Monday, January 12, 2015

Lean In and Show You Care - for caregivers especially

Sheryl Sandberg, of Facebook fame, wrote a recent best-selling book called Lean In. An important message in this book is her recommendation that people lean in to the challenges that face them, rather than avoiding and running away from them. Throughout her career, she has demonstrated that this approach has worked for her, in spades.

This idea of leaning in can be especially useful for spouses and family members as they try to understand the nature of long-term pain. When someone in pain his trying to explain how they feel, it is important to pay attention, to lean in toward them, and to try to learn and understand what they are trying to say. It is not easy, for the person trying to explain how they feel, nor for the people trying to listen and understand. It is necessary, however, to lean in. Even if you do not understand all of the details, leaning in will show that you are at least trying, that you care.

Sometimes, the best way to lean in is to just stay silent, listen and pay attention. Caregivers often feel that this is inadequate and does not accomplish very much. It is also very hard to sit there feeling helpless. You want to jump up and do something. Rather than jumping up and leaving the scene, a better option is to calmly and compassionately ask if there's anything that you can do to help.

In my 25 years of working every day with people in pain, I have found that listening, learning and leaning in can be a very powerful healing tool. It is more practical and useful than you think.

Go ahead. If it a try. Lean in and watch the magic happen.

Yours with care - Michael.

Monday, January 5, 2015

A Gift from The Pink Lady

Happy New Year. I hope this new year can bring little less pain and a lot more life to all of you.

One of my patients received a very nice surprise a few weeks ago. This was a gift from the Pink Lady.

This lovely person had been suffering from multiple injuries, widespread pain, and very high levels of stress for many years. Her stress levels had become even more extreme in the past few months, and with that had come a severe aggravation of her stomach pain.

Her stomach pain had not been her primary injury, or even her primary source of pain, until the past few years. I believe her stomach pain developed as a consequence of years of severe pain, pain medications and widespread losses and stresses in her life.

Occasionally, her pain levels become so severe that she needs to go for additional medical help. A few weeks ago it was necessary for her to go to the emergency room in the middle of the night because her stomach pain was so unbearable.

In previous visits to doctors, specialists and emergency rooms, she has not found any real help, although for the most part doctors do seem to understand the severity of her pain.

This time was different. An emergency room doctor gave her a medicine that she called the Pink Lady. My patient was told to drink this pink liquid and try not to have any of the liquid linger in her mouth. This medication, or combination of medications, seem to work quite quickly. For the first time in many years, my patient had some relief. This relief only lasted a couple of days, but this was enough to provide significant help. Over the next few weeks, my patients suffered from her regular stomach pain, but the extreme unbearable stomach pain did not return. This was truly a gift for her.

I think this Pink Lady can involve different mixtures. Below is a link to a brief description of the medicines that may be included.

Happy new year and stay tuned for more frequent posts this year.

Yours with care - Michael

Monday, April 28, 2014

How To Protect Yourself From Video Surveillance

Your best strategy, by far, is to be open and honest with your doctors and lawyer.

Private investigators are always hoping that they can catch accident victims in a lie. This will make their day, unfortunately. For example, if you have told your doctors that you never mow your lawn and they have a video of you trying to mow your lawn, they will use this video as evidence that you have lied. This situation is even worse if you have stated, under oath at a Discovery Hearing, that you never mow the lawn. Defense attorneys would then try to use this to argue, not only that you lied about mowing the lawn, but that you are a dishonest person and are also lying about your injuries. This will make their day.

It is also very helpful to try to be specific and clear when you're talking your doctors, your lawyer, insurance adjusters and opposing lawyers. For example, if you have said that you can't mow the lawn, maybe you mean that you can't mow the lawn like you used to. If this is what you mean, this is what you need to say.

Most accident victims, even those with serious and multiple injuries, are able to do many activities. Very few injuries actually involved paralysis. You may be able to do the dishes, wash your car or drive your children to school. When you talk about doing these activities, it is important to be clear and specific about just how much you can do. Can you wash the dishes for a few minutes at a time, but not be able to wash all the dishes at once like you used to? Maybe, you can even mow the lawn, but only for 10 min. at a time. When you are specific about these kinds of details, this also makes it easier for your doctors to be specific and to help you when it comes time for them to do a report about your injuries.

These ideas are really common sense. But it is hard to use your common sense when you are so nervous about private investigators and insurance companies trying to hurt you and your family. 

Please check for regular posts. I will be returning to this topic over and over again.

Thank you for reading and please let your friends know about what you have learned from The Chronic Pain Letter.

Yours truly care - Mike

Monday, March 10, 2014

Caught On Video - What Now?

What happens if a private investigator takes a video of you mowing the lawn and sends it to your insurance company? Are you in trouble? Will your benefits be cut off? Will your lawyer not want to have anything more to do with you?

These are frequent fears that individuals have when they are receiving income replacement benefits from an insurance company. It is very common for private investigators, hired by your insurance company, to follow you around and take pictures of you going about your regular activities.

This does not make you a criminal, although you may feel that you are being treated that way. Rather, it seems to be more of a routine procedure used by most insurance companies, for most individuals making claims. This does not make it any less stressful for you. You are just one of the insurance companies cases and this is what they routinely do. It does suck though, not only for you, but also for family members that may feel frightened and intimidated.

In general, video surveillance can only make trouble for you if you are dishonest. If they catch you in a lie, and can show evidence that you lied with a video of you, this does hurt your credibility.

If you are mowing the lawn, usually for short periods of time, generally any video surveillance of this activity will not be a problem. Most people with accident related injuries are able to do activities for short periods of time, even mowing their lawn. Your doctor should know that you do try to do these activities when you can. This way if your lawyer sends a picture to your doctor showing you mowing the lawn, your doctor will not be surprised. In fact, your doctor may have recommended that you do as many activities as you can, again for short periods of time.

The most important thing that you can do to protect your credibility and your benefits is to be open and honest with your doctors, therapists and lawyer. Most limitations from physical injuries do not involve paralysis, but do involved limitations of endurance and stamina. Most accident victims are able to do many activities, but only for short periods of time. Unfortunately, it is very difficult to work when you can only be active for a brief time periods.

This is a very important topic and I will return to it over and over again in later posts.

Yours with Care - Mike

Monday, February 3, 2014

What Is Reactive Depression?

I am going to try to make this very simple.

Historically, there was thought to be two types of depression. One type, called endogenous, was thought to be mostly biochemical in nature and could happen to individuals even when there were no significant stresses going on in their lives. This type of depression was thought to be a true illness.

A second type of depression was called reactive. In this case, depression was experienced by individuals who are undergoing serious stresses or losses in their lives. This is the category of depression that would best describe the symptoms experienced by many people who live every day in pain, or suffer serious prolonged illness or injury. This type of depression happens to people as a reaction to what is happening to them. Clear examples would be, prolonged injury or illness, death in the family, divorce, job loss and prolonged unemployment, or almost any type of serious loss.

Even though the causes of these two types of depression were quite distinct, the symptoms are very similar. Treatment for both types of depression is also similar, and involves, usually, a combination of medication and counseling. Counseling involving cognitive behavioral therapy is the most common and most effective. For these reasons, depression is thought of, nowadays, as being of a single type. Depression is usually diagnosed with the term, major depressive disorder, regardless of the cause.

Although these terms are not used for diagnosis anymore, it is still often useful to explain the concept of reactive depression to patients who suffer from depression caused by their chronic or long-term pain. The idea of depression, as a reaction to the stresses and losses connected to living every day in pain, makes more sense. Importantly, it also takes away some of the fear and stigma associated with depression.

Yours with care - Michael

Monday, January 27, 2014

The Black Dog - Brilliant Illustration

Many people who live every day in pain feel like the Black Dog is hounding them. And it feels like the dog never gives up.

The Black Dog is one of the main characters in a brilliant cartoon put out by the World Health Organization. The Black Dog is a constant and heavy presence in the life of a depressed man in this cartoon. This cartoon perfectly illustrates the symptoms of depression and how it can affect almost all parts of our lives.

Many people who watch this cartoon will say that the Black Dog is like the constant pain they feel. The heavy and intruding presence of the Black. Dog is partly from pain and partly from the depression, caused by the pain. Sometimes, it is difficult to separate out these two parts, because pain is a much more vivid and salient symptom.

Over 90% of my patients suffer from chronic or long-term pain. Many suffer from pain + depression. The depression comes, not only from the suffering caused by their constant pain, but also from the limitations and losses caused by their pain.

What is depression? Let this animation with a dog sheds light on it.

Please check out this brief video. It is well worth a few moments of your time. Here is the link:

I hope this illustration can help explain the mysteries of pain + depression and help your life in even a small way.

Yours with care - Mike

Monday, January 20, 2014

Pain + Depression = More Disability

Many people with long-term pain, especially those that have experienced significant losses caused by their pain, also experience depression. This is an understandable reaction to having a life full of pain and losses, that continues day after day.

Even though it may be very difficult to acknowledge, it is important that depression is recognized as part of the overall difficulties for people with long-term or chronic pain. This is important for several reasons.

From a treatment point of view, help with your depression, even depression that is caused by your pain and losses, can help reduce the severity of your long-term pain. Medications and psychological treatments for depression can help with physical pain. These can also help with sleep, energy and tolerances, all of which are important for  individuals struggling to cope with long-term pain.

When individuals are applying for disability benefits, it is important to have your physical injuries, sources of pain, and secondary psychological reactions acknowledged and accepted. All of these factors combine to create the overhaul limitations that can interfere with an your capacity to work.

Sometimes people in pain only discuss their physical injuries. This can hurt you when you are making claims and are out of work. When you only discuss one part of your overall limitations, insurers are bound to underestimate just how limited you may be. It is important for treatment providers and insurers to understand not just the causes of the problem, but also all of the secondary complications and factors that can limit you.

When it comes to secondary psychological reactions of depression, sometimes a simple formula can help us all understand it a little bit better.

Pain (including multiple sources of pain) + depression =  more disability

Essentially, this means that an individual is more disabled by 2 problems (or many problems) than they are by just one problem. Simple, but true.

This is an important topic and I will return to it over and over again more detailed information - what is depression.

Yours with care - Mike