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Troy, this one's for you...  Thanks for the text today bro!

Yeah, I know it's been a long time, but you have to trust me that it is for the better.  Anything I would have said prior to today would have just been venting out of frustration.  Of late, it seems that I am just playing the role of the Vicodin police.  Which, whatever, is kind of my job, but I've been letting my frustrations slip into my real life.  Take this article I saw on Purdue's homepage.  (Just so you know if you're not familiar, only the biggest news stories from Purdue get posted on the front page.)  Let me quote the first line of the story:

Golfers who play well are more likely to see the hole as larger than their poor-playing counterparts, according to a Purdue University researcher.

This for some reason absolutely infuriated me last week.  I haven't even read the entire article because it is completely uninteresting and would only make me more mad.  I had to stop reading after a quote from this psychologist chick Jessica Witt,

We know a relationship exists between performance and perception, but we are uncertain how they affect each other. For example, do golfers see the hole as bigger so they putt better? Or if they putt better, does that mean they see the hole as bigger? I believe it is a cyclical relationship, but more studies are needed to clarify if one affects the other.

WHO THE HELL CARES?  Why is this news?  Am I alone in thinking that no more studies need to be done on this?  Is this how my tax dollars are spent?  I am stunned that the National Institutes of Health funded this garbage, when I know these funds could be used for research that actually matters.  While writing about this story, I stumbled upon a graphic which was to be included in the University News Service story to help clarify this incredibly difficult concept of the cyclical relationship between performance and perception, but was edited from the final publication at the last minute.  This is a Ternary Complex exclusive:

So I've got this idea that Jessica Witt is so self-righteous that she Googles herself on a weekly basis, so my guess is here in a few days I'm going to get a nasty e-mail from her or one of her MUF (Masters in Ultimate Frisbee) students telling me to take this down.

You see what I mean?  I warned you I become mean-spirited when I get frustrated.  Maybe I'm not as calmed down as I thought I was.  Either way, YouTube has become my safeplace.  I love spending hours on there just seeing where the related videos take me.  People can be so creative and goofy.  I love it!

The thing about work which frustrates me is that I spent all this year learning about how to best serve, educate, and manage a proverbial entity called "the patient."  All the profs say, "when treating your patients..." or "be sure to educate your patient that..."  And we as students naturally tend to envision our grandmas as this proverbial "patient."  I scoured over my notes for hours on end every single day of the year trying to learn as much as I possibly could to be the most help to this "patient."  But then I talk to these drug-seekers like the lady who called the pharmacy today on three separate occasions to ask three different people when Medicaid would pay for her "Vico-dans" next, or the opiate-addicts who I'm supposed to feel good about because I'm replacing their heroin use with Suboxone addiction, and my idealism is chipped away little by little.

I race home to the quietude of YouTube or my book.  I listen to Steve P.'s sermons and get so excited about the fall that I start dancing.  I long for the day that I get regular again (yes, I'm talking about my bowels here).

There's a recurring theme that Dostoevsky keeps bringing up about life, which I discovered several months ago on my own.  I'll be able to write about his interpretation of it a bit later, but I want to quickly introduce my ideas on it to you now.  It's the idea that in order to find anything important to you in life, you have to lose it first by knowingly giving it up -- that you have to fall to the lowest of lows before you can start your climb to redemption.  I remember well my lowest day.  It was Saturday, January 26, 2008.  I'm nearing my 6 month mark of a rocky, but gradual climb.  I have much to be thankful for, and little to be frustrated about, even though it takes a reminder every once in a while.  I'm really growing in my faith, and am very excited about the new push at Northview for "Living a Life on Loan" in service to those in my community.

Coming soon (if I get to it):  a review of Lafayette Civic Theater Under the Stars and another video!

I've been posting about goal-setting, and mentioned the Wish List approach - today I can do the Big Reveal!

Thanks to my colleagues at PMC (who shall remain nameless!) I have attached a copy of the ways-i-want-my-life-to-change-wish-list that people can use at the very beginning of a programme to help identify the areas they want to influence by developing pain management coping skills.  It can be used instead of the menu I showed yesterday, or it can be used alongside it.

There are quite a lot of areas that people would like to change or learn about with regard to chronic pain, and this list isn't designed to be exhaustive. It's also not especially specific in terms of making measureable goals based on research into goal-setting that we've discussed a few days ago.

What it does do is give you, as the clinician, a really good idea of the sorts of needs the person has already identified. In terms of motivation or readiness for change, it can indicate areas that the person is already 'contemplating', or is even perhaps in 'preparation' for change. Prochaska and DiClemente's model (oh yes, I've talked about this a LOT!) and work around this model clearly supports the finding that people need to be in the right space to even start to consider making changes.

If the person is never asked to consider an area that could change, though, it's fairly difficult for them to actually decide that they would like it to be different, so part of our role is to help open up the possibility for change - and you can see this in the 'Wish List'.

I use this Wish List at the very beginning of the programme, asking people to tick all the areas they would like to see changes in. Then after a week or so, I ask them to indicate their three most important 'wishes'. Then we can start working on importance and confidence: why these areas are important (providing the person with the opportunity to reflect on how important it is to them, and uncovering personally-relevant values to support their change process), and how confident they are to achieve them. Once we've identified their level of confidence, it's part of my work to help the person build the confidence to start taking steps towards achieving the changes they want to see in their lives.

To me, pain management is not simply about developing a set of new coping strategies that can be employed while the person continues on in their life. It's much more about reconceptualising who they are: to move from a person who has become quite experienced at being a patient, and following other people's requests or directions, into someone who has their own life to live, their own direction to follow and is becoming a person again.

This is why I feel quite frustrated with many self-help books, even for chronic pain, that are chock-full of new ways to cope, but leave the integration of these coping skills to the person.  Integrating new skills is critical for the skills to actually be used. If you've ever been to a workshop and come away with a whole set of new ideas - only two weeks later find yourself doing just what you've always done, you'll know exactly what I mean!

In industrial and organisational psychology, a lot of research has been undertaken into 'transfer of training' - and things like ongoing support in different contexts, refresher courses, memory prompts, support from 'important people' (eg line managers in a factory) are all known to be both effective and almost essential before training can be implemented in a workplace. (For some good information on transfer of training, this site provides some good resources).

Now, start to think of how we as health providers, support transfer of skills developed in a clinic: how many of us get the support of the 'important people' in the person's life to help them use the new skills? How often do we consider the network of relationships that are a part of an individual's context? How could we help that person make the links between what we show them and what they can readily use in their own environment?

This is really important as far as developing pain management skills in the workplace goes. Without specific support to help someone use their skills, in the context of work where all the cues for old behaviour exist, it's going to be very difficult for them to recall and do something different. Especially when they are perhaps not entirely convinced that this new way of working is helpful.

So while pain management itself is not about 'personality makeover', it is all about reconceptualising the person-as-patient into the-person-as-person. Without that essential 'new belief' the person will likely return to old habits.

Your challenge for today? What about taking some time to think about one method you could use to support someone to recall a skill that you are helping them develop? How could you transfer what they are starting to learn with you into their home or work situation - hey, even into their car!

I felt like climbing the walls tonight.  No thanks to the 2 cups of coffee I had today.  My doctors have warned me against too much caffine.  But I love a good cup of coffee.  I do.  Anyway, as I was mountain biking this evening, came up to that all familiar intersection where the Seneca Niagara Casino parking ramp meets Niagara Street.  I take the bike path that goes to the now anadoned Rainbow Centre Mall.  Well, there is always a jackass who thinks the stop sign there is optional.  Everytime.  So, some guy, like many times before, almost hit me.  So I went in front of his car and, like, stared him down.  At that moment I felt like cutting off his head and stuffing it in a camera bag.

I had to come home and take an Alprazolam.  I still feel edgy.  I'm not violent, or loud, or short tempered.  Just anxious.  High strung.  I was diagnosed with generalized axiety disorder.  Before I started taking Lexapro, I was impossible to be around because of my anxiety.  Sometimes it gets mixed with severe depression.  I ended up in the hospital once, which I'll tell you about some other day.  Anxiety is not fun.  I'd rather be covered in honey and thrown into a hole with fire ants, than to feel anxious.  And the worst part, is the hyperventilation syndrome that sometimes goes along with it.  It sucks.  I shouldn't drink so much caffeine.

but pain is simply taking its toll.  A lady who can hardly speak English (married to a man, same) had put her carseat into the garbage.  Rose, my wife, was going to carry it a block to the dumpster.  Notionally (it was about 60 pounds, about my one-hand weight limit for carrying right now for relatively short distances).  I carried it, and am suffering considerable consequences.

However, there should be a remark just following this entry...

--Glenn

When you can't make the next step, and know you can't--just make it.

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ButYouDontLookSick.com - The daily online magazine for the Chronically Ill and disabled has managed to reach a milestone that so many websites fail to see. This month www.butyoudontlooksick.com celebrates its 5 year anniversary.

The site, founded by Christine Miserandino, offers tips, product reviews, articles and essays which have become invaluable to people with any chronic pain condition, or illness.

“I am so proud to be online for 5 years. I have seen my site grow more then I ever imagined. I always knew we could use technology as a tool for those of us with health issues to help each other and build a community.” says founder Christine Miserandino.

In recent years, ButYouDontLookSick.com has transformed from a personal web site to an international community and support network for the chronically ill as well as their loved ones. The site now features articles from several talented authors as well as a forum, chat room, “Get Well Gift Store”, and daily content delivered via newsfeed or e-mail newsletter.

ButYouDontLookSick.com is also the home of “The Spoon Theory”, a young woman’s explanation of what it feels like to live with Lupus. In her story, author Christine Miserandino wanted to explain how someone with a chronic illness makes choices everyday that a healthy person takes for granted. “I wanted something for her to actually hold. If I was in control of taking away the spoons, then she would know what it felt like to have something else, in this case Lupus, being in control.” says Christine. “The Spoon Theory” has been featured in many health newsletters, magazines and support groups. The story has touched so many of the ButYouDontLookSick.com readers that they affectionately refer to each other as “Spoonies”.

The message boards and chat room at ButYouDontLookSick.com have nearly 5000 active members. “It is very easy to feel isolated and uninformed when you are sick or stuck at home. I built this site to help people living with similar symptoms or experiences make connections.” says Christine Miserandino. With this much growth in the first 5 years we are excited to see what the future holds.

*Christine is available for interviews, quotes, or guest blogging.

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