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PHYSICAL THERAPY
MEDICINE exercise massage
relief
ACUPUNCTURE
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ORTHOPEDICS
& reflexology ILLUSTRATION: SILVIA CABIB
PAIN
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Coping with
DAILY PAIN By TORIE TEMPLE
FIBROMYALGIA SYMPTOMS After 10 years of multiple doctor appointments for an assortment of unexplained pain, Linda Boley asked her doctor the question that started her journey to a diagnosis: “Could my symptoms be related?” The tests that followed ruled out leukemia and many autoimmune diseases; however, it was a pressure point test given by a rheumatologist that confirmed a diagnosis of fibromyalgia compounded with osteoarthritis. “Fibromyalgia is an autoimmune disease,” Boley explains. “The nerve endings throughout the connective tissue of my body are overly sensitive — my body is working against itself.” Boley describes the pain as a shooting, stabbing sensation when touched that can cause even a hug to be uncomfortable. The pain from the fibromyalgia is complicated by the osteoarthritis, which was brought about from the gradual wearingdown of cartilage in her feet, knees, and hips. “I have experimented with massage therapy throughout the years to relieve the pain, since my pain seems to set me back two or three days where I can barely move,” Boley says. Although she has tried pain medications in the past, they only gave temporary relief, became less effective over time, or put Boley’s head in a fog. But despite not finding complete pain relief, Boley’s passion for teaching gets her up and moving no matter what kind of soreness the morning brings. After learning the Arthritis Foundation needed volunteers to teach their Breaking the Pain Chain classes, Boley immediately jumped on board. “This is a course that meets for two hours once a week for four weeks,” Boley says. In the course, she covers the anatomy of the joints, medication, and diet as well as alternative and complimentary therapies. She rounds out the course with managing health care and finding the right doctor. “I feel like I can teach through experience and help others with pain,” she says. “It helps to have a support system that can relate to what you are going through.”
Surrounding yourself with those who can empathize is an important part of coping with chronic pain and something Jacque Haysley can agree with. While volunteering to help clean up after Hurricane Katrina, Haysley contracted a staph infection that exaggerated symptoms she was already experiencing, which eventually led to an official diagnosis of fibromyalgia in 2006. “Anyone can try to sympathize, but until you talk with someone who has what you have, it’s hard to make that connection,” Haysley says. Massage therapy and physical therapy have helped Haysley strengthen the muscles in her neck and lower back, where her pain is centralized. Though these therapies have a history of causing migraines after a session, Haysley believes it is a better alternative to narcotics. Like Boley, Haysley has yet to find anything that takes away the pain completely; however, she takes comfort in listening to those who also have fibromyalgia. “I had an ‘Aha’ moment when I went to listen to Dr. Jacob Teitelbaum speak in Oklahoma,” she says. “He, too, was diagnosed with fibromyalgia and wrote a book called From Fatigue to Fantastic. Listening to someone who had been through what I was going through made me feel better knowing someone understood.” Although Haysley and Boley have never met, their advice for pain management is the same: Find the right doctor and a support group. “Find a doctor who is able to treat you correctly,” Boley suggests. “If you don’t feel like you are being heard, switch doctors. There is no rule that says you can’t seek other consultation.” Haysley agrees, saying, “It’s important to find a doctor that understands and treats your condition. Also, join a support group because the key is being with people who understand.”
“It’s important to find a doctor that understands and treats your condition. Also, join a support group because the key is being with people who understand.”
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Coping with
DAILY PAIN
MIGRAINE PAIN Waking up with a migraine was part of a regular morning routine for Dianne Hess. Diagnosed in the early ‘80s, doctors were never able to pinpoint the cause of her migraines. “Most who suffer from migraines have some sort of warning sign like an aura, but that wasn’t the case with me, making it harder for the doctors to pinpoint the cause,” Hess says. Migraines for Hess meant 18 hours in a dark room with a hot or cold pack on her head. She tried cutting down on triggers such as chocolate, caffeine, and red wine, but nothing seemed to help. After years of searching, Hess started the Imitrex injections that have been working for her for the past 15 years. “I inject the medicine into my thigh when I wake up with a migraine. I still have to stay in a dark room, but with the injection, the migraine lasts for three to four hours instead of 18.” With the right medication, Hess is down to two migraines a year. She believes being vigilant with your doctor is imperative to finding a remedy that brings the most relief. Hess tells other migraine sufferers to do the research, find out what the options are, and tell the doctor what you need.
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“Most who suffer from migraines have some sort of warning sign, like an aura, but that wasn’t the case with me…”
Coping with
DAILY PAIN FIBROMYALGIA
photo credit : jacob mcroberts
Jacque Haysley
HOW DO YOU FIND RELIEF? So many people have to carry on their lives with daily pain. Sometimes there is not one main answer that fixes the problem, but small changes can make a big difference.
MIGRAINE PAIN Tony Rose
Tony Rose has been suffering from migraine headaches for about 10 years. Although he has not found a magical cure, Tony has learned some things along the way to help him cope. “Four years ago my headaches became daily. About once a week I would have a headache that reached migraine level. Sometimes the migraine would last for three days. In the beginning, I dealt with the pain with over-the-counter medications. Before too long taking those medications had little to no impact on my pain.” Taking acetaminophen and ibuprofen with a cup of coffee relieved his migraines occasionally, but its effectiveness weakened over time. “The strain of daily headaches with a weekly migraine began to take a toll on my energy, attitude, and my productivity at work. Since I am a pastor, the attitudinal effect was most devastating for me.” Tony says exploring his options with Dr. Brian Plato of the Norton Neuroscience Institute, has been extremely helpful. “We have not found the exact remedy yet, but we have found a few things that are helping.” He adds, “One thing to note is that because of my recent spinal fusion surgery, I cannot take any NSAID’s (ibuprofen, aspirin, etc.) because these drugs interfere with the bone fusion. So far we have found that Sumatriptan tablets are somewhat effective if I catch the migraine at its start.” For Tony, he has found that staying active is one of the best remedies. “It keeps my mind off the pain. There are times that the pain overwhelms me, and I have to get in a dark room and go to sleep. Whenever one gets still the pain increases because one can only then (focus on) the pain.” He also uses hot and cold packs in addition to Botox injections, which Dr. Plato suggested he try. Tony has had one Botox treatment which gave him three weeks of relief and plans on getting a second round of treatment. — By Alissa Hicks 6
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Jacque Haysley, who suffers from fibromyalgia, uses massage therapy along with physical therapy to strengthen the muscles in her neck and lower back where Haysley’s pain is centralized. Though these therapies have a history of causing migraines after a session, Haysely believes it is a better alternative to narcotics. Haysley has yet to find anything that takes away the pain completely; however, she takes comfort in listening to those who also have fibromyalgia. “It’s important to find a doctor that understands and treats your condition. Also, join a support group because the key is being with people who understand.”
Have You Tried
THESE TREATMENTS?
By TORIE TEMPLE
Traditionally, a physical therapy session incorporates mechanics such as ultrasound, electrical stimulation, or mechanical traction. But as physical therapy continues to evolve, new techniques and technologies have been integrated into individual sessions, helping to make recovery time faster. DRY NEEDLING
“A newer technique is dry needling,” says Dr. John Holland, a physical therapist at Frazier Rehab. “Dry needling is where a microfilament needle is inserted just below the surface of the skin into the dysfunctional muscle with the idea of getting more playability and function.” Despite the sound of its name, which is termed due to injecting a needle without inserting a solution, dry needling is claimed to be a painless technique that can have positive results in just one session. This technique can also be known as trigger point dry needling because of the needle being inserted straight into the trigger point for reduction of pain. Staci Cummins, a physical therapist at Parkway Rehab and Nursing Center and a dry needling patient, says, “I have had it done on my left knee and it was remarkable with one treatment. Once they hit my trigger point on my knee, the pain was instantly gone. The needle does not hurt, and the only thing you may feel is a mild pinch.” According to Dr. Holland, dry needling can be used for anyone with muscular pain or soft tissue involvement. “Physical therapists have to go through specialized training to do dry needling,” he says. This is why not all facilities in Louisville offer it. Patients interested in this type of treatment should consult their current facility to see if it is offered.
KINESIO TAPE
Joey Baribeau, a physical therapist at Ellis & Badenhausen Orthopedics, adds Kinesio taping to the list of new techniques growing in popularity. “It was first made popular by Olympic volleyball player Kerri Walsh Jennings,” Baribeau explains. “She used the tape on her shoulder, which got a lot of attention.” The gold medalist used the tape to compete in the 2012 Olympics after rotator cuff surgery. The tape is a latex-free, cotton material with a heat-activated acrylic adhesive. “It is used to promote healing, soft tissue release, and for postural positioning,” Baribeau says. It also helps weak muscles move properly and can help with swelling. Kinesio taping is most popular with athletes who typically use it on shoulders, knees, and Achilles tendons. Although there are other brands of tape, Kinesio is the dominant brand used by therapists. “Patients can buy it online, but go to a therapist who knows specialized techniques for taping,” Baribeau recommends.
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WATER THERAPY
The Home of the Innocents Therapy Pool started as a pool strictly for the children at The Home of the Innocents, but the results were so remarkable they decided to open it to the public with the name Kay and Jim Morrissey Advanced Therapy Center. One of the physical therapists for the therapy pool, Mickey Baron, attests to aqua therapy, saying, “The buoyancy of the water helps support your body so you can do movements in the water that may be difficult on land. The hydrostatic pressure of the water also helps with circulation and the cardiovascular system overall.” Anyone, despite physical limitations, can benefit from aqua therapy. “There is a stretcher lift that goes into the water made for those who are unable to sit up going into the water,” Baron says. “There are also ramps with special wheelchairs that can go into the water along with chairs to allow sitting while exercising. “Our pool is heated to 92 degrees, which benefits the muscles, and it is also 4 feet all around making it a perfect depth for adults,” Baron explains. The therapy pool has classes for those who have Parkinson’s and arthritis, or patients can create a program on their own. Baron suggests attending one or two sessions she conducts on what to do in the water and learn how to get started on your own.
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THE WORST AILMENT Self-will does not lead to happiness
M
y Dad was a remarkable man. He liked to get up before dawn, go to daily Mass, and never missed a day of work. Self-reliant, afraid of nothing, he stood steady as a pillar when a crisis arose, dealing with a death or illness in the family or repairing anything that needed repair. In worship or in work, he set an example for everyone. Dad knew how to play too. He could throw off his years and join the children at their games. He could relax watching a baseball game or enjoy a good comedy on TV. Dad possessed a great secret: he knew how to put others first. If he bothered to think about his own needs, it was only after everyone else had been taken care of. One day I came home after school with something deeply disturbing on my mind. I had seen, for the first time, a child with a terminal cancer condition. This little boy was consumed with cancer and was unable to come to school. I told Dad about him. “Dad, it must be awful for that boy to be so seriously sick and not even able to play.” His face became very compassionate. He said,
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“Yes, everything in life will be hard for him.” Then he added, “So few suffer from such a terrible condition at his age. There is a much more dreadful disease that can afflict every one of us if we don’t guard ourselves against it all the time.” “What’s that, Dad?” “Cancer of the ego,” he said. The more I have pondered that remark down the years, the more perceptive it seems. Our malignant concern for ourselves, he was saying, constitutes the worst threat in life. And the teachings of every religion bear him out. Repeatedly we are told that ego or self-will, our drive to be separate from the wholeness of creation, is the source of all our suffering. It keeps us from accepting others, from sympathy and
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quick understanding. Puffed up by our selfwill, we look out at the world through the distorting medium of our likes and dislikes, hopes and fears, opinions and judgments. We want everyone to behave as we think they should — the right way. When, naturally enough, they not only behave their own way but expect us to do as they do, we get agitated. And what we see through this agitation makes up our everyday reality. The word ego, as you may know, comes from the Latin word for “I.” Independent of any situation, something deep within us, as persistent as our heartbeat, constantly renews our sense of separateness. Whether we are awake or asleep our ego goes on, though we are
more conscious of it at some times more than at others. Since it is always there, we think of it as our identity, and we protect it as a miser does his gold. Not only that, we expect others to treasure it too. Ironically, this drive for selfaggrandizement has never led to happiness and never will. We cannot always have what we want; it is childish to think so. No one has the power to regulate this changing world so that he or she can continuously sing, “Everything’s going my way.” If we could do so, it would only stunt our growth. I have heard that even simple organisms placed in an ideal environment — controlled temperature, plenty of food, no stress of any kind — soon perish. Luckily, no one is likely to put us in such a situation. Self-will inevitably leads to increasing frustration and pain. What a strange situation! We desire, naturally enough, to be happy. But if we put our personal happiness at the top of the list, we only succeed in making ourselves miserable. Dad was right — cancer of the ego. His message rings true every time my ego takes over.
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By Torie Temple
Have a Seat Don’t count out yoga after orthopedic surgery. Emily Karl is a registered yoga instructor at Wellness 360 Studio, where a chair yoga class is offered for those who need light movements. Mostly everything is done from a seated position for those who can’t get on and off the floor. “Yoga is potentially a powerful vehicle for transformation,” says Karl.
Repurposed Blood
PRP or Platelet Rich Plasma is a new innovative technique used for arthritis sufferers. According to Dr. Kris Ablen, orthopedic surgeon and sports medicine physician for Floyd Memorial Hospital, PRP is an injection of the patient’s own processed blood into the joints. This process is most commonly used on knees and is showing great results.
What makes aqua therapy so effective? You lose 90 percent of your body weight, and it causes 12 times more resistance while in the water than on land, says Carlisle. This creates easier movements and stronger muscles.
“If patients want to start aqua therapy, start with an arthritis class. It is good for anyone after orthopedic surgery. After having my hip replaced seven years ago, I was back in the water, which helped me recover quickly.”
Aqua Advice
Are You At Risk for Brittle Bones? While anyone can develop the disease osteoporosis, you need to be especially vigilant if you have one or more of these risk factors: 4 You have a family history of osteoporosis 4 You’re Caucasian or Asian 4 You weigh less than 127 pounds 4 You had irregular periods or your period stopped in your teens or 20s for three consecutive months or more (not caused by pregnancy or nursing) 4 You have ever taken a steroid medication for a condition such as asthma or lupus 4 You have ever broken a bone as an adult, after low trauma, such as tripping on the curb — Sandra Gordon
Feed Those BONES 12
Buy a supplement with vitamin D3; bones need vitamin D to absorb calcium, and D3 is the most potent and effective form. Supplements may contain three forms of calcium (calcium carbonate, calcium citrate or calcium
ORTHOPEDICS AND PAIN SUPPLEMENT
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DID YOU KNOW?
One in two women over age 50 will suffer a fracture caused by osteoporosis.
Dody Carlisle
Aqua Fitness Instructor Mary T. Meagher Aquatic Center
phosphate). Ask your doctor which one is best for you, and consider the following: • Will you take it regularly? Many calcium supplements resemble horse pills —so if you have trouble swallowing a pill, this may not be the form for
you. You may be better off with a supplement that’s chewable, such as a flavored tablet, soft gel, or chewable candy. • How much does it cost? If cost matters, you may prefer calcium carbonate, the least expensive form of calcium.
? U KNOW DID YOic s comes from,
o ed Or thop ek words, or th d re n a G t, o h tw g s traig meanin eaning child. m , is pa opedic l lly, or th Origina treated skeleta n, ns surgeo ities in childre n te h rm ig fo a e d s tr races to using b child’s bones. the
Active Rehab Staci Cummins, physical therapist for Parkway Rehab and Nursing Center suggests, “After any orthopedic surgery, do all the exercises your doctor gives. Stay active — the more active you are, the more you are going to rehabilitate.” • Does it have side effects? Calcium carbonate causes gas, nausea and stomach pain in some women. If that’s the case, try other forms of calcium. Once you decide on a supplement, take it with meals to improve absorption by 10
to 15 percent. Also, spread your dosage equally over the course of the day. For example, if you down a 500mg supplement every day, take 250 mg at breakfast and another 250 mg at dinner. — Sandra Gordon
By Torie Temple
Newer Procedures
Professionals can now block the pain caused by severe arthritis, especially in the knee, with a procedure called Geniculate Nerve Block. This destroys the genicular nerve that sends pain sensations from the knee to the brain, says Dr. Darryl Kaelin, Chief of Physical Medicine and Rehab for U of L Physicians/Medical Director Frazier Rehab. Although this isn’t a cure for arthritis, it does make pain more manageable. DID YOU ? KNOW tion l stimula
ys lectrica “More e sed in rehab,” sa te la u u g m ti in is be you s . “When acts, it won’t n li e a K Dr. ntr and it co create a muscle nger unless you or e o c tr n s ta t e is g rt of res o, some so h as weights. S c u s s ce plu activity resistan with the mulation it will l sti electrica ote muscle prom growth.”
Custom Replacements
Orthopedic surgeon and Sports Medicine Physician for Floyd Memorial Hospital, Dr. Kris Ablen says patient-specific replacements are now possible by using imaging such as CAT scans and an MRI to make a custom implant for the patient.
What To Look for at Rehab
Rehab facilities are starting to cater to shorter-stay clients due to minimal invasive surgeries that cut rehab time in half, according to Teal Busteed, therapy program manager for Regis Woods - Genesis Rehab Services. Make sure the facility you choose offers privacy, alternative services, and access to healthy meal options.
Don’t Forget the PRE 14
ORTHOPEDICS AND PAIN SUPPLEMENT
Prehabilitation is just as important as post habilitation, says Dr. Darryl Kaelin, chief of Physical Medicine and Rehabilitation for University of Louisville Physicians as well as medical director of Frazier Rehab Institute, “Prehabilitation prepares the joint for surgery by adding strength and increasing activity level so that post-operative rehab is easier,” he explains.
2014