Today is September 10, 2018.
I have spent the last two weeks re-constructing this blog in WordPress.com. When I created this blog in Blogger (a.k.a., Blogspot), I chose this platform to figure out how it works because one of my web clients was using it. She still uses Blogspot, which is very appropriate for her posts, which are always text narrative with no images at all except for her headshot in her picture profile. But, like my diabetes journey, this blog has become so long, with complicated layouts and images, that it's time to move it to WordPress.com.
If you have been following this blog, please go to
https://yearwithoutcarbs.wordpress.com/ and re-subscribe. All the posts (from 1/1/15 to 6/8/18) have been moved to WordPress, and subsequent posts continue my story to the present date. Oh, and my new blog is published under my real name!
Thank you for following my journey with me.
Monday, September 10, 2018
Friday, June 8, 2018
Pain Physical Therapy #4
I woke up at 7:00 a.m. with a bonafide migraine! Got up, took sumatriptan and two Aleve, and went back to bed with an ice pack on my head and my feet on the heating pad. Fortunately, I woke up just in time to get a shower and pour coffee for us to take with us to Union City. Still bummed, though, about why I would be getting a migraine now! I'm convinced it's because the Clarified (brand) 4:1 tincture I've been taking for the past three weeks is just not enough THC to provide the prophylactic effect of my 1:1 tinctures.
Francis was ready to start on time, and I followed him through the corridors to his office. He had to unlock two hallway doors and the door to his office. I appreciate the level of security that Kaiser provides for this building, which houses psychiatric and addiction facilities as well as pain management.
We talked first, about how am I doing and reiterating what my goals are. I felt free to tell him what pain medications I'm on but that my eventual goal is to get off all pain medications, like I was able to get off all diabetes medication, except insulin. He asked if I was still eating low-carb and my response was, "Oh, yes! It's an ongoing permanent lifestyle." I told him about my horrific headaches with gabapentin and that the pain pharmacist was working with me to switch to Lyrica. "We'll see," I said. He was looking at my records on his computer and confirmed that I had last talked with John Poon, pain pharmacist.
He asked me how I'm doing with acupuncture, and I told him, "Fine. Paul Simon told me I'm a good patient!" I told him I have every intention of continuing with acupuncture as long as possible. Francis then told me that patients have a limit of 10 individual sessions with an acupuncturist. After that, patients can go back to group acupuncture for an unlimited number of times. At $35 co-pay for each visit, the same cost as going to individual sessions with Paul Simon. I asked Francis if there is a limit like that for physical therapy visits. He said he didn't think so. That he continues with a patient either until they are totally pain-free and healthy or until physical therapy has done all that is possible to do for them. I told him I knew that degenerative disc disease is not going to be cured, but that I'm determined to find out how to live with DDD without the level of pain that I have experienced.
I told Francis that Paul Simon had asked me if I was using any topical medication for my neck pain, and that I told him what I had never told any other Kaiser practitioner (except for Francis) that I used medical cannabis salve. "CBD?" he asked. I shrugged. "I have no idea. The container just says 'Medical Cannabis Salve'."
Francis had me go to the exam table where he checked how I'm doing with the exercises. He seemed very pleased that I am mastering the initial exercises, so he added dimensions to make them harder. He added one more exercise, which is like the one I've been doing lying down and turning my head as far as possible to the right. Only this one is done standing up against a wall, keeping head against the wall while turning it to the right and back again. A new challenge!
Near the end of the session, when I was still sitting on the exam table, I spotted a trifold brochure in a display on the wall. It was from Harborside. Just one copy, with a business card stapled to the top, and writing all over the brochure. I mentioned it to Francis. "Harborside?" I grinned.
"Oh, yes," Francis said. "You've been there?"
I laughed. "Yes, that's where I got my medical cannabis salve."
He scheduled me for my next appointment after our planned road trip. "First Friday in August?" he asked.
While I was in my physical therapy appointment, Linda and Emily stayed in the van, and Linda took measurements of various parts of the van and wrote them down in a notebook. When I came out, we drove to Home Depot on our way back.
Linda knew exactly what kind and size of wood she wanted. A very nice employee with the last name of Hernandez helped Linda find what she was looking for and then put the wood on the cart I was pushing. Emily and I waited patiently while the cuts were made. Linda located the hardware and drill bits she needed. The young Latina cashier was also very sweet and helpful. I was even able to load the car and unload it when we got home.
But I'm still quite bummed about the migraine I had this morning.
Francis was ready to start on time, and I followed him through the corridors to his office. He had to unlock two hallway doors and the door to his office. I appreciate the level of security that Kaiser provides for this building, which houses psychiatric and addiction facilities as well as pain management.
We talked first, about how am I doing and reiterating what my goals are. I felt free to tell him what pain medications I'm on but that my eventual goal is to get off all pain medications, like I was able to get off all diabetes medication, except insulin. He asked if I was still eating low-carb and my response was, "Oh, yes! It's an ongoing permanent lifestyle." I told him about my horrific headaches with gabapentin and that the pain pharmacist was working with me to switch to Lyrica. "We'll see," I said. He was looking at my records on his computer and confirmed that I had last talked with John Poon, pain pharmacist.
He asked me how I'm doing with acupuncture, and I told him, "Fine. Paul Simon told me I'm a good patient!" I told him I have every intention of continuing with acupuncture as long as possible. Francis then told me that patients have a limit of 10 individual sessions with an acupuncturist. After that, patients can go back to group acupuncture for an unlimited number of times. At $35 co-pay for each visit, the same cost as going to individual sessions with Paul Simon. I asked Francis if there is a limit like that for physical therapy visits. He said he didn't think so. That he continues with a patient either until they are totally pain-free and healthy or until physical therapy has done all that is possible to do for them. I told him I knew that degenerative disc disease is not going to be cured, but that I'm determined to find out how to live with DDD without the level of pain that I have experienced.
I told Francis that Paul Simon had asked me if I was using any topical medication for my neck pain, and that I told him what I had never told any other Kaiser practitioner (except for Francis) that I used medical cannabis salve. "CBD?" he asked. I shrugged. "I have no idea. The container just says 'Medical Cannabis Salve'."
Francis had me go to the exam table where he checked how I'm doing with the exercises. He seemed very pleased that I am mastering the initial exercises, so he added dimensions to make them harder. He added one more exercise, which is like the one I've been doing lying down and turning my head as far as possible to the right. Only this one is done standing up against a wall, keeping head against the wall while turning it to the right and back again. A new challenge!
Near the end of the session, when I was still sitting on the exam table, I spotted a trifold brochure in a display on the wall. It was from Harborside. Just one copy, with a business card stapled to the top, and writing all over the brochure. I mentioned it to Francis. "Harborside?" I grinned.
"Oh, yes," Francis said. "You've been there?"
I laughed. "Yes, that's where I got my medical cannabis salve."
He scheduled me for my next appointment after our planned road trip. "First Friday in August?" he asked.
While I was in my physical therapy appointment, Linda and Emily stayed in the van, and Linda took measurements of various parts of the van and wrote them down in a notebook. When I came out, we drove to Home Depot on our way back.
Linda knew exactly what kind and size of wood she wanted. A very nice employee with the last name of Hernandez helped Linda find what she was looking for and then put the wood on the cart I was pushing. Emily and I waited patiently while the cuts were made. Linda located the hardware and drill bits she needed. The young Latina cashier was also very sweet and helpful. I was even able to load the car and unload it when we got home.
But I'm still quite bummed about the migraine I had this morning.
Wednesday, May 23, 2018
Level 3 Pain Group Follow up #2
May 23, 1883, was the birth date of my maternal grandfather who lived to be 81. Today is another Level 3 Pain Group follow-up session. There were only five of us: two from my January/February group and three others from a more recent group.
Dr. Whitehead began with a long, slow meditation. Very nice. Then she went into the "group therapy" portion. The focus was on what struggles we are having and what successes. The she asked as to write down two tips. I wrote "gratitude" and "forgiveness."
Francis came in for the "gentle movement" part. He decided to go through an adapted series of Yoga positions, some standing, some sitting in our chairs. This is also something I could do at home with Linda, if she wanted to.
Dr. Whitehead began with a long, slow meditation. Very nice. Then she went into the "group therapy" portion. The focus was on what struggles we are having and what successes. The she asked as to write down two tips. I wrote "gratitude" and "forgiveness."
Francis came in for the "gentle movement" part. He decided to go through an adapted series of Yoga positions, some standing, some sitting in our chairs. This is also something I could do at home with Linda, if she wanted to.
Thursday, May 17, 2018
Individual Acupuncture Therapy #2
Everything is very familiar now in Building B of the Union City Kaiser, where I first went for my appointment with Dr. Sumetanon to begin my Pain Management journey. I am ushered into Paul Simon's treatment room by an assistant. She asked if I used the table or the massage chair. She brought in the chair. Then she scheduled my next appointment for June 25.
The first thing Paul Simon asked me when he came into the room was, "How are the headaches?" I explained (I did try to be brief, I really did!) that I was working with my pain pharmacist to gradually decrease the gabapentin to where it did not cause the headaches but would still be effective for pain reduction. We talked a bit more about gabapentin and how evil I think it is.
"Do you use anything topically?" he asked me. I paused then said, "Well, to be honest--and you are one of the few people I admit this to--" He laughed. "I know what you're going to say!" And I knew that he knew! "Cannabis salve," I said and he said, "Yep! A lot of patients do that." He went on to express his opinion that he wished the medical community would/could accept things. Things that work.
He asked me again exactly where the neck pain is (so he would know exactly where to put the needles). Then I got positioned on the massage chair and he put needles in my head and neck like last time. He also put two needles in my right arm, in the exact places of the points he had shown me last time: one on the outside edge of my hand and the other one on the thumb side slightly below the wrist. I could look down at my hands for the next half hour and, hopefully, memorize the exact points. After today's session, he also showed me another point on the top of the hand between the 4th and 5th fingers, explaining that was more for headaches. I recognized that this was the same point on the hand that Toni Narins of Elemental Sound Healing (on Facebook) had demonstrated only on the foot. Interesting. I wish I could reach my feet easily.
During the session, I listened to the background music as I did mindful breathing and for meditation focused on relaxation of parts of the body. The music was not the non-western music that was played in the group acupuncture sessions but was very familiar, soothing orchestral Western music. The first one I was aware of was Debussy's "Claire de lune" followed by the Quaker song, "Simple Gifts," and the Sibelius' "Finlandia."
A few minutes into the session, I began to feel a warmth, mostly on my neck and upper back. I noticed how good it felt and wondered if the acupuncture was responsible for those feelings of warmth. It was only when Paul came back in at the halfway point to make sure I was okay that I found out he was using a heat source above my back and neck! It was a very nice thing.
At the end of the session, when he came back in and took out the needles, he told me I was "a good patient." He checked to see that my next appointment had been made, and he was almost apologetic that it was over 5 weeks away. He explained that part of the reason for that is because he'll be on vacation the first part of June. I said, "That will work out, because I'll be on vacation the first part of July!"
Before leaving, I told him that I had looked at that "S"-shaped tool for using on one's back and neck and that I had then found a tool in Daiso and I pulled it out of my bag and showed it to him. He held it in his hand, put the end on his back and neck in different positions. I could tell he approved! "Plus," I said, half in jest, "it's small enough to put into my bag so I can take it with me on my trip!"
The first thing Paul Simon asked me when he came into the room was, "How are the headaches?" I explained (I did try to be brief, I really did!) that I was working with my pain pharmacist to gradually decrease the gabapentin to where it did not cause the headaches but would still be effective for pain reduction. We talked a bit more about gabapentin and how evil I think it is.
"Do you use anything topically?" he asked me. I paused then said, "Well, to be honest--and you are one of the few people I admit this to--" He laughed. "I know what you're going to say!" And I knew that he knew! "Cannabis salve," I said and he said, "Yep! A lot of patients do that." He went on to express his opinion that he wished the medical community would/could accept things. Things that work.
He asked me again exactly where the neck pain is (so he would know exactly where to put the needles). Then I got positioned on the massage chair and he put needles in my head and neck like last time. He also put two needles in my right arm, in the exact places of the points he had shown me last time: one on the outside edge of my hand and the other one on the thumb side slightly below the wrist. I could look down at my hands for the next half hour and, hopefully, memorize the exact points. After today's session, he also showed me another point on the top of the hand between the 4th and 5th fingers, explaining that was more for headaches. I recognized that this was the same point on the hand that Toni Narins of Elemental Sound Healing (on Facebook) had demonstrated only on the foot. Interesting. I wish I could reach my feet easily.
During the session, I listened to the background music as I did mindful breathing and for meditation focused on relaxation of parts of the body. The music was not the non-western music that was played in the group acupuncture sessions but was very familiar, soothing orchestral Western music. The first one I was aware of was Debussy's "Claire de lune" followed by the Quaker song, "Simple Gifts," and the Sibelius' "Finlandia."
A few minutes into the session, I began to feel a warmth, mostly on my neck and upper back. I noticed how good it felt and wondered if the acupuncture was responsible for those feelings of warmth. It was only when Paul came back in at the halfway point to make sure I was okay that I found out he was using a heat source above my back and neck! It was a very nice thing.
At the end of the session, when he came back in and took out the needles, he told me I was "a good patient." He checked to see that my next appointment had been made, and he was almost apologetic that it was over 5 weeks away. He explained that part of the reason for that is because he'll be on vacation the first part of June. I said, "That will work out, because I'll be on vacation the first part of July!"
Before leaving, I told him that I had looked at that "S"-shaped tool for using on one's back and neck and that I had then found a tool in Daiso and I pulled it out of my bag and showed it to him. He held it in his hand, put the end on his back and neck in different positions. I could tell he approved! "Plus," I said, half in jest, "it's small enough to put into my bag so I can take it with me on my trip!"
Friday, April 27, 2018
Pain Physical Therapy #3
Today is my third individual session for physical therapy with Francis.
When I checked in, the girl did not ask for a co-pay, so I'm sure someone down the line will bill me. I hate doing it like this. I would rather just pay with my card at the time of the appointment, because I have to rack my brain later, trying to remember what date I had an appointment on that I was supposed to be billed for.
When Francis came into the waiting room, I had my back to him and was attempting to perform acupressure on my neck. This did not escape his notice! He mentioned it and applauded me for doing it.
I followed him back to his office, now a familiar place. We talked briefly, as usual. I verbalized my frustration with gabapentin causing headaches but followed rather quickly with, "But I have an appointment with the pain pharmacist next week." He nodded.
I sat on the patient table and he checked my range of motion in my neck and said he thought I was making progress! He asked me to do various movements, and then he manipulated my head and neck in different ways, asking if what he was doing made it feel better, feel worse, or no different.
He gave me a new neck exercise and then showed me a hard rubber massage ball with rounded nubs, which he placed under my neck on the right side and showed me how I could use a ball like this for acupressure. Great idea!
Finally, he scheduled me for another appointment on the second Friday of June.
When I checked in, the girl did not ask for a co-pay, so I'm sure someone down the line will bill me. I hate doing it like this. I would rather just pay with my card at the time of the appointment, because I have to rack my brain later, trying to remember what date I had an appointment on that I was supposed to be billed for.
When Francis came into the waiting room, I had my back to him and was attempting to perform acupressure on my neck. This did not escape his notice! He mentioned it and applauded me for doing it.
I followed him back to his office, now a familiar place. We talked briefly, as usual. I verbalized my frustration with gabapentin causing headaches but followed rather quickly with, "But I have an appointment with the pain pharmacist next week." He nodded.
I sat on the patient table and he checked my range of motion in my neck and said he thought I was making progress! He asked me to do various movements, and then he manipulated my head and neck in different ways, asking if what he was doing made it feel better, feel worse, or no different.
He gave me a new neck exercise and then showed me a hard rubber massage ball with rounded nubs, which he placed under my neck on the right side and showed me how I could use a ball like this for acupressure. Great idea!
Finally, he scheduled me for another appointment on the second Friday of June.
Monday, April 23, 2018
Individual Acupuncture Therapy #1
Today is the long-awaited appointment with an individual acupuncturist (not a group of a dozen or more patients!). The assistant took me into a regular doctor's office, small, with chairs and a patient table. Mr. Simon had already looked at my medical records so he already knew everything I told him. He even actually remembered me as being one of the group acupuncture patients from January 17!
I told him upfront that, in addition to acupuncture with him, I am very interested in pursuing acupressure. He showed me two places on my right hand where pressure points for neck pain are, and he placed a small sticky on each spot. He also showed me three places on my left ankle that were pressure points to relieve pain on the right side of my neck.
He did some explanations of meridians and energy, which I appreciated. For the today's acupuncture session, he asked me if I would be more comfortable on the patient table or a massage chair. I told him whatever would provide the best support for my head. He left for a moment and came back with a portable massage chair, had me sit on it, and made some adjustments.
He placed needles in various spots on my head and neck and two on my arms. I was thinking the right arm needle must be in a small blood vessel because it was pulsating with my heartbeat! The left arm needle didn't do that, but there was no pain in either needle nor with any of the other needles.
I have learned how to stay extremely still, not even twitching a nose!, during an acupuncture session by practicing mindful breathing and meditation. Mr. Simon left the room, and there was soft music playing so the ambience was perfect.
Fifteen minutes later, he came back into the room and asked me how I was doing. "Just fine," I answered, not moving a muscle. So he left for another 15 minutes when he came back in and removed the needles.
How do I feel? Very relaxed and refreshed, as I did after the last two group acupuncture sessions with Sophie.
Before I left, he scheduled my next appointment for May 17.
I told him upfront that, in addition to acupuncture with him, I am very interested in pursuing acupressure. He showed me two places on my right hand where pressure points for neck pain are, and he placed a small sticky on each spot. He also showed me three places on my left ankle that were pressure points to relieve pain on the right side of my neck.
He did some explanations of meridians and energy, which I appreciated. For the today's acupuncture session, he asked me if I would be more comfortable on the patient table or a massage chair. I told him whatever would provide the best support for my head. He left for a moment and came back with a portable massage chair, had me sit on it, and made some adjustments.
He placed needles in various spots on my head and neck and two on my arms. I was thinking the right arm needle must be in a small blood vessel because it was pulsating with my heartbeat! The left arm needle didn't do that, but there was no pain in either needle nor with any of the other needles.
I have learned how to stay extremely still, not even twitching a nose!, during an acupuncture session by practicing mindful breathing and meditation. Mr. Simon left the room, and there was soft music playing so the ambience was perfect.
Fifteen minutes later, he came back into the room and asked me how I was doing. "Just fine," I answered, not moving a muscle. So he left for another 15 minutes when he came back in and removed the needles.
How do I feel? Very relaxed and refreshed, as I did after the last two group acupuncture sessions with Sophie.
Before I left, he scheduled my next appointment for May 17.
Wednesday, April 11, 2018
Pain Management Group Follow-up
It felt like six weeks passed pretty quickly. The commute was easy and uncomplicated. Checking in and sitting in the waiting room felt very familiar although a bit strange since there was only one person I saw from our original group of ten. After we had assembled in our group meeting room, there were just six of us from our original group, plus one other person from another group.
Dr. Whitehead began the session with meditation, which I expected, and that was very nice. It was a familiar guided imagery of the beach! Then we went right into "group therapy" with each of us telling what we are still doing that is helpful (with pain management) and what things we are still struggling with. Several said their struggle is with "trying to do too much." Mine was a variation of that: sitting too long at the computer without a break. Some said it was hard for them to ask other people for help. Well, that would have been me six months ago! In the past six weeks, I've had to ask Linda for technical assistance with web clients. We both struggle with brain fog, but apparently mine is worse when it comes to technology! Finally, we were asked to write down (on cards she passed out) two helpful tips. Then she collected the cards and typed them into a document which she printed out (on bright pink card stock!) and distributed for a take-home.
Francis ended the session with Tai Chi taken from a new YouTube video called "Adapted Tai Chi Part 1," which I looked up at home.
After class, I spoke privately to Francis to confirm that the Tuesday drop-in group on the 4th Tuesday of April (the 24th) would be focused on acupressure, which I will try very hard to be able to attend. It will mean getting to Alameda for the Farmers' Market and Trader Joe's two hours earlier than our "usual" in order to be able to get home to unload groceries and then to Union City for the 3-5 p.m. group.
Dr. Whitehead began the session with meditation, which I expected, and that was very nice. It was a familiar guided imagery of the beach! Then we went right into "group therapy" with each of us telling what we are still doing that is helpful (with pain management) and what things we are still struggling with. Several said their struggle is with "trying to do too much." Mine was a variation of that: sitting too long at the computer without a break. Some said it was hard for them to ask other people for help. Well, that would have been me six months ago! In the past six weeks, I've had to ask Linda for technical assistance with web clients. We both struggle with brain fog, but apparently mine is worse when it comes to technology! Finally, we were asked to write down (on cards she passed out) two helpful tips. Then she collected the cards and typed them into a document which she printed out (on bright pink card stock!) and distributed for a take-home.
Francis ended the session with Tai Chi taken from a new YouTube video called "Adapted Tai Chi Part 1," which I looked up at home.
https://www.youtube.com/watch?v=ZbGvYXB08uk
After class, I spoke privately to Francis to confirm that the Tuesday drop-in group on the 4th Tuesday of April (the 24th) would be focused on acupressure, which I will try very hard to be able to attend. It will mean getting to Alameda for the Farmers' Market and Trader Joe's two hours earlier than our "usual" in order to be able to get home to unload groceries and then to Union City for the 3-5 p.m. group.
Friday, March 23, 2018
Follow up with Francis
Today was a follow-up appointment with Francis, the physical therapist from the Pain Clinic. Once again, he spent a full hour with me. The first thing he said was to confirm his approval of the inflatable neck traction device I had sent him a link to and which is available to buy on Amazon. So, good, okay, I will order one when I get home this afternoon.
He started the examination, of course, with checking the range of motion of my neck, particularly on the right side. Since I had been in pain most of the past 24 hrs., turning my head to the right was very difficult and painful at first. He did various manual manipulations with my head and neck, then he checked me on the three exercises that he had given me at my first appointment (and confirmed that I was performing them correctly). He modified the "windmill" exercise to make my arm go further behind my back. He then gave me a new exercise to do with towel around the back of my neck, then pulling my head, first up, and then to the right and to the left, synced with "mindful breathing," of course. I can do that.
We talked about a lot of things related to my neck pain, including acupressure. I asked him to show me the correct pressure points on the back of my head and on my shoulders that are specifically for neck pain. Which he did. He also told me that the pressure with thumbs or fingers did not have to be hard pressure. Even just touching the pressure points would be effective. So now I have been affirmed with that tool.
I did ask him point-blank about the validity of "tapping," and his response was positive. I told him the hardest thing for me to do was to admit that emotions and highly emotional experiences affect my pain level. He asked, "Why is that?" I told him I guess because, at my age, I can't accept change as easily as I did when I was younger." Then I said, "Maybe I need to see Julie [the Pain Psychologist] again." That made him chuckle.
I told him I have an appointment in April with one of the acupuncturists and he thought that was very good. I told him I wanted to have regular sessions with him (Francis), perhaps every six weeks? He did not hesitate to open his calendar and make an appointment for me on another Friday, five weeks from today.
Thursday, March 22, 2018
Office Visit with Dr. Kalra
I put way more angst into anticipating this visit than I should have! How many times had I rehearsed and re-rehearsed everything I was going to say to Dr. Kalra?!? I wrote down carefully in my notebook the three things I wanted to discuss with him.
His medical assistant took me to Dr. Kalra's exam room, asked questions, took notes, and then checked my blood pressure which was 111/69 and she said, "Good!"
He was a few minutes late for my appointment but I didn't mind. It just gave me that many more minutes to rehearse!
I knew he was probably Indian, but he was younger and shorter than I had imagined. He was cordial but I knew he was a down-to-business no-nonsense kind of person and so I behaved accordingly. I told him that I couldn't take more than 600mg/day of gabapentin or I get horrific headaches. He nodded and said that was common. I said I had heard of a painkiller called tramadol—and he stopped me with a half smile. "That is the next thing I was going to suggest for you," he said, and I internally heaved a great sigh of relief.
The next item on my list was to ask him about meloxicam. I told him I was concerned about destroying my liver and kidneys with Advil and Aleve. He said he would prescribe Mobic (brand name for meloxicam!). Which he did, but only half (7.5mg) of the 15mg dosage that Linda had (and which I took for a few weeks).
Finally, I asked him about the c-reactive protein (CRP) lab test which Google said is "a blood test marker for inflammation in the body." Is it valid, in your professional opinion, Dr. Kalra? He said yes and no. No, because your body's level of inflammation varies so much. A negative test wouldn't really tell you anything. A positive test wouldn't really tell you anything. But (and apparently Kaiser allows the test, covered or not) he was willing to order the test if I wanted. I said no, that's okay. But I just had to ask.
He said that I should have a follow up phone appointment in six weeks. He didn't say it would be with a pharmacist, but I wasn't surprised when his assistant told me that. She also told me I could pick up my prescriptions in San Leandro.
It was raining pretty hard when we got to Kaiser San Leandro but I didn't mind. I had just scored two new drugs! I also purchased, on impulse, a box of Salonpas pain patches, since someone on Facebook had mentioned that they worked for her husband. So…we'll see just how—or if—everything works for me!
His medical assistant took me to Dr. Kalra's exam room, asked questions, took notes, and then checked my blood pressure which was 111/69 and she said, "Good!"
He was a few minutes late for my appointment but I didn't mind. It just gave me that many more minutes to rehearse!
I knew he was probably Indian, but he was younger and shorter than I had imagined. He was cordial but I knew he was a down-to-business no-nonsense kind of person and so I behaved accordingly. I told him that I couldn't take more than 600mg/day of gabapentin or I get horrific headaches. He nodded and said that was common. I said I had heard of a painkiller called tramadol—and he stopped me with a half smile. "That is the next thing I was going to suggest for you," he said, and I internally heaved a great sigh of relief.
The next item on my list was to ask him about meloxicam. I told him I was concerned about destroying my liver and kidneys with Advil and Aleve. He said he would prescribe Mobic (brand name for meloxicam!). Which he did, but only half (7.5mg) of the 15mg dosage that Linda had (and which I took for a few weeks).
Finally, I asked him about the c-reactive protein (CRP) lab test which Google said is "a blood test marker for inflammation in the body." Is it valid, in your professional opinion, Dr. Kalra? He said yes and no. No, because your body's level of inflammation varies so much. A negative test wouldn't really tell you anything. A positive test wouldn't really tell you anything. But (and apparently Kaiser allows the test, covered or not) he was willing to order the test if I wanted. I said no, that's okay. But I just had to ask.
He said that I should have a follow up phone appointment in six weeks. He didn't say it would be with a pharmacist, but I wasn't surprised when his assistant told me that. She also told me I could pick up my prescriptions in San Leandro.
It was raining pretty hard when we got to Kaiser San Leandro but I didn't mind. I had just scored two new drugs! I also purchased, on impulse, a box of Salonpas pain patches, since someone on Facebook had mentioned that they worked for her husband. So…we'll see just how—or if—everything works for me!
Saturday, March 17, 2018
Pain Management: My Review
I have completed the 3-days-a-week 5-week outpatient Pain Management program at Kaiser. The facilitators all made it clear from Day 1 that this is not a pain relief program but a pain management! And they were right. We were not allowed to talk specifically about our pain nor about medications.
I posted in detail about every one of the 15 sessions, for anyone who is interested in that level of detail (from January 15 through February 23). Most readers, however, just want to know my opinion, in general, about the Pain Management program. So, here goes.
In my opinion, Pain Management is probably 80% psychology. Pain psychology, they call it. They have names for specific strategies. Radical acceptance. Tiny habits. Planning, prioritizing, and pacing, which is knowing how to alternate high-impact and low-impact activities. Positive thinking. Social support. And "how to say 'no' without feeling guilty." There was even a session on how to manage a flare: we could list everything except medication!
The rest of it, somehow based on the premise that reducing/eliminating stress would also reduce/eliminate pain, consisted of achieving relaxation through guided meditation combined with "mindful breathing." And there was always a session of "gentle movement" exercises, mostly Tai Chi, with some yoga positions, and core exercises, mostly targeting back pain.
But your question to me is still: Did the Pain Management program help you? Well, yes, it helped me understand that there is no such thing as pain relief! The need to limit time on high-impact activities has made it possible for me to have one or two guilt-free bed rest times during the day, during which I practice my own internally guided meditation combined with belly breathing. I have learned how to do various "gentle movement" exercises during times when I can't do anything else, like waiting in a long line or lying awake in bed during a night of insomnia. These are all essentially attempts at distractions from the ever-present pain.
I still have three more individual office appointments, two next week. One is with Dr. Kalra, the medical director of the Pain Clinic, as a follow-up to my initial telephone appointment with him at the beginning of the program when he prescribed gabapentin. I need to let him know that 600mg of gabapentin is all I can take or I get intense headaches (not migraines but drug-induced headaches). But without the gabapentin, my typical pain level would be 7 or 8 instead of 5 or 6. Dr. Kalra does not think that physical manipulation of my c-spine will do any good, even though the only thing that has come close to pain relief was two specific manual manipulations I experienced in Physical Therapy.
Another is with Francis, the physical therapist specializing in pain management. I feel "safe" with him because he is the only Kaiser practitioner that I've admitted to following a ketogenic diet. I still do the three exercises he gave me to do during the one individual session that I had with him during the program. While these exercises have not perceptibly lessened my chronic neck pain, I can tell that the range of motion in my neck has become easier.
And, next month, I have a one-on-one appointment with one of the acupuncturists in the Physical Medicine Department. Until then, I am continuing to research and explore acupressure and hope that I might get some help with it from both Francis and the acupuncturist.
Finally, apart from the program, I have looked at some introductory materials (both articles and videos) on "tapping." Although it's supposedly related to acupuncture and acupressure, I am not convinced of its legitimacy or effectiveness. Their claims still sound like "snake oil" to me. I'm just not ready for it yet.
I posted in detail about every one of the 15 sessions, for anyone who is interested in that level of detail (from January 15 through February 23). Most readers, however, just want to know my opinion, in general, about the Pain Management program. So, here goes.
In my opinion, Pain Management is probably 80% psychology. Pain psychology, they call it. They have names for specific strategies. Radical acceptance. Tiny habits. Planning, prioritizing, and pacing, which is knowing how to alternate high-impact and low-impact activities. Positive thinking. Social support. And "how to say 'no' without feeling guilty." There was even a session on how to manage a flare: we could list everything except medication!
The rest of it, somehow based on the premise that reducing/eliminating stress would also reduce/eliminate pain, consisted of achieving relaxation through guided meditation combined with "mindful breathing." And there was always a session of "gentle movement" exercises, mostly Tai Chi, with some yoga positions, and core exercises, mostly targeting back pain.
But your question to me is still: Did the Pain Management program help you? Well, yes, it helped me understand that there is no such thing as pain relief! The need to limit time on high-impact activities has made it possible for me to have one or two guilt-free bed rest times during the day, during which I practice my own internally guided meditation combined with belly breathing. I have learned how to do various "gentle movement" exercises during times when I can't do anything else, like waiting in a long line or lying awake in bed during a night of insomnia. These are all essentially attempts at distractions from the ever-present pain.
I still have three more individual office appointments, two next week. One is with Dr. Kalra, the medical director of the Pain Clinic, as a follow-up to my initial telephone appointment with him at the beginning of the program when he prescribed gabapentin. I need to let him know that 600mg of gabapentin is all I can take or I get intense headaches (not migraines but drug-induced headaches). But without the gabapentin, my typical pain level would be 7 or 8 instead of 5 or 6. Dr. Kalra does not think that physical manipulation of my c-spine will do any good, even though the only thing that has come close to pain relief was two specific manual manipulations I experienced in Physical Therapy.
Another is with Francis, the physical therapist specializing in pain management. I feel "safe" with him because he is the only Kaiser practitioner that I've admitted to following a ketogenic diet. I still do the three exercises he gave me to do during the one individual session that I had with him during the program. While these exercises have not perceptibly lessened my chronic neck pain, I can tell that the range of motion in my neck has become easier.
And, next month, I have a one-on-one appointment with one of the acupuncturists in the Physical Medicine Department. Until then, I am continuing to research and explore acupressure and hope that I might get some help with it from both Francis and the acupuncturist.
Finally, apart from the program, I have looked at some introductory materials (both articles and videos) on "tapping." Although it's supposedly related to acupuncture and acupressure, I am not convinced of its legitimacy or effectiveness. Their claims still sound like "snake oil" to me. I'm just not ready for it yet.
Friday, February 23, 2018
Pain Group Acupuncture #3
This is my last day of pain group acupuncture with Sophie. I have requested to be referred to the Acupuncture Clinic for an individual session. So, for that, I will just have to wait.
Today only 3 of us from the class went to group acupuncture! I don't know where everyone else was. Maybe they all think they will just do the make-up group next Friday, but I will be on a plane by then.
I positioned myself, as I did two weeks ago, with my chair back against the wall so I could rest my head on the wall, and I was ready when Sophie got to me with the needles. I don't think any needles came out this week. And, once again, I concentrated on "mindful breathing" and meditation. I may have dozed off and on, but it was a very relaxing, refreshing experience.
In Sophie's talking (as she was putting the needles in), I thought I heard her mention "tapping" in a list of other non-Western medicine strategies, including acupressure, for pain relief. She left the room, though, before I had a chance to ask her about it.
Today only 3 of us from the class went to group acupuncture! I don't know where everyone else was. Maybe they all think they will just do the make-up group next Friday, but I will be on a plane by then.
I positioned myself, as I did two weeks ago, with my chair back against the wall so I could rest my head on the wall, and I was ready when Sophie got to me with the needles. I don't think any needles came out this week. And, once again, I concentrated on "mindful breathing" and meditation. I may have dozed off and on, but it was a very relaxing, refreshing experience.
In Sophie's talking (as she was putting the needles in), I thought I heard her mention "tapping" in a list of other non-Western medicine strategies, including acupressure, for pain relief. She left the room, though, before I had a chance to ask her about it.
Day 15 Pain Management
Today is the last day of the Level 3 Chronic Pain Management program! The first thing they did was have us fill out questionnaires, which I knew was coming. Yeah, by this time, I really do know my Kaiser Medical # by memory!
After the meditation session, Francis led us in the 7 core exercises and then did a game in which each person was to cross the room doing anything--one of our exercises, Tai Chi, or any other movement that no one else had yet done. It was fun, in a campy sort of way. Francis did not, however, talk about acupressure as he had promised.
In Dr. Whitehead's session, she had us each, individually, tell how we deal with flare-up management, and then tell what our goals are now that we're leaving the class. She talked about the "aftercare" reunion class and went to a wall calendar. She announced that the date would be Wednesday, April 11. By my calculations, 6 weeks would be April 4; however, I will wait until the Pain Clinic contacts me.
In conclusion, Dr. Whitehead had us make a list, which she wrote on the white board, of things we had learned in this program. She talked about the "Healthy Living" classes available to Kaiser members, some free, some with a fee.
Finally, she gave out the graduation certificates, one at a time, while the rest of the class clapped (rather halfheartedly, I thought) and then gave the person a chance to say anything they wanted to the others in the group. Several of them talked about a new resolve to exercise. I talked about continuing my quest for actual pain relief, especially in non-pharmaceutical strategies. I asked about acupressure and biofeedback, and Dr. Whitehead indicated that patients could do either one or both by individual appointments with her or Francis. Hmm, I'll have to think about that one.
Many of the members were obviously emotional about leaving our little "community" we've had together for the past 5 1/2 weeks. I'm guessing they don't have a "community" outside their immediate families. They may not live on Facebook like I do! I have already started a new Facebook group called, "Jacquie's Chronic Pain Circle," with membership limited to those who are my Facebook Friends (including Acquaintances). We'll see how that goes!
After the meditation session, Francis led us in the 7 core exercises and then did a game in which each person was to cross the room doing anything--one of our exercises, Tai Chi, or any other movement that no one else had yet done. It was fun, in a campy sort of way. Francis did not, however, talk about acupressure as he had promised.
In Dr. Whitehead's session, she had us each, individually, tell how we deal with flare-up management, and then tell what our goals are now that we're leaving the class. She talked about the "aftercare" reunion class and went to a wall calendar. She announced that the date would be Wednesday, April 11. By my calculations, 6 weeks would be April 4; however, I will wait until the Pain Clinic contacts me.
In conclusion, Dr. Whitehead had us make a list, which she wrote on the white board, of things we had learned in this program. She talked about the "Healthy Living" classes available to Kaiser members, some free, some with a fee.
Finally, she gave out the graduation certificates, one at a time, while the rest of the class clapped (rather halfheartedly, I thought) and then gave the person a chance to say anything they wanted to the others in the group. Several of them talked about a new resolve to exercise. I talked about continuing my quest for actual pain relief, especially in non-pharmaceutical strategies. I asked about acupressure and biofeedback, and Dr. Whitehead indicated that patients could do either one or both by individual appointments with her or Francis. Hmm, I'll have to think about that one.
Many of the members were obviously emotional about leaving our little "community" we've had together for the past 5 1/2 weeks. I'm guessing they don't have a "community" outside their immediate families. They may not live on Facebook like I do! I have already started a new Facebook group called, "Jacquie's Chronic Pain Circle," with membership limited to those who are my Facebook Friends (including Acquaintances). We'll see how that goes!
Wednesday, February 21, 2018
Day 14 Pain Management
There was no Pain Management on Monday, which was Presidents Day.
Today Francis did the meditation session with affirmations. He then divided us up into two groups to go through the Tai Chi routine with no coaching. I asked about acupressure and he said he would talk about it on Friday. Also, there will be an "after care" class with this group on a Wednesday 6 weeks after this group ends.
After the break, Blanca (from the office) came in and requested us to all fill out a "life-care planning" questionnaire, primarily to identify a primary and alternative person whom we designate to speak for us if we cannot speak for ourselves.
Dr. Whitehead facilitated the discussion, starting with what did you do that was fun over the weekend/holiday? Topics of the day included flare-up planning and maintenance planning. Today was Rachel's last day so Dr. Whitehead gave her "graduation" certificate and we said goodbye to her.
Today Francis did the meditation session with affirmations. He then divided us up into two groups to go through the Tai Chi routine with no coaching. I asked about acupressure and he said he would talk about it on Friday. Also, there will be an "after care" class with this group on a Wednesday 6 weeks after this group ends.
After the break, Blanca (from the office) came in and requested us to all fill out a "life-care planning" questionnaire, primarily to identify a primary and alternative person whom we designate to speak for us if we cannot speak for ourselves.
Dr. Whitehead facilitated the discussion, starting with what did you do that was fun over the weekend/holiday? Topics of the day included flare-up planning and maintenance planning. Today was Rachel's last day so Dr. Whitehead gave her "graduation" certificate and we said goodbye to her.
Friday, February 16, 2018
Day 13 Pain Management
I have more pain today, I think after working so hard yesterday afternoon with no break. I opened a new can of "magic" espresso beans and took one.
Dr. Whitehead began with the meditation, this one focusing on body sensations of heaviness and warmth. Great distractions.
Francis came in for the exercises, starting with Tai Chi, only having us do the 10 exercises on our own without his coaching. Then he had us do very gentle head, neck, and body turning to increase range of motion.
After the break, Dr. Whitehead came back. The first exercise was in groups of two. We were to have an everyday, normal conversation without any mention or reference to our pain. The lady next to me asked me if I have any pets, so that opened an easy conversation as I told her about Emily and about Barley. Then she told me about her two cats.
Then Dr. Whitehead asked for "I Statements" to be shared with the group. Only a few had done the assignment, but I did one involving a difficult situation with a web client.
The next topic was how chronic pain affects relationships.
The final topic was to explore your social support system. We ran out of time, though, so I think we're supposed to finish this for homework, along with starting of a general maintenance plan and a flare management plan.
There was no pain group acupuncture today due to Sophie being gone for Chinese New Year.
Dr. Whitehead began with the meditation, this one focusing on body sensations of heaviness and warmth. Great distractions.
Francis came in for the exercises, starting with Tai Chi, only having us do the 10 exercises on our own without his coaching. Then he had us do very gentle head, neck, and body turning to increase range of motion.
After the break, Dr. Whitehead came back. The first exercise was in groups of two. We were to have an everyday, normal conversation without any mention or reference to our pain. The lady next to me asked me if I have any pets, so that opened an easy conversation as I told her about Emily and about Barley. Then she told me about her two cats.
Then Dr. Whitehead asked for "I Statements" to be shared with the group. Only a few had done the assignment, but I did one involving a difficult situation with a web client.
The next topic was how chronic pain affects relationships.
The final topic was to explore your social support system. We ran out of time, though, so I think we're supposed to finish this for homework, along with starting of a general maintenance plan and a flare management plan.
There was no pain group acupuncture today due to Sophie being gone for Chinese New Year.
Wednesday, February 14, 2018
Day 12 Pain Management
What a horrendous day! Started at 3:30 a.m. when I was awakened by an intense headache (not migraine) and was not able to get back to sleep, even after I took naproxen and used an ice pack. Pain Management class was fine, getting lunch at In-n-Out Burger was delicious, and spending the afternoon with grandson #3 was delightful! (Especially after taking a double dose of pain meds.) But then I log on to Facebook on the way home and find out about the 17 dead in a school shooting in Florida, a longtime FB friend who has had a heart attack, and a sweet trans woman FB friend who ended her life 2 days ago. I am stunned and saddened.
But back to Day 12 Pain Management group. Francis was the first presenter, starting with meditation on "loving-kindness" (being Valentine's Day and all). Then he took us through the 10 Tai Chi exercises and suggested we do it with the video at home. He passed out sheets with motivational quotes. He led in a discussion of more "Tiny Habits." And ended with the "Cupid Shuffle" as he had promised.
After the bathroom break, Dr. Whitehead came in for topic discussion. The first part was on good communication and self-esteem. She discussed the characteristics of passive, assertive, and aggressive. For homework, she assigned us to write out an "I Statement." Next will be discussion of social support systems.
But back to Day 12 Pain Management group. Francis was the first presenter, starting with meditation on "loving-kindness" (being Valentine's Day and all). Then he took us through the 10 Tai Chi exercises and suggested we do it with the video at home. He passed out sheets with motivational quotes. He led in a discussion of more "Tiny Habits." And ended with the "Cupid Shuffle" as he had promised.
After the bathroom break, Dr. Whitehead came in for topic discussion. The first part was on good communication and self-esteem. She discussed the characteristics of passive, assertive, and aggressive. For homework, she assigned us to write out an "I Statement." Next will be discussion of social support systems.
Monday, February 12, 2018
Day 11 Pain Management
Linda has been sick all weekend so I had to drive myself today. Pain Level 4 (though I did have a magic dark chocolate espresso bean). Used neck pillow, turned off air and radio (they were distractions). In spite of several traffic lights being out (and we all had to have a four-way stop on about a half dozen lights), I arrived on time. Presenters seemed to be all-business-no-time-for-nonsense and they got right into the day's activities.
- Meditation (30 minutes) with Dr. Whitehead
- Exercises (45 minutes) with Francis. He started with the full set of Tai Chi (10 exercises) and told us to practice these at home with the video. He then taught us the "Cupid Shuffle" (an easy line-dancing move) and then we did it to music. He assigned 3 additional "Tiny Habits" for homework.
- Bathroom break (15 minutes)
- Discussion (1 hr) with Dr. Whitehead. She started with each group member sharing what "pleasant activities" we did over the weekend. I related the Church 1.0 Movie Day. Someone asked what movie so I told them about Jason & deMarco.
- Topic of the day was resilience. Dr. Whitehead talked briefly about challenging any negative "core beliefs" we have. We read an article together and talked about "coping strategies." Homework assignment is to complete the Intentional Happiness Worksheet of writing 3 things that went right and our role in making them happen. Every day for 7 days.
Friday, February 9, 2018
Pain Group Acupuncture #2
Sophie was running a few minutes late today, but she did arrive and got us all settled. I moved my chair back against a wall so I could lean my head back against the wall. She started on the other side of the room and I was the last to get the needles, so that meant I would have 30 minutes of "needle time." She reminded us that she would not be here next Friday because of Chinese New Year. Then, as she inserted needles, she talked about Chinese New Year and China and how it was for her growing up in China.
I started my breathing before Sophie got to me and made sure I scratched all the places on my face and head and arms that usually itch. After I got my needles in, I continued the meditation with a beach scene. Whenever I felt an itch, I approached it with my own adaption of Dr. Arlene Taylor's famous phrase, "Your opinion is none of my business." I said to my itch, "You are none of my business," then I focused on somewhere else on my body that didn't itch. It must have worked; I think I even dozed off a couple of times. Even though it was only 30 minutes, I felt very refreshed and extremely relaxed.
I started my breathing before Sophie got to me and made sure I scratched all the places on my face and head and arms that usually itch. After I got my needles in, I continued the meditation with a beach scene. Whenever I felt an itch, I approached it with my own adaption of Dr. Arlene Taylor's famous phrase, "Your opinion is none of my business." I said to my itch, "You are none of my business," then I focused on somewhere else on my body that didn't itch. It must have worked; I think I even dozed off a couple of times. Even though it was only 30 minutes, I felt very refreshed and extremely relaxed.
Day 10 Pain Management
Meditation with Dr. Whitehead. Guided imagery of beach scene, my favorite.
Exercise with Francis. He started us off with three Tai Chi exercises and told us to go through all 10 with the video over this weekend. He added 3 new core exercises to the first 7: calf stretch, fold-over, and leaning forward from hips. We then did a circuit with all 10 and cardio in between each one. Homework: He passed out a handout and assigned us to do 3 of the "Tiny Habits" exercise using 3 of the core exercises.
Dr. Whitehead's discussion topic was a continuation of "Track Your Thoughts." She used real-life examples from group members. The focus of this exercise was that we may not be able to change a situation but we can change our reactions/behavior to it. Homework: Do two pleasurable activities over the weekend.
Exercise with Francis. He started us off with three Tai Chi exercises and told us to go through all 10 with the video over this weekend. He added 3 new core exercises to the first 7: calf stretch, fold-over, and leaning forward from hips. We then did a circuit with all 10 and cardio in between each one. Homework: He passed out a handout and assigned us to do 3 of the "Tiny Habits" exercise using 3 of the core exercises.
Dr. Whitehead's discussion topic was a continuation of "Track Your Thoughts." She used real-life examples from group members. The focus of this exercise was that we may not be able to change a situation but we can change our reactions/behavior to it. Homework: Do two pleasurable activities over the weekend.
Wednesday, February 7, 2018
Day 9 Pain Management
Today is Alex's second birthday. I failed to get my phone before we left the house, so I am starting this blog with a pen and notebook while in the Kaiser waiting room. (Hence, no pictures or check-in.)
One discovery is that the "Chin Tuck," which can be done any time and in any position, is instant pain relief! For the 5-10 seconds I can hold the "Chin Tuck."
I'm in my second week of gabapentin, having added an a.m. capsule to the p.m. capsule. Still afraid to not take the full 600mg of Advil twice a day. I keep wondering if meloxicam would be any better than Advil or Aleve, which apparently I'm not supposed to take with gabapentin.
Francis started the 10 a.m. session promptly with meditation. I could definitely hear his instructions over the music! Then he discussed our homework to create a 20-minute routine with the 7 core exercises (repeating 3 of them twice) and interspersed with 1 minute of cardio. Then he spent the rest of the time on Tai Chi, using the 10 exercises in the video he introduced to us earlier. Homework is to read "Tiny Habits" handout. The idea is to add a "tiny habit" to some behavior that you are already doing.
http://www.success.com/article/tiny-habits#sthash.s3mkvDO7.dpuf
Dr. Whitehead's discussion topic was reactions to stressors. She started with the Cognitive-Behavioral Model of Pain. Then we did a class exercise with this, giving a specific situation then listing feelings/mood, symptoms/body response, behaviors, thoughts, and then a "new plan" of action that would better deal with the stressors. Our homework is to do one of these on our own at home.
Throughout these presentations, the Kaiser model of prevention comes through loud and clear!
One discovery is that the "Chin Tuck," which can be done any time and in any position, is instant pain relief! For the 5-10 seconds I can hold the "Chin Tuck."
I'm in my second week of gabapentin, having added an a.m. capsule to the p.m. capsule. Still afraid to not take the full 600mg of Advil twice a day. I keep wondering if meloxicam would be any better than Advil or Aleve, which apparently I'm not supposed to take with gabapentin.
Francis started the 10 a.m. session promptly with meditation. I could definitely hear his instructions over the music! Then he discussed our homework to create a 20-minute routine with the 7 core exercises (repeating 3 of them twice) and interspersed with 1 minute of cardio. Then he spent the rest of the time on Tai Chi, using the 10 exercises in the video he introduced to us earlier. Homework is to read "Tiny Habits" handout. The idea is to add a "tiny habit" to some behavior that you are already doing.
http://www.success.com/article/tiny-habits#sthash.s3mkvDO7.dpuf
Dr. Whitehead's discussion topic was reactions to stressors. She started with the Cognitive-Behavioral Model of Pain. Then we did a class exercise with this, giving a specific situation then listing feelings/mood, symptoms/body response, behaviors, thoughts, and then a "new plan" of action that would better deal with the stressors. Our homework is to do one of these on our own at home.
Throughout these presentations, the Kaiser model of prevention comes through loud and clear!
Monday, February 5, 2018
Day 8 Pain Management
Meditation (half-hour) with Dr. Whitehead. Then exercise with Francis, to review the 7 core exercises. Emphasized benefits in strength, flexibility, coordination, and balance. He added in "Cardio" which he defined as any movement in place that will increase your heart rate. He taped 10 pictures of the core exercises on the walls around the room. He then instructed us in doing a "Circuit" with 1 minute of each of the exercises, interspersed in between with 1 minute of "Cardio" for a total of 20 minutes. Homework is to develop this routine at home for a 20-minute "Circuit" done multiple times during the day.
Dr. Whitehead facilitated the topics of the day, first a review of "mini-relaxation" exercises (primarily breathing and visualization). Then a reading and discussion, in class and small groups, of "Radical Acceptance." (Google it if you want more in-depth information.) In our small group discussion, we called it "emotional and intellectual honesty." Dr. Whitehead liked that.
Dr. Whitehead facilitated the topics of the day, first a review of "mini-relaxation" exercises (primarily breathing and visualization). Then a reading and discussion, in class and small groups, of "Radical Acceptance." (Google it if you want more in-depth information.) In our small group discussion, we called it "emotional and intellectual honesty." Dr. Whitehead liked that.
Office Visit with Francis, Physical Therapist
Francis was prompt at 9:00 a.m. And I was ready. He spent a full hour with me, starting with a general overview of my current pain history. He was very thorough and professional and very holistic, asking me about other facets of my life, besides mobility, such as social and emotional factors. I asked him about Spinal Decompression Therapy and mentioned his interest in ketogenic diet (which he admitted was just something he was exploring). He was very careful with his answer.
Then he did a brief evaluation of my range of motion in not only my neck but arms, core, and legs. Then he could be very specific in what he recommended in the way of exercises that would target my neck pain. He went through each exercise with me, moving my head, neck, arms, and legs correctly. He then had me do a full set (10 reps) of each one. At the end, he asked me if I wanted to write them down. (If he had not said that, I would have asked him to review each one so I could write it down.) All 3 exercises can be done in bed (or, more correctly, on the bed), and he recommended that I do the full set first thing in the morning, before I get up for the day, and then twice more during the day (midday and evening). He stressed doing the exercises SLOWLY and only to the point of pain (not past it.)
He started with making sure I knew how to do the "Chin Tuck" and while I did that he placed his hands at the base of my skull and pulled upwards. I came to realize that the motion of the "Chin Tuck" simulates the decompression action he was doing at the base of my skull! The 3 exercises are:
1. Modification of one of the 7 core exercises: Lie on back, knees up, turn left including core and right arms, while keeping chin tucked. The "Chin Tuck" is instead of turning head to the right since that is painful for me. 10 reps.
2. Lie on left side, circle right arm clockwise (like a windmill), then reverse direction to counterclockwise. 10x each direction.
3. Lie on back, "Chin Tuck" while turning head to the right (only up to the point of pain, not past.)
At home, I did the exercise set before my midday bed rest. I am totally amazed at how much lower my pain level has been all day since my morning session with Francis! And whatever he did in the way of manual spinal decompression.
Then he did a brief evaluation of my range of motion in not only my neck but arms, core, and legs. Then he could be very specific in what he recommended in the way of exercises that would target my neck pain. He went through each exercise with me, moving my head, neck, arms, and legs correctly. He then had me do a full set (10 reps) of each one. At the end, he asked me if I wanted to write them down. (If he had not said that, I would have asked him to review each one so I could write it down.) All 3 exercises can be done in bed (or, more correctly, on the bed), and he recommended that I do the full set first thing in the morning, before I get up for the day, and then twice more during the day (midday and evening). He stressed doing the exercises SLOWLY and only to the point of pain (not past it.)
He started with making sure I knew how to do the "Chin Tuck" and while I did that he placed his hands at the base of my skull and pulled upwards. I came to realize that the motion of the "Chin Tuck" simulates the decompression action he was doing at the base of my skull! The 3 exercises are:
1. Modification of one of the 7 core exercises: Lie on back, knees up, turn left including core and right arms, while keeping chin tucked. The "Chin Tuck" is instead of turning head to the right since that is painful for me. 10 reps.
2. Lie on left side, circle right arm clockwise (like a windmill), then reverse direction to counterclockwise. 10x each direction.
3. Lie on back, "Chin Tuck" while turning head to the right (only up to the point of pain, not past.)
At home, I did the exercise set before my midday bed rest. I am totally amazed at how much lower my pain level has been all day since my morning session with Francis! And whatever he did in the way of manual spinal decompression.
Friday, February 2, 2018
Pain Group Acupuncture #1
Finally met Sophie, the acupuncturist, who conducted the group acupuncture session. She was not there on the first Friday of the program (January 26) and will not be there on the 4th week (February 16) due to Chinese New Year. So we will get only 3 sessions instead of the "usual" 5.
There is no co-pay up front; attendees will be billed by Kaiser.
The room was set up with 2 chairs per person, 2 pillows, and all were facing the center of the room, with the back of the chair against the wall. We were each given a hospital blanket and instructed to "get comfortable. Sophie gave a long and complete explanation, that included:
Acupuncture is to:
There is no co-pay up front; attendees will be billed by Kaiser.
The room was set up with 2 chairs per person, 2 pillows, and all were facing the center of the room, with the back of the chair against the wall. We were each given a hospital blanket and instructed to "get comfortable. Sophie gave a long and complete explanation, that included:
Acupuncture is to:
- Reduce inflammation
- Enhance circulation
- Detox (especially from medicines that are no longer as effective). The detox process is to remove any traces of the medication and allow you to "start over" with that medicine so it will be effective again.
- To made medication more effective
- To address emotional stress and increase relaxation.
Day 7 Pain Management
With Francis:
All 7 exercises are included in yoga and tai chi
Introduction to tai chi (10 exercises) - lots of arm movements
Find video on YouTube:
10 Simple Tai Chi Exercises in 10 Minutes - Daily Tai Chi for Beginners
https://www.youtube.com/watch?v=RYzBbo0462s
Second half of today's session presented by Dr. Whitehead. As she talked, it occurred to me that this is actually group therapy for chronic pain sufferers.
Topics for the Day:
- Meditation & Breathing
- Exercises (with breathing)
- Homework:
- Exercises 5-7 (in addition to 1-4)
- "L" (backside stretch)
- Wall plank
- Lying down "bridge"
All 7 exercises are included in yoga and tai chi
Introduction to tai chi (10 exercises) - lots of arm movements
Find video on YouTube:
10 Simple Tai Chi Exercises in 10 Minutes - Daily Tai Chi for Beginners
https://www.youtube.com/watch?v=RYzBbo0462s
Second half of today's session presented by Dr. Whitehead. As she talked, it occurred to me that this is actually group therapy for chronic pain sufferers.
Topics for the Day:
- More on insomnia. Made 2 lists on whiteboard: things you cannot control and things you can control.
- Stress/Relaxation responses. Goal is to find a balance between the two.
- Homework:
- Participate in 2 pleasurable activities
- Do relaxation exercises
Wednesday, January 31, 2018
Day 6 Pain Management
Francis was back and was the first presenter, beginning promptly at 10:00 a.m. with a half-hour of meditation. He played an audio file which he said was accessible in the members' area of the Kaiser website. I could understand about 50% of what the female speaker said.
After that, he took a few minutes to talk about his "medical mission" trip to the Philippines. He said it was special for him because it was his first visit there, even though both his parents had been born in the Philippines. He asked if anyone else had ever been to the Philippines, and M. (the one male in our group of 10 patients) said he had and that his wife was from the Philippines. So I found out those two things today.
Francis then focused on 7 core exercises and assigned 4 for "homework":
At home, a Facebook friend posted this video to my Timeline with the tagline, "We need to address the opioid crisis — but not at the expense of chronic pain patients."
https://www.facebook.com/ChronicIllnessOnThemighty/videos/1641691609185914/
After viewing it, I realized that the Pain Management program at Kaiser--and probably anywhere, for that matter--is a "Pain Acceptance" program! It's definitely NOT about pain relief.
After that, he took a few minutes to talk about his "medical mission" trip to the Philippines. He said it was special for him because it was his first visit there, even though both his parents had been born in the Philippines. He asked if anyone else had ever been to the Philippines, and M. (the one male in our group of 10 patients) said he had and that his wife was from the Philippines. So I found out those two things today.
Francis then focused on 7 core exercises and assigned 4 for "homework":
- Spine twist (on the floor or bed)
- Knees from side to side
- Knees to one side, turn head (at neck) to the other side
- Knees, head, look at hand, rotate hands
- Squat
- In and out of chair
- Slide against wall
- Standing balance (hold on to back of chair at first)
- Lunge (both sides)
- Pacing and Prioritizing
- Sleep/insomnia
- Homework: develop a sleep routine
At home, a Facebook friend posted this video to my Timeline with the tagline, "We need to address the opioid crisis — but not at the expense of chronic pain patients."
https://www.facebook.com/ChronicIllnessOnThemighty/videos/1641691609185914/
After viewing it, I realized that the Pain Management program at Kaiser--and probably anywhere, for that matter--is a "Pain Acceptance" program! It's definitely NOT about pain relief.
Monday, January 29, 2018
Day 5 Pain Management
Dr. Whitehead was, again, the main presenter. We started with a half hour of meditation and breathing, this time imagining we are on a beach. She seemed to be talking a little louder and I got 90% of what she said (instead of missing 90%!). The "gentle movement" was another group walk across the campus and back.
Discussion topics of the day:
Discussion topics of the day:
- The two RNs presented "The Feldenkrais Method" (stress-free exercise for people with arthritis) and guided us through some of the basic low-impact movements. [https://www.feldenkrais.com/about-the-feldenkrais-method/]
- Dr. Whitehead did a quick review of the dietitian's presentation last Friday, only to point out some herbal supplements that were helpful in preventing migraines. This, my friends, IS the "anti-inflammatory foods" list that had been touted.
- Dr. Whitehead then talked briefly about the option of keeping a pain diary (and she passed out forms) in order to determine what life events might be associated with times of pain.
- We talked about high-impact activities and low-impact activities. At this point, we separated into small groups to discuss specific high-impact activities. All four in our group agreed that the most difficult thing to do without pain is getting out of bed!
- Finally, our "homework" assignment is to track high-impact activities following by a low-impact activity in order to prioritize and pace our day.
Office Visit with Dr. Whitehead
9:00a seemed way too early to be up and doing anything! But it was a good session, casual and comfortable. It was mostly giving an overview of my current neck pain history and what else was going on in my life during the past year. I was relieved that she didn't think I was "bad enough" to need medication, though she said to let her know if I got into a place where I felt I needed it. She seemed optimistic that going through the Pain Management program would be beneficial to me.
She told me that Francis was the only physical therapist that dealt specifically with pain. I asked about learning acupressure and she said that Francis teaches that.
She told me that Francis was the only physical therapist that dealt specifically with pain. I asked about learning acupressure and she said that Francis teaches that.
Friday, January 26, 2018
Day 4 Pain Management
End of the first full week. Dr. Whitehead started the session with a half hour of meditation. Again, she was so soft-spoken that I could barely hear here and couldn't understand most of it, but she seemed to be wanting us to imagine we are in a forest. The music that was playing conjured up images of a tropical rain forest, so there I was, with a raincoat and rain boots.
Then Ruby, the dietitian, came in, supposedly to talk about anti-inflammatory foods. She introduced herself as also the diabetes dietitian. But the presentation was specifically about migraines, not pain in general, and did NOT have anything to do with "anti-inflammatory foods"! The main message was to avoid/eliminate highly processed foods with chemical additives. No mention of nightshades, pro or con. It did recommend supplements like magnesium, riboflavin, and feverfew. It was disappointing, to say the least.
The "homework" for the weekend is to choose two pleasurable activities from a long list spanning two pages, and then journal about them. I chose "playing with the grandson" and "writing in a diary." Hence, these blog posts!
Thursday, January 25, 2018
Phone appointment with Dr. Kalra
I set my alarm for 6:00a to make sure I could wake up to be coherent by 8:15a for my phone appointment with Dr. Kalra, Medical Director of the Pain Clinic. I was actually out at my desk, waiting by the phone from 7:30a until 9:30a, when he finally called! After a quick review of my pain status and current medications, he recommended gabapentin (300mg) for pain and said he would send a prescription that I could pick up at the San Leandro Kaiser. He quickly dismissed the idea that manual manipulation of the c-spine would have any lasting effects for pain relief.
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Wednesday, January 24, 2018
Day 3 Pain Management
Today's session started out with Lisa, a Licensed Clinical Social Worker. She continued with the concept of the "Biopsychosocial Model of Pain" to show the relationship of physical pain to emotional responses. She also facilitated the meditation exercise and relaxation breathing. She wasn't nearly as soft-spoken as Dr. Whitehead, so I had no problem following her instructions during the "quiet" meditation.
The second part of this session was conducted, on behalf of Francis, for the "gentle movement" activity, which was to walk, as a group, outside around the buildings C, B, and A, and then back. Then they gave us a link to Francis' videos of exercises, which we can access at home at http://thechronicpaintoolkit.blogspot.com. I went to this blog at home, skimmed through the videos, and then clicked on a link "About Francis," and found this as part of it:
https://www.blogger.com/profile/08556776429137219637
Who knew?!?
The second part of this session was conducted, on behalf of Francis, for the "gentle movement" activity, which was to walk, as a group, outside around the buildings C, B, and A, and then back. Then they gave us a link to Francis' videos of exercises, which we can access at home at http://thechronicpaintoolkit.blogspot.com. I went to this blog at home, skimmed through the videos, and then clicked on a link "About Francis," and found this as part of it:
| Introduction | This is a blog written by a physical therapist who specializes in chronic pain. My goal is to help improve the lives of the patients I serve. |
| Interests | Ketogenic diet, LCHF diet, cycling, meditation, yoga, tai chi |
Who knew?!?
Monday, January 22, 2018
Day 2 Pain Management
First "real" session (no more paperwork to fill out!). Francis is gone for 10 days on some kind of "mission trip" so Dr. Whitehead was the primary presenter. She showed a video of a TED talk by a woman who had had massive body injuries and accompanying pain and told her story of persistence in "getting her life back." I pointed out that this woman had the financial resources to do what she did, and Dr. Whitehead had to admit that was true.
She encouraged us to interact with each other by dividing us into small groups to discuss the video. Then she focused on "belly breathing" and had us practice for a long time. After that, we did relaxation/meditation and "gentle movement." Our "homework" was to practice "mindful breathing" at home. I knew I could best do that (and the meditation) while in bed.
She ended with a group exercise on the impact of chronic pain, what factors "open the gate" for pain and what factors close it. The whole point was to NOT focus on the pain! Yeah, right, a lot easier said than done!
Friday, January 19, 2018
Day 1 Pain Management Orientation
Francis and Dr. Whitehead facilitated this orientation session. There was a little more paperwork to fill out, but the "samples" of relaxation strategies with the breathing and mediation were longer. There was a lot of emphasis on the importance of attending every session (unless you are ill and contagious!), and required the patients to not only be able to attend every session, on time, and stay for the full 2 1/2 hours, but to be willing to go on temporary disability for 5 weeks. Not a problem for me!
I had already sent email to my web clients:
"This is to notify you that we are going to be in a 5-week outpatient program for Pain Management (January 19 to February 23). This does NOT mean that we can’t or won’t serve your online needs during that time. It just means that our work time will be reduced by 60%, so it might take a little longer to get to your job request. So if/when you have deadlines, please let us know as soon as possible. As always, thank you for this opportunity to be of service to you. Thank you for your patience and understanding!"
I had already sent email to my web clients:
"This is to notify you that we are going to be in a 5-week outpatient program for Pain Management (January 19 to February 23). This does NOT mean that we can’t or won’t serve your online needs during that time. It just means that our work time will be reduced by 60%, so it might take a little longer to get to your job request. So if/when you have deadlines, please let us know as soon as possible. As always, thank you for this opportunity to be of service to you. Thank you for your patience and understanding!"
Wednesday, January 17, 2018
Phone appointment with Dr. Whitehead
I was on my way to the third of my three group acupuncture sessions that Dr. Sumetanon had ordered when my cell phone rang just as Linda pulled up to the front door of Building C. It was Dr. Whitehead, calling right on time as Parisa had said she would.
Dr. Whitehead verified that I could, indeed, join the Level 3 Chronic Pain Group that's starting on Friday, January 19. Yay! She also made an appointment for me, right then and there, for an office visit with her in a couple of weeks. Right after this phone appointment (which I had on my cell phone in the car), I went in for the last of my required three group acupuncture sessions.
Dr. Whitehead verified that I could, indeed, join the Level 3 Chronic Pain Group that's starting on Friday, January 19. Yay! She also made an appointment for me, right then and there, for an office visit with her in a couple of weeks. Right after this phone appointment (which I had on my cell phone in the car), I went in for the last of my required three group acupuncture sessions.
Group Acupuncture #3
Another two weeks have passed, and this is my third group acupuncture session. Today I reported a pain level of 6.
I took this picture inside the group room, showing what I had to look at during this acupuncture session. All the other patients were behind me.
This week, the acupuncturist was a man named Paul Simon. There were two newcomers to this group, and he took time to talk to them before it was time to start the group session. He had charts showing the acupuncture points on the ears and a large model of an ear. He explained that this group used the points on the ear because those were the ones most directly related to nerve pain.
Again, I tried very hard to stay perfectly still and resist any movements of my eyes or mouth or neck--as much as it was painful--so the needles wouldn't fall out. When Paul Simon put in the needles, he was more assertive than the female acupuncturist had been, so I hoped that meant the needles wouldn't fall out!
I took this picture inside the group room, showing what I had to look at during this acupuncture session. All the other patients were behind me.
This week, the acupuncturist was a man named Paul Simon. There were two newcomers to this group, and he took time to talk to them before it was time to start the group session. He had charts showing the acupuncture points on the ears and a large model of an ear. He explained that this group used the points on the ear because those were the ones most directly related to nerve pain.
Again, I tried very hard to stay perfectly still and resist any movements of my eyes or mouth or neck--as much as it was painful--so the needles wouldn't fall out. When Paul Simon put in the needles, he was more assertive than the female acupuncturist had been, so I hoped that meant the needles wouldn't fall out!
Tuesday, January 16, 2018
Pain Management Overview Group
This was a three-hour--just what it was called--overview of what the Kaiser Pain Management program was like. They made it abundantly clear that, in most cases, this would not make the pain go away but would give the patient "skills" to cope with chronic pain. The main presenters were Francis, a physical therapist, and Dr. Whitehead, Pain Psychologist. They gave us just short "samples" of relaxation strategies: meditation, "calm breathing" techniques, and "gentle" movement.
There was a lot of paperwork to fill out and more detailed description of the programs offered. There were two once-a-week classes. Level 1 was called "Calm Body, Calm Mind" and was a drop-in group on Tuesdays at 3-5p. Level 2 was also once a week on Wednesdays at 3-5p with group acupuncture optional but encouraged. I knew I had to go straight for Level 3 called "Advanced Skills for Getting Your Life Back." Francis said the next Level 3 group would start on Friday, January 19, and that someone would evaluate our extensive paperwork and let us know within the next week if we would be a good candidate for that class.
I asked Francis how that could work since the next group would be starting in three days! He said to make a note at the top of my application that I wanted/needed to get into this class. So I did and kept my fingers crossed.
There was a lot of paperwork to fill out and more detailed description of the programs offered. There were two once-a-week classes. Level 1 was called "Calm Body, Calm Mind" and was a drop-in group on Tuesdays at 3-5p. Level 2 was also once a week on Wednesdays at 3-5p with group acupuncture optional but encouraged. I knew I had to go straight for Level 3 called "Advanced Skills for Getting Your Life Back." Francis said the next Level 3 group would start on Friday, January 19, and that someone would evaluate our extensive paperwork and let us know within the next week if we would be a good candidate for that class.
I asked Francis how that could work since the next group would be starting in three days! He said to make a note at the top of my application that I wanted/needed to get into this class. So I did and kept my fingers crossed.
Monday, January 15, 2018
Pain Management Program at Union City
At my last physical therapy session (December 7) in Oakland, my therapist recommended the Kaiser Pain Management program. She sent her recommendation to Dr. Chan and I requested Dr. Chan, as well, for a referral to Pain Management. Instead, she referred me to Physical Medicine and Rehabilitation.
So I saw Dr. Sumetanon in Union City on December 14. He prescribed Flexeril, ordered an MRI, and required three visits to group acupuncture before anything else. He recommended that I attend some of Kaiser's "lifestyle" classes. I told him I was most interested in Pain Management, and he told me that my PCP (Dr. Chan) would have to give the referral to the Kaiser Pain Management program. It was only then that Dr. Chan agreed to give me a referral to Pain Management.
Three days later, I got a call from Pain Management. It felt like winning the lottery! As I had just been hearing from someone in one of my Facebook pain groups who had had to wait over three years to get into a pain management program. Someone else said that a two-year wait was very typical for those who get "free" health care in Canada.
So I saw Dr. Sumetanon in Union City on December 14. He prescribed Flexeril, ordered an MRI, and required three visits to group acupuncture before anything else. He recommended that I attend some of Kaiser's "lifestyle" classes. I told him I was most interested in Pain Management, and he told me that my PCP (Dr. Chan) would have to give the referral to the Kaiser Pain Management program. It was only then that Dr. Chan agreed to give me a referral to Pain Management.
Three days later, I got a call from Pain Management. It felt like winning the lottery! As I had just been hearing from someone in one of my Facebook pain groups who had had to wait over three years to get into a pain management program. Someone else said that a two-year wait was very typical for those who get "free" health care in Canada.
Friday, January 5, 2018
Group Acupuncture #2
This is my second group acupuncture session, miraculously scheduled for two weeks after the first one. Again, the girl behind the screen asked me for my current pain level. This time, I said 7.
She gave me the two alcohol swabs and I knew what to do with them this time. I was not a newcomer this time, but still was one of the last patients in the room to get the five needles in each of my ears. I was a little more on edge this time and apparently twitched my nose too much because 2 or 3 of the needles fell out!
She gave me the two alcohol swabs and I knew what to do with them this time. I was not a newcomer this time, but still was one of the last patients in the room to get the five needles in each of my ears. I was a little more on edge this time and apparently twitched my nose too much because 2 or 3 of the needles fell out!
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