Observations, Learning, and Activities for the New "Over 21s"

Archive for October, 2014

On Pain

Pain.  Physical pain.

We all experience it, as evidenced by the huge selection and marketing of pain relief products.  For the year 2013, in the United States alone, the sales value of over-the-counter (OTC) oral pain relievers–tablets and liquid–was over $1.3 billion.  External pain relief products generated another $360 million.  I have had trouble tracking down good numbers for physical therapy, pain management medical programs, prescription pain relief products, and self-help therapy with or without support from non medical personnel, although I am certain that the total cost of services dwarfs the OTC market.  One LinkedIn source estimates that the U.S. pain management market in 2011 was almost $41 billion, but that the market value is declining and expected to drop to $29.5 billion by 2018.

The projected decline in pain management comes as a surprise to me.  As new products with fewer side effects come to market, and with an aging population, it is difficult for me to imagine such a decline.  To date, no one has figured out how to wipe out arthritis as one ages.  With increased life spans and continually rising medical and pharmaceutical costs, declining costs seem less logical to me, especially since it costs pharmaceutical companies more each year to bring a product to market, especially with the increased expectations of the National Institutes of Health requiring greater and more careful clinical study of any new drug a company plans to release.  Homeopathic and “natural” methods may, perhaps, take away some pharmaceutical profits, as more sufferers shun drugs for New Age and ancient Asian and Indian natural dietary products/programs and body strengthening programs such as yoga, tai chi, stretching, water aerobics, and other proactive exercise techniques.  So far, nothing related to the pain management market is clear on how much these contribute to the value of pain management, either actively or prophylactically.

Over the past ten years or so, pain management has become a major issue for me.  Although I kept myself physically fit until I was 40, as I entered into new life changes and circumstances, I allowed my body to weaken.  Shortly after I reached the age of 50, I began to experience numbness and pain from spinal arthritic spurs that were pressing into my spinal cord, along with ruptured discs that exacerbated the problems.  I have seen some of the best pain management physicians and physical therapists in the US, and have been prescribed pharmaceutical regimens that greatly–although not completely–brought my pain to controllable levels.  But the pharmaceuticals have also contributed to other ailments, such as liver problems and bleeding ulcers.  Exercise, diet, and various forms of natural remedies have helped reduce some of the pain.  However, nothing is perfect, and the body continues to degenerate with age, thereby causing more pain.  Until I was taken off of all effective pharmaceutical products when I lost much of my blood to bleeding ulcers last month, I had almost forgotten the extent of the pain level with which I live each day.  The controlled pain was still bad enough to cause insomnia because I could not get comfortable, and limited my independence during the day.  Pain has become my constant companion.

Thankfully, because I have been careful with dietary regulation for a good portion of my life, and because I do not suffer from diabetic neuropathy, I am not as badly off as many people in the US who suffer from chronic pain.  My tolerance for pain is pretty high, and I continue to exercise through much of my pain.  But life with pain has definitely changed aspects of my personality for the worse, and I no longer smile through more excruciating episodes.  Yes, I have become Bitch of the Year.  Pain contributes to crankiness big time.  Moving to a warmer climate would have been a great idea if most of the pain I experience were muscular instead of neural.  Limited medical services here have caused a great deal more crankiness in me than I would have imagined.  Some of the less-than-professional attitudes of certain medical personnel here–and I’m thinking specifically the gastroenterologist who was taking care of me while I was in the hospital–contribute to my increasing crankiness.  My frustration that my husband took a job on this island, forcing me to move away from trusted doctors and other medical personnel, as well as alternative medicine sources, has contributed to my crankiness, while some of the less-than-state-of-the-art medical knowledge and practices have contributed to speeding up my deterioration.  Add these to the crankiness factor and the line between simple bitch and Super Bitch was quickly crossed.

The problem is that many Americans in the US are probably getting less care than I get here on a foreign island.  Red States that are denying aging citizens access to the benefits of the Affordable Health Care Act and U.S. congressional representatives are attempting to curtail Medicare benefits will be leaving more and more Americans in a battle to fight pain on their own.  This appears to me to be the primary reason why costs of pain management are expected to decrease rather drastically over the next several years.  Aging Americans may be more fit and more health conscious than those of preceding generations; but even diet and exercise cannot prevent much of the deterioration that naturally affects an aging body.

Certainly, I have covered only a small part of what aging Americans do to stave off health problems that contribute to pain in later years of life.  However, even allowing “wiggle room” for factoring in remedies and techniques not mentioned here leaves me feeling that pain management cost projections will not decrease as drastically as predicted.




What? No Light?

What happened to the light I was supposed to see–the one at the end of the dark tunnel reported by many people who had near-death experiences?  Even under anesthesia, people see a light.  Not me.

Twice during the past 4 years, I was on the brink of death.  During a surgery almost 4 years ago, I needed full resuscitation.  Less than 2 months ago, it was merely a matter of almost bleeding out and requiring first 4 units of blood, then 2 more several days later—although I would surely have died if my husband had not been there to call an ambulance, at least I needed no resuscitation that time.  I think there may have been some neurological changes from the former situation, with more coming on during the latter because of oxygen depletion from blood loss.  Regardless, I’ve noticed changes to my visual perception–not acuity, but perception–and to my logic.  Undoubtedly, there have also been changes to my personality, but that’s another kettle of fish.

The point is, I can understand no light when I almost bled out because my heart and lungs never actually stopped working.  There may have been a limitation to the amount of oxygen getting to my brain before the ambulance arrived–which was pretty quickly, for the Island (I live in the Caribbean on the Dutch side of the island of St. Martin, in a country called Sint Maarten)–and the EMTs immediately covered my face with an oxygen mask.  But the first time–when the surgical team actually lost me for a few moments on the operating table–there was no light experience that broke through the anesthesia.  In recovery, I had quite a light show, but I know enough about neuroscience to understand that large groups of neurons may have been firing away, randomly or in groups, in protest to the disruption from the anesthetics (I seem to be particularly sensitive to the effects of anesthetic “withdrawal,” or something along those lines).  Or perhaps my neurons simply needed to reboot…

In a way, I felt almost gipped after the life-threatening surgery because I recalled no light.  Then I thought about individual differences, as well as the speed of resuscitation, and decided that maybe I hadn’t died for long enough to see lights.  Who knows?

In a sense, I did see a light.  This light appeared, however, long after I was sent home from the respective hospitals, and across several years.  This light differentiated my family from my friends.  In my case, it is my friends who showed concern for my well-being, not my family.  And I began to realize a few things about both myself and my family: we are not at all close.

Part of the lack of closeness is my own fault.  I’m not exactly the best communicator in the world.  Sure, I call my family members on their birthdays (usually) and on holidays (Christmas, sometimes on New Year’s, Mother’s Day and Father’s Day), but not just to chat.  Some excuses I have stem from things like not being allowed to use the telephone as a child—especially as a teen-ager (not for punishment, but because the telephone was reserved for “important messages”)—and then my mother’s pushy nosiness when I was a young married woman and my mother no longer had control over my life.  As a youngster, I was allowed to take calls from friends (as long as I kept them down to no more than five minutes), but not initiate them.  My mother never called home to her relatives in Europe, claiming the cost was prohibitive.  In fact, when I think back, my mother seemed to have an aversion for telephones, which more recently has shown up in her extreme paranoia…but that’s a story for another time.  The point here is that my early experiences with telephone communication were so deeply ingrained, that I ended up cutting myself off from learning about the lives of my family, and even of my friends, as I got older and older.  As such, there was much that I have missed, especially events in the lives of my sister and children.  I have made all sorts of attempts to overcome this tele-phobia, but have had only limited success; I’ll keep working on it.

Here is part of the back story.  When I married my second husband, I found that I had trouble negotiating the time differences between our home and the homes of family and friends.  Living on the West Coast when my busy family lives Back East or in Texas makes communication difficult.  When I learned about Facebook, I was delighted to be able to increase communication electronically (my kids never responded to email messages).  However, it did not take long to realize that my family was paying little attention to my posts, and, more recently, probably “blocked” my posts from their Notifications list.  Granted, some issues which continue to be critical to me—politics, women’s issues, interesting science and medical findings, etc.—are of little interest to my children and sister, or are even opposed to their own views.  Still, one would think that time lines would occasionally be checked, or a simple “hello” would find its way into my messages.  That much I have made great effort to do with my children, and sometimes with my sister.  When I see a post by a family member, I always “like” and comment (if appropriate).

Clearly, one of the main reasons for the lack of communication between me and my family is because I do not initiate such.  For a long time, I blamed myself for such lack because I am so bad at making telephone calls.  But then I realized that communication is a two-way street: although I am bad at initiating it, my family members are even worse—with me, anyway.  In fact, the only family member who is in regular communication is my sister-in-law, who does not want to lose family connections.  But to my biological family, I have become a forgotten ghost—one who does not even deserve to receive acknowledgement of gifts or e-cards sent.  Interestingly, I am now pretty much in the same time zone as my family—or one ahead—even though we are living on a non-US governed Caribbean Island.  To make things easier for family, we maintain our last US telephone number via Vonage, I maintain a US number via Skype, and I pay a heavy premium to maintain a US cell number from a US provider.  Still we receive communication only from my husband’s sister and her family.

And that includes the grandchildren.  But I am not their parent, I only met most of them this past summer, and their own parents have clearly not taught them the art of acknowledging gifts sent to them.  And I realized that the fault here is not all within me, but in large part with my grandchildren’s parents.  Recently, common courtesy was brought home to me when I gave small hospitality gifts to the children of one of my husband’s co-workers who invited us to their home.  Within days, the older child created a beautiful card on behalf of herself and her very young sister.  This reminded me that I have never been thanked by my own grandchildren—not ever.  It also made me understand that the fault is not entirely with me.  I can understand that my son doesn’t communicate—he was never much one for talking as he was growing up.  I can almost understand that my daughter does not communicate much because, when I married my current husband, I moved three time zones away, my daughter decided to stay Back East with her father, and by the time my California day settled enough to free up time for calling, my daughter was asleep or busy with her extracurricular activities and therefore unavailable to speak.  And I know that she still harbors a lot of anger because her refusal to move to California did not make me refuse to marry my husband and move to the West Coast.  But she is 37 now, and should have made peace with my moves.

My sister, on the other hand, is twelve years younger than I am, and raised five children, the youngest of whom is still attending college.  That her communication time is limited is understandable.  Because of the age difference, we were not close.  In fact, when I was in high school, I even resented her presence in my life—not because I didn’t love her, but because I was forced to babysit her whenever my parents had a social event to attend.  My mother refused to hire a babysitter, and my social plans were often ruined because of my family obligations.  After I married my first husband, I rarely called home—not because I didn’t want to speak to my sister, but because I knew that I would never get to speak with her because my mother would monopolize the conversation and then claim expense before I got to speak with my sib.  So it was not long before I disappeared from my sister’s notice.  Thus, I understand that my sister does not initiate calls to me, even on holidays.

What really hurt was that, even knowing that I was going through serious surgeries or other difficulties—such as my recent life-threatening bout with bleeding ulcers—neither my children nor my sister made a single effort to find out how I was doing.  Even before my mother stopped using the telephone altogether, she would make certain that my sister and daughter knew what was going on with me, and would let me know what is going on with them.  If my sister or daughter had a medical or life-changing problem, I was on the telephone the moment I learned of such.  To my family, however, I have become a ghost—an entity floating into consciousness on occasion, but not someone to contact even under socially appropriate health situations.

That is the light I saw.  Back in California when I almost lost my life during a surgery for tumor removal from a kidney, no one called or otherwise communicated, except my mother.  When a month ago I lost so much blood to bleeding ulcers (a condition I didn’t even know I had), and needed a total of six units of blood within 5 days, no one in my family cared enough to call.  I may not have felt so affected back in California, but this latest illness with no calls really brought home the issue of family ties.  My husband never even thought about calling my family to let them know about my situation, but that’s who he is.  However, it was the first time I realized that my children were ignoring—perhaps blocking–my Facebook posts.

Overall, I may have been far from the best mother in the world, especially when I became a single parent.  Certainly, I made many mistakes in raising my children.  In my mind, I was doing the best I could.  But I thought I taught my children better manners and higher regard for family.  They are old enough to deal with any scars left over from their childhood—my daughter with her anger over being unable to make me stay on the East Coast, my 33-year-old son who was not easy to raise even with a step-father.  As is often the case, as the mother I receive all the blame for things that went wrong in their lives.  I spanked my daughter only once during her childhood, and never spanked my son at all.  Perhaps that was part of my motherhood error.  I tried to teach them to consider others’ feelings and how their actions or reactions could affect their relationship with their friends and family; but I clearly failed there, too.  As a single mother, I may have reacted with yelling and with “No!” when I was particularly stressed from my job (and with my last East Coast position the stress was awful), but I always came back to them and allowed them to change my mind about certain requests/actions once I had some time to calm down and think.  Overall, I think I treated them pretty fairly most of the time.  And both have grown up to be good and thoughtful people.  The credit for that probably goes entirely to their father in their minds.  And perhaps that is where it belongs.  I only hope that when they are my age, they are not ignored by their own children for doing what they believed to be best under trying conditions in their lives now.

Although I will never close avenues of communication between myself and my children and grandchildren, and although I will continue to send holiday and special event felicitations to family members, I will no longer accept blame or fault for the way I raised my children.  They always had more than they needed, even if I had to go without or had to give up something important to me to provide them something they wanted more than needed.  I had given them more time than they will ever remember, and more love and compassion than they remember and that will be eclipsed by whatever resentments they continue to feel.  Their feelings are their own to unravel, as they are plenty old enough to work out their own problems and difficulties.  My fervent wish for them is that their own children never feed on resentment rather than understanding and love.

My light came is letting go of self-blame.  I am not the only player in this family game.