting other people help you - once again, nothing surprising and new.

And sadly, I no longer have C and M and S working with me. The other S, who started with me, stopped showing up. We think she's dropped out. But C, M and S were on their week 5 when other-S and I started: so my week 4 was their week 8, and they've finished the program.

So Thursday was happy-sad, and I hugged them all, and - well. Said goodbye.

Tuesday, I get to be the experienced one in my week 5, while three new people start their week 1.

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!