Fibromyalgia and The Perfect Storm of Hidden Secondary Disabilities

The backhanded gift of living with fibromyalgia for almost two decades has allowed me to develop a primarily positive outlook on what living a good life entails.  That life view altered completely after a rear-end MVA (motor vehicle accident) in 2013 that not only tossed my body around, but ejected my wellness toolkit out of my brain. This last year has been spent trying to reach an acceptance of this perfect storm of hidden disabilities; disabilities that overlap in their symptoms, causing one to activate another.

The MVA injuries I live with include; mTBI (mild cognitive loss; which doesn’t seem mild at all), PTSD, and headaches from a stiff neck. My past years of living well with chronic pain taught me to pay attention to the triggers that made me worse, and helped me feel better. I learned my limits.  I understood that the consquences of pushing through one day meant that the next day would be spent on the couch.  I used journaling, researched books on pain tools, and social media sites that hosted peer groups to better understand my own experience through others experiences. After several years, I was able to craft my own toolkit for my best wellness days, my in-between, and my worst days. Sadly, that toolkit doesn’t work anymore; some pratices still fit but my new disabilities need new, simpler tools. The largest hurdle in this journey is not just the prominent difficulty in having my pain and cognition interfer in researching, but more critically, allowing the acceptance of a lower threshold of living. It’s been overwhelming to embrace this new life path, it feels like giving up.

My original tool kit  was the opposite of giving in to chronic pain.  It allowed me to return to college, then on to university,  a full-time student, who graduated at fifty years of age with a Masters in Social Work from the University of Southern California. It was never easy.  I always hurt, but, I succeeded. I had no idea  that my success was not going to be defined in terms of new career, but instead be defined in how well I would be able to negotiate the perfect storm of cognitive and physical disabilities just a year after graduation. My injuries allow no choice other than letting go of not just a career, but the ability to accomplish most every day activities with any regularity.

Just this past year I made an agreement with myself to accept that most days I will be at home. The cognitive drift (brain fog) inherent in my chronic pain has tripled with the addition of mTBI and PTSD. The fibromyalgia pain is worse. Waking up to more pain each day causes my PTSD trauma anxiety to rise which then triggers my brain to kick into fight or flight mode. This leaves my brain with a limited cognitive process, one that is already comprised by the fibro fog. An alternative route to this same limited cognition is that as my anxiety ramps up, my fibromyalgia pain rises from the fight or flight hormones and my mTBI, always present, leaves me scrambiling to recall, input, or engage in anything more then simple conversations and tasks. With all three constantly present in my daily life, trying to create a new toolkit has been a daunting work, one that will always be in progress. These are all hidden disabilities and as pain peers know, it creates the outward appearance to others that if I’m spending most of my time at home, it should be easy to develop different tactics for daily life.

I spent the first five and half years trying to help others understand why I could not understand the conversation, why I was confused, that I did not remember what happened or the information I was told, why I couldn’t multi-task, why I felt upset, why I always stayed in my home. I no longer engage in this very often. I use that energy to track my pain levels. I research tools used by others with cognitive loss and anxiety. I finally understand my abilities and my limitations. I am almost at peace with my new self.

There are always hidden gifts in change and my latest gifts are beginning to appear. I have the opportunity to explore leaving the city for a life in the country. I have always been a lover of nature and the quiet of being in it full-time helps reduce my anxiety. Reducing constant anxieties lessens my pain thresholds, not enough to join the workforce, but enough to make me feel more confident. With this confidence in place, I have created my toolkit. It’s flexible and ongoing, leaving room to add and discard helping items daily. This is my second gift, and it feels like the best gift.

I have taken my past toolkit, my MSW therapy learning, and new books I’ve skimmed through for my cognition needs and created a basic support plan that I want to share with others. It addresses many different types of disabilities, all of which are inter-related, and is easy to use. I never thought that I would be able to offer others something; it’s been a long journey to offer it to myself. The self validation has been that last piece of acceptance I couldn’t find for so long.

Now, I just need to figure out how to create website where I can share it with my peers,

Lucinda Tart, Pain Peer, Advocate, MSW

New Pathways to Living

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My Story of the Dread Fentynol Patch and Lowering the Dosage to Accomodate Ability to Take Oxycotine, or, Why did my Pain Medications get Pushed up to Such a High Amount, and then I Have to Suffer.

 

chronic pain and prescription medication use

addict or chronic pain lifer

Hello Peers!

I haven’t posted anything in a very long time, sorry about that. I have been steadily trying to understand my PTSD, caused by being rear-ended at 30mph, five years ago.  It’s extremely difficult to understand (I am a degreed MSW; Child and Family Therapist, who actually studied the symptoms as they manifested in our returning military veterans, and the sexually abused, but no real mention was made of a life-threatening event like mine) and even more difficult to live with. My last few years have been spent with very limited energy from the extreme highs and lows that my brain constantly creates from fears that are not occurring in the moment. When I am not spinning out of control because I had to leave the house and deal with events that I can’t control, my pain has been keeping me in bed. It’s not a combination I wish on any of you (in “archives” there is a blog about fibromyalgia and “nature or nurture” that some may wish to read).

I finally found a tiny space of time in which to write about my recent experience in lowering my Fentanyl patch by 25mcg.  I was more than happy to do this, as I don’t enjoy being dependent on medications for pain control. I do my best to live well using other methods, they do help but they don’t control the pain by themselves. I have written and will continue to write extensively about how to live well with chronic pain; this is not about that. Rather, it is a frank discussion about my personal experience with my withdrawal symptoms, my doctor’s agreement about increased oxy pill use during the ensuing months, and the pharmacist who has to live by his corporate policy instead of human decency.

My doctor and I have been discussing lowering my opioid use for a while now. At first we discussed lowering the pills, it seemed a better idea as the patch is continuous relief without the ups and downs caused by waiting for a pill to take effect, and feeling the effect break down after it’s 4-6 hour life span in my system.  Somehow we decided that the patch was the smarter issue to focus on decreasing. Let me say to you all that he is a wonderful general practitioner, not a pain management specialist. He inherited me as a patient and has been nothing but understanding. His practice initiated a change in amounts of total opioids after the CDC drastically lowered the limits “suggested” as the daily allowance. It seemed that my patch was pushing me beyond those limits by quite a lot. So, I got an increase of two pills a day and lowered the patch by the 25mcg.

My doctor assured me that I would have the amount of pills I needed until my body adjusted to this decrease. The first three weeks I found myself in pain I didn’t know I experienced. I also found that I needed more than the extra 2/day he alloted. He knew this could happen, see above discussion about allowing me what my body needed, and the first month he sent my pharmacy an early refill.  The pharmacy filled it.

My adjustment didn’t automatically end there, at the end of three weeks. I was still trying to learn to live with an increased pain threshold. My brain was learning to make new endocrine and seratonin receptors (studies have shown that chronic pain brain’s don’t make enough of these natural pain relievers, so recreating them when they don’t exist is an interesting thought process). Mental addiction is not the same for us, we don’t get “high”, we take these prescribed medications in order to try to be a part of society, just like the rest of the population. That does not rule out that there is no mental addiction. In my case, my mental health went way down. My fuzzy brain symptoms became much worse. Bottom line, it took me three months to relearn how to live well with a higher pain level. Recreating my understandings of what restrictions I had to put into my days, how to adjust my activities of daily living, and more.

Now, the second month of early refill. The pharmacist got distressed and dragged out filling it for three days.  I got through it with luck. The last month, third, I was finally able to use only half of the amount per day of oxy I was allowed; it was too late to not need one last early refill. Now my pharmacist was refusing to fill early and demanding to speak to my doctor. My doctor was in only half a day and I now felt like a drug seeker. I was incredibly humiliated and completely depressed for a few weeks.

I tried to talk with him and reminded him that I had only recently gone down by much, much more than the amount of pills I was replacing the 25mcg of Fentanyl I was on, and, that I just finally accomplished it. No compassion there. My doctor? I don’t know if he called the pharmacist or not, I was too humiliated to phone him back.  Again, I got through with luck. The pharmacist did not fill it until five days later.

I learned a lot from this experience. The first thing I should have reached for was my computer. I needed to do research on how others had lowered theirs. I needed to know that 25mcg of Fentanyl is equal to an incredible amount of oxy pills. I should have lowered my pills first, then the patch, then increased my pills. I won’t be lowering anything again anytime soon.

There is a silver lining here, I did lower both! Yes, I have more pain but I feel better about not having all these medications in my system. I also straddled that line that all those without chronic pain are always “suggesting”, “can’t you do this without all that medication?”; code for, “aren’t you an addict?”. I am not an addict. I have said this many times before. I am addicted though. This is not my fault. This is my body’s inability to generate enough needed hormones and a deficit of substance P. My bodies overactive nervous system.  The CDC, doctors, and pharmacists are not who anyone should be blaming for our high medication dependence. The pharmaceutical companies started this a long time back. If I had known what most still don’t about the fraudulent claims they made about  the “non” addicting pain relief medications, I would never have allowed my doctors to continue raising my medications to these amounts.

I prevailed because I desired to. Because I am not an addict. Because I have a great doctor. Because I am not only a natural advocate but a degreed advocate. My concern is for those who can not do this for themselves. Mandatory lowering or removal of medications that work for us is here. There is no blame where it should be placed, there is a lot of shame where it should not be felt.

XXX

Lucinda Tart, Advocate, Consultant, Chronic Pain Advocate

How Blogging for my Peers Assists Me

Good Afternoon Peers,

Its time for me to thank my Peers who read my posts. One year ago, I began this site. I was still struggling mightily with cognitive issues, from a rear end accident I experienced while stopped at a red light, three years past. I was not able to write a six page post without spending almost three hours figuring out context, spelling, and connection throughout the post. In looking back at the beginning of this blog, I find many spelling errors and dropped thoughts despite the careful scrutiny I used.  I desperately needed both a way to use my MSW degree and feel some sense of purpose.  This small blog gave me that positive purpose. It wouldn’t have happened without all of you.

I am better now, but not well. Along with increased areas of constant increased Fibro pain, I am struggling with PTSD. I have memory deficiencies and problems with executive functions. Critical thinking. This blog and therapy literally keep me on track in trying to both remember and apply my personal toolkit. Which is not to say I am able to use them as well as I did in the near past. I remain hopeful that in discussing my personal and professional positivity paths, some of them will stay in my daily use again. Maybe one day they will stay in mind all week, even all month.

While I know that I can still offer this, even teach these positive ADL’s, I do not know  how realistic my goals for myself are anymore.  I do know that without writing them down, without researching them, and without bringing them back to the forefront of my cognition, I would remain lost in negativity. I am enormously pleased that some of my peers have found issues they relate to, and others, new tools to help them get through their chronic pain!

Despite my new chronic medical issues, this site will always be a happy place for me to take my time and thoughtfully share with all of you.

XX😘