Pain and Depression - Are You Overwhelmed or Proactive?

Chronic pain affects every aspect of your life. [It affects your quality of life as it limits your physical functioning, your ability to perform activities of daily living, and your ability to work. It has social consequences for your marital and family relationships, it may limit intimacy with your partner, and it may prevent interaction with friends. Given the pervasiveness of pain, it's no wonder that chronic pain affects your psychological well-being as well.

Why do pain and depression co-exist so often? Scientists have been studying this relationship through neurosciences and epidemiology and have made important discoveries. First of all, both depression and the suffering of pain are located in the same area of the brain. Second, the same chemical messengers are involved in regulating pain and mood.What are the mechanisms that affect these parts of the brain and these chemical systems? We find that depression runs in families, so that the stress of having pain may trigger the chemical changes in the brain leading to depression in persons who may be vulnerable because of a family tendency (genetic) to depressive illness. More commonly, however, a person has no family vulnerability to depression, but may get "worn down" by all the stress, losses and problems encountered by having pain over many months. Either way, this "wearing down" is biochemical, such that certain important chemicals (similar to vitamins) that are responsible for regulating both pain and mood appear to be functionally depleted. This is why the same medications that are helpful in depression may also effectively treat pain, because they enhance the pain and mood regulating effects of these chemical systems in your brain.

Seeking help and advocating for yourself are the first steps to treating your pain. Your physician's goals in treating you are to reduce your pain, improve your physical functioning, reduce your psychological distress and improve your overall quality of life. There are many different ways to treat depression and anxiety related to pain. Your physician may suggest one or more of the following therapies to reduce your psychological distress:

• Medication
• Cognitive-behavioral therapy
• Stress management (e.g., relaxation techniques, hypnosis, biofeedback)
• Supportive counseling
• Family counseling

It's important to remember that being depressed is not a sign of personal weakness – depression and anxiety are related to chemical imbalances in your brain. Depressive and anxiety disorders are illnesses that can be treated. Taking medication and going to therapy to treat your depression is the same as taking antibiotics to treat an infection – the necessary steps you take to get better.

• Keep a diary and record changes in your pain and emotions. Bring it with you to your doctors' appointments to remind yourself of how you were feeling and when you were feeling better or worse.

• Identify a support network. Support persons could include family members, friends, support groups. 

• Educate yourself through books, reputable web sites, and organizations.

• Set realistic treatment goals.

• Stay active – with your doctor's advice and approval, begin an exercise program.

• Try stress management techniques and use them regularly. Guided imagery, hypnosis, biofeedback, and relaxation techniques really can work if you work at using them. ]

This information is from the National Pain Foundation website:   http://www.nationalpainfoundation.org/articles/98/pain-and-depression

I have had chronic pain for 35 years (from an auto accident) and I struggle with feeling overwhelmed at times. I have found I cannot handle the stress of pain and depression along with other health complications alone. Sometimes I need someone from my support network to help me get back on track. Whether it's taking more time to pace myself because I'm doing too much - or  I may need to get out of the house and get out of myself. My friends and family help me immensely when I'm willing to listen to them and let them help. I will never forget there was a time when I had no support system and that was a very dark time in my life but I did make it through. I encourage all of you who deal with pain (or chronic illnesses) and depression to get the help you deserve. No one should have to deal with these symptoms alone.  Feel free to leave your comments here if this is something that concerns you. 

Faux or Fresh, Foods and Ideas

I have been reviewing parts of Jessica Black's book, The Anti-inflammatory Diet and Recipe Book regarding the elements to avoid and include in an anti-inflammatory food regimen.  Along with this book and the multitude of research articles I've read, the main focus is to eat fresh organic fruits and vegetables,  along with whole grains, lean meats and rich omega 3 fatty fish. The success of this diet lies in avoiding all processed food and drink. Often dairy, wheat and corn products are also recommended to be eliminated from your diet for their inflammatory properties.

I believe it's always important for you to discuss changes in your diet and nutrition with your health care provider, especially if you have serious health issues. Often physicians don't have a lot of nutritional training, but they can refer you to a nutritionist or dietician. I encourage proactive education before talking with your healthcare provider. By doing your due diligence of reading and research, you can be more effective in discussing your symptoms and desired outcomes.

Setting goals and then checking back in a few weeks to see how those goals are working out is a helpful tool to use with your healthcare provider. Modifications can be made and re-evaluated over and over until real success is achieved.

I encourage you to look into getting the support you need to aid in promoting your  health and well being. It's hard to change life long behaviors, but if you are experiencing an increase in health related problems - it's worth looking into the options of learning new behaviors that can benefit you.

Thanks for checking in today - and I wish you all the best 'fresh foods' have to offer. May they nourish every cell of your being with needed nutrients.

Finding the Right Healthcare Professionals For You

                 

I am so fortunate. For the 35 years I've been dealing with complicated health issues, I've had my good share of what I consider to be great medical practitioners. I'm not going to say all of them have been good. But when I come across a physician with whom I do not 'connect', I don't hesitate - I look for another.  I value my health too much to waste time, energy and money on someone who could care less about who I am and all the health issues I deal with on a daily basis.

Over the last 5 years I have been so blessed to receive excellent care from wonderful healthcare professionals. After a devastating 4th hip replacement revision surgery which resulted in paralysis of my right leg from femoral nerve damage, my PCP stepped up to the plate when my orthopedic surgeon denied any assistance. 

My PCP referred me to a neurological physical therapist trained in rehabilitative medicine. We worked together on gaining mobility of my paralyzed leg over a 16 month period. Her devotion, knowledge and willingness to 'think outside the box' in treatment options were invaluable. My PCP offered care for my whole person, including mental, physical and emotional support. She worked with me on diet, supplements, medications, mental health options, and developing a good support system. She taught me how to be proactive in defining my choices in healthcare options. I will be eternally grateful for all of her care and wisdom. I also had excellent alternative care providers, the best of which was the intuitive and trusted hands of my shiatsu masseuse.

I have since switched insurance companies and am currently under the services of a large HMO provider system. I expected to be disappointed in their care and lost in their system. Thankfully I've been proven wrong in my basic assumption. I have one of the best PCP's I've ever had. She is easy to talk to, understands the many complications of my health, and offers me shared decision-making in determining my care. She trusts me to make wise choices about how I care for my body every day, and that's RARE for a healthcare physician in this day and age!  I trust her to advise me in the best treatments available to me. I have not had the same experience with all of the specialists I have been referred to in this system. However the availability of electronic medical records in an HMO system does offer other providers a chance to look into the history and results of a patient's medical record which can be a useful tool for further investigations.

Selfishly I miss the integrated team approach of the physicians and healthcare professionals I had with my previous PPO insurance. I had my PCP, a pharmacist, a physical therapist, multiple specialists (for diabetes, fibromyalgia, neurology, orthopedics, etc.) that comprised my healthcare team. I would meet together with several of them once a year to address options and concerns for integrating my care. I realize this was in a teaching university environment  where they look to teach medical students the effects of integrated medicine.  However it was invaluable to me as a patient knowing that all areas of my health were being looked at and addressed as a complete being.  

Now the decision-making responsibility sits wholly upon the shoulders of my PCP in the HMO system. My care is only as good as my PCP, and as I've said, I have a great doctor that I trust. I choose to be responsible for following up with her and my other specialists, knowing that things do and will fall through the cracks without my proactive approach and education. 

I hope you too take your health seriously enough to be accountable for finding the best physician and healthcare providers to give you the services you need. Another concern for me is to reach out to multiple social network arenas to share information and support with  people who have similar health concerns to mine. This is a time of vast expansion on the internet and discernment is really critical. I value my research skills and the multiple reviews available online to help me question and learn more about health issues.  Especially when patient's don't feel well or are overwhelmed by multiple issues, it can be difficult to think clearly. Sometimes "miracle" cures look pretty tempting. It's good to have a reality check with others who understand the "nature of the beast"(the illness) and can offer another perspective.

Thanks for visiting today. If you have any comments or insights, I'd sure love to hear them. Have the best day you can. Blessings to you and your loved ones.

Limiting Anti-Inflammatory Foods?

There is no doubt in my mind that anti-inflammatory foods are the healthiest foods to eat. Fresh fruits, vegetables, lean white meats, limited oils and whole grains are undeniably the best nourishment for our bodies. However occasionally (or more often) there are complications we face that limit our food choices.

I'm finding after many weeks of eating FRESH anti-inflammatory foods, my intestinal tract cannot tolerate many of my choices.  I have GASTROPARESIS, otherwise known as paralyzed stomach, and I have come to the realization I really need to respect the advice of my health care professionals. Gastroparesis is a COMMON complication of diabetes, effecting over 5 million Americans of all ages. It does not allow food to be digested normally, and does not permit emptying stomach contents, causing tremendous pain, nausea and elimination problems. Undigested food can harden into solid masses that can be dangerous if they obstruct the intestinal tract.

I have to say, this severe bout of Gastroparesis and my intolerance for fresh foods is causing a lot of grief inside me. I was so excited to find out the wonderful things about anti-inflammatory foods. I feel betrayed by my body. Yet I know I will keep searching for ways to incorporate anti-inflammatory foods into my diet some way, because I need the nutrients they provide.

According to GI specialists, nutritionists, and the information found at http://www.g-pact.org/gpdiet.html, the best way to handle Gastroparesis, GP, is in small nutritional steps. The website outlines 3 basic steps to follow. As I evaluate these steps, I'll take what I've learned about the nutritional values of anti-inflammatory foods and see how to incorporate them into these steps. Let's see what options are available to me . . .

• Step 1: Patients with severe nausea and vomiting should take small sips of salty liquids such as Gatorade or bouillon, to help avoid dehydration. Any liquid should have caloric content, however avoid citrus and highly sugared drinks.  The goal is to ingest 1000 to 1500 calories in a 12-14 hour period. (Hmm - no anti-inflammatory foods available in this step.)
• Step 2: As tolerated, the diet can be advanced to include a variety of soups with noodles, rice or crackers.  Peanut butter, cheese and crackers may be added in small amounts if tolerated. These foods should be eaten in six small meals over a 12 hour period. The goal is to ingest 1500 calories and avoid dehydration. It is important to avoid creamy, milk-based liquids.  Any fat in the food will delay emptying the stomach. (I could make a soup stock using fresh chopped vegetables and strain them out. Once you've boiled them to get the broth, there's no nutritional value left in them. Chopping fresh vegetables and letting them cook in the broth is the way to go. If I don't want them chunky, I can strain them out and puree them and put them back into the soup to thicken it and keep the nutritional level up.) 
• Step 3: As the patient tolerates Step 2, the following items may be added slowly. Starches like white bread, noodles, potatoes and white rice breakdown easily and are emptied by the stomach. Homemade soups, mashed potatoes, pasta and rice dishes may be well tolerated. Small portions of baked chicken breast and fish can be added at this time. These solids should be ingested in six small meals over a 12 hour period.  The goal at this point is to find interesting and satiating foods which do not exacerbate my GP symptoms. 
• Goal: Avoid all fatty foods, red meat and (uncooked) fresh fruits and vegetables which delay emptying of the stomach.  Canned (or fresh COOKED) fruits such as peaches and applesauce, as well as fresh bananas and avocados may be added as they do not require excessive digestion. Fresh vegetables MUST BE COOKED until they are SOFT and should be LIMITED to spinach, squash (winter & summer varieties) and carrots. Fresh and fibrous vegetables must be completely avoided as they are too difficult to digest. 

I notice as I write out this list of "safe" foods for me to eat, some of the foods in Step 3 are high on the Glycemic Index which compromises my diabetes, as they elevate my blood sugars more quickly. Potatoes are identified as an inflammatory food and will effect my arthritis and fibromyalgia.  Clearly I have my research work cut out for me; as I balance my food choices for easier digestion along with stabilizing my blood sugars.

Others of you may have health complications which effect your food choices. I'd LOVE to hear from you. I believe our health and well-being are our responsibility. The more we know about our diseases and the nutritional value of foods, the easier it is for us to make proper substitutions and choose different foods that will help us stay on track with healthful eating.

Wishing you all the best today and every day. Thanks for checking in. See you again soon!

For more information on Gastroparesis, please check out these sites:
http://digestive.niddk.nih.gov/ddiseases/pubs/gastroparesis/
http://livingwithgastroparesis.com/blog/
http://www.g-pact.org/gastroparesis.html

You can find support for Diabetes on facebook at:
http://www.facebook.com/Diabetes.n.Diabetics
http://www.facebook.com/diabetesdaily?ref=ts