Interim choices

After my head exploded last month, it took awhile to recover. It wasn’t happening while I was up to my eyeballs in what I can’t do and can’t change, even with daily Epsom baths and extra antioxidants. So, I visited Mom for a bit, soaked myself in her hugs and books and art and homey-exotic collections of interior dec from my upbringing and her subsequent travels, had lunch with my cousin (who did an outstanding job of mental chiropracty on my crippled thinking), and came home almost ready to face my current world.

Which looks something like this:

  • Approaching the hard deadline for leaving my rented home.
  • Lump of expensive metal sitting in my driveway, not driveable.
  • Housemate & ex-fiance (who asked me to marry him for 5 years, until I said yes, then refused to set a date) who really truly simply can’t choose a life-ward path but is increasingly obsessed with orchestrating his end… with frustratingly irrational obliviousness that that’s what it is. I could write a book about this — it’d make a fascinating novel — but confidentiality forbids.
  • Understanding that, after 7 eventful years together during which we’ve saved each other’s lives more than once, that’s not the choice I make every day I rise up against my own pain etc,, but HIS path is not MY choice to make.

Okay, bluntly, that’s:

  • No safe-enough home.
  • No working car.
  • Newly “divorced.”
  • Expecting to be imminently widowed.
  • Helpless in the face of most of this.

And this is where I tune into the meditative practices, because there’s a way I’ve learned to breathe that lifts my heart and brings me into life, no matter what. Helps me let go of the need to care FOR someone as much as I care ABOUT them. Releases him and his future to the care of the cosmos, which is a lot bigger than me, and has a different perspective on life.

I have to get back to writing perky posts! I have to live with this heavy stuff, but it doesn’t usually set the tone of my being. I can’t allow despair more than a look-in, so I’ve learned what it takes not to.

…Breeeeeathe…

It’s probably needless to say that I prefer to stay on the kindest terms possible. Keeping my connections pleasant is hugely important in managing the underlying chaos of my system, so my nerves have less to be jangled by. One of my personal mantras is: Someone else’s bad behavior is not an excuse for mine. Sounds rigid, but it works well in the service of my larger strategy of keeping my system on a more even keel.

Here’s where I huff on my nails and buff them on my nonexistent lapel: I stopped 4 efforts to start an argument in 20 minutes yesterday, and I only pulled one of my old habits of “managing” his tortured thinking 3 times throughout the day. Just letting it all go. He is his, warts and all. Only he (I think) will have to face his consequences.

I also found a couple of possibly-soft-enough-ride cars I should be able to afford, with a bank loan. Just need to arrange the ride to check them out.

Here’s a little cherry on top of the hopefully-expanding sundae of possibilities: the ugly and ill-considered business choices made by the dealership who sold me that expensive hunk of metal, can be addressed by filing online (no car trip! No need to collect and print my documentation & evidence ahead of time! No repeat visits!) with the state’s Consumer Protection department. PHEW! I’m happy to let the authorities tackle this while I deal with my present needs.

Life is short; keep it kind. Be good to each other.

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3rd panel of triptych: The action of deciding

This is the third panel of the triptych. It took awhile to write. You’ll see why soon.

First panel: my pre-CRPS decision mechanism broke, but look! There’s a hack for that! Using remaining fragments, bubble gum & baling-wire, and lots of patience, I can still stagger through even fairly complex decisions.

Second panel: Speaking of complex decisions, I’m looking for a home that meets my physical needs and my financial limitations. Turns out, there is no such thing… Yet. Crossing every available digit and getting really creative.

Now: I’ve been mulling the origin of the act of deciding. When does that happen? It goes by so fast sometimes, I find myself dancing on a spinning log of results before being aware of stepping onto it.

It’s my nature to leap to a decision and be told I’m going off half-cocked, but what I’m doing is processing huge amounts of information very quickly at a largely subconscious or pre-conscious level. I can haul out all the arguments pro and con on no notice, if anyone wants to hear them.

At least, I used to. It’s CRPS’s nature to pour a whole lot of crude-oil over everything between my ears, so things just don’t happen that fast in there any more, and the gears are more likely to slip and chatter. So, I go through a more iterative process and take much more time. If I could adjust my expectations of myself accordingly, I’d be all set…

At the moment, I’m viewing the action of choice with great intensity. I’m convinced that decisions are especially difficult, especially fraught, and especially crucial, for people with CRPS. (Not that this is a competition. If what you read fits, just circle it and write, “me too.”)

Layers of decision-ing:
Conscious vs. Unconscious

So much happens at the unconscious level before we even are aware of having a choice, that it’s impossible to discuss a mental action like choosing without acknowledging some of the most important barriers to thinking clearly in the first place. These are factors that many spoonies (and all CRPSers) have to live with and figure out how to handle, or decide not to handle and just be driven by them instead. (The enormous initiative required to deal with them is overwhelming, so I gently suggest being tolerant of those who don’t, or feel that they can’t, circumvent the circus acts desribed below.)

  • PAIN: Acts on the most primitive brain, and the primitive brain can’t think past the moment. Not its job.
    • Takes a good set of pain-management tips and tools to nudge the primitive brain to the back of the car, so reason can drive.
  • FEAR: Fear hijacks the amygdala and activates the fight-or-flight syndrome. Hijacked amygdalas distort the brain’s function even further, and the fight-or-flight response further destabilizes the already-wobbly central nervous system.
    • This is a one-two punch for CRPSers. It takes a lot of training and practice to work around that, but it usually can be done.
  • The MONSTER: know thy (current) self. Those of us with horrifying illnesses sometimes feel and seem like we’re taken over by some horrible, biting, unpleasant person who looks and sounds a lot like us, but doesn’t act like we normally intend to. This is tough all around. I find myself being emotionally hijacked — say, by a food allergy response, or a surprise pain flare — and, as I’m sitting there with tears of rage and fear pouring down my face and snarling, inside I’m going, “What the hell is going on? Why can’t I stop this??” It’s The Monster, and it’s off the leash.
    • Because I self-monitor so much, I can usually catch The Monster before things go too far, and I sequester myself (that is, I hide) and do distraction/self-care/Epsom baths/whatever until I’m back in charge as (& of) myself.

Bases for decisions: Information — & Certainty

When is the info in hand enough — both in quantity and quality — to base a decision on? (This is where I really miss those old rapid-processing days.) More fundamentally, how can I tell? Because determining and sorting the value of info is yet another, even higher-order level of processing than collecting it!

Having to make choices based on inadequate, unreliable, or unknown-quality info is a far more common task post-CRPS than pre-CRPS. Stumbling around in the dark and guessing, hoping for the best or maybe for the kindness of strangers, is not yet a default, but it sure is more common.

At some level — probably that mile-high view that my “wise self” hangs onto, whether or not it’s talking to me at the moment — it’s funny to see a super-clever type A whizz kid with delusions of promotion, like I used to be, stumbling around in the dark here. There’s a poetic justice to that, um, adjustment that even I can see. My darker side, perhaps, which I usually inflict only on myself.

“There’s always an afterwards”:
Sequelae & Consequences

Reality doesn’t care what drives my decisions; the “afterwards” I face is going to be what it’s going to be, and derive largely from the choices I make — not the ones I wanted to make, or was unable to make, or wished I could have made. They stem directly from the choice I did make, consciously or not, emotionally or not, rationally or not, wisely or not. It takes, again, a lot of practice and some basic training to keep in mind that there will be an afterwards, and force myself to make the decision that results in a better afterwards — even if it’s less satisfying at the time.

The increasing intransigence of reality is really annoying! Can’t it work with me a little more? Sigh.

The older, poorer, and sicker I get, the less flexible the world around me gets. Being young and perky was all kinds of help — I had no idea!

everyone over 50

I distinguish sequelae (|suh-quell’-eye|) from consequences like this:

  • Sequelae are natural results of something. They may or may not be a problem, may or may not need managing, but they’re just what happens as a result of factors we don’t necessarily control.
  • Consequences are results that must be dealt with somehow. Assessing consequences is part of rational decision-making. Who could be hurt? What might it cost? What kind of damage, or benefit, could happen? They’re predictable, if we stop and think things through properly. So, there’s a level of responsibility involved.

We RISK possible sequelae. We FACE possible consequences.

Too much decision-ing:
What About Control Issues?

In the category of bottomless dopamine sinks…

Trying to control too much of my environment is a total waste of effort. It soaks up decision-making chemistry, burns through my attention like a bonfire, and creates a lot more anxiety for absolutely zero net benefit.

People who knew (or dated) me in my 20’s quirk up one corner of the mouth a lot these days. I’m happy to let anyone decide anything for me — as long as it doesn’t do any further harm. My emotional investment in things like where to meet or what to eat, interior decor, stylistic choices, what others should do — pretty much nil.

My emotional investment in being in control is tightly centered on protecting my immune and nervous systems. That’s about it. Anything that meets those (admittedly, enormous & far-reaching) criteria and then looks for something more from me gets a big, airy, sky-bright “whatever!”

I realized that control issues were really a type of anxiety. I have my past traumas, like most, and loads of current problems which are terrifying to contemplate, so it’s reasonable to be anxious. Not helpful, though. Anxiety stalls my brain out completely.

This ratfink disease forces me to choose consciously — and learn to enforce skillfully — what to let myself worry about. It’s one of the great lessons of learning to live with this disease. Speaking as someone who started out being mildly thrilled by emergencies and wound up, at my nadir, being unable to get out of my home and onto a bus because of long-legged terror looming and lunging at me, I’m the first to say that managing anxiety is a journey, a process, any of those things that won’t be completed in my life because it now is part of my life.

This is why I now meditate twice a day. I was mulling, about a month ago, how much harder it was to keep my temper or keep my brain ticking over at a functional rate. The Dalai Lama’s dictum came to mind: “Meditate for half an hour every day. Oh, you don’t have time to meditate for half an hour every day? Meditate for an HOUR every day!”

I’d gotten to the point where an hour before bedtime was not cutting it any more. Figuring the Dalai Lama has never steered me wrong so far, I added another hour (or so) of meditation, after my morning pills go down.

I retest that now and then, but sure enough, if I don’t have time to meditate for the morning hour, everything takes longer and everything gets worse. If I do take that extra hour, I’m a lot clearer and my rate of being able to get things done — and to know, moment by moment, what I’m most able to do as my “glasses” change — surges up to a new normal. I’d like to get used to that — but never take it for granted!

Counter-intuitive, to say the least, but I care more about what works than about what I understand or believe.

Now, back to wrestling with reality to create possibilities that don’t currently exist… No hurry, though — doing the impossible usually takes more effort; might as well do it right the first time.

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Decisions 2 – housing

Making a major decision, for someone with so little margin for error as a ragged, underfunded, spoony crip like me, means being able to answer all of these questions usefully:

  • What are ordinary needs and requirements, in this situation?
  • What are my particular needs and requirements they create?
  • What’s involved in an adequate trade-off?
  • What does success look like?
  • Are there any choices that meet my needs?
    If so…
  • What are the usual pitfalls?
  • What are my particular pitfalls?
  • How do I avoid or mitigate those?
  • How do I make this decision happen?
  • Red light signals and how to respond.
  • Yellow light signals and how to respond.
  • Gotchas and how to handle them.

So here I am, bringing my laborious and slow-motion decision-making process to finding a home I can afford and survive. Definitely a major decision.

This could be fun. Or gruesome. I’ll find out.

Let’s take a look at this through the decision-making stages I discussed in the previous article.

Developing good info about the problem to be solved

Housing is a crucial human need, especially beyond the 35th parallels.

Hang on, I need to come back. Everything went white for a minute there. (PTSD about facing homelessness and surviving criminally unsafe living situations? Who, me? Yup.)

The need has been around as long as we have, so the laws and practices are pretty predictable.

There are two normal fiscal options: renting and buying. There is one additional option available to residents of Vermont: buy the house from the state, which keeps the land but gives you the right to use the part your house is standing on.

There are three normal physical options: freestanding home, adjoined units (apartments, condos, townhomes/row-houses, etc.), or portable housing (mobile homes and travel trailers.)

Nonstandard options include buying an RV (made and insulated entirely with Isy-toxic materials) and living with a level of mobility and uncertainty I can’t even contemplate any more; or buying a boat (a.k.a. a mold factory) and living on that, which I can no longer afford in any way. I have to eschew them both.

Adult co-housing is a nonstandard option that has some appeal. A group of adults get together, develop a set of guidelines that (through a real-estate attorney) turn into a contract, find and buy a place together, and arrange themselves on the property according to their contract.

I’ve seen that go very well and I’ve seen that go very poorly, and quite a lot in the middle. It’s partly a matter of chemistry, but mostly a matter of writing a good, clear, solid contract and everyone agreeing to play by the rules and being able to live and let live.

All I need is a group of adults who are not only willing and wanting to do that, but have no toxic habits (like painting or baking), are willing to live gluten-free (except for cold food brought in from outside) and are willing and able to give up wifi and live off of hard-wired internet access only — no Bluetooth — and, most annoyingly, respect hard limits on how much time the cable box is on. Radiation off that thing gives me unconquerable insomnia in the other room from 30 feet away.

Let’s look at how the remaining options fit into the questions I need to answer.

What are ordinary needs and requirements, in this situation (home-hunting)?

Safe, dry, warm, with working doors/windows/plumbing/electrics; close enough to where the person needs to be.

Also, it has to be affordable.

What are my particular needs, and the requirements they create?

  • Mold free living, in this green land of upland lakes, swamps, and ubiquitous streams.
  • No petroleum-based volatile organic compounds — a category which includes regular paint, all low-cost and most mid-range flooring, and every conceivable kind of carpet.
  • Significant air pollution. For me, this centers around internal combustion engines, chemical processing, and fossil fuels. (For others, it’s woodsmoke that smells like doom.)
  • Loud noises and the vibrations that come with them. (You know how the nearest bully used to sneak up behind you, and then smack their palms over both your ears at once? Remember that feeling that your head just exploded, and hot shards jinked down your spine? Kind of like that, times about 1000. A vacuum cleaner suddenly turning on can knock me down. I used to live near railroad tracks; not an option now.)
  • Radiation of many kinds. This rules out being near power stations, overhead wires, hands-free phone technology (Bluetooth or cordless house phones) and (this is really limiting:) modern wireless signals, which feel like a blunt spear piercing me just below my xyphoid process and spinning barbed tails through my trunk while injecting molten metal up my spine and into my brain.

So much fun.

Believe it or not, after hearing part or all of this list, I’ve had people ask me, “How do you know that you need to avoid all that?” It’s not the words, it’s the tone. The implication is that all of this is somehow the product of a fevered imagination. If only it were!

I notice my responses, which are not subtle from the inside; I work out what particular exposure caused that response; and, intentionally or not, I get multiple exposures to each of these things because they’re everywhere, so I can test out the theory that a particular exposure causes a particular response.

It takes a special kind of person to go to the extraordinary effort to research substances that affect fragile systems and how, and claim to be that ill and be required to make all those compromises and spend all that money to avoid those materials, and give up so much because of it, without actually having their survival depend on it. That particular mental disorder is extremely rare — a lot rarer than invisible illnesses. Anyway, it’s one thing I definitely don’t have.

Examining the options

Rent or buy?

Good question. Let’s look at those from my point of view.

Renting

Rent tends to cost, month per month, about twice what home ownership does around here, even with all the taxes and fees figured in. Boggles my mind, but there it is. (Homeownership has loads of hidden expenses, but rarely do they double the cost month after month.)

Rentals are supposed to get repainted every two years or between each tenant, whichever is longer. That really sucks for me, because even low VOC paint makes me sick, goofy, nauseous, edgy, and unhappy for weeks.

The majority of rental units have carpeting, mostly cheap carpeting consisting mostly of petroleum derivatives, aggressively outgassing toxins all their lives while harboring mold and less savory things beyond the reach of steam cleaners.

Rental units in my price range are in high density housing (meaning there’s normally pollution, Wi-Fi, and noise completely beyond my control), and every single one that I’ve looked at has a mold issue – a solid, interlaminar set of colonies, usually in the kitchen and bathroom, often in the bedrooms, and if they’re in the bedrooms, they’re in the living rooms as well.

So much wrong.

In any case, unless I can find low income, high density living with non-toxic interior furnishings, nontoxic finishes, hardwood floors, no mold, good air, no pollution and no street noise (which would be fantastic for all concerned!), where all my neighbors have no power tools, dulcet voices, and no interest in using their cell phones every hour of every day (yeah, right), then… I probably have to think in terms of a freestanding house.

From the practical standpoint of having people to say hi to and help shoveling the stairs and the like, I would love to have close neighbors! It’s just that I need not to put myself in a position to be poisoned and tortured by regular people simply living their lives.

Buying

What with one thing and another, I realized a year and a half ago that I would have to focus on a freestanding house – despite all the upfront cost and work involved in that. It’s kind of like jumping off the deep end, an especially apt metaphor for a lifelong skin-diver, deep-water sailor, and former live-aboard “grotty yachtie” like me.

I’ve always had a pretty good instinct for real estate, which annoyed my father more than once – he kept ignoring my advice. The prices here only bobbled, they didn’t bubble; the overall trend has been gradually, consistently, steadily upward for a century or more.

This IS a region where it’s a good investment.

Buying requires good credit, but after LINK some work and time, that’s not a problem.

First-time homebuyers and low-income home buyers have special government programs that make it possible for them to get loans from banks by insuring those loans with the feds. Of course, the federal government has to be working for that to happen. (That could happen any month now. Maybe within a year?)

All I want is a clean, dry, safe-for-me 600-800 square-foot house on a couple acres of buffer zone for ~$135k inclusive, somewhere in the area of Easthampton to Heath to Montague to North Hadley, on a paved quiet road.

This is a reasonable price for a reasonable proposition. However, in two years of looking, it hasn’t turned up.

But I’ll show you what has turned up:

Century floodplain houses

How do you spell “moldfest”? It’s actually called “Sick Building Syndrome”, but either way, there’s a reason these places are cheap and still on the market.
[The century floodplain houses]

Foreclosures
First-time homebuyer loans will not cover these, nor should they. Foreclosures are the ultimate black-box proposition — you have no idea what’s in there, but a few observations and questions have taught me to interpret clues. I won’t bother you with photos, because these have since gone off the market and I’m not researching foreclosures any further:

  • Great little house in a gorgeous spot… with a cracked foundation — I mean a busted-right-open-and-let-the-critters-in foundation.
  • Current tenant dropped not one, but two trees across the driveway. Is that a hint? I was curiously disinclined to investigate.
  • The house has stood empty for over a year, and because of that, any characteristics that weren’t up to modern code are no longer grandfathered, but have to be corrected before moving in. This seems to add 30-120% to the effective price, and in one case I looked at, would have cost 3 times the purchase price just to turn it into a code-compliant property.
  • Extensive plumbing work is often required: in one case, the well went bad; in another, the septic system was toast; in many foreclosures, the sinks and toilets are smashed apart to discourage squatters — and add enormously to the repairs required of pipes, flooring, and walls affected, not to mention the porcelain.

[Several examples of what’s in my price range, with wry commentary]

[The total reno, with the great bones] I love this. I would LOVE to get my hands on this. Sadly, I’m now a formerly handy person. Holding the tools required, let alone breathing the dust and fumes involved, are sot even to be thought of. Breaks my heart, darn it! This would have been so much fun!

My needs and wants are very reasonable, but apparently, a place that embodies them doesn’t already exist.

It’s horrifying to contemplate, but I have to think about building my own. There are so many issues, both physical and fiscal, that it simply boggles the mind. Just to start with, how is a first time, low income home buyer going to qualify for a building loan, even where there is so much documentation regarding these special needs?

I’ve spoken at length with builders specializing in non-toxic homes, one company’s owners giving me what amounted to a three-hour workshop in materials, gotchas, and things to know and watch out for in regard to renovation and building. It doesn’t have to be much costlier, but it requires an enormous amount of project management on my part to keep costs down by researching and sourcing used or overstock fixtures and fittings, hardwood flooring, non-toxic and natural finishes (some of which I worked out how to use on my boat), and so forth.

I’ve come up with a couple of novel ways to simplify plumbing and electrics, which are in compliance with the current building codes. (The electrician and builders I’ve mentioned it to are intrigued and plan to keep my ideas in mind for the future. I find that encouraging.) That’s one way I’ve brought down some projected costs, although it depends on my being able to do certain physical work.

I’ve also researched the toxins, materials, labor, permitting, and costs involved in prefab vs. stick built (traditional) vs. log building here.

What I’ve learned about heating methods (toxicity, mold, fuels, weaknesses, etc.) would bore you to tears. I just have two words: steam heat.

While I have always imagined/dreamed of living in a hexagonal stick built house with lots of windows and two small wings, it turns out my family have always imagined I’d wind up in a little log cabin. It looks like they might be right.

What’s involved in an adequate trade-off?

I have to know where I can be flexible. This wiggle-room could make the difference between having a rational home and spinning off the face of the earth. (Two people who couldn’t find a home in time were found frozen to death yesterday. I’m trying not to think about that.)

There’s a little bit of slack in my needs, but not much.

Radiation (from heavy electrics, heavy electronics, cell phone towers too close, and wi-fi) is a no go.

VOCs that can be washed off, treated with pine and baking soda, or aired out in a few days would be fine.

Treatable mold would be fine, but, unfortunately, by the time it shows, there’s usually a well-established root system inside the wall and mitigation becomes the sort of iterative, messy, relentless, and ultimately unresolved nightmare that usually takes three scream queens and gallons of artificial blood to get across on the silver screen; respiratory struggles, immune failure and mental impairment aren’t nearly as dramatic on the outside as they are on the inside.

What does success look like?

I could be really flippant and say that success looks like an added hundred thousand dollars free and clear in my mortgage account. That would definitely put me in a price bracket that would allow me to have my log cabin, with the right fittings and finishes, in a safe clean area, with everything I need and nothing I don’t. Plus…

I used to dream of having a big enough property to put additional cabins on, and provide safe non-toxic living for friends who like small spaces, and maybe some glamping spots for the summer. I’ve already got 2 friends who’d love to sign that lease as of yesterday, and 3 more who’d love to think about it, and that all turned up in 2 conversations. There is clearly a market for safe, small, inexpensive housing, and it would be a good, benevolent, and sound investment. However, the start-up costs (more buildings, more slabs, more plumbing, more septic, etc.) are unthinkable for me. I just don’t have that.

This is where being poor is super frustrating. (Yes, I really do think this way … I’m more frustrated that I can’t help others than I am that finding a place for my own self is so hard.) I could so easily provide safe and sane housing for people who, like me, are fighting their environments all the time, and who would, if they could, much rather be using their energy to contribute to the world. And helping pay my mortgage. There is no downside.

There is no money for it, either.

Okay, onward.

What does success look like?

It looks manageably small, manageably affordable (or self-supporting — hello, cabins!), safe, clean, healthy, nontoxic, and warm.

I have a lot to do, and a lifespan truncated by probably 25-30 years. I’m genetically wired for my 90s, if I don’t smoke, which I don’t. So I’d better hustle!

In order to do my work (write my books, produce my pain-mitigating products, do live trainings on handling chronic pain and disability at home and at work, etc.) I need a home that doesn’t make things worse; Time alone will do that. It doesn’t need any more help from my living environment.

My success path is very, very narrow. I’m still not sure how to get there, but I have a few more interviews with specialist professionals ahead of me.

Are there any choices that meet my needs?

According to two years of market research, there is nothing already built that meets my needs in my price range.

I might have to make it myself, whether I like it or not, whether it’s easy (which it was never going to be) or not, whether there is any standard path to get me there, or whether I have to forge ahead and work the steps out one by one, going purely by what works for me – as I did with CRPS for so long, before clinical practice caught up with what I was doing.

I’m a very reasonable person. I’m just in a very unreasonable situation.

…Again.

I’m almost used to it. Sigh.

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Decisions, decisions, decisions (this is a triptych)

WordPress has utterly changed their writing UI. Apparently, they felt the need to reinvent text entry… (um… Why???)

I usually hold off on publishing a post until I’ve got the formatting tidied up and the images in. I can’t even figure out how to do that yet. So I’m posting a couple of ragged, really funny-looking articles, because it’s better than not posting at all, and there is SO much to keep up with I don’t want to keep falling behind here.

Back to our regularly scheduled programming…

As I’ve said before, making decisions amidst pain-brain and the neurowackiness of CRPS is not the easiest thing to do.

It takes more effort and time than it used to, but the years have led me to certain strategies that help me make good decisions pretty consistently, even though doing so is such an up-hill task.
[Sysiphus image]

1: Good info about the problem.
The idea of “good info” is key. For health and practical matters, I need my info to be coherent, consistent, reliable, and reasonable. Above all, I need it to reflect reality — in other words, to be true.

Opinions are not info, except when they are.

“Hey, thanks for that totally meaningless sentence, Isy! That’s not confusing at all!”

But seriously — a professional opinion, about something that’s pertinent, does matter. That opinion goes into the data pool.

Personal opinions, which are usually accompanied by logical fallacies[LINK], are not data (except to sociologists and comedians) and will never be useful to me. I can provide my own, if I want them. I’ve got loads of opinions, but they go up on the shelf when I’m culling information.

I need facts, data, professional (or highly-skilled amateur) quality input.

At this point, I’m not always as diligent about that as I think I should be. A large part of this early stage of inquiry is getting a sense of the social and cultural clues. I find it almost impossible to immerse myself in a subject without letting in some of the noise around it. /shrug/ Not perfect yet.

1a: Enough good info

After mulling things for a bit, I find that the lower-quality info annoys me instead of pulling me in, and I seek out more higher-quality info with a better basis in experience or science or whatever the best measure of the field is.

I’m building a mental map of the field, and where I see blank spaces, I try to fill them in with information.

  1. Good information about my options.
    This is where it gets interesting. Because of my significant non-standard needs, which are not so much a matter of taste as of survival (key point there!), I have to put extra time, diligence, and effort into developing a good list of options, because by the time I’ve done a reality check to evaluate my options against my diseases and disabilities, the REAL options available to ME tend to be few — even where most people would have a lot to choose from.

This is one of those occasions where the limits I live with just hit me in the face, and I have to figure out how to deal with a reality most people can’t even wrap their heads around as anything other than a bizarre whimsy or a sign of questionable judgment.

That hurts.

Moving right along here…

  1. Time to digest it

[use nav. tree image to illustrate how I absorb info, so it can be used as needed in any context.]

Reality check #1 — floating trial balloons
This is when I can sound half-cocked, because the decisions are floating around in my brain in about 5 dimensions and don’t readily lend themselves to explanatory words. Action words, yes, but not explanatory ones. So,it sounds like I’m going off half-cocked, when what I’m doing is trying on a decision for size.

My focus is oriented towards implementing my current decision, and of course at the time I always think it’s the Real Plan. If I didn’t, I wouldn’t focus as hard and pay as close attention to what goes on when my decisions meet the outer reality.

At this point, I’ve got the basic decision made, and I’m roughing out how to make it happen.

Because I have a peculiar set of circumstances (in every possible respect, it seems), my decisions are rarely off-the-shelf solutions. Every solution is customized. They have to be, or I suffer, lose brains, and die horribly. Or, at least, things don’t go well. YMMV — my mileage varies all the time.

  1. Digest results and lessons learned
    Just what it says. This is a semi-conscious process that I can feel happening, but doesn’t lend itself well to description. It’s more of the tree-and-grass activity, adjusting and tuning my ideas and understanding all the way down and all the way across and all the way up the related chains of ideas. It takes a lot longer than it used to, but it does happen if I’m patient and let it be.

In time, what I don’t know becomes obvious to me, and what I need to unload just goes.

If, at this point, I’ve got a workable choice, I’m done. Time for the next task.

If not, time to re-assess and re-evaluate.

  1. Seek out more and better info
    At this point, I’m past online research alone; I need to talk to experts. This involves phone calls and meetings and interviews. The face-time may not be free. The mobility may not be easy. I may have to spend more time on the phone than my brain is, er, quite happy with.

This one-to-one contact is a super-effective way for me to get more info out of people than they’re aware that they’re sharing, so if I can afford it — physically and fiscally — I’ll do it.

Naturally, being me (and wanting to get the most out of everyone’s time), I prepare for these conversations. I want to make sure I:

  • Have the vocabulary. I’m not at all afraid to ask for corrections, but it’s essential to have a working vocabulary of the subject and the major professionals involved. An hour or four over a few days of web-reading usually provides enough context for me to get going with.
  • Can show an intelligent interest in them and the subject. They need to know I’m taking them seriously in order for them to take me seriously. An extra 15 minutes on their web site, learning about the people and history behind the industry or company, pays off hugely.
  • Have a clear, specific answer to the question, “What can I do for you?” I need to know what it will look like when I have the answers I’m looking for. That means I need to have a pretty good idea what my questions should be. This is rarely as easy as it sounds. All those orbiting words and ideas have to be beaten into some kind of shape so the question marks bursting out of my head have meaningful sentences in front of them.
  • Have note-taking or recording equipment appropriate to the format of the meeting and my physical and attentional abilities at the time. I need notes. As medical professionals get drilled into our heads, “If it isn’t documented, it didn’t happen.” Plus, I want to make sure I get the data right. The ideas I can process; it’s the facts and figures and new terms I need to preserve.
  • Correct contact info for those I want to talk with. (It’s the little things…)

Since the bulk of my online research has already happened, the online part of this “more and better info” search is largely backward-referring:

  • Reviewing the websites I found most helpful
  • Chasing down data or info that seemed less important then, but deserves attention now
  • Filling in holes I didn’t notice or didn’t care about before, but want to clear up now
  • Going through my Evernote directory, if it’s a subject that needs one, and making sure I have enough info in it that I could go back and reconstruct my reasoning just from my information pool.

The discussions and “interviews” with friends and trusted contacts are important (especially in relation to whether an option matches my needs) but much more casual. A significant exchange can happen in 15 seconds at the deli counter or between gossip and talk about the weather. I can “download” a huge amount of info in these brief, solid exchanges with people who know me well.

Therefore, after a certain (large) amount of data-gathering, thinking, and processing, it’s essential for me to do sanity-checks and get assessments from friends and contacts I trust in that context.

  1. Reality check #2 — feasible plan, with fallbacks
    This is where the adhesive meets the tacky surface. There’s a lot more weight and momentum behind a plan that falls into place after all that thinking and working and studying up and experimenting, and it shows.

At this point, I should know what a successful outcome involves, what the major pitfalls — both generally, and for me particularly — could be and how to avoid or mitigate them, and what the likeliest way to implement the decision successfully should be. I should also have a good idea what “yellow light” and “red light” signals to look for, and what to do if they happen. I should have a good idea what the first round of “gotchas” might be and what to do to avoid them or deal with them. (Later “gotchas” are less likely to be out of the blue, and can be figured out more easily.)

To think it used to be so easy, and lightning quick, before I got sick.

I remember wondering, almost a decade ago, how I could possibly make sound decisions when there was so much that was so uncertain in my mind. The time passed, I kept working on it, and the decisions involved in making a process for decisions evolved into something repeatable and reliable. Phew!

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Mental toolkit for overwhelming times

As I’ve said before, much of brain-retraining has to do with speaking to the primitive parts of the brain in ways it can’t ignore.

Being overwhelmed is very common these days. So, this tool is helpful for far more than just  my fellow painiacs. I originally laid this out for someone else dealing with very different issues, and realized as I did so that it was a darn good tool and I’d have to remember it for myself. It has already been a help to me, so I hope it helps others as well.

The State of Overwhelm

I can tell when I’m in the state of Overwhelm because life is just a big old mess of decisions and problems and unresolved issues which are so toweringly massive they stop making sense. My usual ability to sort and prioritize and manage information freezes up, and my brain skids off into the ditch.

pencil and ink wash drawing of WW 1 red cross van sliding backwards off a mountain road

Once I’m in Overwhelm, it’s unreasonable to try to reason my way out of it in my usual way. Each thought is blocked by half a dozen issues backed up against it.

I’ve got to simplify. Not just that, but I need to SUPER-simplify — break it down into binary questions — that is, questions with only one of two possible answers. It’s the only way I can start managing the pile.

(What follows is a technique used in several disciplines. I’m avoiding jargon and simply using the words I use in conversation.)

The roadmap out of Overwhelm

When I was rebuilding my credit, the first thing to do was to figure out what I really owed, and what someone else was supposed to pay. This is a good template for dealing with Overwhelm.

First, whose job is it, really?

When I get overwhelmed, it’s hard to tell what’s my responsibility and what’s really someone else’s. It feels like this:

white box with orange speckles throughout, with the words "my job" on the left and "someone else's job" on the right, with no barrier between them

All the jobs are kind of muddled around in the space and there are too many jobs and not enough space.

When I draw a mental barrier between the two, things suddenly start to clear up:

plain white box, with a line down the middle. "my job" in left part, "someone else's job" in right part.

Notice that, at this point, I don’t need to know who the “someone else” is; the first step is to be clear about whether it’s my job or not.

Managing my care?

my job slash someone else's job box, with my job illuminated and someone else's job darkened

Ordering tests and prescribing meds?

my job slash someone else's job box, with someone else's job illuminated and my job darkened

Testing those meds on my system, tracking their benefits and drawbacks, and updating the prescriber?

my job slash someone else's job box, with my job illuminated and someone else's job darkened

Keeping the dishes clean?

my job slash someone else's job box, with someone else's job illuminated and my job darkened

Keeping the outside steps de-iced?

my job slash someone else's job box, with my job illuminated and someone else's job darkened

(It’s my one outdoor job, and my partner does everything that I can’t and a lot that I shouldn’t, so I bundle up and take care of the steps without a whimper.)

Second, is it something volunteers can do or is it a professional job?

This is an important distinction.

binary box, with "volunteer job" on left and "professional job" on right, with bar down middle dividing the two

When in doubt, upgrade.

Volunteers

Take care not to abuse the skills of your volunteers. You may know lawyers, counselors, accountants, and so forth, but that doesn’t make it right to ask for free professional services from them, except under unusual circumstances.

If those who help me out aren’t being paid (either by an agency/employer or by me), then they’re a volunteer, regardless of the skills they have.

I tread as lightly as I can on my volunteers. It’s an important long-term goal not to alienate them, but to keep them comfortable with me and happy to stick around.

Professionals

The corollary is, I have high standards for my professionals, and hold them to those standards with all the clarity-with-courtesy I can manage. I have no hesitation about firing someone who consistently fails to measure up.

I put a lot of legwork into choosing my doctors. Here’s an overview of the process and links I used a few years ago: How I find my doctors

It’s certainly worth the time and effort to find good people who can do justice to your life and your needs. The question is whether you can find the slack. I hope so.

Examples

Fix the heater?

binary box, volunteer/professional, with professional job illuminated and volunteer job darkened

Put us up for a night until it’s fixed?

binary box, volunteer/professional, volunteer job illuminated and professional job darkened

Give hugs, tea, and sympathy when I’m recently bereaved?

binary box, volunteer/professional, volunteer job illuminated and professional job darkened

Train me in how to get my brain to reprocess deep pain (and the staggering scope of loss associated with it) without short-circuiting?

binary box, volunteer/professional, with professional job illuminated and volunteer job darkened

This is definitely not for volunteers; too much knowledge about neuropsych and too much investment of time is required.

Professional level brain & mind care

For some things, talking to a friend, doing something strenuous, or meditating a lot, is enough to allow a person to heal heart and mind. Life itself is generally a good therapist.

Some things are too complex, too deep, or too dangerous for amateurs. Despite our longstanding social taboos, people with recurring trauma (like central pain or abusive relationships) or PTSD (like survivors of war or child abuse or those who’ve been through worker’s compensation or disability applications on top of a devastating condition) are right and smart to get highly-qualified care for resolving the damage that these things do to our minds and our brains. The damage is not imaginary, and sheer force of will is not a great tool for healing it.

Sketch of brain, with bits falling off and popping out, and a bandaid over the worst

It CAN be healed, even the worst of it. It does NOT require chewing over the past; in fact, that’s often avoided in modern trauma counseling, because that can do to the PTSD brain roughly what our recurring pain does to  CRPS brains.

Line drawing of brain, including medulla, sliced near the middle so the lacunae are visible.

Some techniques DO re-map and re-train the brain to make room for more stability, more healthiness, and move even a CRPS’d brain closer to a normal state.

Less pain! More joy! Less instability! More abilities 🙂

Some keywords for finding relevant mental health professionals: trauma-informed, PTSD, pain psychology. These are jargon terms that usually indicate the professional understands how these profound experiences affect our brains, and how that can be rewound or reworked to a better state.

Another thing you can do

It helps to vote for legislators who see the value in health care, including mental health care. Conservative estimates say that each $1 spent on care saves between $10 and $100 in downstream costs (ER visits, health costs, police activity, lost productivity, lost wages, family impact, etc.) Middle-of-the-road estimates place the savings much higher.

Something to think about, in times like these.

Find your legislators here and let them know what you think:

  • In the US, here’s where you find national, state, and local legislator info: www.usa.gov
  • Canadians, here is your national parliament contact info: http://www.parl.ca/

Please feel free to add contact info for elected officials in other countries in the comments below. It has become clear that voting is a health-care issue.

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CRPS terminology, under the nervous grin

After talking with patients, doctors, and loved ones — and, as a trained observer, carefully noticing the changes in posture, expression, and tone as I’ve done so — I’ve arrived at the following conclusion. I realize it flies in the face of current accepted usage, but there are some things wrong with current accepted usage, and I don’t mind saying so.

/SeeYarP’Yes/ is not that hard to say.

No, it’s not proper to call it CRiPS unless you yourself have it. This is partly because “crips” is a term of abuse for disabled people and using the term for a particular set of disabled people won’t change that, and partly because Crips is the name of a violent organized crime group originating from Southern California. Neither is an appropriate form of address for those who have the most disruptive and intransigent pain disease known to science, and can’t perpetrate violence because of the devastation it wreaks in their own bodies.

Those who have this disease sure don’t need to be subliminally messaged with either association.

I understand that young docs are being trained to use the term in order to remind themselves that it is, in fact, a disabling disease. My view is that, if you’re smart enough to graduate from medical school, you’re smart enough to remember that disruption of the central nervous system can be pretty freaking disabling, in CRPS as in spinal injury or Alzheimer’s or anything else that disrupts the normal structure, chemistry, and behavior of the central nervous system.

The fact that the current name focuses on “pain” is a problem of nomenclature, which will change again as it often has since the year 1548 when it was first described by Ambroise Paré, father of forensic medicine and physician to the French court at the time. (Look him up — great guy. Prefigured that outstanding physician and gifted schmooze-meister Dr. Silas Weir by over 300 years.)

CRaPS, as in the game of chance, is not recommended. It sounds like a vulgar term for bowel excretions, which is — if possible — even more inappropriate. It’s certainly a “crappy” disease, but having said that, it’s time to move on and not keep reminding someone that they feel (and believe they look) like shit.

Of course your CRPS patients say they don’t mind. Check the power differential; their ability to bear to live is in your hands, doctor/loved one, so they’re highly motivated to be nice and go along with anything that doesn’t involve an immediate threat. They want you to feel good about them, so they will laugh along with you, however unreal it feels.

Have some decency — don’t call them or their disease CRiPS or CRaPS, even if they say it’s okay. They don’t need to feel any worse than they already do.

The CRPS patients can call it whatever they like, because only they know how bad it really is, and have the right — and need — to cuss it now and then.

/SeeYarP’Yes/ is not that hard to say. It’s only 4 syllables, like “pain diseases” or “really bad day.” It’s 20% shorter than the word “dehumanizing.”

This moment of intellectual — and emotional — honesty has been brought to you by a nightmare I woke up with this morning. My nightmares are a direct result of my disordered central nervous system, which can no longer process things normally and has to roil around and tear up the pavement in between the constant push-back and re-organization that takes place in my waking state.

It’s pretty crappy, not to mention crippling. But I rise above it, yet again, as I intend to do every day until the day I die. I sure appreciate anything others can do to avoid making that harder.

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Related: health care coverage, economic policy, and racism

The same thinking that underlies racism, sexism, and classism underlies the thinking that says, “Hey, let’s get rid of health care coverage for those who aren’t federal politicians, well-employed, or wealthy.”

The bottom line is treating people as things, and money as the thing of most value.

All humans have something to give, which is only freed up when the basic needs of survival are met; money is a means of exchange but is, itself, neither food nor drink nor fuel nor care. It only gets us any of these things if everyone buys into it as a medium of exchange. That piece of paper has no intrinsic value.

Rational policy is based on the understanding that humans give and receive value, while money represents a part of that value. Corollary is, money must move around to gain value; letting it pile up in drifts and hold still is bad long-term policy, as Reagan’s advisors can now see.

“Trickle-down” assumed that rich people would spend. Rich people don’t spend. They save and invest. Thus, their money moves as little as possible, in order to keep more money coming back to them, where it stagnates further. The real economy (wages, employment, individual bankruptcies, COL, savings, home-ownership, etc.) is nearly dead in the water, but the stock exchange is doing better than ever; that’s how bad the disconnect is now.

With wages lower than a worm’s belly and the formerly-thriving middle class nearly all gone, most human energy is consumed by the struggle for survival. We have, in fact, enough resources and infrastructure that the only people who need to work are those who really want to (that would still be far more than half of us; stop seeing your exhaustion as laziness.)

Given the chance to survive, humans give back. It’s simply what we do. As some cities and a few countries have discovered, with housing, food, and care assured, creativity and productivity blossom. Value grows. Stability grows with it. So does the economy, by the way. Not in leaps and bounds, but at a steady, calm, non-bubbly, sustainable rate.

Weird idea, eh? I mean, who wants stability, right?

matchgrins-horsenwoman_decamps-pauline_4blog

I’ll give you a moment to pull yourself together…

Keeping people feeling cheated, disenfranchised, and looking for someone to blame other than those who hold the scales, is a great way to kill that kind of success. Racism, sexism in all its forms, and classism are the key tools used to divide and conquer us.

By request, I’m pasting in a stream-of-consciousness post I made elsewhere about racism. It relates to “living anyway” because, as with having a horrible disease, having and not having race/gender privilege does NOT have to poison my life, destroy my chances for freedom-within-my-limits, or negate my right to find true joy.

I know you know this about me, but in light of the horrors of the week, I just want to lay this out there, in order to be absolutely clear. Ready? here’s some Isy intensity. (Is-ensity?) …

 

I abhor racism. I abhor it in myself above all, and every day I try to educate/inform/reflect/analyze/remove a little more from my own mind and heart. I screw up sometimes, and the guilt for every screwup never leaves me. (True. OTT, but true.)

 

None of us are free until all of us are free. That’s not polemic, it’s basic psychology. The thinking that pulls us apart is irrational and hostile to our individual and collective well-being. Take a course; take two; you’ll see. It takes real work to get through the mental blocks to understand that fully, and classes provide the guidance and support to make that task feasible. It’s worth it.

 

I take an anti-ism/liberation course or pick up an enlightening book once or twice a year at least, sometimes more if I need it. The reason is this: I shower every day or two, because if I don’t, the stink builds up; same thing happens to the mind of a White woman living in this grubby world. Gotta clean up my thinking, because it’ll inevitably get mucked up by living in my skin in this larger reality.

 

  • As long as Native Americans of all ages are systematically robbed and murdered and left uncounted, I’m hollering for justice;
  • As long as Black people are shot down like amusement-park targets, I’m a co-conspirator in Black liberation;
  • As long as Latinos are thrown out like trash, I’m a gringa curandera for the soul of this nation;
  • As long as Asians, from the Subcontinent or the mainland or any of the islands, are silenced, entombed in unmarked graves, and their history erased from these shores, I’m an impassioned teacher of history;
  • As long as … go on, try to think of a race this country HASN’T systematically trashed. Even Whites — cf. indenture, which has changed its name but not its condition since the founding of this country.

 

Think the rich are free? Imagine the underlying terror of knowing that 99% of the population would gladly end you and destroy all you cherish. (A bit like the rest of us feel about the forces they keep in play, but still.)

 

Want to know more? Use primary sources. Nothing is more telling, or compelling, than the words and images of those who were there. Want to know what the data are? Go to the proximal sources — ignore the pundits. Racism, and its toxic twins classism and sexism (including gender isms; graduate class on that coming shortly), poison all didactic thinking to some degree. Look at primary sources, and digest them yourself. It’s worth it.

 

None of us are immune from the effects of racism. Even loads of money only cushions you, as long as you can access its benefits; it doesn’t make you safer outside your circle. Speaking as someone who changed socioeconomic class dramatically, and rather quickly, I’m strongly aware of the value of having social ethics that don’t lock me to an income bracket or neighborhood.

 

Nobody, but nobody, is free, until all of us are free.

Hatred is no way to run a country, let alone a life.

 

Fiercely and lovingly yours,

Isy

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Freaky Fibro and the elegance of precision

As the title hints, it’s been another fascinating visit with my pain diagnostician.

His current working diagnosis is fibromyalgia, which he characterizes as being capable of throwing some hairy curve balls (my terminology, not his) including the growing litany of food sensitivities, which solves a major problem in my mind.

Thyroid disease can also trigger the symptom complex that otherwise gets tagged “fibromyalgia” (more on symptom complexes in a minute.) I mentioned that I’ve had my thyroid checked several times and last year came up with Hashimoto’s (meaning my immune system is attacking on my thyroid.) Since I developed the first symptoms of this central sensitization around 16 years ago, it seems not like a precipitating event; since “normal” thyroid activity is not the most meaningful term, I’m not sure it’s irrelevant. I guess I’ll learn more as we go on.

He’s also checking my hemoglobin A1c to check for underlying blood sugar instability. I’m always happy to check that. Also B12 (pernicious anemia etc.) and D3.

Now we come to the fascinating (and crucial) distinction between a symptom complex and a disease. Both are used as diagnoses, but they mean different things. (Yes, I’ve used the word “disease” indescriminately here, for simplicity.) Medically speaking, a disease has a cause that can be targeted, what you might call a diagnostic end-point. A symptom complex doesn’t have that level of targeted responsibility for the illness; it’s a consistent set of symptoms that cluster together often enough to get a diagnostic label, which takes some doing.

Here are the two scenarios.

On the one hand, you’ve got someone with a lot of pain, funky guts, sensory reactivity, and normal labs. The doctor (we hope) rules out any other possible cause, and decides the diagnosis is, say, Fibromyalgia. This is a symptom complex, because it’s described in terms of what it does to the person, not in terms of specific pathogens or organs as the causative thingy. (I’m tired; thingy will do.)

On the other, you’ve got someone with a lot of pain, funky guts, sensory reactivity, and thyroid labs that are out of whack. Further examination of the thyroid discovers specific thyroid abnormalities which can be treated. With treatment, the symptoms subside or even disappear. The diagnosis is the disease of hypothyroidism, with a diagnostic end-point in an organ (as in this case) or pathogen.

CRPS/RSD, Fibromyalgia, and some other hideous conditions are symptom complexes. This is used by some as a reason not to “believe in” those conditions, because they aren’t “real.” This is intellectually dishonest, but it does no good to tell them that; assuming that a lack of diagnostic end-point equals lack of ill-health is blatantly absurd, but this is a reality we must contend with. It’s a drawback of having such a flexible language as English, where the same word can mean different things from one context to the next: in Plain English, disease and illness are interchangeable, but in Medical Jargon, they’re definitely different: disease means specific diagnostic end-point, illness tends to suggest a pathogen, and condition is the catch-all term — but is used more for things that really aren’t diseases or illnesses. Another example on a hot issue: in medicine, narcotic refers specifically to opioid analgesics; in law enforcement, it’s a MUCH wider term, encompassing any substance that legislators have decided is not legal. In courts, the meaning of the term has to change depending on who’s involved, which has to be weird.

No wonder there’s confusion around anything medical. What a setup, eh?

This brings us to the physician ethical structure this doc works with, and where it fits into this patient’s worldview. You can almost hear me purring comfortably from here.

He speaks of himself as a Palliative Care specialist. Most people think of Hospice when they hear palliative care, but it’s wider and simpler than that. It means this physician has chosen a field defined by the fact that his patients will probably never recover. That’s what palliative care means: keeping the patient as comfortable and functional as possible, for the rest of their (probably, but not necessarily, truncated) lives.

Yeah, pretty darn special. How many of you who see pain docs hear them use the term “palliative care” naturally and fluidly, without wincing and scuttling on? It’s a little thing that means a lot. It makes me realize I’m seeing a doctor who CAN be there for the long haul, if need be. Someone who would NOT throw me off with the very natural cringe of frustration and failure most docs feel when they can’t save you, or when you’re in the final downhill slide and they can’t face you dying. He can take that strain without failing me. That’s rare indeed.

Palliative care is the very heart of chronic pain care, and I couldn’t face that myself until today.

So now I just have to die before he retires…

Kidding, Mom!

I’d like to go over his approach more, but the fog is descending; it was an early morning and I’m paying for it as usual. I’ve got lots of notes, though. It’s great food for thought, so, with luck, I’ll come back to it.

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Different doctors FTW

My pain diagnostic specialist is elegantly opinionated. Fortunately, he acts out the distinction between being opinionated and being rude about it.

We talked over a few things today. He’s still researching my past exposures to uranium, which he has a hard time believing wouldn’t have lasting effects.

He spent a lot of time combing through the idea that evidence-based medicine (in the sense that doctors use the term, not the sense that insurers do, where it means “how can we treat this as cheaply and barbarically as possible”) is really the best and least scary thing out there. Because, data.

I mentioned Dr. Scott Reuben at this point, and he owned that the scientist-practitioner does have to practice with integrity for the science to be meaningful.

He went on to say that the miracle cases that wind up in the literature leave physicians panting to find the next patient who shows up looking just like that case, so they can try the miracle. Doesn’t happen much, and so, there winds up being a paucity of data on rare cases (like mine) that meets the criteria of medical science as he sees it should be.

In the end, as always happens in conversation with a physician who has intellectual integrity, we found ourselves in the cleft stick of modern science:

While statistical probabilities indicate the best chances of success for groups overall, it has two glaring weaknesses, even in ideal circumstances: statistics depend on copious data, which aren’t always obtainable; and statistics mean nothing in the case of the individual.

Thousands of individuals are studied in order to come up with meaningful statistics. Of those individuals studied, how many respond to the treatment at the level of the group’s statistical probability? How many patients in real life will respond at that level? Pfft. All the statistics do is tell you how much of a crap-shoot a given treatment really is; it doesn’t tell you how well or badly it will do for you.

Last Friday, I saw my allergist/naturopathic MD at Northampton Integrative Wellness. He’s exploring mold toxicity, which sure hits all the hot issues I deal with. It doesn’t meet Dr. Saberski’s mental criteria, as I suspected, but that’s okay — I don’t need Dr. Saberski to follow up on it. I need someone like the docs at Integrative Wellness, who have the relevant background and tools, to follow up on it.

Because of my own experiences, I don’t necessarily assume that a well-educated, well-respected, well-published physician necessarily has a lot of intellectual integrity. However, I’ve come to the conclusion, through our conversations and his decisions along the way, that Dr. Saberski’s entire being (at work) is oriented on intellectual integrity.

We may not view things the same way, and he may not be thrilled at everything I do, but the fact is, he shouldn’t have to be. He’s delighted with my good results when I get them, and if this mold toxicity thing pans out and the treatment goes well, he’ll be truly elated for me — and will keep my chart on file, just in case I come back later.

I find it HUGELY relaxing to have such a resolute scientific conservative with such ferociously diligent, relentlessly inquisitive intelligence, which is completely balanced on intellectual integrity, on my case.

All I have to do in relation to the standard science is let him do his job! I do not have to educate this one — quite the reverse! I savor our conversations and make extensive notes, because he always has something to teach me. (Today’s exciting topics: what makes me NOT look like CRPS; the Flexner Report in history; how anesthesiologists, who have the diagnostic training of a spaniel, wound up running pain clinics — another stupid consequence of US insurance companies; and how the nociceptors and immune signaling in the skin are all entangled into being one thing. Woot! Fun stuff 🙂 )

That, frankly, has been unheard of for most of my time with this illness, whatever it turns out to be. I’m well and truly rid of the fearful weight of using my rare full-brain times to try to stay one step ahead of the risk to my survival and management that every doctor visit can be.

I can use my full- and even three-quarters brain time to study up on the stuff he can’t be interested in. For one thing, the vocabulary and writing style is usually less klunky and demanding. For another, that is supposed to be my job.

Patients should figure out what they can do for themselves without making things worse, so I’m happy to do that.

Now, I’m going to find out more about mold toxicity, methods and treatments, plus what data do exist on what to expect from those treatments and what they do in the body. According to my current info, the main researchers are Shoemaker on one hand, and Nathan and Brewer on the other. My allergy/naturo doc is leaving, so I’ll have to start with another one at the same practice. This means I’d better prepare, so I can move the conversation forward a little faster than usual. That means being able to speak her language in regard to what we’re looking into.

I find it’s best to impress doctors right off and for the first several visits, and then, if I’m having a bad day another time, they have a meaningful bar to measure against, and they don’t lose respect for me or dump me into that “just another whacky pain patient” mental garbage-can. I work hard to make visits as useful as possible, as regular readers know.

I’m also getting ready to do another massage intensive. Looking forward to that! It’s pretty uncomfortable for a couple weeks (arnica pills 6c and 30c, and Advil Liqui-Gels, are essential pre- and post-massage medication), but the payoff could be so spectacular. I’m tired of the downward slide and intend to crank up the functional level one way or another.

Winter bit me pretty hard. It’s time to start biting back.

"Visis mu! I care for you, so let me hand you this wildly inappropriate thing, because I’m too rushed to think things all the way through!"
“Visis mu! I care for you, so let me hand you this wildly inappropriate thing, because I’m too rushed to think things all the way through!”

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More on medical relationships as a 2-way street

I have written about dealing with careless, ignorant, detached, and outright bad doctors, which is needful and — given the many problematic layers of living with chronic, intransigent pain — appropriate. However, I’m also a nurse, and I really do see things from both sides.

You’re both right.

Having said that, I normally have to pull for the patients, because only one person in that exam room is definitely NOT paid to be there and is NOT on duty, and it’s the one seeking care.

Patients

Patients need more advocacy, partly because few of us have the vocabulary to make our real needs and issues understood, and partly because the mere label “patient” instantly drops a person out of the realm of “real human being” in the minds of providers. If you’ve ever seen, or been, a doctor or nurse who needs medical or surgical care, you know darn well how your erstwhile colleagues speak to you differently from how they did before — but still more humanely than they do to most other “patients.”

Being labeled a “patient” is damning. You become a thing, a self-steering talking object, with only a surface resemblance to “real” people. Your main appearance in the eyes of the system, and, at some level, of those who work in it, is as a collection of problems. Your main purpose is to respond to treatment and go away cured.

Chronic intractable pain syndromes become zero-sum games from this standpoint, because pain is inherently demanding — even thinking about pain is painful!*1 — and managing these disease states rarely involves being able to “go away cured.” So, from this institutionalized standpoint, chronic pain patients are set up as failures from the start, because we can’t do our job — go away cured.

Explains a lot, doesn’t it! This unfortunate fact is simply one more thing to work around.

Those of us with intransigent pain syndromes are lucky in one respect — we have interesting sets of problems, and intelligent doctors find that intriguing! Appealing to their curiosity is often more effective than appealing to their humanity, because it gets them where they work best.

A nurse who’s a patient

It has taken many years of painfully humiliating introspection for me to come to terms with this basic dehumanization of patienthood. I was a good, solid, compassionate nurse, but I did not treat people who came under my care the way I would have treated my friends or relatives if they were in my care.

Many reasons for that. For one thing, the profit-driven scheduling doesn’t allow time for anything more than slinging meds and essential care; spending too much time with one patient means putting other patients at risk.

Beyond that, there’s a primal survival reflex involved, because there are things nurses have to do for patients that would be unbearable to do to a friend or relative.

We have to do all of them, thoroughly and without flinching, because they need doing in order for that patient to heal; and we still must be able to come back to work the next day. So, we create a little distance that we can do the work from.

And, of course, the peer pressure is enormous.
They’re all looking at you pretty much the same way. Lovely, isn’t it?

Patients are Other. When they become too human, they can quickly become embarrassing, and every human on earth cringes away from what’s embarrassing. (Just as  every human on earth cringes away from what’s painful, and this explains why we tend to get abandoned by our friends and by the system when our pain becomes too obvious for them to bear. That, in turn, is why we get so crazy-good at minimizing the appearance of being in pain; we don’t like the abandonment, and we don’t want to hurt those around us anyway.)

Speaking as a patient and long-term survivor, starting from the underdog position is a terrible position to negotiate your ongoing survival from.

So, I spend most of my time advocating for and educating my fellow patients. They’re the ones who need it most.

However, once in awhile, something hits me, and I feel a point needs to be made.

Doctors (and other care providers)

This article is a good little anecdote from the ER, my old base:

A patient encounter that almost pushes this doctor over the edge

And that, right there, is the juggling-act providers have to do. The decent ones, which is most of them (really), put their hearts on the line every day, knowing they’re imperfect and doing their best anyway.

When I was doing something intense, like dressing a complex wound or teaching someone about their disease or (obviously) coding someone, that patient was the most important person in my life. I threw everything I had, with all the control and skill I had, into the moment-by-moment demands of their care, the whole time that they needed me.

That patient was my life.

Then, whether they lived or died, I had to arrange what happened next, clean up the mess, and leave the bedside, only to go to the bedside of someone who needed me perhaps just as badly in a wholly different way.

No matter what had just happened, after all that effort and dedication, I had to leave it behind and be ready and focused to correctly identify and move forward with the next patient’s tasks.

So, yes, I rarely came off as a fluffy cuddle-bear (which I tend to do at home), and a lot of my responses could be pretty formulaic, but when the chips were down, “he [still] wasn’t my child.” He, or she, or they, was my whole world.

CPR

Being able to turn away from that intensity is what makes it possible to turn back to it at need. That’s a tough thing to deal with when you’re on the wrong end of it, when you’re not the one dying on the table or getting your insides pulled about. You know you matter, and want to be treated as if you do. That’s right and proper. It might be too much to ask of a full-time RN. (There is definitely something weird about that.)

Nurses are the bedside providers. Physicians are the directors of care, deciding who goes where and why. They’re accustomed to deciding what happens, and expecting others to make it so, so that the patient can get better and go home.

Chronic care is always a long game, sometimes a waiting game, and doctors are dealing with people who simply can’t do what the doctor’s expensive education said was the doctor’s job: “send them away cured.” This means that the chronic care provider is also set up as a failure from the start, as some have found the grace and integrity to express. *2

This must be a special kind of tricky to learn to deal with, so it doesn’t surprise me that not many otherwise good-hearted people, who go into medicine for laudable reasons, don’t always manage it with the tact and decency that chronic patients (rightly) expect.

In that case, it’s not a bad idea to find a way to waft this article their way… It’s not judgmental, and it provides much food for thought, for physicians and patients alike:

How Doctors Respond to Chronic Pain

photo of someone wearing a nametag Dr Whatsit, with a word balloon saying, Oh heck! What do I do?

As a side-note, one strategy I find useful for getting through the thing-ness of being a collection of probl– er, a patient, is being as pleasant and amusing as possible. This creates a safe-zone of humor while drawing the provider in past the boundary of “thing-ness” I’m reflexively put in. The wry, black-nailed, hangman’s humor of living with something so vile and refusing to let it win, coming out in my burbling and whimsical-sounding tones, is probably sufficiently unexpected to blow categories out for the moment anyway.

If I can make them laugh with me (while checking me out with a puzzled “are you serious?” kind of glance) I’m halfway to being human in their eyes, and still being treatable. Then, I just keep up with my due diligence (timelines of care, understanding my treatment options, studying up on things we’ve discussed, etc.) and — with the exception of one doctor out of two dozen, who I thought was a buffoon in any case — my relationships with my doctors have been remarkably good.

me-fingers-peace

 

*1: A write-up of one of many studies about feeling others’ pain:
http://www.dailymail.co.uk/sciencetech/article-1237760/People-say-feel-pain-really-do.html
And a scientific article looking at brain response:
http://cercor.oxfordjournals.org/content/17/1/230.full”

*2: A particularly dazzling piece from a UK doctor on coming to terms with treating (and living with) chronic pain patients:
https://abetternhs.net/2013/09/07/pain/

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