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Accepting is saying: 'Given that this is my situation, what can I do to minimize the disruption and what can I do to have a meaningful life?'"
(JENNIFER P. SCHNEIDER)
Jennifer P. Schneider, MD, is a Tucson, Ariz.-based physician certified in internal medicine, addiction medicine, and pain management, and author of Living With Chronic Pain: The Complete Health Guide to the Causes and Treatment of Chronic Pain. In her practice she advocates a combination of pain-control drugs, exercise, and behavioral therapy so that patients can understand how their own thoughts can affect and improve their coping abilities
Q: Is it accurate to say that most chronic pain, by definition, is not really curable? A: Basically, the only way most chronic pain is likely to be cured is if something surgical is done. For example, a knee is finally replaced, or else a spinal cord stimulator is successful. What prevents most chronic pain from getting cured is that the nervous system has undergone some permanent changes. Q: By the time patients come to you, have they begun coping with the fact that their condition is chronic? A: Most patients with chronic pain, when they first come to see me, are hoping that the specialist will find out what is wrong with them so they will get cured. They're hoping for yet another test, the latest evaluation. But they have to understand that chronic pain is different. It's qualitatively different. It's pain that has lost its usefulness and become automatic in the body. The goal of chronic pain treatment is to minimize the pain and to maximize the function. The pain itself now becomes the medical problem. Chronic pain patients have to accept that their goal is no longer to find out what it is, but rather to find out how they can live with it.
Q: How long does it generally take for chronic pain patients to accept their situation?
A: I would say it takes well over a year to come to acceptance. There are stages of grief. In essence you have go through the last stage of grief and get to acceptance, and that takes a long time. But you can't work through those stages until you understand that you're dealing with something that won't go away. So many patients are convinced that if they only find the right doctor they can be cured. If they're stuck in that, they can't get better. Once you accept that you have to work with what you have—that this vulnerable back is always going to be part of your life—then it will empower you to ask, "Therefore, what can I do to make things better in these circumstances, in terms of compliance with medication, exercise, etc." Q: Maximizing function involves a program of exercise and activity, but doesn't that hurt more? A: If you don't use the muscles, they become deconditioned. For example, you may have nothing wrong with your back, the problem may [originate] in your leg, but if you're not moving, all of your back muscles will get weak, and then it's likely your back itself will hurt. It's very important to keep moving. Q: If it hurts to exercise, how do you make it part of your day? A: You have to take the choice out of your exercise. You can't say you don't have time. I ask patients, "How often do you shower? You make your time for those things because you've taken them out of the realm of choice." You have to make exercise a routine part of your schedule.
Q: Are there some personalities who have a harder time accepting their new limitations?
A: Personality types are very important. Certain personalities, like the so-called achievers, find it very hard to adjust their expectations. They have this picture in their heads of what it takes for them to be loved or admired. But if [the doctor has] some sense of what their sense of loss is, then you have a chance of reaching them. The bottom line is, either they adjust their expectations and gain some peace of mind, and have positive things in their lives, or else they go around forever being angry, frustrated, and miserable. As we get old, of course, we all adjust our expectations. So it's a part of life to adjust—but you have to do it earlier and more severely. Q: How easy is it to find a physician who will take the time to discuss coping strategies? A: There aren't nearly enough pain physicians in the country who take the time to counsel patients. A doctor can hardly make a living doing that. So patients may have to turn to counselors who specialize in pain. But in general any variety of cognitive-behavioral therapist can help. They will talk about the consequence of your feelings, your thoughts, your actions. Q: Because there are no actual tests for things like fibromyalgia or even migraines, do you find that pain patients are discriminated against? A: Yes, and to add to the problem, most fibromyalgia and migraine patients are women. There's no question that there is sexism and racism in the issue of chronic pain. Research shows that women and people of other races get pain treatment in significantly smaller proportions in emergency medicine—but I have a feeling that's true in general. Most fibromyalgia patients come in already having been disrespected by family members, other doctors. And because there is a strong connection between what happens in the mind and in the body, if you are anxious or depressed it will increase your pain. It's a vicious circle. How do you treat this? You spend time with patients, send them to counselors. But this is the ideal. It doesn't happen with most patients.
Q: Caregivers have to provide extra care for a spouse in pain and also deal with the fact that their own lives are disrupted. How do they deal with that?
A: The biggest problem for caregivers is that they can't talk about it, really, with the person who is causing them to be in this situation. They can to some extent, but on a day-to-day basis you can't keep saying to your spouse, "I'm angry with you, even though I know it's not your fault." There's only so many times you can say that, if you can say that at all. So they hold it in. I'm a total believer in support groups for people in the same situation. You can say to people in your support group of caregivers, "You know, there are times when I'd like to wash my hands of this whole situation, and move a thousand miles away." That's totally normal, but it's a temporary feeling. Q: You often hear that friends withdraw from people who are in chronic pain, but do people in pain also withdraw from friendships? A: When you have the flu or a bad cold, when you feel you're dying even if you know it's just a virus, you want to go to bed. You don't want people around. You don't want to relate. And it's the same with significant pain. It takes too much effort to be nice, to socialize. So a lot of people do withdraw. Other people never quit kvetching. It gets to where a friend doesn't even want to ask them how they are because they'll launch into 10 minutes about their medical problems. That's a way of pushing away friends. So there is a tendency toward isolation. Q: What do you admire most in your chronic pain patients? A: What I admire is somebody who is realistic about their limitations, but within that framework is doing their best to have a life. To maximize their function. To have meaningful things in their lives. People who have been able to not have their pain be the only thing in their lives. Accepting doesn't mean doing nothing about it. Accepting means saying, "Given that this is my situation, what can I do to minimize the disruption and what can I do to have a meaningful life?" Q: How do those people minimize the disruption? A: For a start, distraction. Distraction is the first line of defense against pain. You can't distract yourself when you're suffering 10 out of 10 pain, overwhelming pain. But if medication and therapy can get you down to the level where you can be distracted, then a movie, a conversation, television—these things can make you feel better. But you have to be willing to open yourself up to that. Q: Your daughter died of colon cancer at the age of 31. Did that teach you something about acceptance? A: When doctors tell patients to quit being sorry for themselves, most patients discount it, because they're thinking "You don't know what I've been through." But in my case, many of my patients realize that I, too, have been through a devastating experience. So in my office practice I fairly often have a discussion like this: "I know it's really hard to have something bad happen to you. And I understand how terrible this is for you. But one of the things I learned from my daughter's death—and I have now lived twice as long as she did—is that I want to make the best of things. I have a formal practice of noticing every good thing that happens to me. If there's a full moon out there, I'm so grateful to see it. I focus on the positives." |
Wednesday 20 March 2013
Jennifer P. Schneider, MD, Pain Management Expert, Shares Strategies for Moving Past Pain
How People in Pain Can Revive Their Sex Lives
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| I was e-mailed and asked a question about this topic chronic pain does affect you in all areas of your life young and old ....enjoy this article. One of the most difficult things about chronic pain is the profound impact that it can have on your sex life. But if you think you are the only chronic pain sufferer with intimacy issues, think again. "It's a silent epidemic," says Clifford Gevirtz, MD, medical director of Somnia Pain Management in New Rochelle, N.Y. "People are embarrassed to talk about it, but they are suffering." But experts say that many are suffering needlessly: "There is a lot of help available," he says. "They just have to have the courage to ask." Finding the root cause of sexual dysfunction Chronic pain affects sexuality on several levels. At the most basic level, pain itself can inhibit sexual activity. Kerrie Smyres, a 31-year-old writer in Seattle who blogs about her daily headaches, says that the pain in her head often hurts too much for sex. Despite the cliche, it's true that headaches can be a major obstacle to intimacy. In a small 2007 survey by the National Headache Foundation, 69% of respondents said they had avoided sex because of a headache. The last thing a chronic pain sufferer needs is more discomfort. But when sex increases pain and patients avoid sex, a vicious cycle can start. "If avoidance continues, a major fear becomes associated with a sexual activity," says Todd Sitzman, MD, a past president of the American Academy of Pain Medicine. "That lack of intimacy can have detrimental effects on relationships." How emotions play a role The alchemy of pain, sex, and relationships is complex. "Typically what I see is a combination of factors," says Geralyn Datz, PhD, a pain psychologist and behavioral medicine specialist in Hattiesburg, Miss. "The person has chronic pain, and intercourse may be physically uncomfortable." But she says often a person can feel emotionally unwilling or just feel bad about themselves. Self-esteem can also plummet, says Datz: "You can imagine how someone who used to be the head of the household and is now relegated to the couch isn't feeling interested in intercourse or intimacy—their self esteem is dramatically affected." Anticipation or fear of pain is another common problem: For Smyres, orgasms can sometimes trigger migraines, which "doesn't give me a whole lot of incentive," she says. |
Communication is the key to rekindling
People with chronic pain—and those who love them—don't need to resign themselves to a lifetime of celibacy. The subject can be broached from several angles, but the main lesson from doctors and couples is this: Communicate.
First, don't be embarrassed to talk to your doctor. "If the physician doesn't bring it up, the patient should," says Dr. Sitzman. "They should get validation that this is a common consequence of chronic pain and its therapy—and they should expect treatment."
Dr. Gevirtz recommends emailing questions beforehand so they can be discussed during the session. He also suggests keeping a pain diary at home so you can remember the details: For example, at what point during intimacy pain occurred or what the circumstances were surrounding an instance where your pain subsided.
Help is a doctor's visit away
Once your doctor has a clear picture, he or she can help. "The main thing is to validate that this is an anticipated side effect that can be treated, and that sexual activity is a normal part of intimacy that chronic pain patients shouldn't be denied," says Dr. Sitzman. Then, patient and doctor can work together to devise a pain management protocol for alleviating pain during sexual activity.
Addressing the emotional component
Couples can also seek out a sex therapist or couples counselor to relearn the building blocks of intimacy. "A lot of times couples are avoiding even basic levels of contact, not holding hands, not kissing, not even talking," says Datz. Part of her therapy with couples includes helping them reestablish physical contact and teaching them relaxation techniques: "Because there is often a lot of anxiety about sexual activity when you have pain," she explains, "it's helpful to learn to relax mentally and physically."
When a loss of self-esteem is keeping a patient from being comfortable with their partner, "we have specific ways of treating that in therapy," says Datz, including "normalizing" a person's symptoms so they don't feel quite so alone and alienated.
The payoff in pain reduction and relaxation
Reigniting intimacy can actually help pain, at least temporarily: "As doctors, we prescribe external opiates, but the best opiates around are the natural ones that the brain produces," says Dr. Gevirtz. "If you can give someone an orgasm, they will have a flood of endorphins and their overall pain numbers will go down."
Helping yourself at home
Express your limitations and desires to your partner, says Sueann Mark, PhD, a clinical sexologist with a private practice in San Francisco. "The person in pain needs to take an inventory about what touch is pleasurable and what's not," she says.
While communication is important, it has to be done at the right time: "Talking about these issues is best done when not in bed," she says. Instead, set aside a separate time of day. And remember to think beyond intercourse: "You can find ways to maintain some sexual relationship," she says, including massage, bubble bath, cuddling, and masturbation.
Couples find what works
Through trial and error, couples have found creative ways to maintain intimacy. Jennifer, who lives with chronic migraines, says that she takes advantage of her pain-free days: "We make the best of the times that I feel better than usual," she says. "Even if we have plans, we decide that the most important thing is going to bed together."
Smyres says that she tries to initiate sex once a week and at times other than the evening, when her head often hurts. She's found that talking about sex more with her husband also helps.
Smyres is proof that by communicating and staying in touch with your partner, you can have a rich and loving relationship in spite of chronic pain: "In general, I'm very happy," says Smyres. "My husband is great and my life is wonderful, I'm in the healthiest emotional place that I've ever been."
Sexuality and Chronic Pain: Questions to Ask Your Doctor
Express your limitations and desires to your partner, says Sueann Mark, PhD, a clinical sexologist with a private practice in San Francisco. "The person in pain needs to take an inventory about what touch is pleasurable and what's not," she says.
While communication is important, it has to be done at the right time: "Talking about these issues is best done when not in bed," she says. Instead, set aside a separate time of day. And remember to think beyond intercourse: "You can find ways to maintain some sexual relationship," she says, including massage, bubble bath, cuddling, and masturbation.
Couples find what works
Through trial and error, couples have found creative ways to maintain intimacy. Jennifer, who lives with chronic migraines, says that she takes advantage of her pain-free days: "We make the best of the times that I feel better than usual," she says. "Even if we have plans, we decide that the most important thing is going to bed together."
Smyres says that she tries to initiate sex once a week and at times other than the evening, when her head often hurts. She's found that talking about sex more with her husband also helps.
Smyres is proof that by communicating and staying in touch with your partner, you can have a rich and loving relationship in spite of chronic pain: "In general, I'm very happy," says Smyres. "My husband is great and my life is wonderful, I'm in the healthiest emotional place that I've ever been."
Sexuality and Chronic Pain: Questions to Ask Your Doctor
- How familiar are you with treating sexual dysfunction?
- Would you feel comfortable referring me to a specialist?
- What are my options for treatment? (These should include a wide range of things including medication, cognitive-behavioral therapy, sex therapy, and marital therapy.)
Flat-Belly Drink worth a try ......
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Get the best results on this plan with a refreshing cup of tea. Peppermint and ginger teas help keep your digestive system running smoothly.
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Ladies here is one you would sure to enjoy reading ..
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10 Beauty Tricks for Daylight Saving Time
By Maggie Puniewska
This weekend daylight saving time goes into effect, so don’t forget to ‘spring’ your clocks forward.
On one hand the change is good–it means we are that much closer to summer. (Hello sun dresses and sandals!)
But losing those precious 60 minutes can make for groggy mornings until your body adjusts.
Want to skip the dark circles under your eyes and the you-look-tired face?
Check out my fave products for perking up in the morning and getting to sleep at bedtime.
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Sweet Potatoes Stuffed with Shrimp and Salsa
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Sweet potatoes and seafood? Heck yes!
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| Calories per serving: | 314 |
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| Fat per serving: | 3g |
| Saturated fat per serving: | 1g |
| Monounsaturated fat per serving: | 1g |
| Polyunsaturated fat per serving: | 1g |
| Protein per serving: | 13g |
| Carbohydrates per serving: | 59g |
| Fiber per serving: | 8g |
| Cholesterol per serving: | 59mg |
| Iron per serving: | 3mg |
| Sodium per serving: | 391mg |
| Calcium per serving: 93mg Yield: 2 servings (serving size: 1 potato) |
Buttered Sweet Potato Knot Rolls
 Buttered Sweet Potato Knot Rolls
Cute and tasty, these knot rolls are proof that you can use sweet potatoes in almost anything. What's more, this recipe contains only one-third the calories and fat of traditional knot rolls because of the sweet potatoes' natural sweetness.
Ingredients
Preparation
Dissolve yeast in milk in a large bowl; let stand 5 minutes.
Add sweet potatoes, 1 tablespoon butter, salt, and egg yolks, stirring mixture with a whisk.
Lightly spoon flour into dry measuring cups; level with a knife. Add 4 1/2 cups flour; stir until a soft dough forms.
Turn dough out onto a floured surface. Knead until smooth and elastic (about 8 minutes); add enough of remaining flour, 1 tablespoon at a time, to prevent dough from sticking to hands (dough will feel very soft and tacky).
Place dough in a large bowl coated with cooking spray, turning to coat top. Cover and let rise in a warm place (85°), free from drafts, 45 minutes or until doubled in size. (Gently press 2 fingers into dough. If indentation remains, dough has risen enough.) Punch dough down. Cover and let rest 5 minutes.
Line 2 baking sheets with parchment paper. Divide dough into 24 equal portions. Working with 1 portion at a time (cover remaining dough to prevent drying), shape each portion into a 9-inch rope. Carefully shape rope into a knot; tuck top end of knot under roll. Place roll on a prepared pan.
Repeat procedure with remaining dough, placing 12 rolls on each pan. Lightly coat rolls with cooking spray; cover and let rise 30 minutes or until doubled in size.
Preheat oven to 400°.
Uncover rolls. Bake at 400° for 8 minutes with 1 pan on bottom rack and 1 pan on second rack from top. Rotate pans; bake an additional 7 minutes or until rolls are golden brown on top and sound hollow when tapped.
Remove rolls from pans; place on wire racks. Brush rolls with 2 tablespoons butter. Serve warm or at room temperature.
Yield: 24 servings (serving size: 1 roll)
Nutritional Information
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Sweet, sweet potatoes
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Sweet, sweet potatoes
By Benjamin Plackett
It's no surprise that sweet potatoes are at the top of nearly everyone's healthiest foods list. One baked, medium-sized sweet potato contains 438% of your daily value of vitamin A (a white potato contains 1%), 37% of your vitamin C, and some calcium, potassium, and iron too. All this at just 105 calories!
What's more, they also deliver 4 grams of dietary fiber—16% of the daily value—and absolutely zip in terms of fat. And luckily there are many ways to whip them up. Here are 25 great (even kid-friendly!) sweet potato recipes. |
Healthy Sweet Potato Recipes
We all know we have to eat healthy but run out of ideas here are a few of my favorites .....
For lots of healthy recipes click here
 Ingredients
Preparation
Preheat oven to 450°.
Peel sweet potatoes; cut each potato lengthwise into 8 wedges. In a large bowl, combine sweet potatoes and remaining ingredients; toss well to coat.
Arrange potatoes in a single layer on a baking sheet. Bake potatoes at 450° for 30 minutes or until soft and lightly browned, turning wedges after the first 15 minutes. Serve immediately.
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Oven-Roasted Sweet-Potato Wedges
Craving french fries? Whip up these oven-roasted sweet-potato wedges instead. A healthier way to satisfy those cravings, this recipe delivers more taste too, with a kick provided by mustard, garlic, and rosemary. Try them with a dip, as a snack all by themselves, or as a side dish; they pair particularly well with lamb.
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| Calories per serving: | 189 |
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| Calories per serving: | 25% |
| Fat per serving: | 5g |
| Saturated fat per serving: | 0.7g |
| Monounsaturated fat per serving: | 3.7g |
| Polyunsaturated fat per serving: | 0.5g |
| Protein per serving: | 3g |
| Carbohydrates per serving: | 34g |
| Fiber per serving: | 4g |
| Cholesterol per serving: | 0.0mg |
| Iron per serving: | 1mg |
| Sodium per serving: | 307mg |
| Calcium per serving: |
Yoga Moves to Beat Insomnia, Ease Stress, and Relieve Pain
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Soothe stress
Relaxing for one minute in Child’s Pose gives your mind and muscles a chance to escape everyday madness.
How-to: Sit back on heels with the insides of legs and feet touching. Lean forward, bowing torso over thighs and lowering forehead to mat. Extend arms forward, palms down. Relax into pose, widening knees or bending elbows a bit, as desired. Focus on breathing, taking four to eight counts for each inhale and exhale and relaxing deeper into pose with each exhale. |
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Ease back pain
Slipping into bed should be a peaceful experience, but many Americans suffer from chronic back pain that prevents them from relaxing comfortably. This reclined twist will give you on-the-spot relief and ward off future trouble by stretching and strengthening muscles and ligaments near your spine.
How-to: Lie on your back on a mat, bend your legs, and squeeze your knees to your chest. Keeping your legs bent and knees together, lower both knees toward the mat on the left side. Hold your knees in place with your left hand and gently twist to the right. Extend your right arm and look right; hold for 5 to 15 breaths. Bring knees and hands back to the center, then repeat to the right. Stretch to both sides three times whenever you feel tightness in your back. |
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Cure a headache
A pounding head can keep you from falling asleep at night, but you don't always have to pop a pill. This move, called Legs up the Wall, gently stretches the muscles in your neck (often the culprit of tension headaches) and relaxes you at the same time—a combo that can ease your ache in just a few minutes.
How-to: Sit on one end of a mat with your right hip touching a wall. Lean back, turn to lie flat on the mat, and extend your legs up the wall; your butt should be nearly touching the wall and your legs should be together. Put your hands on your belly or rest them on the mat above your head. Close your eyes, relax your jaw, and drop your chin slightly. Breathe deeply and slowly in this position for 3 to 10 minutes. |
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Combat insomnia
Easy-to-hold Iyengar yoga inversions, which send blood to the head, can help send you off to dreamland. The gentle Supported Standing Wide Leg Forward Bend is easy to relax into and will help still your thoughts.
How-to: Stand with hands on hips and feet approximately four feet apart, toes slightly turned in. Place a block or short stack of books on the floor in front of you. Breathe deeply; exhale, fold forward, and place hands on floor shoulder-distance apart with fingers spread. Lengthen spine forward and place crown of head on block so both head and neck are fully supported. Draw shoulders away from ears and hug elbows in. (If you feel a hamstring stretch, widen legs and raise block.) Close eyes; breathe slowly in and out through nose. Hold up to five minutes, then come out of pose slowly. Note: If you have glaucoma or high blood pressure, stick to upright poses. |
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Magic moves for more z's
From Health magazine
The next time you find yourself lying awake at night, grab your yoga mat: Research suggests this ancient form of exercise can help combat insomnia, relieve stress, and ward off aches and pains that can keep you tossing and turning. Closing your eyes and breathing long, slow breaths can have a sedating effect on the body, says Sara Ivanhoe, featured instructor on VH1'sCelebrity Rehab. "I've had trouble sleeping since I was an infant," she says. "One of the reasons I got into yoga is because I wanted to learn to relax on command." (Watch her interview here.)
Here are some of Ivanhoe's favorite calming and comforting moves. For best results, put on your pj's first and do them right before you turn in for the night. |
8 Natural Remedies That May Help You Sleep
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Sleep well, sleep better
By Karen Asp
Provided by AOLHealth
If sleep has plunged to the bottom of your to-do list, you're not alone. Although the National Sleep Foundation recommends getting seven to nine hours of sleep a night, the average American logs only six hours and 40 minutes. What gives? Blame crazy schedules and, of course, sleeping woes. Before you rush to the drugstore to buy an over-the-counter (OTC) sleep medication, try one of the following natural sleep remedies. "These are safer and have fewer side effects than OTC medications," says Jacob Teitelbaum, MD, author of From Fatigued to Fantastic and medical director of the national Fibromyalgia and Fatigue Centers. Many of these can not only help you fall asleep and stay asleep, but they may also promote muscle relaxation. |
Remedies That May Help You Sleep
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Magnesium and calcium
Magnesium and calcium are both sleep boosters, and when taken together, they become even more effective. Plus, by taking magnesium, you cancel out any potential heart problems that might arise from taking calcium alone. Take 200 milligrams of —lower the dose if it causes diarrhea—and 600 milligrams of each night.
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Remedies That May Help You Sleep
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Wild lettuce
If you've suffered anxiety, headaches, or muscle or joint pain, you might already be familiar with wild lettuce. It's also effective at calming restlessness and reducing anxiety—and may even quellrestless legs syndrome. When using a wild-lettuce supplement, take 30 to 120 milligrams before bed.
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Remedies That May Help You Sleep
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Hops
Beer fans will no doubt be familiar with the calming effect of hops, the female flowers used in beer making. For sleep purposes, though, this extract has been widely used as a mild sedative foranxiety and insomnia. Take 30 to 120 milligrams before climbing under the covers.
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