Accepting Life on Life’s Terms

Lately I’ve been thinking a lot about how I spend my time. Prior to my accident, career was my primary focus. With that taken away, how do I find meaning in my life? How do I feel like a useful and productive member of society? Not feeling useful and productive has been one of my most difficult struggles since my accident. I’m the closest I’ve been to feeling like I can slowly begin to find ways of being useful and productive, so I’m slowly taking steps to add volunteer opportunities to my life. I’ve finally accepted, after 15 years, I’ll never be able to return to my career.

Integrating back into society is really difficult. I’ve taken to saying I’m retired when asked what I do (to say I was forced into early retirement is a huge understatement). As long as I accept my life as it is today, and I do have a pretty nice life, I’m good. It’s really only when I fall back into thinking like a career woman (which continues to be a difficult mindset to let go of, even all these years later) that I feel my life is lacking.

I read the following story this morning in Insight Timer (my meditation app). It’s a good reminder:

A boat docked in a tiny Mexican village. An American tourist complimented the Mexican fisherman on the quality of his fish and asked how long it took him to catch them.
“Not very long,” answered the Mexican.
“But then, why didn’t you stay out longer and catch more?” asked the American.
The Mexican explained that his small catch was sufficient to meet his needs and those of his family. The American asked, “But what do you do with the rest of your time?”
“I sleep late, fish a little, play with my children, and take a siesta with my wife. In the evenings, I go into the village to see my friends, have a few drinks, play the guitar, and sing a few songs. I have a full life.”
The American interrupted, “I have an MBA from Harvard and I can help you! You should start by fishing longer every day. You can then sell the extra fish you catch. With the extra revenue, you can buy a bigger boat.”
“And after that?” asked the Mexican.
“With the extra money the larger boat will bring, you can buy a second one and a third one and so on until you have an entire fleet of trawlers. Instead of selling your fish to a middle man, you can then negotiate directly with the processing plants and maybe even open your own plant. You can then leave this little village and move to Mexico City, Los Angeles, or even New York City! From there you can direct your huge new enterprise.”
“How long would that take?” asked the Mexican.
“Twenty, perhaps twenty-five years,” replied the American.
“And after that?”
“Afterwards? Well my friend, that’s when it gets really interesting,” answered the American, laughing. “When your business gets really big, you can start buying and selling stocks and make millions!”
“Millions? Really? And after that?” asked the Mexican.
“After that you’ll be able to retire, live in a tiny village near the coast, sleep late, play with your children, catch a few fish, take a siesta with your wife and spend your evenings drinking and enjoying your friends.”
–source unknown
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Hub Friends and confronting my fears of ableism

The last week has been pretty emotion filled for me. After being added to a Facebook social group, Hub Friends, last week, I was almost immediately confronted by my ableism and my fear of encountering other’s ableism. The first three events I saw posted were things I’d love to do: Revere Beach Sand Sculpting Festival, Figment Boston and Shakespeare in the Park. I’d normally be fine doing these types of things alone, because I’d want to reduce the ableist bullshit I’d have to deal with by being on my scooter, especially from people I know. But this time, the feelings really overwhelmed me. 

I feel so scared and vulnerable. I want to be a person. I want to be part of society. I want to go to events that interest me. I love festivals and hanging out with friends. I also have mounds of internalized ableism based on my experiences thus far. I don’t want to be “disabled Tamm.” I don’t want to feel uncomfortable by the discomfort others feel with me when using the scooter. I don’t want special treatment. I just want to belong.

I don’t know how to do this with my limitations. I don’t know how to bridge the fear. I do everything in my power to make my disabilities as hidden as possible, but I just can’t get around the fact that the accident permanently limited how long I can stand and walk. I’m so grateful I’ve finally reached the point of being able to stand/walk long enough to keep my physical limitations hidden in most social situations. Of course, that’s only until I can’t. I don’t know how to trust this group won’t treat me like others have. People, including those I know and love, always treat me differently on my scooter. Here’s what I don’t want:

  • I don’t want to be treated as a child unable to care for myself.
  • I don’t want your help unless I ask for it, though I won’t be discourteous if you offer it the way you’d hold the door open for someone.
  • I definitely don’t want to be harassed.
  • I don’t want to be treated as if I have an intellectual impairment because I have a physical one.
  • I don’t want your fear of being disabled projected onto me when you see my scooter. That one deserves repeating: I don’t want your fear of being disabled projected onto me when you see me on my scooter.
  • I don’t want to be invisible.
  • I don’t want to be skipped over or stepped in front of in line because you “didn’t see me.”
  • I don’t want to not be offered stupid junk fliers that I don’t want anyway but see every single other person being offered.   

I so want to be part of Hub Friends, but my physical limitations and fear keep me from doing so. I feel like it gives the impression of me not wanting to be part of the group, when I desperately want to be part of it. Maybe I need to get honest and talk about my scooter and the struggles of using it socially. I probably need to find a group, maybe at Spaulding, that can help me deal with integrating back into society. It’s all so scary.

Last night was big. Lots of new people at Hub Discussion Group meant that even though I wanted to stay in Greg’s group to share about loneliness, I went to Rob’s group. I’m so glad I did. It was difficult and I cried, but I managed to tell them how difficult it’s been since joining Hub Friends. Wanting to go to so many events but feeling like the need to use my scooter prevents me from doing so. How lonely that feels. How it makes me feel “apart from” rather than “a part of.” It was really good. My sharing resulted in several others opening up and sharing how they struggle with social anxiety, being around drinkers when they don’t drink, etc. One person spoke about how they too can’t stand or walk for long periods either. I am not alone in my struggle. Most of us seem to struggle to be “a part of.” By the end of Discussion Group, I’d gone from feeling alone and isolated to being so grateful to be part of this community. While I wasn’t greeted with open arms for my scooter, Gene said he’d be okay with me on my scooter, but he was the only one to go that far. I really appreciated his comment. Despite not receiving other support for me showing up at events on my scooter, I’m glad I felt able to be vulnerable enough to share these feelings and receive some support. 

 

True love waits…

In June 2016 I reconnected with someone I loved dearly in 2009. During our six year hiatus, we both thought the other wasn’t interested in reconnecting, only to find out our love for each other was just as deep and passionate now as it’d been in 2009. For reasons basically outside of our control, we aren’t able to be together right now.

I love Sean in a way I’ve never known love before. I had no clue I could love someone with the breath and depth with which I love Sean.  I had no clue how friends could find someone they were willing to commit their lives to, and stay married to, for decades. With Sean alone, I understand those feelings. My love for him is unconditional, and believe me, those conditions have been well tested. I may get momentarily angry, but it’s impossible for me to stay angry or feel resentment towards him. Our time together has never been simple or easy, but it’s always worth more than I could ever express.  I accept him exactly as he is, even accepting our inability to be together right now. I believe in him as much as I’ve ever believed in anyone. He’s absolutely my equal; I’ve never felt above or below him.

While everyday I hope we’ll find ourselves in a place where we can be together, I acknowledge it might not work out. Still I’m grateful for him every single day. He makes me a better person, without having to do or say a thing. Even apart, I feel as loved and wanted by Sean as I love and want him.

I don’t know how this story will play out, but I know it will never be boring. It doesn’t matter if we have 4 days, 4 months or 40 years together, my love for Sean is the realest, truest love I’ve ever known.

Friends who knew us in 2009 might not understand this, and that’s okay.

Babies babies everywhere

My social groups have always been primarily child-free or, if there were kids around, they were older. Between Dec 2015 and Jan 2016, three sets of friends had babies.  At first I thought this was an anomaly.  Then a few weeks ago, I attended Isaac’s 33rd birthday party to play Dominant Species.  The four other players were all recent (or soon to be) parents.  The day before I played 1830 at Ehren’s.  He too has a 5 mo. child.  Obviously the burst of family growth wasn’t an anomaly.

There are many potential explanations for having so many child-free friends and why that may be changing.  The change shouldn’t be surprising given I tend to spend a large portion of my time with 30-somethings, specifically gaming mostly with younger guys, than with folks my own age.  My life has never been very conducive to having children around.  I spent my 20s in grad school; I actually interviewed for my first professional job on my 30th birthday.  During my 30s,  my partners and friends were mostly gay and lesbian.  Laural and Sue both have kids and were the exceptions.  I was 37 when I had my car accident.  My 40s didn’t really exist, as I was primarily housebound recovering from the accident.  So here I am in my early 50s being exposed to babies for the first time since the birth of my siblings over 40 years ago.  I like it 🙂

As much as I like it, I can honestly say there’s not been a single day I wished to have a child.  Don’t get me wrong, I love spending time with kids.  Seeing Erica every month or two is a highlight on those days.  I’d be happy to forego gaming and play with her.  I’d probably enjoy being involved with someone with kids.  I’ve just never had a desire to have a child myself.

I fondly remember the times I spent at Laural’s, when I lived in New Paltz, with her and her two kids, Shane and Tarah.  I used to head straight to their home after work, have dinner with them and then hang out, often playing Scrabble or Chinese checkers.  They’re the closest I’ve come to having kids, and I love them.  At the time, they were around 12-14.  It still warms my heart when I think of Shane bringing me a plant and bottle of shampoo while I was in the hospital after my accident.  Laural wasn’t interested in being involved with me at the time, but had she been, I likely would’ve stayed in New Paltz or asked them to come with me to my next job (aka Boston).  Sue had Harrison (9ish) and Becky (18ish), but I didn’t spend much time with either of them.  During grad school, Margy had Paul (4ish).  Many of my current age-appropriate friends (mostly at Cards and Conversation and my 40+ book club) have adult children they speak of at times, but I’ve rarely ever met them.   That’s about the entire extent of my exposure to kids.

I guess if I’d ever had the desire to marry (which I haven’t), things might have been different.  Valuing a single, non-monogamous, education then career focused life through my 30s didn’t exactly lend itself to me being around many kids.  I’ve had four conversations about marriage and a couple about kids over the years, but I’ve never been very interested.  I remember Donna (from my grad school days) telling me those feelings would change, but they mostly haven’t.

Around the time I turned 50, I did begin to notice a bit of a change. For the first time, I became open to monogamy (though its feasibility remains untested) and even to the possibility I might someday marry.  I can look all the way back to 8th grade and see my proclivity for non-monogamy, even though I didn’t begin identifying as non-monogamous until 1995.  Typically I have several long-term FWB relationships, either with or without a primary partner.   Maybe turning 50 made me think I might like to grow old with someone.  Maybe I’m a little more mainstream as I’m finally recovered enough to slowly reenter society.  Or maybe I’ve sufficiently sewn my wild oats and am finally ready to settle down.

 

Watercolor class 5/8/17

Last year I went to a watercolor class offered by the Charlestown Public Library.  I didn’t like the class because there wasn’t any instruction.  Yesterday I went to the first of three watercolor classes, hoping the instructor would be someone other than the woman from last year.  No such luck…

This time, again without instruction, she wanted us to paint this still life. 20170508_134829 Who asks beginning watercolor students to paint white flowers, without any instruction as to how to do so?  I thought she was crazy, as did most other women at my table.  Of the four of us, only one attempted to paint the flowers.  She too was a total beginner, but I must say, she did a pretty good job of painting light gray shadows and pink dots here and there, such that if you knew you they were supposed to be flowers, you might be able to see them.  At the end of class, the instructor took her painting and started telling what she should’ve done and painted over her work.  It’s another thing I don’t like about this instructor.  Without even asking permission, she just takes your work and starts painting on it!

Anyway,  the instructor labeled our table “the anarchists,” LOL.  We liked that title.  I may have actually started the revolt.  She said we could paint anything we wanted.  She’d shown us several examples of watercolor.  “The anarchists” each chose one of those works.  Emily chose to do a few images from a watercolor manual.  Another woman chose to copy a John Singer Sargent mural.  I chose to replicate a simple ship from a children’s book.Jpeg

I wanted to do something simple that played around with a couple of techniques.  I was pretty happy to be able to make something that resembled the original (I forgot to take a pic of the original for comparison).  The addition of clouds was my doing and I liked it.  Despite how simple it was, I wasn’t able to complete it in the 1.5 hours.  I was planning to go back in and draw the top of the lighthouse after I painted it (which may not have been a good idea), as I wasn’t sure how much I’d be able to leave white.

Will I return for the last two classes?  I guess I’ll find out.  Last time I didn’t continue, but this time I might do so just for the dedicated time of doing something creative.  I really love doing art, but for some reason, I seem incapable of sitting down alone and beginning.  I have the supplies, just not motivation to get started.  Maybe I should find someone to get together with, as if I have room in my already insanely busy life…

Making this post also serves as a reminder that I didn’t finish posting the art projects I did with Elle in 2016.  Before the new round of classes begin, I want to get those posted.  Posting helps me look back and see if I’m making progress over time.

 

Happiness, cultivating compassion and daily meditation

In September, I felt quite stressed and overwhelmed.  In looking for ways to relieve my stress, I found an 8 week secular meditation class, “Cultivating Compassion Training” on Meetup.  Yes, I saw that compassion was in the title, and yes it was part of the Center for Compassion and Altruism Research and Education (CCARE) at Stanford University School of Medicine. Compassion has never been something about which I’ve given much thought. I’d convinced myself it was primarily a meditation class and compassion was just the wrapping. The class was actually all about compassion. I actually took the class twice; the first time to focus on my initial intent of starting a daily meditation practice and the second time to focus on the actual intent of the course, compassion.

I’m so grateful for that stress in September, as it helped bring me to a place of feeling the happiest I have since my accident in 2002.  Sure there’s definitely other factors, but the current 30 minute mediation practice I have each morning has been the major component in me finally being able to say  I’m happy again.  I’m talking about happiness as a state, not an emotion.  Happiness as a state resides deep within; it’s peace, contentment, acceptance, an inner smile. It’s unaffected by the typical ups and downs of life.  Fifteen years is a long time not to have felt this good, so I’m especially grateful for its return.  People tell me I’m glowing, even if I say I’m tired or not feeling well.

It’s been a process getting here. At the beginning, I was meditating about 3-5 times per week, primarily using guided meditations provided by the instructor.  By the end of the first round of classes, I’d started using the Insight Timer app and was meditating daily.  As of today, I have 90 consecutive days of meditation.  By the end of the second round of classes, I was moving from guided to silent meditation.  At first I didn’t know how to spend the 30 minutes, but I’ve since found a formula that works for me.  I suspect it will change and evolve (I’m thinking of adding some tonglen to it), but I wanted to record my beginning here for a couple of reasons:  I had a difficult time finding specifics on how people spend their time in meditation, so I wanted to document mine.  I also want to see how my practice evolves.

So here’s my 30 minute daily practice in a nutshell.  Occasionally I do something totally different (there are many forms of meditation), but this is what I’ve found works for me.  As I said, I use Insight Timer.  It’s set for 30 minutes with a starting bell, one interval bell at 5 minutes and three closing bells.

  • 3 deep breaths, breathing in through my nose and out through my mouth
  • Quick body scan, relaxing my jaw, face, neck, shoulders, arms, back, legs, feet
  • 5 minutes of breath focused meditation
    • As I inhale I feel the cool breath enter my nose. I feel the warm breath leave my nose as I exhale.  I count each breath on the exhalation until I’ve reached five breaths, then I begin again.  I’ve found if I count to ten, my mind tries to keep track of how many total breaths I’ve taken in the five minutes, so I’ve reduced it to 5 (sometimes I pick a random number and count to that instead).
  • About 15 minutes of loving kindness meditation (also known as metta and the focus of the classes I took).  My version of metta progresses through several stages, each with three parts, including a mantra.
    • The stages are:
      • Self-compassion
      • Compassion for people in my life who are difficult
      • Compassion for friends, family and loved ones
      • Compassion for people in my building
      • Compassion for everyone in Greater Boston
      • Compassion for everyone in the United States
      • Compassion for everyone in the world.
    • Each of these stages include three parts:
      • Gathering and focusing the group at hand in my mind
      • Just like me… statements (aka focus on common humanity)
      • Mantra
  • The remaining time, usually about 5-10 minutes, I focus on identifying the many things for which I’m grateful.  5-10 minutes seems long, but once I get going, it’s pretty easy.  I start by focusing on yesterday and the people, places and things for which I’m grateful, then I look forward to today and then I just go wherever my mind takes me.

Now for the nitty-gritty, because that’s where it’s at for me.  I think most people who do metta focus on a particular difficult person and loved one as they go through the stages.  I did so at first, but I found I prefer focusing on groups of people.  If I have some strong feelings and want to spend time focused on an individual I’ll do so, but groups generally work better for me.

Mantra.   The mantra I use at the end of each stage is:

  • May you be happy.
  • May you be free from suffering.
  • May you be free from fear, anger and anxiety.
  • May you know peace and joy.
  • May you be well.
  • May I be gracious and vulnerable with you.
  • May I show you respect, kindness and compassion.

Self-compassion.  I start with self-compassion.  I think about my friends and loved ones who love, support and wish me well. I think about the interconnectedness of us all and how it takes millions of people to support my life, from the farmers who grow my food to the workers who made my furniture to the delivery drivers, administrative staff, managers, service employees, medical staff, government employees and everyone along the way who’ve helped create the life (and the things) I have today. I think about the millions of others meditating, wishing me happiness and freedom from suffering.  Then I slightly tweak the mantra to make it work for me.

Compassion for people in my life who are difficult.  While doing guided meditation, I’d focus on a particular person. After a few weeks of doing so, that person no longer felt difficult to me.  Our interactions began to change, not because they’d changed, but because I had.  By the time I moved to silent meditation, I decided to focus on “difficult people” as a group, thinking about individuals with whom I struggle and types of people who might annoy me.  Then I’d focus on our common humanity; i.e. how they’re “just like me”

  • Just like me, you want to be happy.
  • Just like me, you struggle.
  • Just like me, you have baggage that can get in the way.
  • Just like me, you do your best.
  • Just like me…

I believe it’s been the focus on common humanity  that’s brought about the biggest changes for me.  During class, we only included a focus on common humanity in the beginning.  While I discovered self-compassion to be quite easy for me, common humanity required more effort (this seems to be the reverse for most).  What’s interesting is even though I say, “Just like me…,” what I mean is “I’m just like you in that we both….” Focusing on our commonalities rather than our differences  has been transformative, not just with “difficult people,” but across the board.  I no longer really feel that people are difficult.  I finish with the mantra.

Compassion for friends, family and loved ones.  Here I think of all the wonderful people who’ve graced my life, from childhood, undergrad, grad school, through the places I’ve lived and worked.  I am truly blessed to have known so many beautiful people.  I  focus on our common humanity, such as “Just like me, you have competing priorities that limit your available time.” then repeat the mantra.

Compassion for people in my building.  Since 2004, I’ve lived in the same high-rise.  Like friends and loved ones, this group is pretty simple and straightforward.

Compassion for everyone in Greater Boston.  Here I focus on the people with whom I interact most.  I think about MBTA workers and passengers, people on the streets and in the shops, people at my appointments, as well as people I’ve never encountered.  My common humanity statements tend to focus mostly around transportation and service, such as “Just like me, you lead a busy life and want to get where you’re going with as little disruption as possible.” and “Just like me, sometimes you make a mistake.”  I end with the mantra.

Compassion for everyone in the United States.  Typically I do a quick scan of the country, gathering up in my thoughts folks up New England, across the northern part of the country, including Alaska, down the west coast, eastward through the southern part of the country, back up to Massachusetts then across the heartland and over to Hawaii. My common humanity focus has brought me such peace in these trying political times, with statements like,

  • Just like me, you have strong personal and political values.
  • Just like me, you want to be heard and respected.
  • Just like me, you want to earn a living wage and have adequate health care.
  • Just like me, you want freedom from struggling to make ends meet.
  • Just like me…

Despite radically different ways of being in the world, focusing on our commonalities has helped me reduce the divide and be so much more understanding.  I don’t have to see those with whom my values may be antithetical as my enemy.

Compassion for everyone in the world. I begin by gathering people from large swaths of land, Europe, the Middle East, Africa, Russia, China, India, the rest of Asia, Australia, all the island nations, Canada, US, Mexico, Central America, South America.  As I do, I think about what’s going on in that part of the world.  My common humanity statements reflect the soul-crushing suffering of the world:

  • Just like me, you want to be free from war.
  • Just like me, you want to be free from poverty.
  • Just like me, you want to be free from hunger and have adequate safe drinking water.
  • Just like me, you want a safe and secure place to live.
  • Just like me, you want to be free from abuse and exploitation.
  • Just like me, you want to feel safe and secure physically, emotionally, sexually, financially.
  • Just like me, you want to be free from hypervigilance.
  • Just like me…

Sometimes I spend a very long time on this list.  Doing so has really brought me significantly closer to the devastating conditions under which far too many live every day of their lives. I end with the mantra.

Ending with a focus on gratitude really sets my mind in the right direction for the day.  A focus on gratitude has been shown to have significant wellness benefits, although it takes a bit longer than meditation for them to appear.  Positive effects from meditation tend to be seen within 30 days, while the benefits from a gratitude practice tend to take 120 days to manifest.

I must meditate first thing after I wake, else I’ll never find the time for it.  What I’m doing has really been working for me.  I’m grateful to Renee, the CCT instructor, and to all I’ve taken the class with for their insight and inspiration.

 

Multiple Milestones Achieved

Over the last year (since modifying my inserts), I’ve worked diligently to increase my walking distance and become more independent of my scooter.  Two new milestones are in line with increased mobility.  A third milestone is starting a daily meditation practice.

  1.  Socially Scooter Free.  I began by becoming independent of my scooter in almost all social activities, reserving its use to running errands, where standing in line and walking distances are still problematic for me.  The one exception was ushering at the theatre.  I’m happy to say I’m finally able to usher without the use of my scooter.  The issue was not being able to stand for 30+ minutes.  Since Dec 20, for three performances at two different theatres, I’ve been able to use a chair to sit when I’m not assisting folks with finding their seats.  I used to be outside the doors handing out programs while seated on my scooter.  It’s so much more fun being inside and being a full fledged usher.  I do have to be careful not to overdo it though, as I did have one instance where I ended up with my foot somewhat inflamed, resulting in pain with each step and limited walking for a few days.
  2.  Activity Tracking Goals.  I’m doing another fibromyalgia study.  In part, I have to wear a Fitbit for a week before each of three fMRIs.  With limited mobility, I didn’t expect a Fitbit to make much difference to me, but I was wrong.  I was amazed to find out how much I walk.  On days when I go out in the evening to a social event, I almost always walk 4000 steps.  I thought I walked maybe 2000 steps/day, so 4000 was a pleasant surprise, given that 10000 steps is often cited as a goal for fully mobile folks.  I liked the Fitbit so much, I bought my own (a Garmin Vivosmart HR).  Now, on days when I don’t go out, I walk my hallways (my building is a block long) to try to hit 4000.  I’m unable to do the 4000 several consecutive days in a row without getting too fatigued and/or in too much pain, but gamification has sucked me in!
  3.  Daily Meditation Practice.  From October to December 2016, I took an eight week course:  Cultivating Compassion.  I was feeling stressed and thought starting a daily meditation practice might help.  It was a fantastic class (so good I’m taking it again).  During the course, I was only meditating about three to five times a week.  Since it ended, however, I’ve been meditating daily.  I downloaded and daily use an app (Insight Timer) to track my meditations.  On Friday, I’d meditated thirty consecutive days, averaging 35 minutes daily.  The only way I’ve been able to do this is by doing it first thing when I wake up.  If I start my day, I’ll never get back to it.

Writing this has reminded me I should finish my 2016 Year in Review before 2017 gets too far underway…

Chronic pain, opioid abuse and my first drug test

I’ve been in chronic pain, defined as pain that persists for greater than three months, since my car accident in 2002.  I’m a staunch believer the medical community–from PCPs to surgeons to pharmacists and even to the CDC and insurance companies–are primarily responsible for the current epidemic of opioid abuse.  Inappropriate and overprescription of opioids by physicians and lack of followup and tracking by physicians, pharmacists and insurance companies have set up patients for abuse.  Sales of prescription opioids in the U.S. nearly quadrupled from 1999 to 2010, without an overall change in the amount of pain Americans report.(1)  “An estimated 1 out of 5 patients with non-cancer pain or pain-related diagnoses are prescribed opioids in office-based settings.”(3)

In March 2016, the CDC  came out with twelve recommendations aimed primarily at PCPs, including

  1. Nonpharmacological (cognitive behavioral therapy (CBT), exercise therapy, etc.) and nonopioid (NSAIDs, acetaminophen, cortisone injections, etc.) treatments are preferred.  If opioids are used, use concurrently with other treatments.
  2. Opioid pain medication should be slowly advanced (starting with lower categories and progressing upwards), and with the immediate-release form (vs. long-acting) in the lowest effective dose possible.
  3. Prescribe for lowest effective duration, which may be less than three days vs. the often prescribed seven day course for acute pain.
  4. Discuss treatment goals and realistic benefit and risks with patients.  For new opioid patients, evaluate after 1-4 weeks; evaluate long term use patients every three months or sooner.
  5. Monitor the patient’s history of controlled substance prescriptions using state prescription drug monitoring programs (PDMP).
  6. Annually perform urine drug testing.(2)

Among the rationale used by the CDC for creating these recommendations was that  physicians feel they’ve been “insufficiently trained in prescribing opioids” and “find managing patients with chronic pain stressful.”  If a physician doesn’t feel adequately trained to prescribe a drug, why would they even consider prescribing that drug ?  Why are PCPs prescribing opioids at all? It baffles me that the first four “recommendations” weren’t already considered common sense, especially when the CDC goes on to state that across specialties, physicians believe, “long-term opioid therapy often is overprescribed for patients with chronic noncancer pain.” (2)

Due to changes in MA controlled substance laws following the latest CDC recommendations (specifically 5 and 6 listed above), I recently had my first ever drug test and had to sign a narcotics agreement (9), because I take Tramadol.  In the years following my car accident, I’ve tapered down from Morphine/Oxycontin (three weeks in hospital) to Oxycontin/Percocet (quickly got off Oxycotin AMA after returning home) to Percocet (eight months until attempting to return to work in 2003) to Vicodin/Percocet (several years) to Tramadol/Percocet and finally to Tramadol (haven’t taken a Percocet since I started Baclofen in 2013).  I find it odd, with all the narcotics I’ve taken over the last fourteen years, it’s Tramadol that’s finally requiring I be followed for potential abuse.  I take 100mg twice a day; the maximum dosage is 400mg. I feel pretty certain if I hadn’t been the one pushing to decrease the amount of narcotics I was taking, I’d likely be physically dependent on Percocet, as are so many other chronic pain patients.

In 1990, my partner at the time and I each had surgery:  my partner had a lump removed from his forearm in early 1990, then I had shoulder surgery in December 1990.  In both instances, the surgeons urged us to take Vicodin and Percocet respectively, despite each of us requesting Motrin for pain.  When we objected to the opioids, both surgeons told us not to come back to them whining about being in too much pain.  We each took only a few Motrin for pain relief.  In my case, my right arm was immobilized for six weeks and then required extensive rehab, but I still didn’t need opioids.

Most of the three weeks I was hospitalized following my car accident, I was too out of it to pay attention to what narcotics I was being given.  Once home, when I learned of the highly addictive nature of Oxycontin, I told my surgeon I wanted off of it.  He protested and said I needed to stay on it longer to adequately control my pain.  Having been through this before, I told him he could take me off it or I would do it myself.  He reluctantly agreed.

Piecemeal recommendations and changes in opioid management have been the norm for several years, but different states continue to have different requirements for how they handle opioids.  As of 2012, across the country the number of painkiller prescriptions per 100 people ranged from 52-143!(3)  Why are physicians writing so many opioid prescriptions, and why are they clustered in certain areas of the country?  If the stats I’ve provided aren’t shocking enough, a recently published study of 3000 patients who’d overdosed on opioids showed that 90% of them were put back on opioids after their overdose!(4)

It seems the opioid epidemic is finally being addressed across many levels of government and medical professionals.  Here’s a few examples:  In April 2016, amid pressure from the White House, more than 60 U.S. medical schools pledged to teach new federal guidelines for prescribing opioid painkillers.  Currently most med students only receive a few hours of instruction on prescribing opioids throughout their four years of med school.

Tufts Medical Center ED has seen its total number of narcotics prescriptions, as compared to total prescriptions written, decrease from 18% to 11% from January to August 2016.  At their monthly meeting, they simply began displaying PowerPoint slides showing the number of narcotic prescriptions written by each ED doc, without comment. Simply by seeing the differences in the number, higher prescribing physicians have reduced the number of narcotic prescriptions they write.(5)

Led by Massachusetts governor Charlie Baker, 44 governors have agreed “to adopt a common set of strategies to fight opioid addiction, signing a compact modeled after policies that have already been implemented in Massachusetts.”(6)

Among the arguments Dr Tanya Feke makes as to why doctors didn’t cause the opioid epidemic, she believes regulations have forced doctor’s hands in prescribing more opioids.  An increased focus by Joint Commission on Accreditation of Healthcare Organizations (JCAHO) on pain as a vital sign (think of all those pain scale posters) has changed medical practice.  Patients often give low scores on patient satisfaction surveys if their pain isn’t “completely” controlled or if they requested opioids and didn’t receive them.  When such surveys are tied to financial incentives, doctors can feel as though their hands are tied.(7)

Everyone’s getting on board, right?  Well not exactly.  In April 2016, amid little opposition or media attention, the Ensuring Patient Access and Effective Drug Enforcement Act of 2016 was passed and signed into law.  “Critics say it takes pressure off companies to detect and report drugs flowing to the black market. The top DEA official for regulation of pharmaceutical firms left the agency last fall, in part, he said, because of a bitter dispute with members of Congress over his view that the bill was misguided and would worsen the epidemic.”(8)

One example is Purdue Pharma, who’s made more than $31 billion from Oxycontin. Purdue collected extensive evidence of a drug ring but didn’t notify law enforcement or take any measures to stop the supply of pills. Essentially, the law gives big pharma little incentive to prevent abuse unless the DEA accuses them of violating the law. (8)

Without a willingness to view addiction as a chronic illness and not a moral failing (a call being made by the current Surgeon General Vivek H. Murthy, M.D., M.B.A.) and increased funding for addiction and mental health treatment in general, can we really expect any significant resolution of the epidemic?

REFERENCES AND NOTES

  1. Centers for Disease Control. Vital Signs: Overdoses of Prescription Opioid Pain Relievers — United States, 1999–2008.   MMWR 2011; 60(43);1487-1492. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6043a4.htm?s_cid=mm6043a4_w%20-%20fig2.
  2. Centers for Disease Control. CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016. MMWR 2016; 65(1);1–49.  http://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm
  3. Centers for Disease Control. Injury Prevention & Control: Opioid Overdose.  March 16, 2016.  http://www.cdc.gov/drugoverdose/data/prescribing.html
  4. Suzuki, Joji. Why are doctors writing opioid prescriptions — even after an overdose? Harvard Health Blog.  January 28, 2016.  http://www.health.harvard.edu/blog/why-are-doctors-writing-opioid-prescriptions-even-after-an-overdose-201601289060
  5. Kalter, Lindsay. Tufts reports drop in ER opioid prescriptions. Boston Herald. August 31, 2016.  http://www.bostonherald.com/news/local_coverage/2016/08/tufts_reports_drop_in_er_opioid_prescriptions
  6. Schoenberg, Shira. Led by Gov. Charlie Baker, 44 governors sign compact to address opioid addiction.  masslive.com.  July 13, 2016.  http://www.masslive.com/politics/index.ssf/2016/07/led_by_gov_charlie_baker_44_go.html
  7. Feke, Tanya. I am a doctor, but I didn’t cause the opioid epidemic.  www.kevinmd.com. May 26, 2016.  http://www.kevinmd.com/blog/2016/05/doctor-didnt-cause-opioid-epidemic.html
  8. Ryan, Harriett and Christensen, Kim. Amid opioid epidemic, rules for drug companies are loosened.  LA Times.  July 17, 2016.  http://www.latimes.com/local/california/la-me-pharma-bill-20160728-snap-story.html
  9. The attached narcotics agreement is the actual agreement and risk assessment included in my medical record. It can be difficult to know what these things really look like, so feeling like there wasn’t any personal information I hadn’t already made public on this blog, I decided to go ahead and link to it in its entirety.

Intro to Watercolor class, Charlestown Library

Over the weekend, I was pleased to discover several art classes offered at public libraries throughout Boston.  Yesterday I went to the first of four classes offered by local artist, Elisa Solignac, at the Charlestown Public Library.  Lest anyone think I might have some drawing ability (at least not without instruction), this class demonstrated my lack of innate ability.   It’s a good thing I’m teachable.

We started with a couple of drawing exercises.  After repeatedly telling us to take a close look at the still life she’d composed, she covered it and asked us to draw it from memory.  I have no clue as to the purpose of that exercise, unless perhaps it was to see how we drew something we couldn’t see.

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Drawing the still life from memory.  My attempt at creating folds in the cover cloth is pretty hilarious.  The items are floating above the cloth, and I have no idea why everything is so small. 

The next exercise was one of my favorite types of exercises:  we were to draw the still life without looking at the paper.  I often seem to do better when I’m looking at the form rather than the paper.  The exercise works well if you’re drawing a single object–e.g. a hand or model–but not so much for a multi-item still life.

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Drawing without looking at the paper.  The draping of the cloth is the best of all attempts.  There’s more perspective in the table legs too. 

We were then told to paint the composition.  The only instruction we were given is that light blue and purple are useful for shadows when something is white.  I wouldn’t expect a beginning watercolor to feature so much white (table cover and bowl were both white and the bottle was clear) and multi-level no less.

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1st watercolor attempt — that blue blob at the bottom doesn’t belong there and my attempt at fabric folds on the left side was a complete failure.  There’s also no sense of perspective identifying the table as such.  There’s maybe a hint of it being multi-level.  I didn’t even attempt to paint a white bowl on a white cloth.
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With some instruction, this might have turned into a decent piece.  I like how the clear part of the glass bottle turned out.  The table cover definitely needs work.  My attempt to use blue and purple to highlight the cover folds and create perspective was a big fail.

I was really looking forward to the class but left kind of frustrated.  Unfortunately there was no instruction.  I heard someone comment to another that when they took the same class last year with the same instructor, at the end everyone felt they got at least one thing from the class, as if that was a consolation.  I won’t be able to make the next class; whether or not I return for the final two classes remains in the air.  At least I learned one thing…I’m seriously in need of instruction on perspective!

Up next in about an hour…figure drawing with Elle!

Self portrait drawing class

Last year, I took a six week art class that covered a different medium each week.  This year, the class is back, but it’s open-ended so we have more time to devote to each medium.  I love doing art, but I’ve never had formal training and have no clue what I’m doing.  I used to believe I wasn’t creative at all; at least, that’s no longer the case.  I would’ve also told you I totally suck at art, but I’m coming to believe that’s not the case either.  It’s amazing what a little instruction has been able to do to those beliefs.  I now believe with instruction and practice, I might find I’m pretty decent.  I’m gong to record the journey in this blog.

The last two weeks we’ve been focusing on portrait drawing, especially lights and darks.  We began by outlining the whites in a series of black and white portraits.  We then used tracing paper over a face to color in the dark and light spaces.

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Traced lights and darks of face

I didn’t do this exercise correctly.  I was supposed to trace the darkest and whitest space.  I did the darks, but instead of doing the white, I did the intermediate shades.  What isn’t traced in are the whites.  It still shows the contrast, though not as clearly as if I’d done it correctly.

We then moved on to a series of handouts showing the proportions of the face and how to draw each element.  These handouts have been crucial in helping me, though my noses are still WAY too big.

The next exercise was to scratch out the whites of our face, using a mirror, on a sheet of black coated paper with a special tool.  Being my first attempt at a face, I wanted to attempt to draw it first then move on to the black paper, but the instructor really wanted to see what it would look like as a first attempt, so I abandoned the drawing attempt and went on to the black paper. It wasn’t until I added the whites of the eyes that it looked anything like a face.

The final exercise of week one was to complete the other half of a face.  My proportions are off in relation to the other half, but overall I thought it wasn’t half bad for a first attempt:

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Finish the face

In week two, we did a series of 5-15 minute self portraits, each with a different focus. First, we did a 5 minute drawing of the face (you can really see the problems with my nose proportions here) followed by a quick drawing on black paper with colored chalk focusing on the whites of the face.

The next two exercises were my favorite, though I definitely didn’t expect them to be.  We covered the paper with charcoal then used a charcoal pencil and eraser.  The first attempt was ten minutes and the second fifteen.

None of these look like me, but at least they they could look like someone.  Everyone, most especially I, was impressed with my final attempt.  With only three hours of instruction and limited time to work on each drawing, I’m very happy with my progress.   I should take some time to see what I can do.  How long might it take me to get something that actually resembles my face?

For the last half-hour, the class focus shifted to gesture drawing.  Again we only had a few minutes for each drawing.  My basic shapes were all drawn without looking at the paper, focusing on the outline of the model.  Elle wanted to see what we’d do with no instruction.  Next week, we’ll learn about anatomy and figures.  I had a bit of an advantage here, as about 15 years ago, I attended a weekend long camping retreat called, “Art without Walls,” that included some quick gesture drawing.

Finally here’s the drawings of everyone in the class.

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Class self-portaits studies
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Class gesture drawings