Another blogging public service announcement: “Like-spamming”

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You know those people who come along and “like” something on your blog, but when you go to check out their blog you don’t find a blog, but a website trying to sell you up for some kind of marketing scheme?  I’ve come to think of this as “like-spamming”– the people who seem to go around and click like on everything, just to create as many opportunities as possible to draw more people in to their site.

I always wanted to give those people the benefit of the doubt.  I thought maybe at one point they had a blog like me, and found out they could make more money doing X, Y, Z.  Maybe they still had a real blog somewhere and just forgot to include the link to it.

And me being such a nice person, I like to check out the blog of everyone who comes to mine, just to give back some support (sorry if I’ve missed anyone!).

Well today I just did that, and decided to see what all of these marketing promotions were about.  For the first time ever, I actually clicked on a link on one of those pages.

Immediately a notification from Norton Anti-Virus pops up, warning me it had just protected my computer from a “well-known malicious attack.”  The offending URL, sure enough, matched the link I had clicked on.

Now let me just say that it takes a lot for Norton to actually call something both well-known and malicious.  I’ve almost never seen it put anything in the “Code Red” category.  Normally it just warns me that something might be suspicious.

Which means that the scammers who built this link were pretty brazen.  They didn’t work too hard to disguise their attack, probably because they know that bloggers are, on the whole, such an open and trusting bunch.

But that’s it for me: no more feeling guilty about ignoring some of the people who click “like” on my blog.  From now on, if I click on someone’s profile and I don’t actually see a blogblog, then forget it, I’m out of there.  I advise all of my readers to do the same!

Troll photo: Marchange

Seeking your opinion on my blog layout

frozen maple leaves

Hi everyone… you might have noticed that I’ve been changing the theme/layout of my blog a lot recently.  I mostly liked the way it looked with the Twenty-Ten theme, except I thought the black bar at the top where all the page titles were listed was extremely ugly.

So I finally purchased the Custom Upgrade and have been playing around.  If you have a moment, I was hoping you could take a look at my blog and tell me whether or not you think the changes I made today are a step in the right direction.  I will probably continue to keep experimenting, but I’m just wondering… does the new theme make my “Pages” stand out in a more appealing way?  I’m trying to emphasize them more because my blog really depends on pages to explain what the heck I’m talking about.

Feel free to be honest, and let me know if you think I should just stick with what I had.  I have 30 days to cancel the Custom Upgrade and get my money back.

Thank you!!! I apologize for the fact that my blog might look different every time you look at it for the next few weeks :)

My current background photo is from Andi Licious, published under a Creative Commons license.

30 is looming closer and closer: How should I move forward with my career?

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The work I’ve done on this blog and the positive responses I’ve received (thank you all so much!) have opened up new ideas for me.  In the month and a half since I started working on this blog, I already feel as though I’ve been able to make somewhat of a difference in others’ lives.  I know I don’t have a ton of readers (yet), but it seems as though people who’ve faced similar issues to me have really appreciated the information I’ve collected here.  I’m incredibly gratified, and inspired to do more.  But how?

I’m definitely going to keep working on this blog, and possibly purchase my own domain name and create my own website on pain science in the future.  Right now that actually seems like the best way to get information out to people.

But as age thirty looms closer and closer, it would be nice to advance along my career path as well.  I would like to make a career out of helping people who have faced similar issues to mine, but I’m not sure of the best way to go about it.

I have a Bachelor’s degree, and for years and years I’ve been considering different options for graduate school.  I’ve been holding off because I can’t quite figure out what would be the best use of my time and money.  Here are the possible career roles I have considered going back to school for:

Social Work & Psychology

Throughout most of the time I was in college, I wanted to be a social worker/mental health counselor.  But as I got more experience with the field, I realized it wasn’t the career path for me.

I have always found psychology fascinating, and have the utmost respect for the vast majority of psychologists.  But in my opinion, the field of psychology is moving in the wrong direction on the subject of pain.

Though most psychologists and social workers today would be pretty quick to dismiss the ideas of Sigmund Freud as wacky and outdated, the one area of mental health where he still seems to hold an influence is in the treatment of pain.  It was Freud who first came up with the diagnosis of conversion disorder (where a patient’s “unconscious psychological conflicts” manifested themselves as unexplained pain or numbness in the body).  If you read this article by Toni Bernhard, you’ll see that as we enter 2013, today’s psychologists haven’t strayed very far from these ideas.

Diagnoses such as “somatoform disorder” and “psychogenic pain” imply that the patient is in pain because something is wrong with his or her mind.  Not only is this mindset disempowering, but it doesn’t take into account any of the things that neuroscientists have learned about pain in the past two decades.

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Freud. Image provided courtesy of http://www.all-about-psychology.com/

In my opinion, there’s no good excuse for this, really.  It seems like people who are already established in the fields of psychology and social work haven’t done a great job of opening themselves up to research in fields other than their own.  Critiquing work done by someone trained in another field just seems to be something that “isn’t done.”  Graduate students in these fields learn about the discoveries of the psychologists and social workers who came before them; and, for the sake of their own career success, learn to follow the rules and blend in.  Future therapists must protect themselves from liability by knowing here their limits are, and they are definitely not trained to dispense medical advice.  So it appears that these inaccurate, harmful conceptions of pain and illness are passed from one generation of mental health counselors to another.

Becoming a doctor

Having ruled out a career in mental health, I sometimes think about becoming a doctor.  I have met some pain specialists and physiatrists who I believe are really brilliant, intelligent people.  But with that being said, it seems their primary role is to order tests, rule out more serious conditions, and then refer the patient elsewhere for treatment.  Whether that’s physical therapy, occupational therapy, or mental health counseling, it’s always go see someone else, and I am interested in being the person who works one on one with the patient and helps him or her over time.

Additionally, the majority of the doctors I’ve seen over the years have all seemed to be short on time.  Rush, rush, rush: the next patient is always waiting.  Many times during my appointments, I haven’t had the chance to ask any of the questions I came there with until the doctor is halfway towards the door telling me it was nice to meet me.

I have heard of doctors setting up private practices.  That seems like a way to have control over the number of patients one sees.  However, I believe that is mostly something that primary care physicians do… I’m not sure how often doctors in physical medicine and rehabilitation or pain management do the same.

Nursing

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Thank you to timefornurses on Flickr for the use of this photo.

Nursing is something that seems to hold a little bit more promise.  I once had a conversation with a fascinating doctor of nursing (yes, as much of an oxymoron as that sounds, you can actually earn a Ph.D. in nursing).  We had a great conversation about everything I’m interested in regarding pain and the nervous system.  She told me that once you get to the master’s and doctorate level of nursing, much of what you do is research.  She also told me about translational medicine, which is literally a branch of medicine/nursing that attempts to bridge the gap between what researchers are discovering, and the treatments actually given to patients.  This sounds absolutely fascinating to me, and I must know more.

That being said, I believe that the majority of nurses, including nurse practitioners (those with a master’s degree) spend most of their time doing what doctors do: running tests, ruling out serious conditions, and referring the patient elsewhere for physical therapy, etc.  I’ve never heard of a nurse that meets with patients regularly just to talk; at least not about the issues that I’m concerned with. Even at the Ph.D. level, I know there is often a huge divide in the academic world between those who research and those who treat; I’m not sure how much time a translational medicine researcher would be able to spend treating patients.

Physical therapy

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This is the career path I am probably focused on the most.  I have met some truly amazing physical therapists over the years, and in many cases they have helped me more than the doctors that sent me to them.  I would leave their offices basically wanting to be them, because I was so blown away by their knowledge and ability to understand both the body and my fears as a patient.

Good physical therapists are able to add a bit of counseling into the mix rather than just instruct you in exercises.  In general, I feel that when a physical therapist doesn’t appear to take the time to really try to relate to a patient, it is a reflection on his or her general inability to empathize rather than the field of physical therapy in general.

Much of the research I discuss on this blog was done by physiotherapists in Canada, the UK, and Australia (this is the equivalent of a physical therapist in the US where I live).  This bodes well for me: physical therapists have provided the most answers for me personally as well as academically.

The only limitation of a career in physical therapy would be that I wouldn’t have the ability to order any diagnostic tests such as x-rays or MRIs, to order blood-work to check for inflammatory conditions or Lyme disease, or to prescribe medication.  These are all things that must be done before any kind of diagnosis can be made, and before you can make any kind of pronouncement about a patient’s degree of central sensitization.   Since the field of medicine in general really has yet to catch up on issues of pain, I am afraid I would become frustrated as a physical therapist trying to treat patients who came in having been brushed aside by their doctors.  I am a very take-charge person, and I’m afraid I would regret going down a career path where I couldn’t just order tests and prescribe medication myself.

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So there you have it.  These are pretty much the major options I am considering returning to school for, and I am very interested in any input my blogging friends can give.

Have you ever been in a similar situation?  What did you end up deciding to do, and how did you make your decision?

Don’t worry! You can still get help, even if you can’t find a doctor who treats fibromyalgia.

For years I thought I needed to find a doctor to diagnose me with and treat me for fibromyalgia.  I sought out various pain specialists; physiatrists and anesthesiologists, the heads of departments.  Some of them even listed fibromyalgia among their clinical interests, which I thought was sure to be a good sign.

Yet every time I actually got into the exam room and asked one of those doctors if I had fibromyalgia, the response was vague.  “I don’t know, I don’t generally diagnose people with fibromyalgia,” was the general answer I got.

After so many doctors in pain management failed to help me, I tried seeing a rheumatologist.  I had done a lot of reading about fibromyalgia online and learned that they often treated patients with this condition.  Of course, I ended up getting the one rheumatologist who tells his patients “there’s no such thing as fibromyalgia.”

After all this time, I have never actually seen a doctor who treats patients for fibromyalgia.

I don’t know how this is possible.  I live in Boston– we have some of the best hospitals in the world.  But this has been my experience.

However, between an amazing physical therapist, some caring medical specialists (see my suggestions for doctors below), and a lot of persistence and research on my part, I have still learned how to manage my symptoms and live a more functional life.

So, I’m writing this post for people who might be stuck in the same position I was once in.  If you can’t find a doctor to diagnose you with fibromyalgia, that’s okay.  You can still get all of the same treatments without an official diagnosis.  You’ll just have to do a lot of your own research and advocate for yourself.

Understanding Fibromyalgia

To understand fibromyalgia, you need to know that research is increasingly pointing to central sensitization as its cause.  Central sensitization refers to the changes that happen to a person’s nervous system to increase his or her sensitivity to pain and other stimuli.  These changes are part of a very complex process that science doesn’t yet fully understand, and no one knows why it happens to one person versus another.

Generally, this process is thought to occur after the body goes through some kind of traumatic physical event, such as injury or surgery.  It’s also more common among people who have an inflammatory condition such as lupus or arthritis, because their daily experiences of pain have an effect on the nervous system.

While not every doctor believes that fibromyalgia is a real condition, the phenomenon of central sensitization is much less controversial.  I’ve had many productive conversations with pain management specialists about the fact that I probably have a heightened sensitivity to pain; this is something that can be addressed without anyone using the word fibromyalgia.

I’m not saying it should be this way– of course it shouldn’t.  And I’m happy to say that I do believe awareness of fibromyalgia and other chronic pain conditions is growing.

In the meantime, I offer you these suggestions for moving forward:

Try consulting a physiatrist about musculoskeletal pain.

Physiatrists are a relatively new type of medical specialist (and no, I’m not saying psychiatrist!).

Physiatrists work in the specialty Physical Medicine and Rehabilitation.  Basically, they specialize in all of the ways to treat musculoskeletal pain, and they are trained to look at the whole person, rather than focusing in on one body part.  So a physiatrist may ask you about your daily life, and how your sleep is.  They may offer you medications such as Lyrica or Cymbalta (see below).  They may also offer different types of injections, such as trigger point injections, to help with muscle tightness.  In general, they can help you think of solutions you may not have thought of.

Anti-depressant medications can treat chronic pain.

There are antidepressants you can take that have been shown to relieve chronic pain in some people.  (When I say chronic pain, I mean pain due to central sensitization, the same thing as fibromyalgia pain).  There are two antidepressants, Lyrica and Cymbalta, that are specially marketed for pain sufferers.  You can get these from a psychiatrist that specializes in pain management or from a physiatrist (Physical Medicine and Rehabilitation specialist).

You can also see if traditional anti-depressants help you: many of them have been shown in studies to relieve symptoms of chronic pain, and you don’t need as high a dose as you would to treat depression.  You can get these from a psychiatrist or even from a primary-care physician.

You don’t need a fibromyalgia diagnosis to try these medications.  You just explain that you’ve been in pain in a long time and you’ve heard that these medications can help.

Make sure you are getting good, quality sleep.

One of the potential explanations for fibromyalgia patients’ heightened sensitivity to pain is that they might be experiencing disturbed sleep, which in turn wreaks havoc on their nervous systems.  (Indeed, other studies have shown that when you take healthy, pain-free people and severely deprive them of sleep for a few days, they start to feel pain similar to that of fibromyalgia sufferers).

You don’t need a diagnosis of fibromyalgia to see your primary care physician or a sleep specialist.  Perhaps they will order a sleep study to see if you have sleep apnea, or else suggest some sleep medications you can try.

Physical Therapy

The key is to find a good physical therapist– in my opinion, about 50% of the physical therapists out there are no help at all for issues of chronic pain where the nervous system has gotten stuck in a feedback loop.  They’ll just look at you like you’re either lazy or crazy, and nothing will be accomplished.

What finally allowed me to turn the corner was that I found an amazing physical therapist.  He had attended a training by Neil Pearson, and was able to explain to me why my nervous system was freaking out.  This physical therapist helped me to see that just because I felt pain in one part of my body didn’t mean that there was something necessarily wrong with that part of my body.  This helped to bring my level of panic way down and weakened the cycle of pain I was caught in.

The funny thing is that not once did my physical therapist use the word fibromyalgia.  Neither did Neil Pearson in the online lectures I keep obsessing about all over this blog.  Instead, they used the terms “chronic pain” and “persistent pain.”  And both of those men helped me more than anyone else.

If at all possible, try to see a physical therapist that has attended a training by Neil Pearson, Lorimer Moseley, or any of the other amazing pain scientists I talk about on this blog.  There aren’t many out there, but if you can ask around and read different physical therapists’ websites to see what they specialize in, it is worth it if you can find someone.

If you can’t find someone who has attended such a training, you can still benefit from working with a physical therapist who is really sympathetic and makes you feel comfortable exercising.  Someone who motivates you without pressuring you into doing things you’re not comfortable with.

As you’ll see when you watch Neil Pearson’s amazing online lectures, pain is your body’s alarm system: when you do something your body isn’t comfortable with, you make the alarm system scream louder.  You have to respect your body’s limits and exercise as much as you can within those limits.  You might find that having a trusted physical therapist on your side will allow you to feel comfortable trying new movements that you wouldn’t be okay with trying on your own.

Digestive Symptoms

If you have digestive problems along with your fibromyalgia, you need to find a skilled gastroenterologist to help you figure things out.  I had to go through five gastroenterologists before I found a doctor who said something other than “you’re obviously under a lot of stress.  Try to relax.”

There are all sorts of things that you should be tested for if you have GI troubles, and a thorough doctor will be happy to order them for you.  But if your tests all come back normal, you probably have irritable bowel syndrome, which is caused by nervous system changes similar to those that cause fibromyalgia.

Just as it’s possible for the rest of your body to have a heightened response to pain, it is possible for your digestive system to have a heightened response the things you eat.  A good gastroenterologist and/or nutritionist can help you experiment with eliminating certain types of foods from your diet to see if your symptoms improve.   Stress, of course, can be a factor, but it’s certainly not the only factor.

Conclusion

That just about covers the basics.  I hope I’ve reassured you that you can get better, even if you can’t find a doctor who treats fibromyalgia at the present moment.

I’ll be writing more about the causes and treatments of fibromyalgia in the future.  In the meantime, if you have any questions, you can leave a comment below or email me at sunlightinwinter12@gmail.com.

Thanks!

Thoughts on Chiropractic Care

I couldn’t believe this myself when I first added them all up, but I have actually seen a total of seven chiropractors over the past eight years.  I have one chiropractor now who I absolutely love, but because it took me a while to find him and even after I’d found him, I went to college in a different area, I’ve ended up having the opportunity to sample many different approaches to chiropractic care.

I’m sure that these days, pretty much everyone has heard of chiropractors and has some idea of what they do.  For those who aren’t sure, chiropractors perform what are called “adjustments” on bones and joints.  Using either their hands or a tool called an activator, they push or tap on different parts of your body, mainly focusing on the bones of the spine, to make sure your bones are lined up in the optimal position.  I have never really found the adjustments to be painful, although at times I have been sore for a day or so afterwards (never so sore that I regretted the adjustment, however).

Based on my experiences with these seven chiropractors, I have come up with the following suggestions for anyone who is interested in trying chiropractic:

1) If you don’t feel better after the first, or at least the second visit, look elsewhere.

The first chiropractor I ever saw promised me that I’d start feeling better after about four to six weeks, and I never did.  In retrospect, I was totally taken in by his initial presentation, detailed explanations, and optimism.  I signed up for an extended treatment package, which gave me a “discount” off of the price of each adjustment.  I showed up twice a week, got an adjustment from him, and followed his instructions to put ice on the areas he’d adjusted when I got home.  I never actually felt a difference in my level of pain.

After about a month, I was tired of being patient, so I went to see a new chiropractor, who my father said had really helped him.  I felt better the instant I got up from the exam table.  “You mean I can actually expect to feel better right away?” I asked.  He nodded at me, incredulous that any chiropractor would have told me differently.  This is the chiropractor I still see today.

Of course, this doesn’t mean that you will only need one or two visits for your pain to be “cured.”  A general rule of thumb is that the longer your problem has been going on, the more time and chiropractic visits it will take to get better.  I consider the pain relief I experience from each individual visit to be more of a short-term fix than anything else.  However, assuming your chiropractor knows what he or she is doing, your visits will have a cumulative effect, and long-term relief will come over time.

2) It is normal to be a little bit sore after an adjustment. 

This is simply because your body will be aligned a little bit differently.  Even though your bones and joints are lined up in what is anatomically-speaking a healthier position, your muscles, tendons, and ligaments are not necessarily used to being in that position.  It will take some time to get used to it.

I know I mentioned how I felt immediate relief the first time I saw my current chiropractor, and I did.  I felt a mild rush of euphoria the second he popped something around my right shoulder blade that had been bothering me for months.  But I was also incredibly sore that night.

You should be able to tell whether or not the adjustment helped you by whether or not the pain has shifted.  If he pain feels exactly the same as it was before the adjustment, your chiropractor probably didn’t really make a big difference.  But if you feel soreness in a new area of your body and notice you are no longer focused on the area that you asked the chiropractor for help with, this is probably a sign that what he or she did was effective.  The key is to be able to see a difference in in the type and location of the pain you are feeling.  Post-adjustment soreness will gradually fade away over the course of the next day or so.

I have found that my level of soreness following an adjustment corresponds with how much pain I was in prior to an adjustment.  If I was in a lot of pain and things felt totally out of place before the adjustment, I will definitely be sore for about 24 hours afterwards.  If I’m having a week where everything feels okay but I go to the chiropractor as a form of maintenance, I probably won’t be very sore afterwards and I’ll go about the rest of my day as normal.

3) Don’t allow a chiropractor you are unfamiliar with to adjust your neck. 

Many people, including some medical professionals, believe that chiropractic adjustments to the neck pose a risk of stroke.  My best understanding of the reason this could happen is that during the extreme neck movements that occur during an adjustment, the edges of your cervical vertebrae (the bones in your neck) can come into contact with the major arteries that run up either side of your neck and damage them.  This can restrict blood flow to your brain if a clot is formed.

I personally choose to let my chiropractor adjust my neck because I really trust him.  He has been in business for decades, and I honestly think he would tell me if he believed there was any risk from what he was doing. With that being said, I only let him adjust my neck with the activator.  My neck remains in a neutral position than the activator, which seems a lot more safe to me than having him pick my head up in his hands and contort my neck to pop things into the right place.

Whether or not you will allow a chiropractor to make adjustments to your neck is a decision that only you can make.  I suggest you inform yourself as much as possible.  Here are a few starting points:

http://www.guardian.co.uk/science/blog/2012/apr/27/chiropractic-manipulation-spine-strokes

https://www.facebook.com/pages/Chiropractic-Stroke-Awareness/126567887356198

4) Don’t believe chiropractors who make exaggerated claims about what chiropractic treatment can and can’t treat.

The first chiropractor I saw (the one who didn’t end up helping me) sent me home with a small paperback book about all the things chiropractic could fix.  It basically claimed that regular chiropractic adjustments could reverse the course of about every health problem short of cancer and AIDS.  As far as I can tell, there is really no evidence that this is possible.  I would stick to viewing chiropractic primarily as something you do for musculoskeletal pain.  My current chiropractor has made adjustments on all different parts of my body, not just my back.  Over the years, he has performed adjustments on my knees, ankles, elbows, and even hands, but the purpose has always been the same: to treat muscular pain and improve my body mechanics.  I strongly believe you will be wasting your time seeing a chiropractor who claims he or she will cure your ear chronic ear infections.

For an example of the type of chiropractor not to see, check out this article about a chiropractor who was found guilty of causing the death of a patient with epilepsy.  This chiropractor convinced the patient to stop taking the medication she used to control seizures, insisting that chiropractic treatment alone could “cure” her. The patient died after she ceased her medications.

My current chiropractor has never made such wild promises about what I could hope to experience after his treatments, and he has never once suggested that I should follow his advice over that of regular doctors.

5) Check to see if your insurance company will pay for chiropractic care. 

The different health insurance plans I have had have paid for between ten and twelve visits a year.  For someone with severe issues, this isn’t very much (I definitely went through that many visits alone in the two months after I first hurt my back).  But it’s still worth looking into, especially if you can’t afford to pay out of pocket.

A side note to this is that there are some physical therapists who have been trained to perform manipulations similar to those performed by chiropractors.  The physical therapist who did this for me performed motions that were similar to what my chiropractor did, but they were more gentle and seemed to be done with much less force.  My pain relief afterwards wasn’t quite as dramatic, but it was still pain relief, and it was covered by insurance.  Unfortunately I don’t really have any great trips for how to find a physical therapist who has been trained in this, but you could try asking around for someone who knows how to do “joint mobilizations.”