Guided Meditation

For the last few days, I've been participating in guided meditation sessions. At times they make me laugh.

This is a practice I haven't done for decades, and I'm finding it difficult to return to. Guided meditation can be useful, I think, to people who are unfamiliar with the practice of sitting meditation, or to people involved in a therapeutic situation, but I'm not sure it works very well for someone who doesn't fit those fairly narrow categories. It's a technique that's often used as introduction and motivation, and not solely in a Buddhist context.

Introduction to what? Motivation for what? In my case, I was looking to dealing with some habits I'd built up over the years I've been dealing with chronic health conditions. I was in so much routine physical pain for so many years that I had consciously and unconsciously developed habits to cope with the pain. Habits that continued even when the pain was gone. They restrict my movements and actions and my thinking, ultimately interfering with living a relatively full life in my dotage. As I explained to a relative not long ago, I'm pretty much housebound these days, even though the original reason for limiting my activities (pain) has almost completely dissipated.

The pain has been all but gone for the last three years or so thanks to a whole lot of medication and treatment, but the habits I developed to cope with the pain continue. I could say that about a lot of habits I've developed as coping strategies. But I specifically wanted to deal with the habits of pain-coping when there was no longer any pain to speak of.

I thought guided meditation could be useful, and to some extent it has been, even if the guides from time to time unintentionally spur my laughter. One, for example, started the session with a very long introduction, claiming over and over we would be doing a two minute guided meditation, starting "now," and then doubling back on himself and introducing and "starting" the meditation again, and so on repeatedly, so that in the end, the two minute meditation took a good ten minutes and maybe more. Each time he went around the introduction circle I laughed. I don't know whether he was conscious of doing that, and I doubt he saw or understood how funny it was to people like me.

On the other hand, by participating in the sessions (a few more to go) I've been able to focus my attention much better on my particular goals for starting these meditations, and gradually some of the habits that are no longer useful are dissipating or lifting.

Just yesterday, I was able to get up and do things consciously and mindfully without falling back on coping mechanisms that had stymied me in the past. It's going to take some time to work through all of this, though, and that's OK. I can see progress already, and because the necessity to cope is lessened if not altogether gone, I can more easily visualize a forward path.

Many years ago, I had guided meditation tapes that were useful to begin a series of zazen sessions, but I was encouraged not to rely on them, ultimately not to need them. I don't recall how long I used them -- I don't think it was very long -- but it was a little odd to be put back in that guided context again after so many years. My laughter, I think, was prompted in part by the realization that this was something I hadn't done for so long but with which I was very familiar. Is it like riding a bicycle? You never forget? Well, guess what? I can't ride a bicycle very well anymore.

As I gradually become re-accustomed to the dharma, all sorts of things are changing, coming back to me, new paths opening. Christians refer to being "re-born". That isn't quite what's happening. But it is very interesting to witness a kind of automatic youth reversion that carries me back to another time. Or at least evokes it.

Wonders never cease.  

An Updated Condition Report -- with Update to the Update

It''s now just short of a week since I had the first of four Rituxan infusions. As I reported, after the infusion I felt pretty darned good. No pain for the first time in weeks, months. Almost  complete freedom of movement. A lingering twinge now and then but the feeling of release from pain and restricted movement was magical.

It lasted three days.

Friday, I started noticing moderate joint pains and a dull throbbing pain in my lower back; in addition, there were signs of pain returning to my left hip, along with numbness in my left leg -- sciatica returning.

I took a Flexeril muscle relaxant as a precaution, and the pains seemed to diminish. But Saturday, they returned, focusing in different spots -- the way RA pain does, leading me to believe that I was having or trying to have another RA flare (for many weeks, weekend flares were routine). But then, almost magically, the pain of a flare seemed to disappear, and by late Saturday morning, I felt well enough to start mowing some of the out of control herbage out back.

Mistake. The pain came on again. I didn't take another Flexeril, but I did have to rest. I stayed up quite late Saturday night, monitoring my condition. When it seemed like the pain was not going to worsen, I went to bed.

When I got up Sunday morning, pains in my hips and shoulders were noticeable. Wrists and finger joints were painful as well. It was flare all right.

Later in the day, however, the pains diminished until they were almost gone. That never happened with previous flares. My neighbor Wes came over to help with the mowing, and though I didn't do much, I was able to take care of picking up some of the branches downed by the wind. No noticeable pain. Later in the day, however, when Ms Ché and I went for a supply run, I started experiencing sharp pain in my left shoulder, somewhat less pain in my right shoulder and wrist. Both knees were periodically painful as well.

So the flare isn't over. It's modified. Is that due to the Rituxan? I don't know. I'm supposed to talk to one of the nurses at the Rheumatology department tomorrow about what's been happening. On Thursday I sent an email to my rheumatologist describing my trip to the ER and what seemed to be miraculously pain free days since the Rituxan infusion.

Twice, nurses from rheumatology called me Friday to find out if I was OK. I said yes, but the flare really got going on Saturday.

So, we'll see where this latest episode goes. Right now, I'm feeling pain in my left shoulder, twinges elsewhere. But it's not nearly as bad as previous flares.

We'll see...

UPDATE: (Monday May 15, 2017)  Word came from my rheumatologist that my "good feeling" last week was not likely due to the Rituxan -- effects don't generally kick in for several months -- but was from the high dose of steroids included in the infusion.

I reported my current symptoms -- various joint pains -- and was told that's to be expected. For the time being anyway...

Sigh.

Why Wypipo Are Dying

I've been reading this deeply flawed Brookings study (60 pg pdf) on morbidity and mortality in the 21st Century. It has so many problems it's almost useless, but it nicely fits the narrative of suffering, despairing rural white folks -- who elected Trump in their misery -- that it's become something of a go-to "proof" that white folks are dying in their multitudes (ostensibly from despair at their future-less lives.)

The statistics do not support the conclusion. The  simple facts don't. But don't let that stand in the way of a good narrative.

The primary issue for the authors is the increase in opioid addiction leading to overdose deaths in rural America -- even though it is not the leading cause of death, but so what. It involves drugs, and everyone knows drugs are eeeeeevil.

There have been any number of reports that parts of rural (white) America have been flooded with prescription opioid pain killers; millions and millions of doses sent to pharmacies in areas that have populations in the tens of thousands if that. Surprisingly, these areas then experience a spike in opioid addiction and overdose death. How interesting.

The authors of the Brookings study, however, are careful to hold harmless the prescription drug manufacturers, pharmacies and doctors in those areas. The problems associated with opioids are entirely on the shoulders of the patients who, apparently, falsely claim to be in pain in order to procure a scrip, then trade the meds among themselves. Or something.

It really doesn't make sense given the already restricted access to opioids and other narcotic pain medications. And at least 9 times out of 10, patients presenting with pain are in pain, not "despair," real, physical pain, and the medication is intended and used for pain relief.

Yet the narrative says, "No, no! These people are not in physical pain. They suffer from Wypipo-despair!"

OK.

Interestingly, in other drug abuse frenzies (the crack epidemic, the crank era) nobody cared a whit about the why of such drug use. They wanted to see the users and their unpleasantness eradicated forthwith.

And so it was with the ever-present War on (some) Drugs and (some) Drug Users.

Now, though, the issue is Salt of the Earth Wypipo in rural communities who voted for Trump and all of a sudden, treatment, love and compassion for the despairing victim-users is the general  attitude toward the Unfortunates.

No war on these people and their drug use at all. No sirree.

Except.

Well, there is an exception. What is being proposed and in some cases enacted are further tightening of the restrictions on the prescription and dispensing of opioid pain medications.

In other words, the point is not to "help" the victims -- poor, rural Wypipo that they are -- the point is to make it difficult or impossible for people in pain to legally obtain opioids for pain relief. There. That should solve the problem, right?

Jeebus.

In some areas it is already nearly impossible for people in pain to legally obtain opioid or other narcotic pain relief medication because doctors are terrified of the DEA and refuse to prescribe it -- or any effective medication for pain.

They refuse outright and patients are left on their own to find medications to deal with their pain -- or just live with it. Too bad, so sad. The proposed additional restrictions and prohibitions will simply mean that more people in pain will be refused medications to alleviate their suffering.

I think that's the point of the narrative. "Suffering is good for the soul," right?

Whatever else Our Rulers want to do, they want to impose sufficient suffering on the Rabble to keep them in line, and they want to punish anyone who gets out of line.

That's Doctrine.

Of course I have a personal interest in these things. Until recently, pain associated with my condition was fairly well controlled without specific medications for pain. But about two weeks ago, I started having what they call a "flare," something that hasn't happened since before I started treatment, and it lasted a good long time, despite attempts to mitigate/control the pain with steroids. I received no pain medication at all.

Steroids alone were supposed to be enough to control the pain, but they weren't. What was happening was that generalized joint pain would concentrate in one joint or pair of joints and at one point I could not walk because of the intensity of pain. Standard pain killers like Aleve had no effect.

As it happened, I had some left-over pain medication from a previous bout of sciatica, and sure enough, within minutes of taking it, the pain was controlled.

But it's an opioid, and it was never offered by my doctor -- nothing was -- for pain relief, only the steroids, which did not control the concentrated joint pain that made basic functioning impossible.

According to what I'm being told, my condition has "evolved" into a new and more serious phase that requires more aggressive treatment with stronger immunosuppressants an other drugs that can have serious or fatal side effects. But that's how it goes. I'm not as concerned about that as I am about being stuck in a painful situation (another "flare" for example) without access to effective relief.

Given the urge of policy-makers to further restrict or prohibit the use of opioids for pain relief, I wouldn't be surprised...

[This Politico article explores some of the criticism of the Brookings study. Still, the general thrust of it is accepted.]

RA

I'm coming to grips with an impending diagnosis of early stage rheumatoid arthritis as soon as my doctor gets around to coordinating and evaluating the avalanche of test results that have come in this week.

It's hard to state coherently how much pain I've been in for the last several months, but it has periodically been severe and debilitating. Joint pain. It began with two episodes of general joint pain -- involving practically every joint -- last summer, pain which did not respond to pain relievers -- aspirin and naproxen -- that I had been taking. My doctor recommended that I try ibuprofen, which I did, and sure enough, it seemed to help. On recommendation by a relative, I tried turmeric curcumin which also seemed to help.

After the second episode of general joint pain, the problem became one of a pattern of periodic joint pain that would center in one set of joints after another. Ibuprofen continued to control the pain until mid January of this year when the inflammation and pain seemed to concentrate in my hands and wrists and the pain was nearly constant no matter how much ibuprofen I took. I was up to as much as 2400 mg per day, and still would wake up in the middle of the night needing more.

I'd stiffen up during the night so much it would take hours for me to unstiffen enough in the mornings to even brush my teeth.

Finally the pain became so bad and so constant that I tried an old left-over prescription of Tylenol and codeine that I'd gotten years ago for back spasms. I hated taking it then, and I didn't want to now, but something had to be done. It controlled the pain long enough for me to get some sleep, so that was good. The side effects were still unpleasant, though, and I didn't want to rely on it for pain control.

So it was time to see the doctor again. After hearing what I had to say about what had been going on, the doctor ordered a raft of blood tests, x-rays, and suggested this was probably an auto-immune issue, not osteoarthritis that is caused by degeneration of joints.

She also prescribed an anti-inflammatory drug diclofenac -- which I'd never heard of -- which she said I must not take with ibuprofen. In fact she said over 800 mg a day was ineffective anyway. Oh, well. I beg to differ, but that's another issue for another day.

The anti-inflammatory helped right away. I'd s say the pain in my hands and wrists was 60% controlled almost immediately, and by the second day of taking it, the pain was almost gone for most of the day, though there was still a good deal of stiffness and swelling.

Then the test  results started coming in. At first they were ambiguous, suggestive of an auto-immune issue, but not clearly pinpointing it.

Then results came in that confirmed a  diagnosis of rheumatoid arthritis with an possible other autoimmune component on top of mild osteoarthritis.

Understanding what it is is taking me a while. My sister had lupus for the last 20 years of her life, and I really never knew what it was. She was periodically in intense pain, but she seemed to be getting along reasonably well at other times. Medication helped, and after the first few episodes, the pain seemed to diminish though it kept coming back.

My doctor tested for lupus, and that's the other autoimmune component that appears to be confirmed.

I'm noticing that the anti-inflammatory's effectiveness appears to be diminishing. From 60% control, it's down to about 40% and overnight stiffness and pain seems to be returning in force.

I'm not the world's best patient, so this is going to be an interesting time.

I'll try not to be too self-pitying!

Prison

This video was posted by the Sacramento Bee recently. The video was made by prison staff who have been ordered to document every use of force against inmates. It shows the "extraction" of a mentally ill inmate from a single-man cage (euphemistically called a "holding cell") at Corcoran State Prison in California on December 3, 2012, after he allegedly refuses to leave the cage voluntarily. Some of it is difficult to see or hear because of censorship of sounds and censorship bars over the backs of some of the "extraction" team, but enough can be seen and heard to realize that the only means the staff has to deal with this prisoner is pain compliance, coercion and humiliation; there is literally nothing else available to them.

It's an obscenity. It happens every day. Sometimes with much greater brutality. Under no circumstances are inmates to be treated with dignity or respect. Only pain, humiliation and coercion allowed.



Is it any wonder they rebel?

The Silk Pillow Effect

Silk Pillow

I've been out for the last few days with an episode of sciatica, a recurring problem I've had for the last ten years or so. This is the first time it's happened since we've lived full time in New Mexico.

There was a precursor episode about ten days ago, when I knew a sciatic attack was underway, but the symptoms were mild enough that I wasn't particularly bothered. I could walk, sit, stand, and the pain was relatively mild, focused on the left side of my lower back. It felt as if a vertebral disc was protruding and pressing on the nerves that ran down my left leg. I've had this before, and it's annoying. Sometimes the leg goes completely numb, but more often, my left foot is numb which can make it difficult to walk without lurching and limping about. Usually the pain is mild and can be controlled with Advil or the like. Initially, too, I applied Holy Dirt from El Santuario de Chimayó, which caused immediate and lasting pain relief. Milagro! I can't explain it, but that's what happened. I knew that there was still a sciatic condition, for I could feel the disc protrusion, but the nerve pain was nearly completely gone, and I was quite in wonder at the miracle of it all. I think I then became somewhat complacent. Mistake.

On Friday I woke up in real agony, with intense pain in my left hip, so intense that I was unable to sit or stand or walk for more than a moment or two without experiencing excruciating pain, and so,  for all intents and purposes, I was confined to bed. This was the worst episode I'd had for close to ten years, and the evocation of what I went through back then was not pleasant. Something had happened during the night to force the disc out further and press even more severely on the nerves involved thus producing a constant intense pain. Movement of any kind was difficult. Sleep was impossible.

I came very close to calling Emergency Services, even though it would mean transport by ambulance over 40 miles to Albuquerque's Presbyterian Hospital emergency facilities. This was not an idea I enjoyed at all. Bad as I felt, the thought of an extended trip in an ambulance to wait in an emergency room for essentially little or no treatment and then a ride back home in the car (would that even be physically possible?) was daunting.

I would just have to tough it out somehow.

Sciatica is the set of symptoms signifying a nerve condition in the lower back and hip region often affecting one leg as well (rarely both). It can cause extreme pain and discomfort, numbness in leg and foot, and difficulty walking, sitting or standing normally. As it is right now, for example, although the pain is mostly gone, I can only walk with a very pronounced limp and may have to start using a cane. The cause, in my case, is a herniated and protruding spinal disc that presses on the sciatic nerve that runs down my left leg.

Yes, when it is bad, it hurts like almost nothing you can imagine. There is no escape from the throbbing, shooting pain that lies so deep in the tissue of the leg and hips that it seems to come from some mythic place you didn't know existed. In my case, it was impossible to sit or stand or walk for more than a moment or two, and even lying down could be fiercely painful. Adjusting positions could become an agonizing trial. 

As I say, I've had the condition for ten years or more, the first episode occurring when I was getting out of the car one day and twisted my back just so, causing the spinal disc to protrude. I knew something had happened, because I could feel the protrusion before the pain started. Once the pain started, I couldn't move without extreme pain, and had to be transported by ambulance to the ER where I was promptly seen and diagnosed, but apart from a cortisone injection (which really didn't help much) and some meds, there was nothing, they said, they could do. It would have to heal itself, which they said would happen in a few weeks -- or months.

True enough. The pain gradually dissipated to almost nothing, though leg and foot numbness was constant and relatively severe. In about three months, I felt the disc pop back into place, and the pain -- and most of the numbness I'd been experiencing -- promptly went away. But not completely. In fact, ever since, I've felt consistent numbness in my left leg and foot, sometimes mild, sometimes relatively severe, and I have had modest difficulty walking and have a slight limp favoring my left side. It's been very difficult for me to bend down to pick something off the floor, and there have been other issues, especially around driving long distances (which I used to do quite a lot). For all intents and purposes, sciatica is a chronic condition for me, sometimes debilitating, typically merely annoying. One learns to cope.

This was the first time a severe episode had happened in several years, and it was the first time I had experienced it since moving permanently to New Mexico. Now that I have Medicare Advantage through Presbyterian (one of the major health care providers in New Mexico) at least I have access to medical care if I need it. The problem is that Presbyterian's services are located in Albuquerque, and we live out in the country 40 or more miles away from the closest Presbyterian clinic or hospital. There are alternative services closer to us, but they tend to keep banker's hours and are not equipped for emergencies. If I were to use these out of network clinics, the financial consequences would be essentially the same as if I had no health insurance at all. One thinks long and hard before doing so. On the other hand, when we actually did have no health insurance, we had to use an urgent care clinic for a badly infected wound, and the cost was surprisingly modest, the service competent and quick. The really major expense was for antibiotic medications, not for clinic services.

In this case, since I knew what had happened -- oh yes -- and knew from previous experience that except for certain prescriptions (and possibly a cortisone injection), there was nothing that could be done about it except to grin and bear it and let it heal on its own, I decided to forgo medical treatment altogether. I had enough meds from the most recent episode, a nice cozy bed, and I'm always more comfortable at home than in the noisy, frantic atmosphere of a hospital, especially the emergency room, in any case.

I came to suspect my cozy bed itself was part of the problem. It has one of those memory foam mattresses, which at first was extremely comfortable but over time -- we've had it well less than a year -- began to develop rather more permanent depressions where we sleep than returning to shape as advertised. We have another bed with a more traditional innerspring mattress in the south bedroom, but that room isn't heated during the winter due to our energy conservation routine (we close off unused rooms during the winter, so as to heat the least amount of floor space we can. Still heating costs are quite high as energy is relatively expensive in this part of the country -- about twice the rates for gas and electricity we were paying in California, for example). There was no way we could exchange the mattresses between rooms in my condition. So, we had to figure out if there was something we could do to modify the foam mattress enough to support my hip rather than let it sink in.

This is where the Silk Pillow came into play. The pillow is usually on Old Joe's chair, the one item of furniture we retrieved from Joe's house next door in California after he passed away. Frank and Rosemary, who had been taking care of him, were clearing out the place preparing it for sale some weeks after he died. They thought the old chair was worthless and were grateful that we wanted to take it for the memory of him. It's a very '40's style rounded upholstered chair, beige, very much like Joe himself, and we treasure it. For a time, it was my main seat in the living room, but I traded it out for another old leather covered chair we have some time ago. Old Joe's chair became the "sickie-chair." When we are feeling under the weather or one of the cats needed care, we'd use Old Joe's chair because it was snug and comfortable, and we all seemed to heal better and faster there. The Silk Pillow was on top of the seat cushion as extra padding, just enough, it seemed, to make the chair quite soft and supple. We decided the Silk Pillow was needed on the bed to support my left hip, and that's where it went.

Relief began almost immediately, though the pain continued to be quite severe nevertheless. From Friday to Sunday, there was no let up in the pain, though I could tell it wasn't getting worse -- a good sign -- and I was gradually able to move somewhat more freely. By Monday, I was able to get up and get around, not exactly freely, but at least I could become physically more active and walk -- or hobble -- to the bathroom, that sort of necessary thing. I had a very pronounced limp, though, and nearly fell over a number of times. It was as if my left leg had shortened several inches. Sitting was still a problem, but as the day wore on, even that became less and less troublesome.

Finally, by the end of the day yesterday, I could say with fair confidence that the pain was gone, though numbness continued in my leg and I still have a significant limp. I can still feel the disc protruding, though not as much it did during the worst of the episode. Pressure on the nerve is mostly relieved, whew.

In the course of this episode of sciatica, I've used several tactics to control and relieve pain, some of them remarkably effective, if only for a short while. The Holy Dirt was the first thing I tried, and it worked -- miraculously -- until Friday when the pain became severe and the Dirt didn't work when I applied it. Well, I shouldn't say it "didn't work," because it did, sort of. The pain near surface level immediately vanished, but the deeper pain continued unabated. Something else would have to be tried. The medications I had included Darvocet, Vicodin, and Valium. I took them at recommended dosages, not really expecting much relief (as I'd used them before, briefly, and didn't think they helped much) but I was willing to try again. In fact, this time they did work surprisingly well though not perfectly. Pain was controlled for as long as a couple of hours, which was better than nothing and allowed some sleep. We used ice packs on the affected hip (actually frozen vegetables wrapped in a towel) which was a real, if temporary, relief. Thanks to a recommendation, I tried a topical analgesic "StopPain" -- which at first seemed to make the hip pain much worse -- OW! -- but after fifteen minutes or so, the pain was literally gone, and the effect lasted for about another fifteen minutes. Hmm. Success, modest though it was. The Silk Pillow continued to support my hip so that there was lessened pressure on it and thus less pressure on the nerves that were being squeezed by the protruding disc. And that, in the end, seemed to do the trick. As the pressure was relieved, the pain lessened to the point that it was practically unnoticeable.

And then there was the cat, "Girl" she's named, who recognized right off I was in distress and she wanted to help. Cats are very sensitive that way. Unfortunately, she wanted to help by curling up tight on my right arm -- which strangely made the pain in my left hip and leg flare up. So I told her, "No." She didn't understand at first, and then it occurred to her that she could help by lying closer to the source of the pain, but not actually on me,which she did. By golly, it did seem to help, and she seemed so pleased and proud of herself to have aided my recovery. She liked the Silk Pillow, too.

And so, there's the story of sciatica and the Silk Pillow Effect.

We do what we can... ;-)