I did two presentations to the UW telepain today. The first one I filled out the formal paperwork. The second one was more about an addiction case. UW used to have a pain and addiction telemedicine on Fridays, but it was poorly attended and went away.

But a comment was made that floored me. The pain specialist running the conference said, "Is this person in pain?"

I thought, what?

He said, "Where does the patient hurt? This is a pain conference. I don't treat addiction patients."

Um. So here is my reply. It's taken me part of the evening to get over being appalled at his attitude and frankly appalled by the university specialists.

Dear Dr. X:

In my experience, all addiction, mental health and dual diagnosis patients are in pain. Chronic pain and horrible pain. The addiction patients are often belligerent, frightened, try to use charm or threats, but the drug is out of their control. My goal as a rural family doctor is to be able to help treat or find help for anyone who walks in my door. This means I treat high blood pressure, heart disease, foot pain, broken bones, depression, domestic violence, grief, alcoholism, mania, pregnancy, newborns and drug addiction and just about anything else you can think of. I have diagnosed two patients with guillain barre, a 1:10,000 occurence, I've diagnosed rheumatic fever, followed up a heart nuclear study where a rib lit up to diagnose multiple myeloma. But in addiction and mental health, I am not just treating a patient in pain. I am treating a family and a community. The person's parents are in pain, the spouse, the siblings and most of all the children. I have drawings from children thanking me for treating their parents and stabilizing them. The pain of a person caught in addiction is like quicksand, is like a tarpit, is like falling in a deep hole and realizing that it is slowly filling with water and trying to climb out up slippery mud and falling back over and over. When I treat and help one of these people I am treating and helping whole families and my community.

So yes, I would say that that my addiction patient has chronic pain.

Lots of things going on in my head today. Yesterday a guy I work with brought his daughter in with an explanation that she was having some problems with anxiety. When she was younger she witnessed her younger brother vomiting in a movie theater. While the experience was understandably unpleasant, she developed this phobia of getting sick herself. Now whenever she's around someone who is ill, or is sick herself, she feels like she's going to vomit. I felt really bad for her as she stood in the store, pale, tall, and uncomfortable. I talked to her instead of her dad, she's thirteen, I have a thirteen year old daughter who is more reserved and quiet. I feel as if this is a generation that is more comfortable with silence than speaking. 

In my opinion this girl needs professional help. She needs a trained therapist to help her get to the root of this issue and some coping strategies to help her get through these panicked feelings. I think she's a perfectionist who represses a lot of things, that's a guess on my part, based mostly on how she interacted with her father. He says that she's very close to her mother. It was an awkward situation all around. I'm glad that her father is trying to help her out, products can help ease some anxiety, but if you aren't addressing the core issue the problem will persist.

Last week the mother of a woman who works in the cafe stopped by to shop. We ended up talking for a while, she gave me her number or I gave her mine. I learned that her father had trouble with a heart issue that has never troubled him before. She cleans houses for a living, she wants to lose weight, we spoke for a while about life, careers, kids, and food. She mentioned that she starts her day with a smoothie, has a snack in the middle of the day, gets home and devours everything in sight. I've been through that cycle, like her I have a physically demanding job. Food is a source of energy, I wondered if she started her day with a heartier breakfast while saving her smoothie for when she's on the road might help her meet more of her calorie needs during the day so she's not starving when she gets home at night.

Periodically I text my friends and family members. I like to keep in touch with others and find out what is going on in their lives. Her dad is home and resting comfortably. This morning I asked how she was doing given the recent experience. She said she was good then she told me she was out the door, but wanted to let me know that she had been eating more for breakfast and having her smoothie at lunch. She said that had been amazing advice and thanked me for it. That made me feel really good. She works hard, yesterday I skimped on food while I was at work, came home and ate all sorts of things before I went to bed. Even though it was primarily healthy foods, it was still too much that close to bedtime. 

I rearranged my schedule at work to keep others happy. That was a mistake that I'm working on correcting. I'm going to ask my boss if I can close both weekend nights to get out of closing during the week. Working that late messes with me and my body. I know my boss will understand, but I'm not looking forward to the backlash I suspect will accompany this change. This is driving a wedge between me and my friend. I'm productive during the day and useless at night. My health is suffering as a result of these crazy hours. I can't sustain this and I know there are soluations available to me. I'm proud of myself for being a team player, she wants it to be fair, life never is and never will be fair, but I still feel bad about it.

In other news keeping up with a food diary, weekly calendar, mood journal, and financial plan is a lot more work than I thought it would be. Several books I've read speak about playing to your strengths. Writing things down is a strength of mine so I'm doing more of it. Recording what I eat and how I feel allows me to view how my food influences my mood and vice versa. Monday morning I was stressed about my friend coming over, I ate what I thought was a decent amount of food for breakfast and then ate a second meal before she arrived. I wasn't that hungry for lunch, but ate a bunch of chocolate I didn't want which only increased my agitation.

When the accountant told me I could come in for a tax review I shoved a bunch of things in a bag and left. I came home, drank part of a smoothie that was disgusting, called Verizon, went in to get my phone switched over, came home and drank some hot cocoa and a cup of miso soup. That much caffeine that close to bed resulted in me waking up at 1:51 which was less than ideal. I'm not sure whether journaling my mood would have led to a decrease in chocolate consumption, but my guess is it might have. When I see my youngest daughter next I'm going to show her that I have been using both of the calendars I bought in addition to the one that I had. She's right about one thing, the small one needs to go back to Walgreens

I feel like I'm moving forward in a way that differs from previous advancements. I'm more focused on the processes and systems in my life. I'm paying closer attention to what works and honoring that while trying to determine what is holding me back or not working for me. Take my current clothing situation. I need pajamas. I've wanted them for years, but for some reason I don't buy them for myself. My mom bought me part of a set, but I ended up getting rid of them because they weren't what I wanted. I'm not sure what the problem is here. I think it's lack of knowing what I want and where to buy it. Being petite is such a pain, companies act like you're eighty, or rail thin. I need some help, but I'm not sure who I can ask for guidance and support.

I wish I had a personal shopper. I could give this person money, a list, and have them take back anything that doesn't work for me. I detest shopping. I hate the crowds, the uninspiring clothes, I hate looking at myself in mirrors and I hate coming home with not quite the right thing or having something I really liked and wanted be a disappointment when it starts falling apart on me after minimal wear. I need to figure out what my style is, I think that's probably closer to the heart of the matter than I care to admit. Do I want to be classy, sporty, neutral, fun, etc..., this is the problem. Clothes feels uncomfortable, I enjoy very few things that I own although I have made several purchases that continue to please me.

My plan is to try and go shopping without buying anything. Just go, try things on, get a feel for what I like while keeping in mind what I think I want when I'm at the store. I'll go to a variety of stores, keep a list of things I may want to purchase when I return, and determine what I'm willing to spend on clothes. I'm going to leave my money at home so I'm not tempted to compulsively or impulsively buy anything on my trial run. I would really like it if I could get a friend to go with me, maybe I'll ask my sister if she can go with me, but I'm kind of nervous about going with her since she tends to be critical and harsh. My other sister might be a better option. I'll have to think about this. Lots to do today, but I'm really glad I took some time to write. The brain dump helps, thanks for reading and listening.

Until next time,


P.S. My new thing is writing a poem on the back of each daily sheet I have. Currently on Ode to Verizon IV, I really need to find a new topic, or do I?

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