What is a “personality disorder”

I keep reading news reports about the Sandy Hook shootings that describe the shooter as having a “personality disorder”. No explanation is given and no effort is made to enlist the help of mental health professionals to define “personality disorder”. Here is my attempt to provide that much-needed explanation.


Personality disorders are personality traits that are rigid and self-defeating, interfering with functioning and may lead to psychiatric symptoms. They are typically classified as Axis II disorders. Axis II is reserved for life-long problems usually appearing in childhood. Mental retardation is also considered an Axis II disorder. Axis II  disorders are viewed as having a primarily genetic or environmental cause, as compared to Axis I disorders that can be treated to the point that a person no longer meets the criteria for that diagnosis (i.e. Depression, Anxiety, etc.). There are medications that help manage the symptoms of many Axis I disorders, but very few that treat Axis II disorders. People who suffer from these disorder are often considered difficult, if not impossible to treat.

Below is a summary of the Personality Disorders recognized by the DSM-IV-TR, the professional guidelines for diagnosis mental illnesses.


Cluster A – Odd or eccentric disorders

Paranoid Personality Disorder

  • pervasive mistrust of others’ motives
  • tendency to hold grudges
  • perception that others are “out to get me”

Schizoid Personality Disorder

  • often detached from social connections
  • restricted range of emotional expression
  • NOT TO BE CONFUSED WITH AUTISM OR ASPERGER’S which have a genetic and/or environmental component

Schizotypal Personality Disorder

  • odd thinking and speaking patterns
  • odd beliefs
  • lack of close friends
  • chronic paranoia
  • confused with Schizophrenia which typically present in young adulthood.

Cluster B – Dramatic, emotional or erratic disorders

Antisocial Personality Disorder
Individuals with this disorder experience stigma due to society’s perception that anyone with this disorder is a “killer”. While these individuals do frequently break the law, most are non-violent.

  • sometimes referred to as a “sociopaths”
  • does not conform to social norms regarding laws and rules
  • engages in chronic lying, conning, and use of aliases
  • repeated physical fights or verbal aggression
  • chronic impulsivity
  • lack of remorse
  • inability to demonstrate compassion or mercy

Borderline Personality Disorder
This diagnosis is very controversial as it is sometimes confused with several other Axis I disorders by even the most skilled clinician. Some even believe that it isn’t truly a personality disorder because successfully treatments are available.

  • frantic efforts to avoid abandonment
  • a chronic pattern of intense and unstable personal relationships
  • a tendency to idealize or devalue others to the extreme
  • self-damaging impulsivity in response to emotional stressors (spending, sex, substance abuse, dangerous driving, binge eating)
  • recurrent suicidal or self-mutilating behaviors
    NOTE: Not all cases of self-injury indicate Borderline Personality Disorder.
  • extremely reactive mood (sometimes confused with Bipolar)
  • chronic feelings of emptiness often described as “feeling like an imposter”
  • intense inappropriate expressions of anger/rage
  • possible paranoia or dissociative symptoms (not to be confused with Schizophrenia or Dissociative Identity Disorder).

Histrionic Personality Disorder

  • insatiable need to be the center of attention
  • engages in inappropriately seductive or provocative behaviors
  • displays rapidly changing,  shallow emotional expressions
  • uses physical appearance to draw attention to self
  • overly dramatic (“drama queen”)
  • suggestible, gullible
  • often misinterprets the level of intimacy desired by others

Narcissistic Personality Disorder

  • grandiose sense of self
  • exaggerates their achievements
  • expects to be recognized as superior without proving it
  • preoccupation with fantasies of success, love, beauty, intelligence, etc.
  • believes that he/she is special and misunderstood
  • requires excessive admiration
  • has a great sense of entitlement
  • takes advantage of others to achieve personal goals
  • lacks empathy
  • envious of others
  • often projects arrogance and disdain for others.

Cluster C – Anxious or fearful disorders

Avoidant Personality Disorder

  • avoids interpersonal contact due to fears of rejection/criticism
  • fearful of not being liked
  • chronic fear of being embarrassed
  • socially inhibited
  • poor self-image
  • reluctant to take risks.

Dependent Personality Disorder

  • requires excessive advice/reassurance from others in order to make decisions
  • pathological need for others to assume responsibility for major areas of his/her life
  • difficulty expressing disagreement
  • difficulty initiating projects, or acting independently.
  • excessively pursues nurture from others
  • feels helpless when alone (believe unable to care for self)
  • urgently pursues relationships as source of care/support
  • terrified of being alone due to exaggerated fears of abandonment

Obsessive-Compulsive Personality Disorder 

  • preoccupied with lists, rules, order, schedules to the point that nothing gets accomplished
  • extreme perfectionism interferes with task completion
  • excessively devoted to work to the exclusion of recreation and relationships (not explained by cultural, religious, or economic reasons)
  • unable to discard worthless or worn-out objects
  • reluctant to delegate
  • extremely frugal and hold others to the same standard
  • often perceived as rigid and stubborn

CAUTION:
These are normal personality traits taken to the extreme that interfere with a person’s ability to function effectively in society and for healthy relationships. Every one of these traits is a part of the normal human experience when viewed in isolation. True personality disorders are difficult to diagnose and very controversial. Mental health professionals disagree strongly on the origins and treatment of these disorders. Unfortunately some clients are labeled with these disorders when treatment fails as a way of “blaming the patient”. Within the mental health community these disorders are sometimes used as derogatory labels to describe individuals who are difficult to treat. Patients can improve or recover with the right therapy. It is a slow, lengthy process not readily available in our “quick fix” society. These individuals are not necessarily dangerous or violent. Their condition is not due to some moral failing or character flaw. They deserve our compassion and effective treatment, not derision or fear.

For more information…
BehaveNet | Personality Disorders
TARA Association for Personality Disorders
NAMI | Mental illnesses
Behavioral Tech
APA | Help for Personality Disorders
APA | What causes personality disorders?

Helping children cope with tragedy

Parents everywhere held their children a little closer yesterday. The massacre of innocent children in Connecticut shook us all to our very core. Despite our best efforts to shield our children from this horrific news, most will discover it anyway. Your child might feel sad or afraid. After all, if it can happen in one school, it can happen in any school. Young children may experience nightmares, mood swings,and even fear of attending school.

How can parents help?

What is the best way to reassure your children?

How can you help them process their emotions while still reeling from your own?

Kids take their cues from adults. They learn how to respond by watching us. If we sit in front of the TV or computer engrossed in news reports, our children will watch, too. If we cry, scream, or lash out in anger our children will demonstrate these behaviors. Kids can pick up on our anxieties, fears, and phobias. If we are afraid to let them out of our sight, they will be afraid to leave our side.

Children lack the capacity to identify and process emotions effectively. They do not have the verbal skills to “talk it out” or the reasoning capabilities to understand as an adult. Plus, they are keenly aware of their vulnerability. Kids are small and defenseless against adults and they know it. Yet children are resilient. Most can bounce back from tragedy and thrive. Despite their size and lack of mental and emotional maturity, kids do have one amazing coping skill that most adults do not.

Children play.

Through their play they unknowingly process emotions too complex and powerful to speak aloud. Adults can use this skill to help children in times of tragedy. Here are some suggestions you can use to help your children.

  • Act out “a day at school” using miniatures, dolls, action figures, Barbies, etc. Let your child take the lead and just see where it goes. Make objective statements and ask questions.
  • Have your child draw a picture of a “bad guy”. Tape it to the wall and encourage them to express their thoughts and feelings toward the image.
  • Does your child have intense feelings of anger? Give them a bucket of ice cubes to throw on a hard surface outside. Let them cry or scream as they break the ice.
  • Is your child feeling vulnerable? Create a “safety map” to demonstrate the many adults who work to keep your child safe (parents, teachers, ministers, coaches, police officers, etc.). Tell them stories of heroic adults who have protected children.
  • Children have amazing capacity for empathy. If your child expresses a desire to “help” then you can use art supplies to create sympathy cards to send to the victims.

If, in spite of your best efforts, your child is displaying any of the warning signs listed below, it’s time to get him or her some professional help.

Warning signs:

  • Recurrent nightmares
  • Difficulty sleeping
  • Excessive fears of being alone, going to school, etc.
  • Poor appetite
  • Frequent mood swings
  • Isolation
  • Increase in aggressive behaviors
  • Poor school performance
  • Regression (bed wetting, nail-biting, “baby talk”, etc.)

Don’t wait to get help. The longer you wait, the worse it can get.  A few sessions of play therapy with a therapist who specializes in treating children can help your child get back on track.

Feverfew for Migraine Prevention

Feverfew for Migraine Prevention
feverfew_feature2
Edited for size and used with permission from creator H Zell through Wikimedia Commons.

When thinking about trying a natural remedy to treat migraines, it’s important to use the same common sense wisdom you would use with any other medication. The key is to recognize that there’s no doctor or pharmacist to blame if things go wrong. It’s your responsibility to make wise choices for yourself and accept the risks and benefits. You need to get answers to these basic questions before you can make an informed choice. Instead of asking a doctor or pharmacist, you will have to find the answers yourself.

Does it work?

The short answer is: “No one knows for sure.”

Like any other preventive, it may work for some and not for others. The research quality is inconsistent and the studies that show no benefit are either literature reviews or used an atypical formulation. It costs money for good quality research. Feverfew can’t be patented. It’s not expensive to grow or convert to useable forms. Unless someone gets a grant to do multiple longitudinal placebo-controlled, double-blind studies with several formulations and doses, we might never know for sure.

How does it work?

A 2005 study published in Cephalalgia reported that parthenolide was identified as the active compound responsible for feverfew’s anti-migraine effects. Parthenolide is a 5-HT (serotonin) agonist. It inhibits platelet aggregation in response to a release of serotonin. We’ve all heard the theory that dramatic fluctuations in serotonin may be responsible for the activation of migraine attacks. Triptans work in a similar way by rapidly counteracting the rise in serotonin that accompanies an attack. No studies support the use of feverfew as an abortive. However, its properties do indicate the potential to stabilize blood vessel reactivity to changes in serotonin in both the brain and the gastrointestinal tract. Some researchers have suggested that its actions are similar to methylsergide (Sansert) which is known to block the effects of serotonin.

Feverfew also decreases smooth muscle spasms in the vascular system. While the vascular theory of migraine has largely been debunked as a potential cause, vasodilation does still occur during migraine. By reducing the spasticity of vascular tissues, feverfew can reduce the pounding and throbbing felt when blood vessels over-dilate in response to chemical changes in the migraine brain.

As if that wasn’t enough, feverfew has also demonstrated the ability to block histamine release and inhibit prostaglandin synthesis to act as a natural NSAID. Good stuff, huh?

How much should I take?

The NIH recommends taking 100-300 mg of a standardized extract (0.2-0.4% Parthenolides) 4 times daily. The dried powdered leaf extract is shown to have the most favorable response. Tinctures (liquid) are also viable options. CO2 extracted supplements have the poorest outcomes.

How long before I know if it works?

As with any preventive medication, you should expect to use it 4-6 weeks before seeing any results. Maximum benefits are typically seen after 90 days of consistent use. No studies have linked the long-term use of feverfew to adverse effects.

Personal Experience:
In 1995 I tried a 0.7% dried leaf extract capsule daily for 6 months and saw significant reduction in frequency and severity of attacks. I had to discontinue use when I became pregnant. When I started taking it again 2 years later, it didn’t have the same effect. I don’t remember the brand I used. I’m sure it was different the second time around. The quality difference may have been the reason it didn’t work for me. I mentioned it to my naturopath who told me that my experience was typical and that if it works, it should be taken continuously to maintain benefit.
.

What are the potential side effects?

Most people do not report any adverse effects from taking feverfew. Those who experience side effects usually do not find them disturbing enough to stop taking feverfew. The most common complaint is stomach upset which can be mitigated by taking it with meals.

People who are allergic to ragweed have a slight risk of a similar allergic reaction when taking feverfew as it is in the same Asteraceae family as daisy and ragweed.

The most significant side effect is an increase in heart rate. If this occurs, check with your doctor about the safety of continuing to use feverfew.

Feverfew has a long history of use. At times raw leaves have been chewed or dried ground leaves have been steeped as a tea. Use of feverfew in this way may result in mouth ulcers, tongue and lip swelling, or loss of taste. If fresh leaves are applied directly to the skin, you may develop dermatitis. These side effects can be avoided by using only capsules, tablets, or tinctures.

Who should not use it?

  • Do not use if pregnant or nursing as feverfew has uterine stimulant properties. It has a risk of inducing abortion, labor, or menstrual bleeding.
  • Do not give to children younger than 2 years.
  • Adjust dose based on weight for children aged 2-18
  • Rapid discontinuation may result in headaches, insomnia, joint pain, irregular sleep patterns, stiffness, tension, tiredness, muscle and joint stiffness. If you must stop, wean off slowly or under medical supervision to reduce these symptoms.
  • Feverfew may inhibit platelet activity and interfere with blood clotting.
  • Check with your doctor first before using if you take any blood thinning medications such as aspirin, Warfarin, Plavix, or Ginkgo
  • Check with your doctor and/or pharmacist if taking any medications metabolized by the liver as feverfew may affect the rate of absorption, half-life, or change the action of these medications.

SOURCES:

  1. Biggs MJ,Johnson ES, Persaud NP, Ratcliffe DM. Platelet aggregation in patients using feverfew for migraine. Lancet.1982;2:776.
  2. Feverfew:Medline Plus Supplements. Natural Medicines Comprehensive Database Consumer Version, Therapeutic Research Center, 1995.
  3. Feverfew – A new drug or an old wives′ remedy? The Lancet
    Volume 325, Issue 8437, 11 May 1985, Pages 1084.
  4. Johnson ES, Kadam NP, Hylands DM, Hylands PJ. Efficacy of feverfew as prophylactic treatment of migraine. Br Med J. 1985;291:569–73.
  5. Murphy JJ, Heptinstall S, Mitchell JL. Randomised double-blind placebo-controlled trial of feverfew in migraine prevention. Lancet. 1988;2:189–92.
  6. Pareek, Anil, Suthar, Manish, Rathore, Garvendra S. , Bansal, Vijay. Feverfew (Tanacetum parthenium L.): A systematic review. Pharmacogn Rev. 2011 Jan-Jun; 5(9): 103–110.
  7. PfaffenrathV, Diener HC, Fischer M, Friede M, Zepelin HH. The efficacy and safety of Tanacetum parthenium (feverfew) in migraine prophylaxis–a double-blind, multicentre, randomized placebo-controlled dose-response study. Cephalalgia. 2002;22:523–32.

DISCLAIMER: This post is for educational purposes only and not intended to be the definitive source on Feverfew. Please follow the links to do your own research. Choosing to use natural remedies is an individual process that should take into account your preferences, health history, and a thorough analysis of the benefits and risks.

Natural Remedies for Migraine Prevention

Many medications used to prevent migraines come with some serious side effects. Patients complain of memory loss, difficulty concentrating, insomnia, fatigue, dizziness, nausea, tingling of hands and feet, mood swings, depression, and much more. Some of preventives can lower blood pressure to dangerous levels, trigger seizures, cause weight gain or loss, kidney problems, liver problems, vision problems, even heart attack or stroke. With all these scary side effects, many people are afraid to treat their migraines. Loved ones might even wonder aloud why in the world migraineurs would risk such dangers for “a little pain relief”. But that’s the point. Isn’t it? This pain is so bad that we would risk our lives to gain a few more moments of normal. It’s not “just a headache”. If it were, then we’d all just pop a few Tylenol and move on. But we can’t.

I meet with a lot of migraineurs who are desperate for safer ways to prevent migraines. Many turn to natural remedies for relief. Most experience the bitter disappointment of wasted time and money because they lack the knowledge to know what to look for, how to use it, and when to know it’s time to move on. Like any preventive, natural remedies must be used properly for a sufficient amount of time to assess their effectiveness. Additionally, they do have side effects, carry risks, and are not recommended for everyone. Natural does not equal safe. These remedies must be used with wisdom and respect. If you’re not serious about getting educated and taking personal responsibility for using natural remedies, you’re safer to stick with ice packs and heating pads.

Years ago I owned a health food store. During that time I studied Herbal Medicine and became a trained Reiki Master. It’s time I put that knowledge to good use again. Over the next few posts, I will be covering the details of what you need to know about several popular natural migraine remedies. If you have a special request for a certain topic, please post a comment or send me a message.

Next up: Feverfew: What migraineurs need to know

The Fairy & Pixie War

The Fairy & Pixie War

I’ve angered the Migraine Fairies and Cluster Pixies. My end-of-the-month positive Facebook post (50% decline in “headache days”) prompted a 2-day protest. They gate-crashed the party in my head and tried to trash the place.

In earlier days I might have tried to appease the pesky critters and ply them with offerings of remorse. Not any more.

Lucky for me I have great bouncers.

  • Excedrin was first to fight, throwing some well-placed punches that knocked several fairies into the next room.
  • However, when a swarm of fairies hit me from behind, Zomig had to step in and throw the buggers out.
  • Not to be outdone, the pixies fought back with moltov cocktails and strategically placed IEDs.
  • It took the combined efforts of Zomig, Oxygen, and Tiger Balm to send them packing.

ID-10035745I won the battle, but I know they will be back. Next time I’ll be waiting. If I hadn’t forgotten to call in Gabatril, Kudzu, and Melatonin those critters might not have even gotten in the door. Guess I won’t be giving them the night off anytime soon.

The place got cleaned up in pretty short order. I was able to host a few parties despite the two thwarted attacks.

  • First there was the Buying New Pretty Clothes party. That was the one that got their knickers in a twist in the first place.
  • Then there was the Happy Birthday Hubby celebration. That’s when the trouble started. It had to be rescheduled and moved to an alternate location, but the party, although subdued, still went on.
  • There were some smaller events, like Long Overdue Sewing Project, Final Lesson Plans for Kiddo, Project Dig Out the Pile to Find the Tabletop, and Stop the Infernal Leak in the Water Cooler. All in all, the weekend was a pretty good success.

Here’s mud in your eyes, pixies!

Coping with disappointment

Given the narrow margin of victory in many of yesterday’s elections, at least half of all Americans are experiencing disappointment today. No one likes to lose. It is human nature to emphasize our opponent’s weakness and over-estimate our team’s strengths. We want to win. When we lose, we might experience negative emotions and begin to distort reality to fit our emotional intensity. There are many ways we can lie to ourselves in order to make the “facts” fit our emotional responses.

All-or-nothing thinking
We focus on the extremes and fail to notice the infinite number of alternatives between our preferred (“wonderful”) option and the one we’d like to avoid (“horrible”)

Over-generalizing
We can simplify issues so much that they lose their meaning, fostering apathy and the tendency to assign value to “categories” rather than seeking to understand the infinite variations.

Mental filter
Seeing only one perspective; refusing to consider other alternatives robs us of opportunities to learn new things.

Disqualifying the positive
Nearly every situation has positive and negative aspects. When tend to minimize or ignore the positives and focus on the negative

Mind-reading / Fortune telling
We make the mistake of thinking that we know what others are thinking or feeling and assign value to the person, thing or idea based our own interpretation of their motives without checking for accuracy.

Catastrophizing
This is a form of All-or-Nothing Thinking in which we extrapolate the worst possible outcome for an event. Often when we stop and reflect on “worst case” scenarios, our current situation becomes less of a crisis and more an inconvenience.

Emotional reasoning
This happens when we believe our emotions even when logic and reason oppose it. We start making decisions based on emotion while ignoring facts.

Shoulds and Oughts
Thinking that life “should” be a certain way, with little room for change, flexibility, or compassion. We can turn this in as self-criticism or out in judgement of others.

Labeling
By assigning labels to people or situations, we minimize humanity and limit opportunities for growth.

Personalization
Sometimes an event is just an event. It isn’t always a reflection on your character or worth. Yet for some reason, there are situations that “hook” into our emotions and vulnerabilities. We take things personally that have nothing to do with us.

When faced with disappointment, take a quick inventory. Are you engaging in distorted thinking that is transforming your sense of defeat into despair, depression, or anger? If so, now might be a good time to gently challenge yourself to overcome these distortions.

Muscle Dysfunction as Migraine Trigger

Did you know that muscle tension can trigger a migraine attack? Neither did I until just a few weeks ago. Technically the diagosis is Cervicogenic Headche, a secondary headache disorder that has a lot of features similar to Tension-Type headaches. Apparently it is common to experience more than one type of headache disorder and each one can be a trigger for the others.

This certainly makes sense from my own experience with headache disorders. I’ve been experiencing episodic migraine attacks since I was 5 years old. Shortly before my 30th birthday, I experienced something entirely new and frightening, a Cluster Headache. It took 8 months to get an accurate diagnosis and effective treatment. Since then I have noticed a cyclical pattern of worsening migraines associated with spikes in cluster headache activity.

Thanks to my new neurologist, I have discovered that neck and back pain due to dysfunctioning muscles can create occipital head pain, which in turn, often triggers a migraine. The acute treatment for Cervicogenic Headaches often starts with the use of muscle relaxers and prescription pain relievers. My neuro is very conservative, so all I get are muscle relaxers. While they don’t take all the pain away, they do help take the edge off so I can function more normally. The next step was to discover the reason for neck and back pain through diagnostic testing (nerve conduction studies, MRIs) and a thorough exam by a physical therapist specializing in the treatment of neck and back pain.

We are still working to discover all the unique aspects of my condition by continuing to monitor my progress in physical therapy and test for nerve damage, bulging discs, and other possible issues. One thing is for sure. I have learned to recognize the early warning signs of neck and back pain and treat it effectively without pain relievers. This has reduced the severity and intensity of both migraines and cluster headaches by about 25%. Progress is slow yet certainly in the right direction.

Sources:
ICHD II – Cervicogenic Headaches
Cervicogenic headache ICHD-II 

Feature image source: http://commons.wikimedia.org/wiki/File:Neck_MRI_131332.gif
Attribution: © Nevit Dilmen

Grieving as a way of life

Grieving as a way of life

When life is impacted by chronic illness, grieving can become a way of life. As the illness progresses, changes must be made to accommodate the loss of function, loss of income, loss of loved ones, loss of control, etc. Each new change brings with it the need to acknowledge the loss through healthy grief. Getting comfortable with this process is part of healthy disease management. One of the ways we can do this is by dispelling the myths about grief.


Myth #1 – There is a “normal” timetable for grief. If I don’t “move on” within that time, there is something “wrong” with me.

Truth – Each person’s grief is unique. There is no established “time limit”. The duration of the grief process is influenced by a variety of factors, including severity of loss, emotional significance of loss, inability or refusal to participate in socially-accepted mourning rituals, learned grief behaviors from family of origin, physical injury or illness, and biological predisposition to mood, anxiety, or other mental disorders. This is not an exhaustive list of mitigating factors — just a few examples to help you understand the complexity of grieving.


Myth #2 – The stages of grief only apply if someone dies.

Truth – It is healthy to grieve any and all losses. These stages apply no matter what the loss. People experience grief at the loss of a job, loss of health, loss of property due to natural disasters, house fires, or violence. An often overlooked need for grief is due to emotional traumas.


Myth #3 – Once I get past a stage, I will never have to experience it again.

Truth – These stages are not linear. You can’t just check them off and be done. People can and do experience each stage multiple times and in varying order. One day a person might feel anger, then next day he or she is in denial, then perhaps a period of acceptance comes for a time only to be interrupted by sudden burst of negotiating characteristic of the bargaining stage.


For those not familiar with the 5 Stages of Grief, here’s a quick summary of the stages:

  1. Shock/denial – “This can’t be happening”, “It’s not a big deal”
  2. Bargaining – “If I would just relax/eat healthier/exercise more”, “What if I did this?”
  3. Anger – This can be directed at other people or the disease itself.
  4. Depression – “I’ll never get any better”, “This is killing me”, “It’s hopeless”
  5. Acceptance – “I can do this”, “There is hope”

How has living with migraines created loss in your life?

Can you identify your losses?

What stage you are experiencing right now?

If you find yourself struggling to process grief or feel “stuck” at a particular stage that is interfering with your ability to live life to its fullest, then perhaps it’s time to consider a few sessions of therapy. Not all therapists are equipped to address the grief that comes from dealing with a chronic illness. Take your time and look for one that specializes in “health psychology”, chronic pain, and grief.

 

Physical Therapy

I started physical therapy today. It was not at all what I expected. I was prepared for a lot of bending, stretching, and lifting. That’s not at all what I got. It was closer to massage therapy than exercise…but still painful.

Think of it like this…

Imagine you are lying on your back and someone is poking their fingers on the most tender spots at the back of your head. The weight of your head is balanced on their fingers, sending jabs of pain searing through your skull. Then they say, “Relax!” Umm…I thought I was relaxed. Guess not. So, I let go even more. At first it hurts worse…okay that part seems to go on “forever”. Then something changes. I can feel the muscles release and my head sinks into those fingers.

Just when things start to feel good it’s time to move. I thought massage was suppose to be relaxing? OUCH! He swears he’s barely touching me, but the left side of my spine (yeah, I now know that’s the trapezius muscle) is screaming.

1-s2.0-S1356689X03000948-gr8Just when I think I can’t take it anymore I get a break…sort of. I roll to one side and he grabs my arm. Again, he says, “Relax!” Duh, you’d think I’d learn, right? He starts moving my shoulder the “right” way, gently correcting me each time my “shoulder” muscle (actually the deltoid muscle in my upper arm) tenses up. He says, “Don’t try to move your arm yourself. Just notice how it feels when I move it correctly”. Then he makes some good-natured remark about my obvious need for control and that “another kind of therapy” deals with that. Yeah, yeah…a therapist with control issues…guilty as charged.

This “therapy” goes on for about 45 minutes until he finally lets me up and teaches me a few exercises to do at home. I never was any good at P.E. class. I’m just too clumsy.

“Use your abs.”

“Keep your neck straight.”

“ROTATE your arms back IN.”

“That’s it, 90 degree angles.”

“Don’t over do it.”

“Don’t try so hard.”

Ugh…

I will get the hang of this.

I don’t like to fail.

I want this to work.

Now let’s just see how much I remember when it comes time to do the homework each day.

I think I’m okay now

checklistI have this mental routine each morning. It goes a bit like this:

Right eye? …Check
Head pain? …Check
Neck pain? …Check
Right arm? …Check

It’s a survey of all the potential pain sites throughout my body, any one of which can slow me down or prevent me from achieving my goals for the day. Most days my goals are modest. But every once in awhile the goals are grand or immovable. Those are the days I must plow through despite the pain even though all my good sense tells me to take it easy.

This last weekend was full of these kinds of goals…more like requirements. I rested when I could, tried to keep within my known limits, and engaged in the best self-care efforts possible. Severe pain still dominated the weekend. Often the morning after such a weekend, I am full of pain or exhaustion and nothing gets accomplished. This morning was a pleasant surprise. As I did my “inventory” I noticed that very few alarms were going off. I’m not completely pain-free, but I realized that I felt well enough to tackle the day. The dishes would get done, the laundry washed, and I would likely be able to work this afternoon. What a pleasant surprise!

I think I’m okay now.