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.

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!

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.