Hi, Anna-Liza here.

I had to take an unplanned day off to get some emergency dental work done. I managed to break a molar and went in this morning to have my dentist take a look at it. Turned into an impromptu root canal, so now I'm on vicodin (or the generic equivalent thereof) and noticing that it doesn't work as well as a jawful of novocaine. Then again, it's nice to be able to taste things and feel my tongue.

You know what? I need to quit doing that mom thing. You know, that thing where we take care of everyone else's stuff first, and get around to our stuff when we get to it ... or it hurts? Yeah, that thing. Because I knew I'd chipped a corner off this molar weeks ago, but I didn't do anything about it until more bits broke off and it started hurting. It would have been a lot less expensive, for one thing!

I did get a chance to use my Health Savings Account for the first time. Our insurance has it set up so you get a debit card that you can use to pay for things directly out of your HSA. It's really convenient! I just have to make sure I don't confuse it with my regular card.

And I have different dental insurance now, with the new job. I had to change dentists, and I'd never met this guy before. Luckily, he's a good guy and very nice. And when I said something about having put off coming in, he just shrugged and said, "So, you're saying you're human." I really appreciate that--I hate getting scolded by the dentist or hygienist almost as much as I hate getting the novocaine shot.

So instead of getting a temp filling and going in to work for the afternoon, I'm typing this and thinking about taking another pain pill. I'll be spending the rest of the afternoon reading (probably not knitting, unless it's something pretty simple). Even so ... I'd really rather be at work!

I am taking the opportunity to do part of the Reading in Wonderland challenge. My daughter, the Knitting Sprite, turned me on to Tamora Pierce's writing a while back. I'm reading the Circle of Magic quartet now, which is set in a different world than most of her books. In this series, she focuses on magic in craft, such as spinning, weaving, metalsmithing, gardening, etc. I'm enjoying it quite a bit! This one would be, I guess, the "read something from a genre you don't usually read" category. It's Young Adult, so it doesn't quite fit the Children's Picture Book challenge. However, I have to admit I read YA once in a while, because an awful lot of really good books get missed because they've been put into that category. Trust me. And go check out the "teen" section at the library sometime soon. 

(ETA: I actually wrote this over a week ago and forgot to post it. But I reread it and decided to post it anyway. Damn drugs! --A)

Sometimes you need to celebrate the little victories.

If you've been reading for a few days you've noticed I started adding a little number (rated out of 10) at the bottom of my posts. This is an old technique from my more intensive therapy days. About five years ago I went through some intensive obsessive compulsive disorder (OCD) therapy. Of course, L was by my side the whole time.

One of the techniques I learned was to simply keep a running gauge of how "un-ok" I am- a rating of my anxiety, stress, or panic. It could represent in a variety of ways but the idea was that at around 5 it starts to impact my day to day functioning. At 10 I should probably be really worried. Ever since Sunday night, when I first received L's email, I have been averaging a 6 or 7.

Two days ago waiting for an elevator pushed me up to an 8. Wednesday night I was able to stay at a stable 5 long enough to enjoy a movie. Walking into the office to run a meeting today may have pushed me up to a 7 for awhile but I am very proud to announce I am currently at a 3, the calmest I have been all week.

While yesterday held a steady 5-6 range most of the day I prefer having this nice dip down 3 even if I ride back up.

I cite a number of different sources that helped to bring it back down that low:

• Eating and sleeping. I kept forgetting to do these till I got myself down to a 6.
• No alcohol. I tried it the night after I got the email and all it did was give me nightmares.
• Lots of hugs from my friends. Hugs are like homeopathic sedatives.
• I spoke with my boss at work and resolved most of the anxiety that taking the leave had been causing. It's nice to have a boss who believes in you no matter what.
• Conversations with my friends and therapists as needed. Most of the time they pick and aren't too annoyed when I repeat the same comments about how much I miss her.
• Three words: xanax, xanax, and xanax.
• My first solo session with the therapist, who helped me come to terms with some of L's cognitive dissonance about the relationship (you'll hear more about this later, I'm sure).
• Getting out in the sunshine, at least for a little bit.
• Watching my complete Neon Genesis Evangelion box set (though you may prefer something less animated and violent for your therapeutic viewing pleasure).
• Of course, writing this blog and reading others has helped immensely. Shout outs to:Sanityfound, nkartist06, Getting Past Your Past, The World Observed, and Send Them To An Island. Breaking 100 views was nice too.
• Did I mention my friends and family yet?
• Finally, being able to finally sleep through the night. That's a real big one.

I still hold on to the hope that she'll come back but at least I'm starting to be prepared for the alternative. So I proudly pronounce that:

My Current Emotional Panic Level is 3

Maybe it won't last all night but it is nice to at least feel the calm for a moment.

I didn't die! Yay!

My surgery was very interesting. I am glad I wasn't totally knocked out because it was fascinating what they do to you! I was numbed up with some very painful shots (I thought I would get four, one for each tooth, but it was more like 6 for each tooth!). The worst was the shot in the jaw. Ouch! I also got laughing gas, which never once made me want to laugh. It just made me really tingly. Then it was time for the fun to start.

I was fortunate enough to bring an ipod and an eyemask for my surgery, so I was able to zen out as much as possible given the circumstances. I could still hear the drill loud and clear, but the drill doesn't scare me at all. What was scary was the tremendous force the dentist used to pull my teeth out. I actually thought he might break my jaw. On one tooth, there was a horrifying crack, and a lot of pressure on the jaw. But since I seem fine I must conclude that it was just my tooth breaking. Another icky part is feeling the thread against your cheek as you are getting stitched up.

A few hours after surgery (and a lot of spitting up blood, yuck), I called for my first dose of God-knows-what pain meds. I took eight pills and waited. Two hours later I was still in pain and considering the rescue drug. I didn't ask for it though, because I wasn't sure how much pain relief I should be feeling anyways. Maybe it was working, just not a lot? Also, I didn't want to screw up the study. I was allowed a second dose of something that could be the same or could be different in 6 hours if I could make it that long, so I tried.

After a while, I felt like my head was going to explode, so I asked for an ice pack which most of the other 8 study participants seemed to have. I was told I couldn't have one until I took the rescue drug, because it would alter my perception of pain. When I looked around, I counted five others with ice packs. So 5/8ths of the participants had already cracked. At this point I was three hours from the second dose drug, so I decided to keep waiting. But I am weak. I only lasted one more hour before giving in and getting Vicodin.

Oooh sweet Vicodin. That stuff is amazing. Not even 40 minutes later, I was nearly pain free. So that's what a drug is supposed to do! I don't know if I got a placebo or the experiment drug in my first dose, but if it was the drug, they should give up now. It doesn't compare at all to Vicodin.

The rest of my time there was pretty smooth. The Vicodin would wear off after four hours, but I could only dose every 6, so I had to spend those hours in pain. Also, to keep from getting sick the nurses would make me eat with every dose, even though I didn't want to. It's weird to eat and not chew!

The nurses were pretty great. They would get us drinks, food, pills, ice packs. The beds were comfy and we got DVD players and selection of magazines and movies. It's not a bad place to hole up for 24 hours. The only downside was that it was hard to sleep. We were awakened every hour at least to rate our pain and get our vitals taken. I also had my blood drawn twice (which was almost the worst part of the whole process in my opinion) and I had 3 or 4 EKGs. At least I know I'm healthy now!

All in all, I'm glad I did it. The surgery probably took 30 mins, I can't believe how much dentists charge for it when it's so little work! Now that it's over, I'm happy that I did it and got all four of my wisdom teeth out for free, plus I get paid $400 to boot. (There was one study going on while I was there that the participants were making $8,000 to do, but they had to stay there for a full month. I couldn't do that!)

I should also point out that Anthony is a very good caretaker. When I got home, he had made me 3 kinds of jello, mashed potatoes and had bought tons of mac n cheese, apple sauce, cottage cheese, etc.. for me to eat. He even made me a sign that says "SMILE" for me to hold up when I want to smile (since my cheeks are too swollen to actually do so).

¿Cuándo es necesario tratar una depresión?

Desde la introducción de los fármacos antidepresivos a mediados de los años cincuenta se ha producido una mejora significativa en la perspectiva de tratamiento de los pacientes con depresión. Se considera que estos fármacos son eficaces en el 60 a 80 % de los pacientes, siendo la respuesta variable en función de la gravedad de la depresión y de la presencia de otros factores que pueden "entorpecer" la acción del fármaco como pueden ser acontecimientos vitales estresantes mantenidos, características de personalidad alteradas de base o mal cumplimiento del tratamiento. Además hasta el 90% de las depresiones responderán a algún tipo de tratamiento antidepresivo.

La depresión parece estar asociada a la existencia de niveles bajos de determinadas sustancias a nivel cerebral tales como la serotonina, la noradrenalina o la dopamina. Por ello, los fármacos antidepresivos actúan intentando aumentar alguna de estas sustancias en el cerebro a través de distintos mecanismos de acción.

Antidepresivos tricíclicos. Fueron de los primeros antidepresivos en aparecer. Presentan una elevada eficacia aunque por su potencial de producir efectos secundarios como sedación, sequedad de boca, estreñimiento, temblores, hipotensión, etc. se recomienda iniciarlos a dosis bajas e ir aumentando en función de la tolerancia del paciente y del efecto antidepresivo, hasta conseguir la dosis que equilibre la mayor eficacia posible con los menores efectos secundarios. Se tienden a utilizar en casos graves de depresión. Por su perfil sedante, alguno de ellos se indica también en depresión con elevado nivel de ansiedad.

Para mayor Informacion visite: http://www.trustedprescriptionsonline.com

Hello friends and readers,

Today being the 30th of May marks a very huge milestone in the ethical treatment of all Women in Pain! Today Cynthia Toussaint and her For Grace organisation are holding a conference "Gender Matters" and for the first time she is bringing the health professionals and the pain patients into the same room together on level ground. This is the first time anything like this has been done, she has fought hard to bring this conference together and I hope it is a huge success.

Also thanks to Cynthia's hard work LA City Proclaims Women in Pain Awareness Day - 30th May every year!

Thank you Cynthia, you have encouraged others to keep going and to make a difference!

love & light
Mel xx

Vulvodynia

Symptoms of vulvodynia include chronic pain, burning, itching, and/or rawness of the vulva (female genital tissue). This discomfort may involve the entire vulva or only specific areas. The pain may be constant, intermittent, or may be experienced only when the vulva is touched or with penetration (i.e. intercourse or tampon insertion). Vulvodynia is often associated with burning, frequency and urgency of urination when no infection is present. Many women with vulvodynia are misdiagnosed with vaginal infections, HPV (genital wart virus), or herpes. Treatment with most vaginal creams (especially creams containing hydrocortisone), acids such as TCA, laser surgery and most other surgeries can increase pain, sometimes permanently. Many women have been helped by the topical application of Estrace cream, nutritional supplements such as calcium citrate, the low oxalate diet, and biofeedback/physical therapy. The cause of vulvodynia is unknown. Many women with vulvodynia also have fibromyalgia.

LINKS

Center of Vulvar Diseases -- a division of the University of Michigan Medical Center's Department of Obstetrics and Gynecology. Some of the best information on the web on this topic.

National Vulvodynia Association -- home page for this organization.

The Vulvar Pain Foundation -- home page for this organization. Includes detailed information on treatments such as Estrace cream and the low oxalate diet.

Vulvodynia.com -- Dr. Howard Glazer's site, home page of a vulvodynia listserv as well as live chats on vulvar pain issues. Also includes links, bibliography, and information on biofeedback treatment.

Vulvodynia Information Web Portal -- Julie works to obtain permission to publish articles on vulvodynia on the web. Her page is an invaluable resource.

Camilla Cracchiolo's Home Page is also the home of the Vulvar Pain FAQ, a "must-read" for anyone with vulvodynia.

LISTSERVS

Listservs are email discussion groups and are an invaluable resource to anyone with vulvodynia. They offer support and information from other women who understand and in doing so, they help combat the isolation most women with vulvodynia feel. Please consider joining at least one of the two below.

VulvodyniaList -- information on how to join.

The Vulvar Pain Forum -- for information on how to join this listserv, email Paige.

BOOKS

A Woman's Guide to Overcoming Sexual Fear & Pain by Aurelie Jones Goodwin, Ed.D. and Marc E. Agronin, M.D.

One time I was carrying out some work for a large organisation that wanted to train a lot of people to do some assessment work. It annoyed me for some reason, and I've finally hit on the problem (OK, several years too late, but never mind!). The problem was that instead of teaching principles, I was asked to train on process and procedure. Now I don't know whether this is a 'me' thing, or a more general thing, but I find that if someone tells me to do something following a certain structure or format, I NEED to know the underlying framework so it makes sense to me.

What does it give me? It gives me flexibility - and this is why I haven't yet posted on specific questions to use when learning skills in carrying out cognitive behavioural therapy. Today's post is an endeavour to look beyond the specific questions to ask and into the underlying direction and rationale for the questions. I think that for occupational therapists, physiotherapists, nurses, social workers - anyone who uses CBT alongside other therapies or activities - it's necessary to be very flexible, because we can't rely on the pre-determined structure of a CBT session to 'programme' the level we might work at.

For example, I was working with a woman yesterday who was undergoing a trial implantation procedure. She had been through many pain management programmes and seen many different therapists over the 10 or more years she had experienced her neuropathic leg pain. I was talking with her about what would happen when she returned home with her new device implanted, and working to draw up a daily plan of activities. As I started to sketch out the most important activities in her day and put in a rest period, I noticed a change in her affect.

At this point I asked her 'What was going through your mind just then?'

She replied that she would never have stopped doing her household tasks 'just to take a break'.

In many cognitive therapy sessions, this would have been the cue to work with her automatic thoughts and help her challenge her underlying rule that 'you should always finish a job you start'. The typical pattern of enquiry would be to ask what that thought meant about:

• herself as a person
• other people in general
• what it would be like to violate that rule
• what it meant about her pain

In this case, given the timeframe I had and the purpose of the session, I decided to follow a behavioural tack. After confirming that she was ready to try taking short breaks, and reflecting to her that I wondered if she might find it difficult at first to stop in the middle of a task, I started working with her to identify ways she could remind herself to take a break - and reward herself.

Now if we were following a 'trained monkey' approach, we may not have siezed this opportunity - we may have either decided it wasn't an important focus for the session, or tried to work through the questions that are usually used to help someone challenge their thinking.

What am I trying to say here?

• That it's important to think beyond a formula or recipe

• That attending to the overall purpose of the session is important, but to take opportunities as they arise
• That choosing from a range of options, and being respectful of the individual's values, can mean the door remains open
• That knowing the underlying principles of cognitive behavioural therapy opens up options that relying on a process can't offer

What are some of the principles?

1. The basic foundation of CBT involves understanding the cognitive elements as well as the behavioural elements
2. 'Homework' is not the only way to assist with behaviour change!
3. Behaviours respond to behavioural reinforcement that includes rewards, recording results, and social modelling - thoughts and beliefs, while important, don't always have to change first. They may in fact change as a result of discovering that new behaviours are working.
4. Having in mind the formulation (explanatory model) that is being developed and/or confirmed helps guide your interventions.
5. Core beliefs may be the reason someone finds it hard to use a new strategy. Unhelpful core beliefs, especially those that are applied rigidly, may be resistant to change.
6. Past events don't need to be revisited except insofar as they help you and the person gain insight into their current beliefs and behaviour.

What do I mean by process?

This is what I also call 'cookie cutter' therapy. This is therapy that relies on a series of standard sessions and is applied to any and all patients. Or has a standard formula for every session. Or standard home-based activities.

People and therapists are not monkeys. We don't respond to the same process, format, style or approach. We also don't work at the same pace. We don't have the same issues or factors influencing our experiences.

As occupational therapists, physiotherapists, nurses, social workers, speech language therapists and others use CBT within their practice, we can offer distinctive flavours of therapy, and this means our clients/patients have a greater chance of finding something that works for them. What we must guard against is rote learning a series of questions or standard sessions and thinking that this is sufficient.

More on CBT tomorrow - and next week, some worksheets! Don't forget you can subscribe via RSS feed (click the link at the top of the page), or bookmark this site. You're always welcome to comment, and I'm happy to be contacted too. Just head to the 'About' page.

Everyone has a wisdom teeth story. And now I have mine. Some things I came away with:
1. It's not as bad as they say. I didn't leak blood all over my pillow at night. I didn't get dry socket. Not yet at least.
2. Variety in a diet has a regulatory effect.
3. In the same way the restroom at a restaurant speaks to the cleanliness of the kitchen; everything from the Italian leather couches to posh decorative vases correlated with the quality of care I received. They even gave me laughing gas because I was nervous about inserting the needle for anesthesia! Yea buddy.
4. I love Vicodin (as well as the other narcotics my dad picked up from a friend with back pain when those ran out. They became a source of worry for my boyfriend when I started slurring my speech and whispering sweet nothings into his face at random, like "Today is the day you hate me. You decided to hate me today didn't you, baby?" [ass grab])
5. I refuse to terrify others with my wisdom teeth extraction experience. Call it pseudo-lying, but it's my prerogative. Maybe I'm the type that'd rather be "in the dark" than loose sleep the week before thinking the experience would be comparable or "worse," as one mother swore up and down the night before relaying her story at Open House, than birthing pains.
6. Despite the anxiety I feel over needles and blood loss, I think I have a pretty high pain tolerance.
7. I was confronted with my need for others. There are those rare, but true times in life when the pain comes on so strong it wakes you from sleep and the only relief comes in the form of having someone lie awake with you and play with your hair just so you don't have to feel like you are suffering alone.

An elementary school teacher in the Liberty school district has been accused of forging a prescription for pain medication, according to prosecutors.