Living With A Chronic Illness: Arthritis

Monday, June 16, 2008

Managing Chronic Pain-This Patient's Prospective

No matter how many commercials you are exposed to by the media, chronic pain cannot be controlled by over the counter drugs. Chronic pain requires a combination of oral medications (commonly called a "medical cocktail") as well as, pain medication injected directly into the inflamed area. Once your pain gets to the level where ordinary pain medication cannot stop the sharp, stabbing, grinding never ending but constantly increasing pain, you are most likely searching for, or have been referred to, a "Pain Management Doctor".

Pain Management is not an easy or quick fix. It may, as it has with me, take years for you and your doctor to find the right combination of medication. My pain is managed by a team of doctors at Tennessee Valley Pain Management.

At first the amount of medication can be overwhelming, especially if you are still in pain. But you must be be involved. An uninvolved patient creates an ineffective doctor. Every patient is different. Maybe that needs repeating. Every patient is different. Waiting until your next appointment thirty days into the future to notify your doctor that the last prescription is not helping you is unacceptable. There is no pain medication that takes that long to work. It helps or it dose not.

When pain block injections are used. These injections are performed in doctor's offices or "Out Patient Medical Centers". Surgeons perform surgery in these out patient centers daily. With the continued reduction of what insurance companies will pay for their policy holders medical care, these medical facilities are becoming more abundant. As a result, doctors are opting to use them instead of hospitals.

One of the major causes of pain in aging adults is the degeneration of the disc of the lumbar spine. As we age, the disk gradually drys out losing strength and resiliency.

As shown above, degenerative disc disease can cause the disc to lose height resulting in the narrowing of nerve pathways and causing nerve impingement, inflammation and pain. Says Doctor Darryle Antonacci, MD F.A.C.S

Epidural Steroid Injections

Epidural Steroid injections are commonly used to relieve chronic pain. For the proper placement of the medication into the damaged area, the use of fluoroscopy or live x-ray is used. The doctor monitors his direction by watching a screen showing the x-ray of your spine as you lay on the operating table. Usually a solution of cortisone, local anesthetic and saline is injected into the inflamed area.

The type of anesthetic is called twilight. I usually find myself going in and out of consciousness. Sometimes I can feel and hear what is taking place and sometimes I am completely out of it.

Once the procedure is completed, you are taken to a recovery area where you remain until the staff is sure you are not having an adverse reaction to the medication. This takes about an hour. You are then wheeled out to who ever has accompanied you to the procedure. You must have a driver or no anesthetic can be used.

Side Effects that have affected me are

Localized increase in pain - usually last a few days following the injection

Anxiety

Sleeplessness

High blood sugar - my blood sugar levels are elevated for about a week following a procedure

Decrease in the immune system. I have suffered with staph infections twice

Cataracts were recently diagnosed by Dr. John E. Miller , my ophthalmologist. He sees no reason for concern at this time. The cataracts could be from normal aging or from prolonged use of steroid medication.

The purpose of this blog is to inform you of the help that is available for you. Of course, there are others and they will be discussed in future blogs. The important thing is that you are as informed as possible. When you walk into that office, go in with the confidence and knowledge that you are making an educated decision. Make it your decision and not just an agreement to a suggestion that your doctor has made to you. You always have the right to refuse a procedure.

Tuesday, April 8, 2008

ADD, the Invisible Disease of RA

Doctor - What are your mornings like?

Patient - I wake up in pain. The kind of pain that I did not know anyone could live with. I take my medication. I go back to bed.

Doctor - And, does the medication stop the pain?

Patient - No, It just takes the edge off it.

Doctor- Does sitting, standing, or lying down help your pain?

Patient - Usually lying down with my legs propped up helps.

Friend - I came by to see if you wanted to go to lunch.

Sick Friend - I would love to get out of this house. However, I have been in so much pain today. I am afraid I would not be very good company. Maybe we can try it another day.

Friend – But, you do not look like anything is wrong with you.

If these words ring cold in your ears, you, like me, are probably suffering with the Autoimmune Deficiency Disease of Rheumatoid Arthritis (RA). With RA, the body fights off infections. However, once the illness has healed, the body malfunctions and continues fighting as if the disease is still in your body. It then attacks parts of your body that are perfectly healthy. Joints and internal organs are at risk. Having suffered with Arthritis for over thirty years, I cannot count how many times I have heard those words. "You don't look like anything is wrong with you."

At first, we accepted the statement as a compliment. You think to yourself, "At least I don't look as bad as I feel." Nevertheless, as it continues to ravage your physical frame, those simple words start to cut into your spirit. Maybe the person is attempting to pay you a compliment. On the other hand, maybe, when they cannot see any visible changes in your appearance, that person simply cannot phantom that you could be as ill as you say you are.

No matter what their reason, we need to hear and feel the validation. "Yes, I can tell you don't seem to feel well today". "Yes, I see you are moving slower and with great difficulty". These are words, you may never hear. Not even from your doctor. The absence of these words is what sends so many of us into depression and eventually to a psychologist.

Our world has changed forever. To stop the pain, we will go through many treatments, medications, medical procedures, and operations. If we are lucky, we find something that gives us temporary relief. After all, that is actually what all the exercise, change in what we eat, and the barrage of medical treatments are for. We simply want to stop the pain.

For years, many of us conceal our illness from our employer, our family and our friends. We do not want to be different. We cannot afford to lose our job. Or passed over for a promising promotion. We do not want our family to think that we are needy and our friends to think that we are no longer fun loving. We want to appear as normal as possible.

RA eventually makes decisions for us. We finally conclude that we are going to have to end our careers. Our getting dressed for work used to take a casual hour. Now, it may take two or three hours. On the other hand, we may start getting ready for work and simply do not have the energy to push ourselves any further. We reluctantly return to bed, maybe for that day or maybe for that week. RA does not operate within our timetable and neither does the depression that so often accompanies it.

Usually, we only let people in when the illness has become chronic. Our bodies have deteriorated to the point that we must enlighten others of our inability to take full care of ourselves. Our being told, by well meaning family members, "you just needed to get out of bed", does not give us the energy to get up. Our being cautioned "You are on too much medication", does not stop the unbearable pain that we, not the well-meaning love one, are experiencing without the medication. There is little sympathy or understanding for suffers of the invisible illness of RA.

As time passes, our invisible illness starts to outwardly show its' ugliness. By that time, we have usually experienced years of chronic pain, feelings of separateness, miss understanding, and our social calendar is nonexistent.