Category Archives: Managing Your Condition

There’s Nothing Common About a Cold When You Have Chronic Pain

Empty cold medicine cup Chronic pain – whether it’s from fibromyalgia, RA, ME/CFS, or any other illness – ought to be enough for any lifetime.

It really, really oughtta be enough. It should entitle us all to a free pass for life from all colds, influenza, sinus infections, stomach bugs, and other manner of conventional temporary illness.

Yet, sadly, as we’ve all discovered much to our own chagrin, it obviously doesn’t, since we all still get sick from time to time.

Take now, for instance, for me.

For the last three days, I’ve been completely unable to breathe through my nose, thanks to the stuffy, compressed kind of congestion. I’ve had low-grade fever on and off, just enough to make me feel like crap (that is, on top of the usual fibro pain). And this morning, a lovely new symptom – a painfully engorged lymph node right where my lower jaw hits the neck area.

Can I just say “owie”?

We can take all the precautions in the world, but short of living inside a plastic bubble, we’re just never going to completely eliminate the risk of catching a cold or the flu.

But whereas that’s true for all of humanity, it’s also true that things like colds and the flu are even harder on those of us living with chronic pain conditions.

For me, being sick this week has been especially rough. Thanks to some unexpectedly cancelled income opportunities, I’ve had to scramble hard this month to make up the lost cash for rent, utility bills and groceries.

But at the same time, coping with a bad cold means I’ve lost the ability to focus for any significant period of time. So I constantly feel as if I’m coming unmoored and flitting around from thing to thing, or problem to problem, without being able to spend enough time in one spot to solve even one of those problems.

I think another key challenge for us in dealing with things like colds and other viral or biological infections is the way it makes us feel so inadequate to the task of coping. We’re so used to a certain level, type, and quantity of pain. Then a cold comes along, with a fever that causes additional pain, or a sinus infection which makes your face feel like it’s going to explode painfully. And there’s this whole new level of pain and discomfort.

I don’t know about you but for me, it’s like …

What the crap do I do NOW?!

How do I deal with THIS?!


This has been happening frequently for me at night, when I am trying so desperately to sleep so my body can heal, but my inability to breathe is causing me to wake frequently. On a couple of occasions this week, in the middle of the night I have hit that point feeling like I’m drowning, like I’ll never breathe again.

So, it’s a problem on many levels.

For me, the only real relief I can find to that scary “ACK-OMG” feeling is the relief I find on the yoga mat – the ability to experience something physically without living in it emotionally or mentally.

Coping in this manner requires some conscious effort at changing the running monologue in my head – consciously revising the script of self-talk from the fear-based to the objective.

Of course, you can’t jump from “I’M SUFFOCATING!” to “I’m fine.” You have to go up level by level. So it might look something like this:

I’m suffocating! I’ll never breathe again! This is going to kill me! … OK, that’s not something I can possibly know for sure right now, so how about I get up and get vertical and see if that helps … OK, it helped a little…OMG I am never going to get to sleep! And then I’ll hurt like hell tomorrow, and then … OK, maybe I’ll hurt more than usual tomorrow, but I can deal with that then. Right now, what’s the problem? I can’t breathe and I can’t sleep. OK, if I can’t sleep, then I might as well see if I can make myself more physically comfortable. Maybe another dose of Nyquil? Maybe that nasal decongestant spray? etc., etc…

Like I said, it’s a process, and one that requires significant effort on my part.

I think that level of sheer effort is why so many of us just don’t even try to challenge that tendency to catastrophize. We live there by default, and we’re unaware that all the while, we’re literally training our brain to cause us more pain.

And don’t we have enough of that to contend with?


photo credit: stevendepolo via photopin cc

two women meditating

Lifestyle Changes to Ease Chronic Pain (Guest Post: Dr. Lynn Webster)

Note: This is a guest post for Euston Arch by Dr. Lynn Webster.

two women meditating
Chronic pain is a life-altering condition, affecting every aspect of a patient’s daily routine. Its invasive nature makes adapting to life with the condition difficult for pain sufferers.

However, adjusting your lifestyle can help you find more relief and improved quality of life. After years of working with chronic pain patients in my practice, I’ve noticed that helping them make small, positive changes to their lifestyles has increased the efficacy of their treatment processes immensely.

To give you a better idea of how you can take back control of your life with chronic pain, I’ve compiled a list of the lifestyle changes I suggest to my patients. Taking time to evaluate your current lifestyle and implement each of the following changes in your daily routine will help you develop a solid base for battling your condition.

Get Moving

Developing and sticking to a comfortable and consistent exercise routine will help you build the healthy body and mind needed to fight your condition. Talk to your doctor about your current activity level and source(s) of pain to come up with a plan that is both safe and effective.

Reach Out

It’s not always comfortable to ask for help, but support is of key importance to chronic pain sufferers. Whether you need help with a task that has become difficult with your pain or could simply use a good listener, reaching out to trusted family and friends during your times of need will help you move through the pain.

Study Up

Knowing and understanding both the source and treatment options for your condition will help you play a more active role in your treatment process. Looking to reliable online sources and speaking with your physician on a regular basis will help you stay informed and aware of what your body needs for relief.

Listen to Your Doctor

Sticking to the therapy and medication schedules given to you by your physician is of utmost importance in finding optimal success throughout the treatment process. Stay on top of your schedules by keeping printed copies in a highly visible area (i.e. your mirror or fridge). This will give you the reminder you need until your treatment steps become routine.

Take Time for R&R

With all of the “should-dos” on your list, it can be hard to stop and take a moment to unwind. Whether relaxing means reading a book in a quiet place or spending time with loved ones, taking more time to do what you enjoy will not only distract you from the pain, but give your body necessary rest as well.

Treat Your Body Right

Eliminating the bad and replacing it with good can do wonders for an individual’s overall well-being. Avoiding or cutting back on substances like alcohol, tobacco and junk food and replacing them with beneficial choices like water and nutrient rich meals and snacks will help you boost your mood and offset the effects of chronic pain.

I hope that these tips will help you find optimal success in your treatment process and wish you the best of luck in your journey to chronic pain relief.

About Lynn Webster, MD

Dr. Lynn Webster Dr. Webster is Medical Director of CRI Lifetree and current president of the Academy of Pain Medicine. He has conducted or participated in over 200 clinical studies over the course of his career as a pain physician and researcher. His research work centers on the development of safer and more effective therapies for chronic pain and addiction prevention. He is best known for developing the widely used Opioid Risk Tool (ORT) and for his public campaign to reduce overdose deaths from prescription medications. You can find more information on Dr. Webster by viewing his Health Grades profile.

Photo credit: jessica wilson {jek in the box} via photopin cc (top photo)


On Moving, Keeping Moving, and Asking For Help

Man Pushing Cart with Belongings So, as I revealed in the last post, I was forced to move last year.

I’m sure we can all agree on this point: Moving? Sucks. Regardless of the excitement of new digs, fresh start, all that jazz – it just sucks.

But when you’re living with chronic pain, moving is its own special brand of hell. Things that the normals take for granted – like, say, packing, cleaning, walking – we basically roll the dice on. Will we be able to move that box from the truck to the house? It’s a crap shoot.

Fortunately, I had a fair bit of advance warning. True, the former landlady started out giving me two weeks notice, but ultimately, she was very fair and I ended up having two months, give or take a few days, in which to get ready for the impending trauma.

Sounds perfectly reasonable, doesn’t it?

Two months. I mean – eight whole weeks! That’s plenty of time for us to get our crap together, weed out the stuff we didn’t want to move, arrange for a new place, line up help …


Here’s what actually happened.

Figuring It All Out

The biggest obstacle was the first one I had to face: figuring out everything I had to do in order to accomplish the big-picture goal of relocating.

Now, see, normals just go find a place, get some boxes, start packing, call some friends, order up pizza and beer, and they’re done.

But CP Dolls have additional hurdles they have to clear. Reduced physical capacity means reduced capacity to earn, which means reduced income – in my case, severely reduced income. So, job one was finding enough money to actually accomplish the move.

First month’s rent, deposits for the house and for the utilities, the actual costs of moving – I don’t have a car (I had to sell it a year ago to make rent), so I was going to have to rent a truck – all these expenses totaled up were well beyond my means.

I was incredibly fortunate, and my friends and loved ones were incredibly generous. My brother contributed the truck rental costs. Through a few friends who worked in the social aid community in my area, I found out about a new grant-funded program at our local Section 8 agency that was designed to help folks like me with relocation costs. That program ended up helping me with the deposit and first half-month’s rent on the house.

With a little careful juggling, friends who chipped in generously, and a last-minute website job that came in, I had just enough cash to cover the utilities deposits and hiring some folks to help with the physical labor.

Barely, mind you. But I had what I needed.

So then it was on to the next dragon I had to slay …

Finding Someone Who Was Willing to Rent to Me

Spoiler Alert: This one’s got a surprise ending. Well, it was a surprise to me, anyway.

Refer back to that whole “reduced earning capacity”/“reduced income” thing.

Another unpleasant side effect of living with chronic pain is the poverty that comes with it. And the poverty itself also increases the cost of living. In other words, it costs the poor more to live in many instances.

This particular project, then, would reflect one of those increased costs.

Normals can go out, look at apartments or houses, fill out an application, and generally go on with their lives while making their decision – get that, their decision – of which of the handful of suitable options they want to live in, because of course their applications will be approved.

Why wouldn’t they be? They’ve got healthy-ish bodies and the jobs and (relatively) solid credit scores that go with them.

But when you’ve been struggling with CP for years, and the last several of those years were of the self-employed, cobbling-a-living-together-from-all-your-random-skills variety, then you’ve got a whole different cobble-stoned, obstacle-laden road ahead of you. It looks more like this:

  • Call a bunch of places that advertise available space.
  • Find out which will accept Section 8 (which you anticipate getting in two to four months, since you’ve been on the waiting list for two years).
  • Plot out with military precision the bus routes you’ll need to take to go view the three or four units still on your list.
  • Cry, because you realize even with the bus routes you’ll end up walking three miles and you just cannot do it.
  • Cry more when the first landlord calls back and says that you took too long trying to arrange transportation and the unit is no longer available.
  • Talk to a friend – or more accurately, listen while friend talks you down off the ledge. Dig deep. Somehow, find your resolve again.
  • Start all over.
  • Find one possible apartment or house, then call the cab and go see it immediately (paying $12 for the one-way trip) and on the way, mentally pep-talk yourself up into your best, most positive, friendly, reliable persona so you can convince the landlord to rent to you despite the fact you’re self-employed and lost an apartment in eviction proceedings four years ago when the world fell in on you.
  • Which, by the way, is freakin’ exhausting, so after it’s over, collapse.

Rinse and repeat as needed.

But here’s where the universe surprised me big time: That first cab ride?

Ended in a signed lease.

For a beautiful 900 square foot 2-bedroom 1945-built cottage with hardwood floors.

And despite the lack of heat and the piss-poor water flow, I LOVE THIS PLACE SO MUCH.

(Although I do have to get wi-fi installed. This every-day-trek-to-the-coffee-shop is good for my body but bad for the wallet.)

So, the lesson I took from all that goes something like this: “Plan for the worst, but be open to the possibility that God might throw you a curve ball and really delight you with an unforeseen assist.”

Which left only the biggest, baddest dragon of all …

Actually Moving

“How many times have I moved in my life?”

The question occurs to me as I sit here struggling to come up with the words to describe what happened not even two months ago.

The answer, as near as my fibro-fogged brain can tell, is “24.”

Twenty-four moves.

Is that a lot? ‘Cause it seems like a lot.

I’m including in that tally a move from Chapel Hill back to my hometown when I was six years old, though I left out the move from hometown to Chapel Hill three years prior (because, hello, I was a toddler) and I probably shouldn’t even count this one at all since my contributions consisted exclusively of holding a doll and sitting well out of the way.

And it also includes all the times I moved into and out of a dorm in college – that’s eight moves right there.

That still leaves 13 moves. Yeah, that’s still a lot, isn’t it?

So, let’s go back to the “24.”

For the first 18 of them, I had help.

But the last six?

  • Out of mom’s mobile home and into the 100 square foot studio apartment
  • Out of that apartment and into a friend’s basement
  • Out of that basement and into a friend’s spare room two states away
  • Out of that room and up to another basement, in another (now ex-)friend’s house, in the city where I currently live
  • Out of that God-awful basement and into two rented rooms in someone’s home
  • Out of those rooms and into the rented basement (that’s three basements in three years, for those of you playing our home game)

Without help. All of ‘em. Each and every move was accomplished by yours truly.

And that leads us to this last move – out of that last rented basement and into this lovely cottage.

But here’s the difference between those six and this most recent move, and it’s a pretty damned big one: This time, in addition to clothing and books and toiletries and stuffed animals – little stuff even I can lift – this time, I was moving furniture and a whole kitchen-ful of … er, kitchen crap.

We’d lost all our furniture years before, in two separate waves. The first wave hit after the eviction, when I had to give away or abandon a lot of furniture I just couldn’t fit into that shoebox studio, and the second one crashed months later, when I couldn’t afford to keep up with the storage unit rent for the stuff I hadn’t been able to bear parting with.

But over the course of the last two years in that rented basement apartment, I’d accumulated a somewhat sparse collection: two couches, a loveseat, a table, three chairs, two beds … that’s it, and it all came from donations from other people and giveaways. It was all hard-used and definitely looked like what it was: second-hand crap. But it was my second-hand crap, damn it.

And now it was mine to move.

I called the few male friends I had made who were local, but they all were booked up solid for the Thanksgiving holiday, and couldn’t lend a hand.

Next, I called the contacts I’d made in the local social aid community – they said they’d get back to me but, since it was a holiday, they were all overworked taking care of the homeless population in town.

I even asked the cabdriver who drove me to look at the cottage that first day. He was 72 but, bless him, he said he’d be happy to help – but I’d have to find someone else to help him, and I’d have to do the move on the Tuesday before turkey day, which was two days before I could get in to the new digs.

Then, I got creative. I called the local homeless shelter on Thanksgiving Day and spoke to a very nice worker there named Matt.

And that’s how I ended up the morning after Thanksgiving, driving a seventeen-foot Ryder panel truck carefully through my city’s sketchier downtown area, a block from the homeless shelter, looking for a group of homeless men who would be standing near a dumpster, Matt had said.

They saw me before I saw them, and they all ran towards the truck, shouting enthusiastically, some in broken English, and smiling at me.

This was a new experience. I wasn’t sure how I was supposed to proceed. Interview them? Ask for references? Draw straws? Fight club? A motherfucking walk-off?

I rolled down the window and held up two fingers.

“I just need two guys,” I said.

The first two guys that reached the truck hopped in and introduced themselves as Jorge and Luis.

Jorge spoke very good English – Luis understood me, but had trouble forming sentences of his own, so we slipped into an easy relay pattern where they’d converse in Spanish, then Jorge would relay a question to me, I’d answer, and Jorge would translate for Luis.

They had experience in moving; I could tell by the way they took a quick visual inventory and then started loading the heavy stuff – my second-hand mattresses (I know, ick) and the couches – into the truck first, and the efficient way they carried all the smaller stuff out and arranged it carefully.

And they were careful with my second-hand crap. Like they were all priceless antiques.

It took them three hours to empty the basement and unload it all into the cottage. It cost me $30 for each of those hours, plus an additional $10 tip to each of them at the end.

Parting with that $110 was the best fucking feeling I’d had in months.

The Aftermath

The day still took a crapload out of me, despite Jorge and Luis doing all the heavy lifting.

There were floors to be swept, trash to be picked up, bagged, and emptied, and last-minute packing of all the stuff we’d forgotten. In the new place, there were beds to be made, clothes to be unpacked, food to be arranged …

By the end of the day, I was hurting like I hadn’t hurt in a long, long time. Every muscle screamed, and my left leg was so nearly numb and useless that all I could manage were short, cane-assisted hobbles to the fridge and the bed.

And I continued to pay those dues the next day, too. All that Saturday, the pain throbbed in my neck and shoulders, and spread down to my calves and ankles. My back was one twisted, spasming knot of angry muscles.

But then something odd happened. The next day – Sunday – I felt better.

That’s two days after the massive, unusually strenuous exertion.

See, before the move, I expected to be bed-ridden for four days or more.

But there I was, Sunday morning. I was still hobbling and gingerly favoring a very sore back and leg, but I was up. And cooking breakfast. And unpacking.

I was functional.

Two. Days. Later.

I’m not sure mere words can describe how overwhelming that sudden infusion of hope felt to me.

For the first time in – well, years, I guess – I felt something other than resigned acceptance or bull-headed “I’m gonna have a good life despite the chronic pain” optimism in regards to my chronic pain experience.

It was the first time I felt it might be possible for me to heal.

Back to the Grind

Picture of Large Ocean Wave Breaking Near Shore Ugh.

I just wanna throw my hands up and go “UGH” some days.

There’s the micro-level of “UGH” — little mini-waves on the shore of life. The dish disposal grinds to a halt and you have to kneel down on the hard cold floor to reset it with that weird little wrench thingie. Or the kid committed you to 4 dozen Italian Wedding Cookies for the fall festival bake sale at school. And it’s THIS WEEKEND.

Then there’s the macro-level “UGH”: you get a notice from the landlord that he’s sold the house you’re renting and you have to move in 30 days. Or your previously static level of chronic pain suddenly decided to be not so static after all and started degenerating rapidly.

Finally, there’s something I like to call “the Universal UGH.” This is when several mini-ughs, which would have been totally handle-able on their own, or even just one at a time in succession, conspire to take place all at once. Or, well, at least within the same four-to-six day period of time.

Life’s like that, of course. Of course we know that.

But somehow when you’re coping with chronic pain, those mini-ughs — even the micro-ughs — just seem grossly magnified. Full on Monets, as Cher said.

And when it’s a Universal UGH?


But life being what it is, the Universal UGH will show up from time to time. Yes, even for the chronically pained.

Take me, for instance. Right now, I’m dealing with a Universal UGH of fairly massive proportions. I mean, as far as these things go, it’s not on par with, say, the massive shitstorm I dealt with four years back. (Now that, my friends, was a Universal UGGGHHHH.)

But it’s bad enough. It’s got all the usual biblical stuff — y’know, survival, life, death (no lust though, damn it) — and it’s been something I’ve had to weather for several months now. I hope (oh God pleasepleasepleaseletitbeso) that it’s almost over. (Well, either that, or the light I see is, in point of fact, the oncoming train and I’ll be squashed like a bug here any day now. Either way: win/win.)

And I noticed something kinda funny this time around. This sort of escaped me in previous Universal UGH-times, though I’m not sure why. I mean, it’s only logical and entirely foreseeable, when you think about it. So here’s my DUH moment:

When you’re in life-crisis, you forget to manage your health and your pain.

I mean, I FORGOT.

I took my meds, of course, because – well, I’m really not so keen on the whole withdrawal thing.

But it was like I woke up one day recently here and said “Dude. WTF is going on here? I haven’t … ”

Here’s what I “haven’t”:

  • Hit the yoga mat in the AM for the “getting the muscles warmed up” routine
  • Hit the yoga mat in the PM for the “winding down and relaxing kinked-up muscles” routine
  • Taken my vitamins
  • Paid attention to the no-sodas, no inflammation-trigger foods rules
  • Meditated. MEDITATED.
  • Walked a mile

Now, I’ve done these things sporadically over the last several months. It’s not like the yoga mat is lost somewhere in the house, buried under a foot of dust bunnies.

But I haven’t done all of them routinely. And it’s that routine that keeps the pain managed.

So, now I’m paying the price. Walking my child to the bus stop (a mile total, most of it on a steep incline) has become a serious physical effort. I fear I have gained a little weight. (OK, more than a little.) My blood pressure is up (yes, I’m taking my medication). I feel scattered throughout the day, and — duh — I hurt more.

Why on earth do we do this to ourselves? We know better. And it’s not like we don’t have immediate and noticeable proof that this stuff works. And yet, when times get tough and we arguably oughtta be doing more of this stuff, instead it’s the first thing that goes.

WTF are we thinking?!

WTF was I thinking?!

Back to the grind, dammit. I might not be able to resolve the UGHs but I can damn sure make certain I don’t hurt any more than absolutely necessary while they’re paying a visit.


Exercise: Pain Relief or Pain Trigger? The Answer Might Surprise You

Person lacing up a pair of exercise shoes

Prescription for pain relief: medication, nutrition, sleep hygiene ... and exercise?

Here’s a particularly nasty little Catch-22 for CP dolls: We’re told over and over that exercise will help us feel better, yet post-exertional pain — that is, exercise-triggered pain — is a prime cause of our bad days and fibromyalgia flares.

The truth of this quandary has been driven home in a very in-your-face kind of way to me in the last month. Four weeks ago, I began feeling bad — I mean really, really bad. Most of the day, every day, I rated my overall pain levels at a six out of ten, often increasing to seven or eight at times. (Normally, my mean pain level is three or four, topping out at six right before the next dose of tramadol is due.)

And what happened next is easily predictable by anyone living with a chronic pain illness: I stopped moving. I withdrew into myself, stayed glued to the heating pad on the couch, and whimpered through my day.

Doing so only made logical sense: when I had to move — say, when I went to the bathroom, or took a shower, or cooked dinner (on the days I was even capable of making dinner — there were a boatload of pizza boxes passing through our house last month!) — the pain levels increased. I walked around the house with a shuffling, “disabled old woman” gait, grabbing my back or hip in futile attempts to stop the searing pain.

And as for sticking to my daily routine of 20 minutes of walking and 30 minutes of gentle yoga? Forget it.

This went on for four weeks. I might feel slightly better for a few days, but then I’d go right back into debilitating pain. I joked that I’d invented a new yoga pose: the Couch Potato position.

A “DIY” Two-Day Intensive Pain Relief Program

Then, this past weekend, I decided it was time to get serious about feeling better. For two solid days, the only thing I paid attention to was my health and my pain level:

  • I ate low on the food chain: vegetables, fruits, whole grains, minimal meat.
  • I took my multivitamin every morning.
  • I drank water and caffeine-free tea, eliminating all sodas and artificial sweeteners.
  • I took hot baths, followed by a rub-in of Tiger Balm on the particularly sore spots.
  • I meditated three times a day.
  • I took my full complement of prescribed pain medication (flexeril and tramadol), as well as the maximum safe dose of acetaminophen.

It was extreme, but desperate times call for desperate measures. Yet as exhausting as that list may seem, there was one more thing I did for those two days, and it’s what I think truly tipped the scales for me:

I moved, almost constantly.

Movement vs. Exercise for Chronic Pain

I won’t dignify what I actually did by calling it “exercise” — mostly, it consisted of simple stretches from a seated or prone position, twisting from side to side in a very gentle arc while standing, and so forth. I set a goal for myself: for every five minutes of inactivity, I’d do one minute of movement.

Sitting on the couch watching cartoons with my daughter? Flex and point my feet, alternating left and right. Or reach up to the ceiling and stretch one side of my ribcage and then other.

Cooking dinner? I’d do simple calf and hamstring stretches. Or gentle shoulder circles.

And yesterday, after two days of this intensive approach, I felt good. Not just better, but actually good.

Now, I do not think that not moving caused the flare-up in the first place. As I said, I usually walk and practice yoga every day. But that gingerly-moving, couch-sitting approach, born out of self-preservation as it was, may well have made things a whole lot worse.

The Painful Results of Inactivity

Like the amateur scientist I fancy myself to be, I treated this as an experiment. I had a working hypothesis — gentle, regular, consistent movement helps to stave off flare-ups of chronic pain, while a lack of movement will increase pain levels.

So I set about testing it. To test the hypothesis, I willingly went immobile this morning. No movement. Sat on the couch and watched Law & Order: SVU for hours on end.

And right now, as I write this, at 2 PM EST, one full hour after my afternoon dose of pain medication, I do hurt a little more than I did at any point yesterday.

Is this proof? No, of course not. But it does support the experts who have been telling us all along to get up and move, if we want to feel less pain.

I’m not about to suggest exercise is the end-all, be-all of pain management. That’s ridiculous. But I am suggesting that some form of movement or exercise may be a vital part of a comprehensive pain management program.

Finding Your Movement Sweet Spot

So why am I not advising you to go join the Y or start running? Because I think the experts have only half the picture right. The other half is just as important, and it’s this: the reality of post-exertional pain flare-ups.

We all know it. Move too much — do too much — walk too much — practice yoga too long, even — and you’re going to pay for it the next few days.

What this tells me, the pseudo-scientist with the curious mind and the half-full bottle of tramadol, is this: there’s a sweet spot, and it’s the job of each CP doll to find her own.

In between the “extremes” of post-exertional pain and couch-potato-induced pain lies a middle ground that will help you feel better. The problem is that those “extremes” can be pretty darn close together on a spectrum of effort and movement. Walk ten minutes and you’re feeling great. Walk another five minutes and you’re in bed for two days.

And there’s another complication: sweet spots for the chronically pained — even those with the same exact CP illness — will, I suspect, vary wildly. That’s true for the same reason that our general experiences with chronic pain illnesses vary so much from person to person: because chronic pain illnesses implicate so very many different facets of daily life.

From nutrition to stress to genetics to medication to body chemistry to sleep hygiene … it all plays a part, and every new facet gives the illness another level of complexity.

Exercise — movement — whether and how we use our bodies — this plays a part, too. Your mission: find your sweet spot, and attain that level of movement each day you are physically able to do so.

How to Get Moving and Find Your Sweet Spot

A few tips before you get going:

  • Talk to your doctor first. Make sure you’re healthy enough to do some activity.
  • Start slowly and gently, with movements and stretches such as the ones I described above.
  • Begin with where you are — not where you want to be, or where you used to be. This one’s hard for me, personally. I used to be a dancer, and in some part of my mind, I can still go for thirty minutes at the barre and sixty on the floor. Of course, I can’t. I have to get my ego out of the equation, and stick to my “sick person” routine. Because that’s where I am now.

Let me know in the comments what you think about exercise as part of a pain relief program. Do you exercise? Can you tell what’s going to trigger a post-exertional flare when you’re doing it, or does it always surprise you when you can’t crawl out of bed the next day? Are you physically capable of exercise? Also, be sure to visit Euston Arch on Thursday, when I’ll look at some commonly suggested forms of exercise for chronic pain conditions.

This Doll’s Story – Part 3: Painful Lessons and a Mini-Rant

Green chalkboard with erasers on wooden stand

Even bad experiences can teach us something about our chronic pain

I’d been accused of pharmacy-shopping, apologized to and then ignored, was on the brink of withdrawal, and found out I’d lost track of 21 tramadol pills.

But somehow, probably due to the power of email, we finally got on the same page and I picked up the remainder of a one-week supply on Saturday afternoon.

Almost one week later, I found myself back in the clinic’s waiting room, anxiously eyeing the clock. It was my first appointment since the whole kerfuffle went down, and I was understandably nervous. I didn’t know how much my P.A. had been told about the various head-butting and misfires, which meant I didn’t know how to approach the whole thing. Should I start off with a complaint? Should I pretend like nothing had happened and then do a “now, about last week” thing at the end?

As it happened, I needn’t have worried. She brought it up, right off the bat, after the preliminary “how are you doing?” inquiries. Now, I should be clear here: the P.A. wasn’t confrontational or rude. She was very polite, she listened actively, she took her time … overall, I had no problem with the P.A. during this visit, except for the script she’d apparently been handed right before my appointment.

First, I brought up the issue Dr. C had raised with me: that the medication should have lasted to the end of the month. “I did the math, so to speak,” I said to her, “and it wasn’t exactly as it had been represented to me. I was actually short 21 pills, which is five days plus one pill.” I went on to explain the two possible times I remembered in which the pills could have been taken.

She listened politely, and cleared her throat when I was done. Here’s what she rattled off to me next:

  • “As a medical practice, we’re going to be treating tramadol just like Percocet.”
  • “Tramadol is already treated as a scheduled drug by 17 states. We’re just waiting for the others to fall in. It’s just a matter of time.”
  • “We’ll need you to sign a pain medication contract.”
  • “Also, since we don’t have your records from your old provider yet, we’ll need you to come in every week or two weeks to get refills for the tramadol.”

Well, the hits just keep on coming, don’t they?

I toyed with the idea of tearing down her spiel, point by point (which had been read off to her by one of the doctors, I’m guessing, during a staff meeting about that horrible patient who kept calling and emailing last week…). After all, tramadol is not anything like Percocet; it’s nonnarcotic, even though it does need to be tapered off to avoid withdrawal; and seventeen states isn’t even half, and our state isn’t one of the seventeen, so what does that have to do with the price of tea in China? And don’t even get me started on pain management contracts or why I’m being held hostage by my former doctor’s willingness to fax over hundreds of pages of medical records.

We went through a pain evaluation survey, and when I mentioned muscle spasms that I’ve been experiencing lately, she offered me Flexeril. I found that really strange. If they were so worried about me and my drug use, why suggest an additional drug? One of the riskiest of risk factors in pain medication abuse is mixing drugs like pain relievers and muscle relaxers — say, for instance, tramadol and Flexeril. Yet here she was bringing it up, after all the fuss about the quantity of tramadol I was (supposedly) taking. (Truth: I am NOT complaining. One Flexeril at night has turned out to be a godsend for me in terms of guaranteeing me a good night’s sleep.)

Overall, I left rather stunned, and unsure what to think or conclude. On the one hand, there’s “every two weeks” and a pain medication contract. On the other hand, there’s proffered Flexeril and a very mild-mannered approach.

I debated with myself for a few days about what to do. I could have complained to the layperson director of the clinic’s board, but there was that possibility the clinic would simply dump me as a patient. I finally decided the best approach was to go ahead and keep the two-week appointment, but at that exam, show the P.A. my pain log and explain the nature of the hardship they were placing on me.

Two weeks later, I marched in armed with my pain log and my medication bottles, and a printout of the costs to me, compared with my limited income, to be required to come in every two weeks. The exam portion of the appointment went just as smoothly as the prior one had, and as she was wrapping up and segueing to talking about my next appointment, I said, “Well, I wanted to talk to you about that…” and prepared to go into my rehearsed speech about how I should have earned a little trust here by now …

And she cut me off and said, “Yeah, no, you’re fine. I’ll see you in a month.” When I picked up the refill, it was for a month, with a one-month refill.

Exactly what she’d given me the first time I ever saw her.

It would kind of be funny if it wasn’t so infuriating, I think. What changed between the prior visit and this one? What justified changing the two week schedule to a monthly one? I hadn’t even gotten around to showing her that I’d been responsible with medication. She didn’t have the old records yet (I know that because they asked me to sign yet another release because they “couldn’t find” the one I’d signed the first time I saw them), and that was the rationale she’d offered for the bi-weekly requirement.

So what was different?

Or am I to conclude that this clinic simply runs on whim?

Granted, there are a number of potential explanations in between those two extremes. I am likely never to know with any certainty.

What I am certain of, however, is that even in such an infuriating situation, in which things were done to me, as opposed to things I did , there are lessons to be learned:

  • Keep a pain log. ALWAYS. That pain log helped me figure out that I had never taken more than the prescribed dose, and it could also have offered support for my position about the frequency of the refills, had we gotten that far. Over and above the potential use as evidence for the defense, the pain log is crucial to show your doctors how your medication helps you. (It’s got a ton of other uses, too. If you don’t keep one already, start one today. At that link, you’ll see five other ideas to help you be an empowered CP patient as well.)
  • Keep a running count of your medication. Had I counted the pills periodically, I would have noticed the problem a lot earlier and could have alerted my P.A. then and there, which might have countered the suspicions of her coworkers.
  • Maintain your calm. Always. I lost my temper a little bit, and I’m sure that prolonged some of the brouhaha.
  • When all else fails, try putting it in writing. I have absolutely NO doubt that the first email to Dr. A was what saved me, ultimately. Writing allows you to get out the emotional angst, then go back and edit that out so that your email or letter paints a portrait of you as a rational, even-tempered, responsible (i.e., not addicted) adult.

So, there it is — the sordid tale of my experience being unfairly accused and suspected of drug addiction or, at the very least, prescription medication abuse. I appreciate the ongoing comments of support and empathy, but I also hope you pull something of value out of this story. Something like this could happen to anyone. And the horrible part of it is that you cannot prove you are not an addict. Then again, unless you demonstrate a pattern of abuse indicators, you shouldn’t have to prove anything.

Until reality catches up with that ideal, though, I’m counting my pills and filling out my pain log, every damned day.

This Doll’s Story: Part 2 – What We Have Here Is a Failure to Communicate…

Frustrated woman on the floor next to laptop

Yep, that's pretty much how it felt...

So, after being accused of pharmacy-shopping, I was a little floored, as you can imagine.

Standing there in the Walgreens’ pharmacy waiting area, having just raised my voice considerably, I became acutely aware of people staring at me. I felt a sudden rush of shame, of all things. I’m not even sure a coherent thought or rationale attached to that emotion — just a hot rush of shame.

But what did I have to be ashamed of?

It didn’t really matter, I realized. Because to any casual observer, I was the woman screaming at a doctor’s office at a pharmacy. Clearly, I was drug-seeking and had been turned down. Right?

No, of course not. Wrong, wrong, wrong. But try explaining that to someone — anyone. The futility of defending yourself against implications of this kind was rammed home with particular force a few days later, but there and then, in the Walgreens, I decided I didn’t care what these strangers thought of me. I took my fourteen pills and went home to plot my next move.

I’d decided initially to file a formal complaint — something I’d never done in my entire life. My state’s medical licensing board’s website contained everything I needed to know to get that process started. Yet something made me pause for a moment. I wanted to know who, exactly, I was dealing with.

That’s when I found out that my provider — the one who was on vacation — was a physician’s assistant, not an M.D. That didn’t matter to me so much — P.A.s are great, in my experience. But the doctor who was covering her wasn’t just a full-fledged M.D. – she was the chief M.D. for this practice. She was the boss, in other words.

So what was going on here? Had my P.A. violated some clinic policy in giving me the prescription in the first place? Would complaining about the doctor get the P.A. in trouble? Did I care?

I actually began to consider not saying anything to anyone.

That embarrasses me now, in retrospect. Me, the health and chronic pain blogger — the woman who preaches the need for patients being their own best advocate — I was considering letting this whole mess slide without comment.

What kind of hypocrite would I be if I remained silent?

So, yeah, I had to say something. But to whom? And how?

I did a little more research on the medical licensing board site. There, I discovered something that appalled me: doctors in my state could discharge patients — refuse to treat them altogether — if the patient lodged a formal complaint!

This may not be news to anyone but me. It certainly knocked me for a loop, and suddenly I had a much bigger concern. It had taken me months to find a practice with fees I could afford. There were very few remaining options for medical care, and given my conditions — scoliosis, degenerative disk disease, fibromyalgia — all incurable, all chronic, all very painful — I couldn’t risk losing access to a doctor.

Even one that thought I was an addict? It felt at that moment like an unsolvable problem.

Then a middle ground approach occurred to me. I brought up my email program and began to write. Using the chief doctor’s email address, which I found on the practice’s website, I composed an email to her.

In that email, I laid out my medical history pertaining to my chronic pain conditions. I discussed this blog. I told her where I stand on the intrusion of law enforcement into medical care decisions. As I wrote, I was vaguely aware of how important this email was — more important than any blog post or email I’ve ever written. This email was my last hope to get the care I desperately needed.

I’ve edited out the identifying information from that email, and turned it into a PDF, so I can share it with my readers. You can get that file here (PDF link). But I wanted to share one excerpt here — after recounting the facts of what happened (which you can read in the first post, here), I wrote:

I don’t know if you can appreciate the feeling of humiliation and frustration that naturally arises when you’re placed in such a position. I felt unjustly accused and labeled, without any justification for such treatment. You have never seen me professionally, nor do we have any sort of relationship. We have never even met. Yet, simply because I called and asked for a refill for a medication that I have taken without incident for over six years, you apparently assumed that I was a drug addict.

I have never experienced this before, in over ten years of being a chronic pain patient. If I handled it badly, I apologize. Yet I maintain that I have not been treated with dignity and respect, and I have given you absolutely no reason to question the legitimacy of my treatment protocol, of which medication is an important (though certainly not the only) part.

I have maintained a website devoted to patient advocacy in the chronic pain context for several years, most recently at Even so, I confess I feel some trepidation even writing this email to you, for fear you may retaliate by dropping me as a patient from your clinic’s family practice. This sort of chilling effect is not conducive to good patient/doctor relationships or to the practice of good medicine, as I’m sure you realize. I see from the clinic’s website you are the medical director for the clinic. In such a leadership position, I am sure you would want a patient to feel free to raise a legitimate concern over his or her medical care. Yet even I, with my educational opportunities and background, and with my professional interest in patient advocacy, thought long and hard about writing this email.

I re-read that email several times, and though I was generally pleased with it, I was still very nervous about rocking the boat with this clinic. So I decided to ask for the input of two people I trust, and sleep on it myself. The next morning, having received full-throated approval from both friends and feeling somewhat stronger emotionally myself, I sent the email.

Within a few hours, I received a telephone call from the clinic’s main number. It was Dr. C, another M.D. who was apparently Dr. A’s second in command. He told me Dr. A had asked him to deal with my situation and forwarded the email to him. Right off the bat, he apologized for the miscommunication and the way I’d been treated, which earned him some goodwill from me.

The very next thing he said was, “I’ve already called in another 21 pills for you. That should be enough to get you to your appointment with Ms. B.”

Phew. “Thank you,” I said. “I do appreciate this.”

“There’s just one thing, though,” he continued, sounding hesitant. “We went back and double-checked your medical records and you should have had enough tramadol from that refill to last to the end of the month.”

It was the 21st of April.

For the second time in 24 hours, I was flabbergasted. This time, however, words failed me. I sputtered and stammered something like “I don’t think that’s right…” as I frantically searched for a calendar and my old bottle of tramadol, to match up the dates.

Pretty quickly, I realized that my addled brain wasn’t up to the simple addition and multiplication tasks inherent in figuring this out. Somehow, I managed to catch my breath, calm down, and say somewhat intelligently, “I’m not sure what happened there, but I will certainly look into it immediately and discuss it with Ms. B next week.”

He said that was fine, and he apologized one more time before hanging up.

OK, I thought, trying to calm my racing heart, this is a very different scenario. My mind raced back through the last four weeks, trying to figure out what had happened, and when. I knew I hadn’t taken more than the prescribed dosage, so when I got to the bottom of the pill bottle, I just naturally assumed it had been four weeks. But after consulting the calendar and doing the math, I had to admit that Dr. C was right: I was off by about 21 pills.

What had happened? When had it happened? This was pretty much all I thought about for the next two days. I retraced my steps mentally, going all the way back through a very busy month in which I’d moved (yet again) and coped with all the stress that brings.

Was it possible I’d taken more tramadol than I was supposed to, or been careless with the pills and dropped them, somehow? That didn’t seem plausible for a few reasons. First and foremost, I knew from the past when my old doctor raised my dose that taking more than I was used to taking produced severe waves of nausea. I hadn’t experienced anything like that. Also, we weren’t talking about one or two pills — five whole days’ worth of tramadol was missing here. Over twenty pills. That, I would have noticed if it had been accidentally dropped or spilled.

After combing back through my memory of the preceding weeks, I could pinpoint two possible scenarios: one in which I’d walked out of my motel room the day before I moved so the maid could clean it, and the other on the day I’d picked up the refill, courtesy of a ride from a fellow motel resident whom I didn’t know very well. On the way back to the motel, we’d stopped at a fast food restaurant and I’d grabbed my wallet and walked in, leaving the driver, my purse, and the pills in the car. I was gone for about ten minutes.

So I was pretty sure I knew what had happened, but it didn’t make me feel any better. If I told the doctor or Ms. B, my P.A., what I suspected, would they wonder why I didn’t file a police report? Should I report it? I couldn’t prove anything at all had happened, and wasn’t it just as likely suspicion would fall on me? I mean, if someone is of the opinion I am an addict, is anything I do going to change their minds?

What a mess.

And it got even messier, if you can believe it, the next day. I had left Walgreens with 14 pills — enough for 3.5 days. My last dose from that batch would be Saturday morning. Dr. C had called me Thursday morning and assured me he’d already called in the prescription for the remaining pills (plus seven extra, which I figured it was best not to even mention). So, I figured, if I get to Walgreens Saturday morning, I’ll be good.

Something nagged at me Friday night, though. (I only wish it had nagged at me before 5 PM…) On a hunch, I called the local Walgreens just to reassure myself the prescription was ready.

You can hear this coming, right?

They had no record of any prescription for me having been called in during the preceding 48 hours.

I hemmed and hawed a bit, but ultimately realized there was only one thing I could do: call the clinic. Again. This time, of course, it was after hours. The on-call nurse took the call and, after checking some records, told me she thought my medication was a third pharmacy which was open on Saturday. I was pretty sure that Dr. C had called it into the clinic’s pharmacy, which was not open Saturdays, but I agreed to call the third pharmacy in the morning to check, all the time thinking to myself I was going to be making yet another call to the clinic in the morning.

And, in fact, there was no pharmacy by the name the nurse had given me in my area. So, I called the clinic again. This time, a very helpful triage nurse offered to check my records and call it in herself to Walgreens. She put me on hold for several minutes, but when she came back on the line, her voice was very different — stressed, apologetic.

She’d called the P.A. on call to verify she could simply transfer the prescription, and the P.A. had read her the riot act, apparently. Here’s what I heard from the apologetic triage nurse:

Um, she said to tell you that this line is for emergencies only, and this isn’t an emergency. She said to tell you that tramadol doesn’t cause withdrawal symptoms, but that she’ll try to take a look at your file if she can sometime today and maybe call you back.

How many problems can you spot in that quote? I see three:

  1. The after-hours line to the clinic is not for emergencies. That’s what 911 is for.
  2. This was an urgent issue, requiring immediate assistance. If I did not get the medication I needed, I would go through terrible physical withdrawal symptoms. On top of my already-compromised immune system? Seriously?
  3. Tramadol most certainly does cause withdrawal when a patient stops taking it abruptly.

I was so frustrated at this point, I almost started to cry. It was unfathomable to me that a physician’s assistant could be so blase and so uninformed. And, still, the undercurrent of accusation leaped out at me from the nurse’s repetition of the P.A.’s words: you’re an addict, aren’t you?

There was nothing more I could accomplish by continuing to talk to the nurse, I realized — her hands had been effectively tied. I simply stressed once more that withdrawal was imminent for me, and the P.A. or someone really needed to do something about this.

A few hours later, I got a call back. It was pretty much what I feared: “Sorry, can’t help you. Call on Monday.”

I was totally out of medication by now, and angry about it. Had I known this was going to happen, I could at least have reduced my dose or tapered off a little to minimize the impact somewhat.

Then my eyes fell on the laptop. Email worked pretty well the last time, I thought … so back to the computer I went. I sent another email to Dr. A and cc’d Dr. C, explaining what had happened and what I’d been told by the P.A. through the nurse.

I didn’t get a response via email, but I did get another phone call around 1 PM (about the time I usually take my second dose) from yet another triage nurse. Suspicion and attitude were fairly dripping from her voice. “Mmm-hmm,” she said repeatedly, as I reiterated my request, in that way that clearly communicates “I do not believe one word coming out of your mouth, lady.”

I just stopped, mid-sentence. I took a deep breath, and I said, “You know what? It’s clear to me that you’re not interested in listening or helping, so I’ll just reiterate this: I am not asking for more pills. I am asking for what was already called in to be transferred to the correct pharmacy. That’s all. Goodbye.”

An hour later, having heard nothing in reply either via phone or email, I tried calling the pharmacy.

My prescription was ready for pickup.

Tomorrow, I’ll wrap this up and discuss the lessons I learned from this horrible, humiliating experience.




What’s the Difference Between Addiction and Dependence?

Image of Martini Glass Full of Colorful Pills

It seems like you can’t browse the web or flip through a paper or magazine these days without coming across another dire warning about the epidemic scourge of addiction to prescription pain pills.

One question nobody seems to be asking is this: Is it really that bad?

Nobody can really argue with a straight face that addiction to prescription pain medication doesn’t exist, or that it isn’t an increasingly occurring problem. But in the great debate playing out in the national media, I suspect that fear-mongering and sensationalism are being fed by a radical misunderstanding.

Put simply, I think a lot of media outlets, journalists, and anti-pain medication advocates are confusing addiction with dependence .

(NB: Yes, I’ve written about this before, but the issue is of such importance and complexity that it bears further discussion.)

Comparing Addiction and Dependence

The first thing to understand is this:

If a person is addicted, she is suffering from an abnormal physical & psychological disorder. If a person is merely dependent on medication, she is experiencing a normal physical response to the medication.

Another key difference between addiction and dependence is that an addict takes medication to achieve a “high,” whereas someone dependent on medication simply takes the medication to function.

Complicating the matter, however, is a set of behaviors that has been termed pseudo-addiction by some experts. It mimics addiction in some ways – a frantic, clock-watching anticipation of the next dose, for instance – but it is caused by the person’s experience of pain, possibly breakthrough pain or possibly pain that is not being adequately controlled by the prescribed medication.

Hallmarks of Addiction to Prescription Pain Medication

The following behaviors can indicate a potential addiction:

  • Taking pills more often than prescribed dose;
  • Taking medicine via an unorthodox method (i.e., crushing, snorting, injecting, etc.);
  • Going to a number of different pharmacies within the same time period;
  • Repeatedly refilling prescriptions before the medicine should have run out according to the label information (i.e., number of pills and frequency of dosage);
  • Doctor shopping;
  • Difficulties in socializing with others, where socialization came more easily before the medication usage began;
  • Increasing isolation from family, friends, and life activities previously enjoyed; and
  • Overall, a sense that the person’s life is in a downward projection, increasingly spinning out of control.

Comparing Drug Dependence to Addiction

It might sound bad – after all, who wants to be dependent on anything, let alone prescription pain medication? But dependence as a biological state is not inherently morally blameworthy as addiction is often viewed as being.

Dependence is simply the body’s natural acclimation to the drug. It is probably more accurate to say that the body is dependent on the medication, rather than the person.

Some of the characteristic hallmarks of drug dependence, as contrasted with the hallmarks of addiction set forth above, are:

  • Medication taken as prescribed, both in amount and frequency;
  • Medication taken via prescribed method – i.e., no alteration of the physical form of the medication;
  • Patient may need an eventual increase in dosage, but compared to the addict’s self-administered increase, this increase is done under supervision of doctor and according to prescribed instructions;
  • Patient may exhibit anxiety in anticipation of next dose, but once pain is relieved, that anxiety goes away;
  • If pain is being managed, patient is able to function in her life activities and continue to socialize as before; and
  • Overall, a sense that the patient’s life is progressing in a positive direction, given the patient’s diagnosis and prognosis.

The Real Risk of Addiction

I can’t fault the growing numbers of chronic pain patients who express fear and repulsion at the thought of taking prescription pain medication. I was one of them, not that long ago. I completely bought into the hype that everyone got addicted, or could get addicted, to a long-term use of any prescription pain medication.

But that’s simply not true. The studies that have been done on addiction in chronic pain patients do not bear out the fear-mongering we see in our headlines every day. One study looked at over 24,000 chronic pain patients who were administered opioid medication. The number of addicts that resulted? Seven.

Not seven percent. Seven addicts. Out of 24,000.

Yes, I believe the crisis of prescription pain abuse has been somewhat overstated. And I believe that this unfortunate slant has resulted in a climate of fear that in turn results in fewer and fewer chronic pain patients being treated assertively for their pain.

Look, I am all for exploring conservative, non-prescription pain relief methods first. I am also completely in favor of looking at alternative treatments for chronic pain symptoms.

But when you’re in so much pain that you cannot function in your life, I believe you have the right to access any treatment that can restore that function, and that includes prescription pain medication.

It’s true that prescription pain medication, especially in chronic pain conditions that are poorly understood and for which there are currently no cures, will not address the root cause of the illness. Again, I’m all for getting to the root of the problem.

And I agree that most chronic pain conditions are rooted in a complex machinery that combines lifestyle, anatomical, biological, chemical, environmental, and, yes, emotional factors, and thus one pill isn’t going to solve the problem.

My point is that none of us is required to suffer needlessly with pain while we explore that machinery and get to the root of the problem, especially not on the basis of some exaggerated claims about addiction risk.

Bottom line: Know the facts, educate yourself, and make the best choice for you.


The Wall: Stress Will Make You Worthless

Image of a brick wall

Harsh words in that headline, and I mean every single one of them.

Here’s what happened: Last week, my housing plans fell through. I’d been staying with an acquaintance, which was always a temporary solution and the plan was that my daughter and I would be moving in with another friend and her family, to share expenses. Then friend’s house had a temper tantrum, losing both its air conditioning and the downstairs plumbing in the space of 48 hours.

So I had to scramble to find something else. I’d had a back-up plan but in the comedy of errors that is my life, that also imploded hilariously, leaving me with about one week in which to find a place to live.

So, with the aid of a friend and Craigslist, I set about scrambling for Plan C. Thankfully, I now have Plans C AND D, and that’s pretty awesome to have options — nothing firm yet, but we’ll know tomorrow, almost surely by Tuesday at the latest.

OK, crisis averted. But the thing that struck me like a ton of bricks late Friday night, after five full days of escalating efforts and exponentially skyrocketing stress levels, was summed up in this Facebook status update:

Screenshot of Facebook update about stress and energy levels

Something Alice Cooper can’t cure? That’s new …

In all seriousness, this feeling — as if someone tilted me over and let everything run right out into the ground — was totally new to me, despite ten-plus years of living with fibromyalgia and degenerative disk disease.

See, I’ve always been a very optimistic person. And the best thing about that kind of optimism, the kind that’s bred into your bones, is that it provides its own energy source. Even in the worst of times, the certain conviction that things will get better keeps me going.

But not this time. I hit the wall. I couldn’t move. I couldn’t think. I couldn’t even write, which has always been my best form of therapy.

I didn’t know what to do. So I went to bed. (And then promptly stayed awake for four more hours while the current housemates sang Venetian folk songs and argued about who was “right from the beginning.” Sigh.)

The next day, I felt much better. So we can assume fairly safely that if you hit this stress-induced wall, sleep helps.

What else makes it better? I honestly don’t know. I’ve never felt that way before so it’s a completely new experience. So I’m asking you all — have you ever experienced The Wall? What helped, if anything? What doesn’t work? Let’s share our collective wisdom!