The popular TV show Grey’s Anatomy is filmed in Seattle, and maybe its Pacific Northwest roots are part of the appeal for me. (This season the show made a move to 9:00 p.m. on Thursdays, so it is on ABC an hour before ER airs at 10:00 p.m. on NBC; I tape them both and watch them on the weekend). Aside from its obvious (and frequent) quirkiness, the show has real and touching moments that occasionally tend to unearth some truths about life and relationships.
 
Last Thursday’s Sometimes a Fantasy really caught my attention. Most episodes are filled with several different story lines, with some, not uncommonly, continuing from week-to-week. And the story of Izzie’s loss resumed this time. She had fallen in love with a heart-transplant patient who had asked her to marry him. However, shortly after he popped the question (and after Izzie had made an ethically-questionable call about his care), he died. Izzie’s story was juxtaposed with one about Megan, a young girl who came to the emergency room with multiple injuries. Although she was bruised, beaten, scarred and had stapled a wound on her arm with an office stapler, she claimed to feel no pain. The ultimate diagnosis for her was “chronic insensitivity to pain.” (Who knew there was such a thing!?)

So, he we had: Megan, dramatically physically damaged, who claimed to “feel no pain.” And Izzie, who stood immobilized outside the hospital, unable to motivate herself to return to work, when asked where it hurt, said “everywhere .”

The array of possible human experiences always tends to amaze me. In this dramatization, one person feels immense, debilitating, chronic, paralyzing pain, and the other, none at all.

During the operation on Megan, the surgeon observes that “everybody wants a life without pain. What does it get you? She needs to be on a poster somewhere to remind people that pain’s there for a reason.”

I know, I know. This is a TV show. But the writing this week seemed incredibly good…and provided a degree of wisdom than one typically does not encounter during prime time.

Of course, these observations extend my previous commentaries. You know that I think about pain a lot ; and an episode of a medical drama focusing on the topic is bound to attract my attention and dwell in my thoughts. Six days ago, in an attempt to address my chronic myofascial pain issues (including my long-standing chronic lower-back pain), I allowed a doctor to inject me 19 times with small amounts of Marcaine in my first major attempt at trigger-point injection therapy. Although I experienced some short-term relief that day, by the evening I was back to “normal.” And, as my back pain has been the predominant factor in my existence the last couple weeks, I drove to Eugene to see my chiropractor on Friday.

If “pain’s there for a reason,” I ask, “what is it ?”

I struggle with this question.

I suggested yesterday that the pace I kept leading up to the start of classes was an energy-depleting one. For me, of course, it’s not only the job that tends to wear me down, it’s the entire rest of my life. For example, in addition to commencing the school year this last week, I had two doctor appointments. The anxiety resulting from this schedule contributed to my fatigue, I’m sure.

The first of these appointments was with my urologist. As I’ve aged (I’m now almost done with my fifties), I have had to increasingly struggle with BPH; this is a condition I monitor carefully. Consequently, I have blood drawn for a PSA test every six months to assist in this process and to rule out prostate cancer (as my PSA level continues to slowly rise). About four years ago, my PSA number was of sufficient concern that I underwent a prostate biopsy. The rigors of this every-six-months examination, as well as the ever-present specter of cancer (or, simply, another invasive biopsy), probably are the reasons my blood pressure was up slightly for this appointment. Luckily, my PSA was more-or-less unchanged from last time and there are no obvious indicators, from the physical part of the exam, that I have cancer. This kind of news is always such a relief!

The second appointment of the week was the follow-up to my CMP diagnosis of last month. The blood work that I’d had done came back with an array of acceptable numbers, including my cholesterol and triglycerides. My HDL (“good cholesterol”) result was especially encouraging to me (I must be doing something right!). And my blood pressure at the beginning of this appointment was much better news than a couple days earlier.

At the previous appointment, I had been advised that I should stop the anti-anxiety medication I had been taking (to help with sleeping) if we were going to make progress on the chronic myofascial pain issues. I have since weaned myself from this drug successfully, and am now able, apparently, to pursue a treatment path. The treatment recommended is trigger-point injections, as this physician has been doing such therapy with his patients for about 15 years and reports many stunning successes.

So, I have now started down this road. Typically, he states, about 18 trigger points are injected during a session. I allowed him to do only 4 injections during my appointment (and only after a one-hour talking consultation), however, as I’m not totally convinced, after doing my research, that this is the best route to go. But, I got modest, temporary symptom relief on Friday and I’m going back tomorrow for the next step. We’ll see how this all works out.

I guess the last thing to report (for this entry anyway) about current experiences contributing to my anxiety and fatigue, is the noise element in my life (and the resulting, somewhat-tenuous relationship with my neighbor in this apartment complex). The bass vibes from the stereo keep coming through my living-room wall. The kids keep screaming as they run up and down the stairs. The adults keep slamming their door. And I keep feeling like I need to run away.

After a few weeks now of talking to my neighbor as frequently as once a week, when I handed in my rent check yesterday to the office, I mentioned my uncomfortable living situation to the manager on duty. Unfortunately, I did not get the sympathetic, good-listener ear I was hoping for. I was told, though, that they would give the neighbor a written notice about the complaint. I’m betting that this has happened already, as the reception I received on the stairs this morning was quite a cool one.

For now, though, I’m sure I can live with an unfriendly neighbor as long as she’s a quiet one.
Work, health, pain, doctors, needles, noise, neighbors. My life. And anxiety.

A recent article in Time magazine addresses The Mystery of Pain. (Of course, we’re talking physical pain here, although, I believe, emotional and psychic wounds can lead to just as much distress as physical ailments do.) This piece was of interest to me because physical pain has been an ongoing nemesis in my life…for almost all my life. For the timespan of most of my twenties (about seven and a half years), for example, I experienced daily, often-times debilitating, headaches. And, it was during these years that I began to cope with periodic lower-back pain as well. I ultimately interpreted both of these physical conditions as reactions to the overwhelming stress in my life at the time, namely finding myself in a marriage that was the completely wrong place for me to be. When I left that relationship at about age 30, I was able to turn around the crippling nature of these physical conditions, get myself off the medication (Valium) I was using to cope, and make some progress in the areas of physical health and emotional growth. (The obvious smack-in-the-face exception is the fact that I moved directly from being addicted to Valium to a lifestyle of alcohol use and abuse, and that subsequently took a few more years to overcome.)

There have been some small portions of my life where I have lived relatively head- and back-ache free, but those times seem rather a dim memory. I continue to cope, the best I can, with daily pains in these parts of my body, and succeed pretty well most of the time. They have become, simply, conditions I have learned to live with.

But, I have aged. And I’ve not acquired the ability to get rid of chronic conditions, but, rather, seem to be an unwilling “collector.” I am not one of the people identified in the Time article who has a deteriorating body and is asymptomatic. Nope. When something is “off” with my system, I feel it, often times, it seems, with a higher degree of intensity when compared to others. I have recently written, for example, about my diagnosis of Chronic Myofascial Pain. This is a condition that dominates my awareness in terms of the feelings (or lack thereof) in my lower extremities all-day, every-day. I’ve apparently not yet made significant-enough progress in my learning curve about this condition, given that my attempts at self-treatment have yielded virtually no change. The bottom line is: I live with these chronic pain conditions everyday AND try to be as functional a human being I possibly can at the same time. I find this pretty challenging.

The writer for Time asks “why does the same problem hurt one person and not the next?” Good question! I often wonder this myself. He suggests that we consider three factors: the “pain-inflammation connection;” “neural blockades;” & “depression and hormones.” Although I’m sure that the inflammation connection is a large part of my physical stuff, the relationship of depression to pain, of course, intrigues me. That has to be part of my dynamic as well, given my propensity to perpetually struggle with my emotional health. I’m convinced, in fact, that if I could find the right something (drug? herb? sleep potion?) to help me with chronic depression, then these other ailments would not loom as large for me as they currently do.

The article concludes with the statement that “today pain remains a tantalizing mystery.” (Duh. You think?) For now, we are advised to “cheer up, pop an Advil, keep working, go to the gym, eat something and buy your spouse a present.”

Ohmygod. I certainly feel reassured about handling my pain now. Thanks, Time.

During Thursday and Friday this week, I attended a retreat of UCC faculty as part of our beginning-of-the-school-year inservice activities. The event was held at the Big K Guest Ranch in Elkton, Oregon (about 30 miles from here). The place is truly in the middle of nowhere. After driving about 18 miles north of (I-5 Exit 136) Sutherlin on Highway 138W, you take a right-hand turn onto a gravel road and proceed onward for another four miles…an experience bound to rattle your bones and car frame, even at 15 mph. However, the setting is quite idyllic, and a great spot for a group our size to get away and do some retreat-type work. The organizers constructed a very worthwhile agenda, and I was amazed at the effort and energy expended to make this a wonderfully-successful experience for everybody.

A lot of the time together was spent in small groups, examining topics relevant to both new and returning instructors. Even though I am not an instructor anymore [I was one of two administrators present (the other being the college president)], I found I was able to participate fully. And, the greatest benefit to me was getting to know faculty from my new, large division (as well as the entire campus).

On the final day, yesterday, we held discussions (during both the morning and afternoon sessions) on a variety of hypothetical ethical-dilemma situations. The final scenario involved a student who wore a t-shirt to class that had a (unidentified) racially-offensive message on it. The questions: what to do? How to handle this?

A variety of perspectives were offered. One person offered thoughts about a dress-code. Others provided suggestions aimed at trying to control student behavior and, hence, suppression of the t-shirt’s message.

I could not hold my tongue. At the end of the discussion (and our time together), I raised my hand. I offered the thought that a t-shirt was not offensive in and of itself, and that this was neither a dress code nor a student-conduct issue, but rather a free-speech one. Freedom of expression is one of our most cherished and important constitutional rights, I said, and that, especially in a college environment (where we are presumably devoted to a free exchange of ideas), we cannot stomp on such a fundamental American freedom. I observed that quite a number of campuses over the last couple of decades have attempted to restrict student behavior with speech codes, virtually all of which had been struck down by the courts on constitutional grounds. I tried to convey the message, and personal (legal?) opinion, that we cannot attempt to silence a student merely because his or her message might be offensive to some.

Of course, I likely sounded like an over-the-top civil libertarian. And, I know, I delivered this message with some degree of passion, but hopefully not so extreme as to offend my new colleagues. The ACLU has an excellent summary of this issue on their website, as well as descriptions of many specific cases involving freedom of expression (including t-shirts).

I was educated as a chemist (a lot of my formal education is in that discipline, anyway), and I remember thinking a long time ago that chemistry is life. Well, that orientation has changed; biology is life is more where my head is at now.

I spend so much time these days paying attention to my body (primarily its limitations), that it’s practically laughable. And, here I am trying to learn all I can, as fast as I can, frustrated a lot by mostly having to teach myself.

Of course, I speak of the incredible learning curve I’m experiencing right now regarding myofascial pain. I have an entire new discipline to master as I try to learn all about myofascial trigger points, referred pain, self-massage, and living with a chronic pain condition. The Trigger Point Therapy Workbook is rapidly becoming my bible, from which I do daily readings, guiding my daily practice for health-seeking.

Here is another definition of a trigger point (see also “Survival”): “a highly irritable localized spot of exquisite tenderness in a nodule in a palpable taut band of muscle tissue” (Davies & Davies, p. 19)…which they elaborate on by saying “a trigger point hurts like the devil when you push on it.” There are apparently several methods available for relieving trigger points (and the pain that can subsequently be referred to other parts of the body), some of which require the services of a professional (a savvy doctor or physical therapist, for example); there are other methods one can pursue independently. I have a doctor, of course, who diagnosed this condition for me, but in the time I have before my next appointment, I’ve been studying up and attempting to start a regimen of self-care that includes locating and massaging the trigger points responsible for my pain. This is requiring a lot of time with the trigger-point reference manual, trying to identify muscle groups with which I have limited familiarity, probing my body, and struggling to locate my trigger points so that I may massage them. (This is turning out to be a non-trivial task!)

At any rate, I have intensely steep learning curves both at my new job and in the health area of my life. This is incredibly tiring, but I guess it’s merely playing out the hand I’ve been dealt right now.