My Invisible Pain – It’s Present Whether I Speak or Stay Silent

When we are feeling pain of any sort, sometimes the biggest challenge is to decide whether it serves best to speak or be silent (and yesterday I spoke)!

During a long interview with a broadcasting company who specializes in medical topics, I was able to give voice to my own struggles about dealing with pain day (and night). It was an afternoon where I was being asked to be honest about how I felt (physically and emotionally) about living with a specific medical problem that may never resolve itself. The interviewer posed questions that made me think hard about how I view my life where I now need to set some limitations on myself and activities I once enjoyed.

One of the highlights of the discussion was what I’ve personally found to be one of the most difficult aspects of this challenge; that is, I look healthy. Unless I tell someone I’m hurting, they don’t know (and even if I do…some don’t believe me). So I’ve learned to communicate what I feel like using very descriptive words with vivid mental pictures…then I’m better understood.

Since I have felt the frustration of not being understood when describing the pain I’m experiencing…I asked my co-author, Dr. Christopher Foetisch, to weigh in how patients can best communicate their pain levels when they talk with their doctors.

Is there a trustworthy gauge or guide that a person can accurately use to communicate her pain levels to others, to her physician in particular? Read below to better understand what a physician (compliments of Dr. Foetisch) silently thinks in answer to a patient’s description of her pain.

· When communicating pain scales, it’s important to be realistic. Exaggerated numbers do not impress physicians. In fact, doctors will be less inclined to believe patients are credible if they tend to exaggerate.

· For reference, the definition of “Level 10” pain is, “Pain so intense you will go unconscious shortly.” This type of pain occurs in those who have suffered a severe accident with multiple broken bones or injury such as a crushed hand or leg.

· Most people come to a physician’s office with a “Level 6” pain or less.

· Clues as to how much pain someone is in comes from nonverbals such pacing or rocking, difficulty thinking clearly or rationally, and difficulty speaking due to waves of pain or shortness of breath.

· If your pain is truly a “Level 7” or greater you should be in the Emergency Department and not in a doctor’s office.

Family History – It’s More Predictive Than You Might Expect

Last week I took this photo of Logan and at five months old, I can already see dramatic changes in his appearance, his awareness of the world around him, and his responses to people and things…it’s amazing how quickly babies change. Along those same lines, I’m similarly amazed how much change occurs in adults’ emotional/mental/physical health as well.

Time never stands still. Whether a person is five months, five years, or fifty, our bodies are always adapting to the what we put in them and what we put them through.

One of the most proactive steps we can take to stay our healthy best is to know our family history (and pass along that information) to our family and our physicians.

As I age, I want to be sure I’m considering my parents’ health history and making wise choices for my health (with theirs in mind). I also want to be careful to pass on possible problematic areas of concern to my own kids (so they will grow up and stay strong too).

For some “vital stats” on why family history matters…read Dr. Foetisch’s comments on the subject from his perspective as a physician.

Family History – It’s More Predictive Than You Might Expect

Top health-related reasons it’s essential to know and understand the physical history of your immediate and extended family members. Even when we might fear the worst, knowing is best.

· While risk factors for disease can be attributed to numerous factors such as age, nutrition, and environmental exposure; genetics, or family history, is likely the most compelling factor for risk of disease.

· Knowing your family history can provide valuable information for your physician. Certain cancers and medical problems require routine screening per recommended guidelines that are often accelerated for certain medical problems based on family history.

· To the patient, this means that those individuals with a strong family history often require earlier or more frequent screening. Family history of colon cancer is one such disease. If early screening is instituted, it may allow diagnosis and treatment of a condition when it as at an earlier, more treatable stage.

· Important: knowledge of family medical history can assist your physician in making a diagnosis that may not otherwise be considered. Therefore, whenever possible it is valuable to document the medical problems of your parents and siblings and take this information to your physician.

Furry Friends and Other Falling Hazards

Don’t let his innocent face fool you. This 90 lb bundle of fur knocked me flat earlier in the week while I was innocently walking around outside. Chester got too excited and too distracted by his furry friend and didn’t notice me. Honestly, it could happen to anyone…and does. Falling isn’t fun (believe me and my aching body), but it’s more common than we might believe. Here’s some facts on falling that my orthopedic surgeon and co-author put together. Definitely falls under a “need to know” category in my house and home.

Dr. Christopher A. Foetisch, orthopedic surgeon at the Toledo Clinic writes –

Expert Advice to Avoiding Falling; Just How Prevalent is it for the Elderly?

How big is the problem?

The Fact is:
· More than one third of adults 65 and older fall each year in the United States.
· Among older adults, falls are the leading cause of injury deaths. They are also the most common cause of nonfatal injuries and hospital admissions for trauma.
· The elderly account for seventy-five percent of deaths from falls.

Who is at risk?

The Fact is:
· The risk of falling increases with age and is greater for women than men with women being 67% more likely than men to have a nonfatal fall injury.
· In 2003, about 72% of older adults admitted to the hospital for hip fractures were women.
· Men are more likely to die from a fall. After adjusting for age, the fall fatality rate in 2004 was 49% higher for men than for women.
· Two-thirds of those who fall will fall again within six months.
· The risk of being seriously injured in a fall increases with age. In 2001, the rates of fall injuries for adults 85 and older were four to five times that of adults 65 to 74.

What Can a Person Do?

The Fact is:
· Older adults can take several steps to protect their independence and reduce their risk of falling by exercising regularly. Exercise programs such as Tai Chi that increase strength and improve balance are especially good.
· Ask their doctor or pharmacist to review their medicines, both prescription and over-the counter, to reduce side effects and interactions.
· Have their eyes checked by an eye doctor at least once a year.
· Improve the lighting and reduce hazards in their home that can lead to falls. Avoid throw rugs and move furniture out of the way to leave ample room to move.
· If a source for falling is not identified, a physical workup by a neurologist is recommended.

Getting a Good Night’s Sleep at the Self-Help (or any) Hotel

If you know me, you know I value sleep. Good sleep. Every night. No exception. Everyone has a weakness and mine is being able to rest soundly night after night…and when obstacles such as (my loose shoulder) keep me tossing and turning throughout the nighttime hours my mind can wander…and lately it’s been wandering back to a trip I took with my good friend, Mary. She’s going back to Europe soon. I am not. Sadness. But, I can reminisce about our two wonderful trips together and dream.

Here’s one snapshot of our travels….and how we learned to get a good night’s sleep far, far away.

On a recent dream trip to Florence, Italy, my close friend and I were treated to daily half day long art history lectures by a college professor whose passion for the topic of art is unparalleled. His enthusiastic talks left us both inspired and mentally exhausted. We’d then walk the streets of this ancient, yet so modern city, until we were worn out and so ready for a good night’s sleep. Back to the “self-help” hotel (as we lovingly dubbed this understaffed, yet pricey establishment) we’d wearily trek. Unlocking our door, we were surprised to find our room, not being cleaned, but used as the cleaning staff’s late afternoon gathering spot for watching Italian soap operas (on the edge of my bed, no less).

Though our room was aesthetically restful in appearance, it was frequently missing those bedtime ritual items such as toilet tissue, bath soap, pillows and blankets. Often, we didn’t notice until we were ready for bed. My friend and I similarly assumed that other hotel guests (and their crying babies) would be courteous enough to stay within the confines of their particular hotel room…not walking down the hall outside of ours all night long. Cultures are different and sometimes these differences can make the difference between enjoying sweet slumber or not.

We quickly discovered that if we needed something, we had to get it ourselves…and that revelation included making practical preparations for enjoying a good night’s sleep.

Given our rigorous daytime schedule, you’d think we would sleep deeply, soundly, and without interruption after having walked ten-plus miles during the day. But, sadly, we didn’t…even though our bodies cried out for rest and a rejuvenating night’s sleep…we didn’t rest well (and on some nights…hardly at all). Why? We didn’t prepare in advance. We took for granted that given how physically and mentally exhausting our daytime schedule was, we would plunk our heads on our pillows and be out within minutes. First mistake.

Sleeping in an unfamiliar hotel room (in this country as well as abroad) realistically requires as much advance preparation, as does the planning for one’s active daytime hours. As Dr. Christopher A. Foetisch, an orthopedic surgeon from Toledo, OH, observes, “It is best to keep to the same sleeping schedule when traveling as at home. Even when traveling from one U.S. time zone to another, try to go to bed around the same time even if it means getting to bed ‘early’ for that particular part of the country.” Attempting to stay up extra late or get up extra early to “get yourself used to” another sleep schedule usually does more harm than good, unless you are traveling overseas where the time difference is significant.

Our second mistake was making assumptions about how quickly we’d adapt to such unfamiliar sleeping conditions. Neither of us was used to sleeping with the other (me being the morning person and my friend being the night owl) and adjusting to opposite sleeping schedules and personal bedtime routines was tricky at best.

After several consecutive nights’ lack of sleep, we, in bleary-eyed fashion, realized we needed to apply some forethought (and fast) to the upcoming evening’s respite of sleep. Otherwise, we’d end up even more emotionally and physically frazzled. After a strong cup of morning espresso, my friend and I planned wisely. We’d duplicate our normal at-home sleeping environment as much as we were able…and give it a trial run.

If it didn’t work, we’d continue to make alterations until we achieved our ultimate goal: sleeping until the “self-help” hotel staff awoke us with their morning wake-up call. By the week’s end, we had our routine down pat…just in time to head to the airport for home. (And did we ever sleep on the eight-hour airplane trip home, pure bliss.)

Tips for sleeping soundly away from home.

· Request a non-smoking room located as far away from the elevators and ice machines as possible.
· If you are traveling with a friend, make sure the room has two double beds.
· Consider investing in the cost of a private room for maximum quietness and personal down time.
· Bring your own pillow from home.
· Purchase earplugs if you are used to “white” noise at home to help block out sounds from the hallway or by a roommate’s movements.
· Consider using an over the counter or prescription sleep aid as needed.
· Unwind before trying to sleep, transition slowly from the day’s activity to night’s slumber. Read the Psalms, listen to soothing music, and spend time in prayer.

Keeping Your Orientation in Health and Life

This week I’ve been busy studying and prepping to view a total hip replacement surgery and what I’m learning is fascinating. Apart from the marvelous strides in medicine itself and how patients who were once destined to endure disabling injuries and illnesses can now be repaired and healed, I’m being reminded how much physical health (and the journey to get there) is similar to life’s journey. Both are filled with progression and setbacks, seasons of strength and weakness, moments to grieve and then celebrate…

Today, I’m remembering the first time I was in the OR as an observer…

Last year, I was given the opportunity to observe a shoulder surgery operation. While the entire morning was riveting, I keep recalling one specific step the surgeon performed at the outset of the procedure. Before he could begin to repair his patient’s injured shoulder, he needed to correctly identify and mark the places on her body where he would make the necessary cuts. As he carefully felt around her shoulder, I later found out he used her bony anatomy to “keep his orientation.”

Interesting phrase, and what a great parallel to everyday life.

As adults, we’re frequently sidetracked from our main purposes because we have lost our orientation. That is, we become so bombarded by overwork, busyness, and the stresses that deplete our emotional and physical reserves, that we lose sight of what’s most important. Our visual clarity becomes blurred, we grow unsure of what’s the next best step to take, and we grow so desperate for relief we end up simply living in survival mode. Said another way, when we’ve lost our primary focus, we often relegate our decision making to whatever’s easiest, closest at hand, or requires the least amount of resistance. Which, over time, can quickly become problematic on multiple levels.

In the same way a surgeon takes the necessary time to deliberately study his patient’s injuries, illnesses and weaknesses before carefully mapping out his plan to correct, so should we similarly take the needed time to plan our days, weeks, and months. Staying on task (while moving toward our main objectives) grows simpler when we routinely keep an eye balanced between today’s immediate responsibilities and tomorrow’s more flexible expectations (and we make adjustments accordingly).

Keeping Your Orientation in Three Easy Steps

• Take a brief glance to the month ahead – know what’s coming, but don’t spend too much time mulling over the details.

• Keep an eye on the week ahead – make it a habit to do a cursory review of the next seven days at the beginning of every week, then issue verbal/written reminders to each family member.

• Pay careful attention to the following day – every night before bed make all necessary practical preparations for the smoothest possible transition into a new day.

QR Codes for Smartphones — Burdens Do a Body Good Video

I’m constantly amazed at what these little codes can do…since I don’t own a smart phone (or I should say, I don’t have an activated data plan on my smart phone), I can’t prove this works…but you can! In theory, you should be able to scan this little code and watch the video (anytime, anywhere)….give it a try and let me know how it works!

Bonus!!! If you try it out, let me know and you’ll be entered into a drawing for a copy of Burdens Do a Body Good!

MommyMD’s Give Their Pregnancy Advice

The Mommy MD Guides
Tips that doctors who are also mothers use for their own families

By Jennifer Bright Reich

When that little stick turns blue, your whole life changes. I know mine did, both times. Pregnancy is exciting and wonderful, but it can also be concerning and downright scary. Ob visits sometimes feel few and far between.

Over the years as a writer, I’ve interviewed hundreds of doctors. Every now and again, one would say, “When my kids were small, I used to…” That always got my attention because doctors don’t have the time to mess around with stupid stuff. If a tip worked for a doctor who’s also a mother, I figure it’ll probably work for me too.

That’s why I decided to join forces with a terrific doctor who’s also a mother (we call them Mommy MD Guides) named Rallie McAllister, MD, MPH. We decided to gather together all of those trusted, reassuring Mommy MD Guides’ tips. We launched http://www.MommyMDGuides.com last year, and the first book in our Mommy MD Guides series, The Mommy MD Guide to Pregnancy and Birth, More than 900 tips that 60 doctors who are also mothers use during their own pregnancies and births, just released. Here are a few of my favorite tips!

Taking prenatal vitamins: Vitamins are no good to you if you throw them up. One trick if you have morning sickness and can’t choke down your prenatal vitamins is to chew a children’s Flintstones Vitamin instead. Flintstones Complete vitamins, for instance, contain 400 micrograms of folic acid, which is what most experts recommend pregnant women get each day.
—Ashley Roman, MD, MPH

Telling your partner the good news: I took my pregnancy test at the hospital, and my med school classmates knew that I was pregnant before my husband did. When I took the little stick home with the positive sign, I just rang the bell and stood there with it in front of my face. My husband’s jaw dropped, and then he just smiled!
—JJ Levenstein, MD

Coping with morning sickness: At some point in the pregnancy, I stopped being able to tolerate flat liquids of any kind—even water. Seltzer water always came to my rescue. It worked best during those times when I was at a restaurant and I felt the nausea wave coming. If you don’t like plain seltzer, try one with fruit flavoring.
—Tyeese Gaines Reid, DO

Fighting fatigue: I was in my last year of residency during my third pregnancy. Standing on my feet was simply too exhausting, so I made great use of the rolling stools in our practice. I sat on one every chance I got. I’d even roll it in the hall between exam rooms instead of walking. Sometimes I’d ask other people to push me! When you’re tired, don’t walk if you can stand, don’t stand if you can sit, don’t sit if you can lie down, and sleep whenever you can.
—Rallie McAllister, MD, MPH

Easing the (heart)burn: When I was pregnant with triplets, I had terrible, unrelenting heartburn. I discovered that eating ice cream and sipping a little milk helped. So I coated that heartburn with some ice cream! The ice cream (plus medication my doctor prescribed) eased the heartburn enough that it wasn’t waking me up anymore. Of course, by then I was waking up for a zillion other reasons.
—Sadaf T. Bhutta, MBBS

Coping with cravings: I think it’s important to listen to your body. Cravings are a normal part of pregnancy. They’re not a sign that anything is wrong. If you’re craving something unhealthy, try to eat something healthier, such as yogurt instead of ice cream. But if you really must have that ice cream, eat it.
—Erika Schwartz, MD

Soothing itchy skin: During my pregnancy, I had itching on my belly. I put a lot of vitamin E and cocoa butter lotion on the area. If the itching was very intense, I put an ice pack on it, which really helped.
—Diane Truong, MD

Preparing your pets for the baby: Our cat was our baby before our babies were born. My husband and I bought a tent for our baby’s crib to keep the cat out of it. We were concerned how the cat would react to the baby because she was already five years old when our daughter was born. We were right. When the baby came home, the cat was not very happy!
—Mary Mason, MD

Resting up before delivery: I snuck in a pedicure the afternoon before my water broke. That was my
last pedicure in a very long time, and I was so glad that I got it in just under the wire.
—Ashley Roman, MD, MPH

Going into labor: When I went into labor, my husband and I both panicked a bit. He’s a cardiologist, and he started telling me to breathe.
“How do you know I need to breathe?” I asked.
“It’s what they do in all of the movies,” my husband said.
So we mimicked what we had seen on TV and in the movies, and it was fine. I don’t remember early labor being very uncomfortable at all because it happened so quickly.
—Diane Truong, MD

Controlling pain during labor: I wanted to have an epidural, but I really wanted to feel what contractions
felt like first. I was induced. My mom kept saying that she thought I had been having contractions prior to going in, but I didn’t feel a thing. She insisted I was having them and just didn’t know!
“I’ve never had a contraction before,” I said. “But I think I’d know it if I felt one.”
Then the contractions got started.
“Nope, I didn’t feel that before,” I said. “I’ll take that epidural now.”
—Kerri A. Daniels, MD

Dependency vs Competency – Words in High Def with Diane Markins

Writers love to put their thoughts into the written word, they also love to discuss these same concepts and principles “out loud” and this exactly the interchange that writer and radio host, Diane Markins, of Words in High Def and I enjoyed on her new radio show this week. Diane is a superb writer, thinker and advocate for women. I hope you’ll take a few minutes to visit her website and then along with a cup of coffee…listen to our interview. Diane’s known for her “grace and grit” and it’s infectious! Be encouraged today.