Understanding pain in my patients

I've been through some painful things in my life (not some of the ones I've been told in medical school are the most painful -- childbirth, kidney stones, peritonitis, or bone cancer), but none-the-less painful.

Most recently, I herniated my L5 disc.  At least, the docs are fairly certain I did -- no MRI was done, but symptoms all pointed that way.  And between visits to the chiropractor, visits for OMM, and doses of Advil and Prednisone, I'm doing better.

But better doesn't mean pain-free, and anyone who's had a back injury knows that pretty much everything you do (from yawning and coughing to walking and sleeping) involves core muscles.  Which means everything you do involves pain.

I wear a pedometer, and lead a fairly active lifestyle.  Even with medical school studying, I manage to average well over 10,000 steps a day, and that's not including runs.  The first couple days of my injury (until I begged some family to come help me out), I basically laid in bed in excruciating pain, preferring dehydration and hunger over the possible need to get up and use the bathroom.  I averaged only 300 over those early days . . . and when you think about my bed being 50 steps from the bathroom, that's saying a lot.

I finally spent a half hour on the treadmill yesterday, just walking and testing out the waters.  Of course, by the time I was done, I was sore and tired, and not just from the back injury, but also from the disuse and stiffness my muscles had accumulated after a week flat on my back.

Even now, walking is 85% back to normal, and sitting is at least 50% there.

And I'm laying flat on my back as I type this.  Even though the pain isn't extreme, it's there.  It nags with every movement I make.  Every action requires a little extra preparation, a little extra thought and planning.  Instead of hopping out of bed in one smooth movement, I carefully execute three.  Standing for an hour has me exhausted.  Sitting for two hours had me wracked with pain.  Everything I do adds just a little pain, and takes just a little effort.  And it all adds up -- to pain, and to exhaustion, both mentally and physically.

I know that getting up and going for a walk will feel good, and that it's better for my body.  Half of me is antsy to be up and jogging again.  But the part that's winning as I type this is the part that knows that as long as I just lay here, I won't hurt for now.

There's immediate cessation of pain if I just lay here.  IMMEDIATE.  If I move, even though it'll pay off in the future, it'll mean I hurt today, add to the growing overwhelming exhaustion, and have to dive back in.

I think I might finally understand how patients with chronic pain syndromes feel.  

Studies have shown that exercise greatly improves health of those suffering from most chronic pain syndromes.  And in my mind, I always thought, "Well, if they KNOW it'll help them, and it's THAT bad usually, why not do it?  Wouldn't you give ANYTHING to feel better?"

Dear patients . . . I'm sorry.  I get it now.

In no way am I trying to say that what I'm going through is as debilitating as month after month or year after year of symptoms, but sometimes someone just has to make their own "ah ha" connections.  This is mine.

This is not a well-researched article on chronic pain, or a well thought-out position piece on treatment.  This is the largely unedited stream of consciousness from someone who's been subsisting on Advil, Flexeril, and Prednisone for a week, and got a quick and fleeting glimpse into the life of someone with chronic pain.

"Never forget the 343" (9/11)

As 9/11 rears its head tomorrow as the 11th anniversary, there will be a lot of talk about never forgetting the 343. 

Well, please allow me to alter that number:

343 members of the NYFD (341 FFs, 2 paramedics, and a chaplain)

23 members of the NYPD

37 law enforcement officers of the Port Authority

8 private service EMTs and Paramedics

55 military personnel serving at the Pentagon

And a poor bomb-sniffing dog named Sirius.

My point is, there were almost 3000 victims of the attacks, not to mention families and loved ones, and far more than 343 of them were serving in one form or another. Lots of people "ran in while others ran out", including civilians.  When we think about the men and women whose lives have been lost in the war (ostensibly) begun by the attack, the number jumps even higher.  

So honor the 343, but when you say "never forget", please never forget the others, either.

And to all of you who serve in any way, or who hold someone who serves dear, thank you.

Edit:  Emergency medical service personnel who are non-fire-based often feel like the red-headed stepchildren of emergency services.  We/they are often ignored, ridiculed, criticized, or forgotten all together.  Yet their ranks include some of the brightest and best out there.  I'm sure this applies to law enforcement officers of non-city departments, as well (such as the port authority).  Regardless, I wouldn't want someone forgetting my colleague who died trying to save a life simply because he wasn't on NYFD, let alone if that person were family.  

Spin and media coverage does not a hero make.