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.

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!

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.