Grand Rounds on Prudence, M.D. this week

Another great Grand Rounds -- this one hosted by Prudence, M.D.
She introduced me to a lot of wonderful blogs. And I am honored to be included.

Tagged: The Meme Challenge

Okay, I’ve been double tagged for a meme challenge -- by Terry at Counting Sheep and by Sandy at Fighting Fatigue (if you aren’t reading these blogs regularly, you should. They are treasures). I’m not sure about the origins of the meme challenge but I read somewhere that it began in 2005. Who am I to break with such an ancient tradition?

The Rules:
1-Link to your tagger and post these rules on your blog
2-Share 7 facts about yourself on your blog, some random, some weird
3-Tag 7 people at the end of your post by leaving their names as well as links to their blogs
4- Let them know they are TAGGED by leaving a comment on their blog

7 facts about me:

1. I was one of five people who was at the Woodstock music festival who didn’t get stoned.
2. My father and I said, "I love you" to each other for the first time at my wedding.
3. I once rode up in an elevator for 25 floors with George Harrison (of the Beatles, remember?).
4. I climbed to the top of Mt. Kilimanjaro and dove a wall off Grand Cayman island. I learned that I am happiest on top of mountains or 100 feet under water. It's in between where I have the most trouble.
   
5. I have been going to an annual 24 hour science fiction film festival for over 20 years where 300 people sit in a dark theater for 24 hours watching sci-fi films from the 20's like Aelita Queen of Mars ( a silent Russian film about the workers' revolution on Mars); red menace films from the 50's like Invasion of the Body Snatchers (for all of us kids who believed we were adopted into the wrong family), and The Day the Earth Stood Still (the best sci fi movie ever); films from the 60's onward like Dr. Strangelove; 2001 A Space Odyssey; Blade Runner, Buckaroo Banzai, Donnie Darko and on and on and on.......
   
6. My favorite book is Don Quijote by Miguel de Cervantes (which, for literary trivia buffs, is the first novel ever written).
7. I know the words to most of the songs from Richard Rodgers and Oscar Hammerstein musicals, but only the walls of my shower will ever hear me sing them out loud.
   

Here are the blogs I am tagging:

Own Your Health

Dave DeBronkart My Story

Everyone Needs Therapy

Trick Cycling For Beginners

A Chronic Dose

How To Cope With Pain

Nurse Ratched's Place

After Thanksgiving Blues

I can’t help it. Whether it’s tryptophan withdrawal or disgust at eating massive quantities of foods I never eat during the year, I am suffering from post Thanksgiving blues. I wander around the house. Sit down for a few minutes. Get up. Wander a bit. Start a book. Put it down. It’s like I’ve been demagnetized and can’t lock onto anything.

Dishes pile up. Laundry piles up. Richard keeps asking me, “What’s your mood?” “What’s on your mind?” “Are you ok?” My mood is flat; my mind is floating; and yeah, I’m ok, in the global sense. That is, I have nothing to be particularly unhappy about.

This Thanksgiving, we did what we always do – gather with the friends who have become family. Some we see regularly; others once a year around the Thanksgiving table. We talk about life events, travel, favorite books and movies, political opinions, and lawyer jokes. Nothing new. Good friends and good times – a regular Hallmark card.

There’s such purpose in Thanksgiving. In the food, the table, the wines, the companionship. And sometime, during the drive home late Thursday night, the purpose dissipates. The focus shifts to email and meetings and snow tires and telemarketers. The ordinary moves back in.

Richard sees me staring at nothing. He says, “Do you know that when I ask you what your mood is or if you’re ok or just say ‘Hi babe’– that I’m stroking you with words? I’m making contact.” I didn’t know that. I feel better.

Chronic Pain: A Burden Often Shared

The second part of Jane Brody's three piece series on the New York Times on chronic pain looks at the impact of pain on the family. She writes, "Chronic pain is a family problem. When people experience unrelenting pain, everyone they live with and love is likely to suffer."

She suggests family members remind the patient that they are in this together and learn as much as possible about the condition. She also reminds family members to take care of themselves -physically and emotionally.

While this piece does not go into a lot of depth about the complexities of pain and families, the very fact that she is addressing this angle earns her merit.

Kudos again to Ms. Brody

Grand Rounds on Mexico Student

Check out this week's Grand Rounds from Mexico:

http://www.mexicomedstudent.com/

Not only a great variety of posts, but set to music.

Pet Therapy or Sometimes A Human Is Just Not Enough

My days were spent trying to sleep as long as possible. Sleep meant no pain. When I could no longer fool myself into thinking sleep was still possible, I meditated and listened to wellness tapes instructing me that imagining myself healthy was essential to becoming healthy. After ten minutes of these tapes, I began to feel like an impostor, like a weary atheist listening to a sermon hoping that the words alone, without belief, will create the miracle. I got out of bed, starting the day already feeling defeated. The combination of my complete isolation from life along with physical pain and emotional upheaval was not a pretty sight.

My husband, worried over my increasing distance from life, suggested we try pet therapy. I was lost, a refugee cast out from my own body with little sense of direction left. I did not agree or disagree with his plan. I simply let events happen. He spoke with a friend who is a breeder of Cavalier King Charles Spaniels, and she gave us Mina, a ruby-colored beauty with a gift for healing.

Over the next few weeks, as my pain level fluctuated, Mina began to show her powers as a gifted empath. When I sat quietly to meditate, she moved a few feet away, staying in range, but not intruding. When pain or depression forced me to lie down, she snuggled closely, resting her head on my shoulder. Sometimes she scaled my chest with her paws until her head was level with mine. Then she looked me right in the eyes, nestled her cheek against mine, pressed her paws against my neck, and hugged.

One late winter afternoon, after I had been swimming in deeper and deeper pools of pain all day, I finally collapsed to the floor in a wretched heap of tears. My husband was at a loss as to how to help me. He was afraid that this time, I might have sunk too far down and would not be able to pull myself out as I had so many times before. I could see the fear in his eyes, and that only increased my sense of hopelessness.

At that moment, Mina came over and sat in the curve of my body and relaxed against me. No hugs, no licks, no attempts to persuade me to shake myself out of my misery. She just rested against me, composed and patient. In her stillness, she was able to tap into a thread of hope that still endured somewhere deep inside. From that source, I could draw a clear breath. Her calmness reassured me as no human intervention could have.

Over the months, I watched her closely. She taught me what no therapist or body worker or tape on healing could. Mina lived entirely in the present. She slept at the exact moment when tiredness overtook her. She quaked with delight at the sight of a treat being extracted from its bag. She sat patiently while I prepared her food, and then leapt toward the spot where I always placed her dish. Even though she got walked four times a day, each walk was a wonderful new adventure with droves of squirrels to chase and a seething ocean of underground smells to fathom. Sometimes, as we walked, she was so stuffed with exuberance that the excess burst out of her, propelling her into a pirouette. Those rare times when I scolded her, she retreated into a sulk for a few minutes, but then her irrepressible desire to be fully engaged in life returned, and she was once again leaping, hugging, sniffing, and sleeping.

She anchored me back in life as nothing else could. I no longer experienced pain as an endless desert. It was punctuated by the rising and falling of her chest as she slept by my side. When her puppy face, draped by her long, silken ears, was nestled against my shoulder, I felt sheltered. And as the years passed, and I slowly recovered, whenever dark habits drew me back into a state of depression, I whispered her name, “Mina.” The ensuing rhapsodic swishing of her feathery tail reminded me that there were squirrels to chase, bones to unearth, and a life to be lived.

Love and Alzheimer's: How Do Couples Adapt?

An article in today's New York Times describes what could be either a tragic or a blessed aspect of the ravages of Alzheimer's. As the disease erases memory, patients who have been with their partner for years often stop recognizing him/her. For the well partner, this is perhaps the most traumatic aspect of Alzheimer's. Your partner is your mirror, reflecting back to you the shared memories of childbirths, of Hawaiian sunsets, of narrow escapes, of terrible disappointments, and of the thousands of spots of intimacy that dotted your lives together. When your partner forgets you, this mirror shatters, and you have to grow a new sense of self.

The article goes on to say that sometimes the well partner must watch the partner with Alzheimer's fall in love with someone entirely new -- someone who plays a role more associated with his/her current existence. The husband (who suffers from Alzheimer's) of retired Supreme Court Justice Sandra Day O’Connor found companionship with a woman in the nursing home in which he lives. For the patient, this new relationship, often with someone with similar cognitive impairment, is a blessing. This new person fits entirely in the patient's present -- no straining to remember what has been erased; no trying to please someone who is now a stranger. The patient can find a reflection of his/her current identity in the eyes of the new companion -- a reflection that asks no hard questions and accepts what is -- a hand to hold, a smile, a body to lean against.

For the well partner, Alzheimer's paves a path of chronic grief, spread out over years. Yes, along the way, there can be appreciation, love, even new forms of innocence and sweetness. I think it must be both a blow and a relief to see the beloved who has forgotten you finding comfort with someone new.

What do you think?

Everybody Has to Have a Holiday List

Here's mine:

THINGS TO AVOID AND EMBRACE OVER THE HOLIDAY SEASON

AVOID:

1. Watching the movie It’s a Wonderful Life, again
2. Eating the third piece of pumpkin pie
3. Sloppy, wet kisses from people you only see once a year (it’s flu season, after all)
4. Egg Nog (what’s a nog, really?)
5. Listening to radio stations that only play Christmas music, and start on November 1
6. Articles that tell you how to have stress-free holidays
   

EMBRACE

1. Great big hugs from people you’re happy to see, even if it’s only once a year
2. That second piece of pumpkin pie
3. Snow – especially while it’s still white and fluffy
4. Reading your favorite book, again
5. Listening to Nat King Cole sing, “The Christmas Song” as often as you like
6. Sitting in silence and feeling part of something bigger than yourself

This list is also posted on the website But You Don't Look Sick

Grand Rounds on Dr. Anonymous' blog

Check out the collection of health and medical posts on this weeks Grand Rounds, hosted by Dr. Anonymous.

The postings are all lively and diverse, spanning the range from touching to scientific. I am again honored to be included.

And check out Dr. A's other postings. This is a great blog.

Cancer and Emotions: A Recent Study Finds That There is No Connection

''A fighting spirit has its advantages, but one of them is not, apparently, cancer survival,'' said James C. Coyne, lead author of a study from the University of Pennsylvania in which more than 1,000 patients with head and neck cancer were followed. ''We looked at whether exceptionally high emotional well-being or exceptionally low emotional well-being had an effect. We found absolutely no evidence for either.'' They conclude that the power of the mind has been overestimated in the fight against cancer. One commentator added that cancer patients can feel relieved that their negative feelings are not culpable, and that they should not feel responsible for their cancer.

I have lived on both sides of this debate. I certainly want no responsibility for having caused my pain syndrome, but I do want to believe that my emotions, one of the realms in which I can exert some control, can influence my body. Without that, I feel even more helpless -- a kidnapped passenger on a runaway train bound for darkness.

And if their result is valid -- and applies beyond cancer -- how can I explain those nights when I'm laying in bed bent double with pain, clutching a heating pad like it's a life preserver, diving deeper into the pain/fear/constriction/pain cycle - and I ask Richard to stroke my hair and rest his hand on my forehead. That simple act brings me to a different realm of feeling where I am soothed, comforted, connected. I bring that state back to the pain and tell it -"So there! What are you gonna do now?" And not always, but often, it's the pain that cringes and weakens, not me

Floating Island: A Day Without Pain

Richard, my sweetie, and I spent the weekend visiting old friends we haven't seen for over a year. They moved to a new home that has its own name carved on a stone post by the driveway and a pond with a floating island. They're not rich folks. The house was a mess when they bought it. In fact the first rain storm that hit after they moved in cascaded like a waterfall through the roof onto the dining room floor. They worked very hard for two years to uncover, discover, and recover the beauty they saw beneath the mildew and grime in their new home.

During our visit, I had a moment. Richard and I were sitting in a couple of deck chairs by the pond. The early morning New England sunlight glanced off the swirl of fierce red, yellow, and brown autumn leaves, as the wind blew them onto the silent water. I was acutely aware of being here, in this cocoon of beauty, without pain. Without pain was, for a moment, as powerful a sensation as pain had been. To be so sweetly aware of the absence of my enemy, to praise my body for being bigger than pain, to take Richard's hand and know that he was thinking the same thing.......this was a moment.

Our friends will have years of joy in their new home. But my joy, in that one moment, was a life time.

Grand Rounds, again!!

Again, I am so pleased that my posting Chronic Pain: Tormentor & Mentor was selected for this week's Grand Rounds, hosted by a blogger I only recently discovered through Grand Rounds. Terry Freemark blogs at Counting Sheep about tales from the nurse anesthesia front. She is a wonderful writer and tells some shocking and some funny tales.

"Grand Rounds is the the weekly rotating carnival of the best of the medical blogosphere." Each week a host blog picks a theme and health care bloggers submit postings. On Tuesday, the host posts the blogs he/she has selected. Terry's topic was pain and she presents a really multi-faceted look at pain and includes some powerful graphics too.

Chronic Pain: Tormentor and Mentor

Pain was my abusive parent, and I was its intimidated child. My moments became consumed with trying to predict when another outburst would occur. The child learns to watch for the narrowing of the eye lids, the slow, methodical clenching and unclenching of the fists, the smell of gin saturated sweat. I learned to look out for an early morning feeling of bladder urgency or a mild sensation of abdominal pressure that would inevitably become a storm of wild horses rampaging inside my body by late afternoon. And like that abusive parent, pain taught me its rules.

One winter day, I lay stretched out on the bedroom floor beside the wood stove, wrapped in a green fleece blanket and stared out the skylight at a classic New England winter scene – blue sky rippled with white clouds and trees heavy with snow. As I tried to relax into this calming view, I began to feel the telltale signals of an impending spike in abdominal pain. Instead of curling up into my usual fetal position and sobbing, pain compelled me to stand and begin walking. After so many blows over the past nine months of living with chronic pain, my will and my fear were beaten down to the point where I was able to hear my body’s instructions.

I stood in the center of the room and started to walk in one direction. When I reached the far wall, I turned around slowly and walked very consciously and deliberately in the opposite direction. Each step measured only four inches, and I rested for three breaths before taking the next one. After completing thirty laps, I could walk in a straight line with my eyes closed.

I tried this procedure several times a day. As I paced, I focused on each micro-movement of my feet and noticed the subtle, shifting realignments that naturally happened as my weight moved from heel to ball to toes. I noticed the exact moment my foot made contact with the carpet and the tickly feel of the fibers along my sole. I noticed the exact moment my foot lost contact with the carpet and felt a soft pat of cool air.

At some point during each walk, I began to feel my essence dropping down from my mind to inhabit my feet. When this occurred, I felt no pain. My focus was so totally concentrated on the micro movements of my body in motion, that the pain was somehow eclipsed. I paced in this manner for hours at a time. Over the following months, I carved furrows in the carpet with my glacial walks.

My pain was not only my tormentor, but also became my mentor. It shouted when I strayed too far from the lessons it was requiring me to learn. And it quieted when I listened to its urgings. This was pain’s first teaching -- that I acknowledge my body. I had always thought of my body as a convenient suitcase, useful for carting around a collection of bones and organs. I was bound to it but was rarely inside it. Pain brokered these first authentic contacts with my own body – forcing me to move with it, to see it, to be in it.