Categories
Addiction Education Health and Wellness Heath and Medicine

Back Pain: Don’t Make These 5 Mistakes

chippy

Two days ago my dog spied his adversary chippy the chipmunk and pleaded for me to let him out. Since his discovery of the fawn nesting in our neighbor’s bushes, I’ve grounded him from all independent runs in our wooded back yard.  I put his leash on him and opened the door thinking the two of us would carefully walk down the back steps, he would do his business, and we would say hi to Chippy as we happily went back inside.

What was wrong with my brain?  Was it sleep deprivation? Perhaps my preoccupation with the days responsibilities? Whatever caused my sudden lapse in judgement is irrelevant now. I opened the door, and my dog bolted while I was holding tight to his retractable leash.

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After one step down I knew I was in trouble so I let go. Thanks to the laws of motion, I flew over the remaining 3 steps and hit the ground with a thump.  I was sure I broke bones and would be forced to lay there helpless, at the mercy of our evil garter snakes and my dog’s sloppy wet kisses.  It was 7:15 am – my husband out of town and my three teen boys lay sound asleep two stories up, door shut, fan on, and a good chance noise canceling headphones were still attached to their ears.

sleeping

If I couldn’t move I was doomed.

Surprisingly the only injury I seemed to suffer was wounded pride and a knee abrasion.  That was then. It took a day for my body to reveal the extent of the damage. Now, I write to you from my couch where I lie supine,  ice on my lower back and pillows strategically placed for optimal comfort.  It was not just my pride and knee that were hurt, but I messed up my back as well.  Back pain  sucks, but it is as common as vanilla ice cream. 85% of us will experience it at some time.  The problem with back pain is if it isn’t handled properly when it happens, it can result in over treatment, unnecessary diagnostic testing/referrals/surgeries, and can begin a spiral down into crippling disability and even opiate addiction.

The Don’ts of Back Pain:

  • Don’t ignore it – Pain is a warning sign that something is wrong.  Most back pain is mechanical, meaning it is from injuries such as the one I described, or its the result of poor body mechanics with lifting.  It is always a good idea to see your provider to have your back pain evaluated and so you can receive proper instruction on how to mend. Your provider will also assess for red flags.
  • Don’t baby it – The worst thing for back pain is bed rest. Give yourself 48 hours of limited motion, applications of ice, and Over-the-Counter pain relief, and then start rehabilitating through careful positioning, movements, and strengthening exercises. Avoid heat as it may feel good at first but can delay healing.
  • Don’t overmedicate it: No you don’t need narcotics.  I have many people in the addiction clinic that started on Oxycodone for their back pain.  Back pain can be adequately managed with Ibuprofen or other NSAIDs, and tylenol.  Use creative pain relief interventions such as trigger point massage, cold packs, gentle whirlpools, and distraction. According to U.S. Pharmacist.com:

The use of opioids for managing low back pain remains controversial. Opioids are the agents of choice for managing severe acute pain and chronic pain associated with cancer.

 

  • Don’t underestimate the importance of prevention: Prevention is the key to all back pain.  Practice proper lifting techniques.   Strengthen your core muscles.  Recognize potential fall hazards and avoid them.

  • Don’t remain ignorant: learn the latest treatment and diagnostic guidelines for back pain management.  You are doing yourself potential harm if you don’t know the difference between good care vs quack care.  Millions of dollars are spent on unneeded surgeries and overzealous practitioners who take advantage of your mechanical back pain and pad their pockets with your money.

An ounce of prevention is worth way more than a pound of cure when it comes to your back.  So stand up straight, be smart (don’t use retractable leashes), and be safe.  If you treat your back right, you’ll be waltzing on your 95th birthday.

Here’s to healthy backs! P1020954

Categories
Addiction Health and Wellness Heath and Medicine

You Can’t Get Heroin While Fishing in the Middle of a Lake


Sunrise-on-sea

You can’t get heroin while fishing in the middle of a lake. That’s what my patient told me when I asked how he has stayed ‘clean’ for the past several years. He said he had to completely change his environment. By changing his environment, he was able to radically amputate the triggers that would inevitably lead to his drug use.  So, he moved to the suburbs, stopped hanging with his old friends, and took up fishing.

Addiction is a not a disease that is cured through detox, support groups, and medications. Yes, those things are all a part of recovery, but addiction to opiates, alcohol, or other substances means that despite a successful recovery, there is always, ALWAYS the possibility of relapse.  For some it happens in a few days, others a few months, years, or sadly, decades later.

You can’t remove the hedge of protection.  A recovering addict should never say,

I can resist the temptation.  I’m a different person, trust me, I’ve learned.  I will never use again….

To say such things is hubris.  It’s stupid. Dangerous. Deadly.

Get rid of the triggers.  Unless you bring it with you, you won’t find any drugs in the middle of a lake. An old shoe maybe, or if your lucky – a nice 20 pound walleye.

 

Categories
Addiction Writing

The Hardest Part of Addiction Medicine

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I just heard the news a client I met ten days ago has died. I am stunned and saddened.  I see so many patients in an average work day that I have a tendency to blur names and faces.  But not this girl.

I remembered her so alive, happy to be in recovery, looking forward to the future. She smiled as she told me she was thankful for second chances. She had almost died not too long ago from a complication of her heroin addiction.  But she survived. Her glance into death’s eyes changed her.

She vowed to get clean. To make amends.

To live.

Not everyone gets a second chance. She died in her sleep. There was no way she could have used in her tightly supervised setting.  She said goodnight and…..died.

Heroin addiction is a horrifying thing and has snuffed out another beautiful light.  The practitioner in me knows the disease of addiction, the organic complications and expects morbidity and mortality in this patient population that I work with.  Yet my heart trumps my knowledge and clinical experience.  My heart hurts.

I close my eyes and shake my head baffled.

The last time, this time, the next time, it will always be sad.

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Categories
Addiction Heath and Medicine

9 Tips to Keep you Healthy and out of Jail

There are many practices and habits that keep you healthy and lead to longevity.  Here are the top 9 I focus on when counseling my patients and family to a future of jail-free good healthy living.

P1090362Don’t smoke.  You know it’s bad for you, so if you want to be healthy, the smokes have to go.  It is rare for me to see a non-smoker with a truckload of medical complaints.  Yes, I know it’s hard, really hard to quit.  But if you really want to do it, you will find a way.

Exercise.  Move. Excuses? I’ve heard them all: I am on my feet all day, I’m too tired, I’m too busy, I don’t have a gym membership, I don’t like to go out when it’s cold, or hot, or raining. I have arthritis. My allergies will act up. I don’t like exercise. Walk around the dining room table 50 times if you have to.  Walking my dog Frodo (thats him with the giant cigar) is my favorite form of activity. Strive for 150 minutes of walking a week.  More is even better. I also like to put my exercise bike in front of the computer and watch something on Netflix.

Get your lipids (cholesterol), blood pressure, and glucose (sugar) checked.  If anything is out of whack, see your provider to develop a plan to get things under control.

P1110892Deal with obesity. Overweight, yeah, welcome to the club. That’s another thing that’s a rarity – falling in the ideal weight range or BMI 24.9 or below. But obese is not healthy.  It’s a road to diabetes, hypertension, joint problems, and cardiovascular disease. Don’t hide behind the news that obesity is a disease and you can’t help it. You want to be healthy or you wouldn’t be reading my post.  See your provider, and get the help you need to get the hell out of obesity. My BMI is 26.4. Eat good food in modest portions.  Fuel your body properly, and it will be good to you.

P1080374Wear seat belts.  Seriously.  Ask any of my friends who work in the ER.  No seat belt=more serious injuries.  Ejection in a car crash is not a good thing.

 

 

 

 

Game OverdoseNo opiates or other drugs. This will keep you out of jail.  I work in addiction medicine. I hate opiates, I hate that you had pain from a broken bone, back injury or surgical procedure and now you are addicted to oxys.  None ever for me, and yes I live with chronic pain.  There are other ways to deal with it.

 

 

Brush and floss.  Teeth don’t take care of themselves; you have to do the work.  Bad teeth and bloody, gunky gums are a haven of deadly bacteria. I understand you don’t like going to the dentist, neither do I.

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My childhood dentist nicknamed me Worry Tooth. I still am Worry Tooth, but I don’t let my fears stop me from taking care of my teeth and going to the dentist every 6 months. Take it one tooth at a time.

P1110884Manage your stress. If you are rushed, angry, nervous, rude, selfish, moody, not sleeping enough, unhappy – there is a problem and you need to tend to it. This may also keep you out of jail. Physical health is only 1 part.  Get mentally and spiritually healthy as well. Don’t forget to listen to music and dance. Go to concerts too.  Oh, and get a dog.

P1090520Be nice. It’s not that hard.  It makes you and the receiver feel good.  And isn’t that what life should be about? Do what you can, where you are, with what you have to make your corner of the world a better place.  You may never know how your act of kindness changed someone’s life. Some of you changed mine. We’re only here for a short time. Don’t waste it.

Categories
Addiction

The Many Faces of Addiction

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She was my last patient of the day.  When I called her name from the waiting area she rose gracefully and pranced down the narrow hallway as if it were a catwalk.  I was in awe.  She was stunning. She was the cheerleader, the homecoming queen, Bella Swan, Miss America, Barbie, the girl every other girl wanted to be.  She was also pregnant, and a heroine addict.

I’ve seen all faces in addiction. Senior citizens, procurers, exotic dancers, soccer moms, professionals, blue collars, athletes, goths, ex-cons, body-builders, latino, black, white, asian, gay, lesbian, transgender, religious, homeless, immigrants, second generations.

And now, a doll.

She was 96 pounds, had plush champagne hair, and big forget-me-not colored eyes with lavish lashes.  Her teeth were bone white perfect. Her nails were glazed with apple red polish, just the right length. She wore Abercrombie ripped jeans and a form fitting long sleeved sweater that accentuated her perfect figure. She was Barbie. The only tell tale signs that she really wasn’t were those ugly track marks that blemished her arms.

We made small talk and as she left I wished her success on the program.  I added I was glad she was here for help. But I lied.  I wasn’t glad she was here. Somewhere over the rainbow she should have landed in college, not in a drug addiction clinic.

modelShe should be studying to be a nurse, a physical therapist, or a designer. When she was young and dreaming of her future did she consider she’d grow up to be this?

Barbie, I am so sorry you are here and not there.  I hope things work out for you and you do the best for your baby.

Maybe someday you can go to college, if that’s what you want. I hope your Ken is a good man.  You have a baby on the way, take care, be well. And, learn from your mistakes.

 

Don’t ever forget –  It’s never to late to be what you might have been.

Disclaimer: I am not saying Barbie (as in the doll) is a drug addict. The real Barbie is not a substance abuser. But, she is anorexic.

Categories
Addiction

Bath Salts Jeopardy and Zombies

night_of_the_living_dead_3

I’ll take drug names for one hundred.

This synthetic, psychoactive drug with a chemical structure similar to the stimulant methamphetamine and the hallucinogen mescaline was first synthesized by a German company in 1912, developed in 1969, and was put on schedule 1 of the U.S. Controlled Substances Act in 2011.

Ummm..what is methylenedioxymethamphetamine (MDVA)?

Correct!

Let’s go with drug names for two hundred.

MDMA is commonly known as this product used to soothe minor aches and pains through soaking the skin and releasing a pleasing aroma.

What is bath salts?

Bath salts is correct!

Today, bath salts no longer conjure up associations with pleasant stress-reducing rejuvination, relaxation, and soft skin, but rather tales of super-human strength paranoid zombie flesh eaters who growl like wild animals. Here are first hand descriptions from some of my patients who recently dabbled with these designer drugs.

I stayed up for 48 hrs straight.  I had so much energy.  I felt alive.  How could legal plant food make me feel so great?  Then things went bad, I got paranoid, I thought my friends were backstabbing me. I went ballistic, I wanted to crawl out of my skin. I was messed up.  I wanted to hurt someone, anyone.  It nearly destroyed me.  I remember the cops came, cuffed me. They told me I barked like a dog. My heart was pounding so freakin’ hard, I was sure I was about to die. It took three big dudes to restrain me. I was unaware, I was hot. I ripped off all my clothes and panted.  I had time distortion. Voices were screaming, yelling all around me. I saw weird ghosts, demons. I was sure I was in hell.

screamin driftwood

Widely available in smoke shops, convenience stores, and specialty stops, MDMA is packaged as incense, plant food, insect repellant, potpourri and clearly labeled with warnings of not for human consumption.  Yet teens and young adults recognize these products from their many attractive names – Ivory Wave, Vanilla Sky, Bliss, Amped, Tranquility, Zoom, Red Dove, Legal Phunk, and Hurricane Charlie.  Talk on the streets is this designer drug is no different that caffeine, a stimulant that will energize, animate, and will serve as the perfect compliment to a weekend party. Sure thing, if your idea of a good time includes a trip to the Psyche-ED for treatment of mania, disturbing hallucinations, and intrusive paranoia.

nosferatu-shadow

Sounds similar to LSD, but LSD is a hallucinogentic, while MDMA is a stimulant (similar to cocaine and crystal meth). Bath salts have been eaten, smoked, injected, inserted rectally, inhaled, snorted.  When it reaches the brain it produces stimulation, alertness, euphoria, sensory awareness, and often hallucinations. But along with the desired effect, comes the undesirables….elevated blood pressure, increased heart rate, panic attacks, paranoia, and psychosis. Reliable sources tell me that for every ten people who try a bath salt, one person will experience a psychotic nightmare, one that will take a very long time to recover from.  This person was one who had a propensity for mental illness and the drug was the ignitor that turned that illness switch on.  Another one or two out of the ten will crave that nasty drug like walkers crave flesh. That insatiable appetite that results in addiction.

Zombie_mob_participant

Bath salts have virtually been eliminated from the western NY drug market. Lately, when I do a drug history with new patients and ask if they do bath salts they look at me  with horror, and tell me their stories.

Hey-thanks for reading. I’m Kathy, wife to Gary, and mom to three teenage sons. I’ve been a family nurse practitioner since 1991 and currently practice in addiction medicine. I also negotiate clinical placements for APN grad students. We’re home schoolers with a dash of un-schooling. My most memorable celebrity patient: the Munchkin Coroner from the Wizard of Oz.

Categories
Addiction Writing

My Weekly Insight From The Halls of Methadone

Life is as unpredictable as the weather and as jumbled as the landscape.
You have traveled through valleys, mountains, lush fields, barren, dusty deserts, muddy swamps, and have seen hurricane winds, gloomy fog, sandstorms, and calm, temperate days. You’ve experienced the extremes of mother nature and the changing terrains in life, moving through them either with tenacity and the adaptability to enjoy the breaks in the weather, or you remain hidden in the damp, moldy corners of the dismal places even when the climate has settled.
The air is fresh and clean, skies bright and cloudless –  yet your eyesight is blurred and your vision is scarred by the imprinting of the horrible storm you have just barely survived.  Your flesh now accustomed to being terribly cold or unbearably burned that you can’t adjust to the even temperature.
Soon another gust hits, but you’ve still not recovered from the last and remain buried under an avalanche of snow. You wonder how you will ever dig free when you can muster only the strength to gasp shallow breaths through a small hole.
Ah, the sun will melt the snow, and you will feel the warmth and thaw.
Open your eyes! The storm has passed.  
You are not a block of ice, you can wiggle your toes and feel your feet. Peel off the layers of wool and down and expose your skin to the warm air. The weather has changed, you have survived the storm.
Enjoy the respite.
Don’t dwell a second more on what you have endured.
Listen.
Doesn’t the quiet sound beautiful?
Don’t be afraid.
Life is unpredictable, and there is no way of knowing when the next storm will come.
But, next time it won’t be as bad. When you see the fast moving clouds, the increasing ocean swells, and the daylight casting an eerie glow, you’ll know what to do.
You’re a survivor and can weather anything.
Look how far you’ve come, you are still breathing, even if it be but through a small hole, it is still a breath, and where there is breath there is life.
where there is life there is hope.

Hey-thanks for reading. I’m Kathy, wife to Gary, and mom to three teenage sons. I’ve been a family nurse practitioner since 1991 and currently practice in addiction medicine. I also negotiate clinical placements for APN grad students. We’re home schoolers with a dash of un-schooling. My most memorable celebrity patient: the Munchkin Coroner from the Wizard of Oz.