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.

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.

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.

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.

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.