Your Chronic Pain: an owner’s manual

When it comes to acute trauma, the damage is obvious. The broken leg is at a bad angle, the blood is pouring out of somewhere, or multi-coloured bruises radiate from where the damage was done. Hospitals are equipped to handle it. Doctors are trained to manage it. People comprehend it. There are cures and solutions for acute pain with a clear end point.

 

Chronic pain, on the other hand, isn’t well understood. Doctors can’t fix it. Surgeries often make it worse. Society either doesn’t understand it or puts their own baggage on top of it as though it were a trolley. Chronic pain doesn’t have a cure, the solutions are often worse than the problem itself and the best possible outcome involves accepting your new normal, not trying to change it.

 

It’s been more than ten years since I reached for my toothbrush one morning and realized that my left index finger was numb, as though I had slept on it but nothing else on my hand. I went with the folk cure of leaving it alone and hoping it gets better, but my doctor didn’t seem too worried. Four months later, I woke up with shooting pain down my arm so bad that I couldn’t sit up. Any part my left arm could bend radiated pain.

 

When you have pain, the doctor is trained to use the pain scale. Zero being no pain at all, ten being the worst pain imaginable. There’s no litmus paper or formula that comes up with that number; it’s self-reported. For acute pain, it makes a lot of sense in an emergency situation, but for chronic pain, it’s next to useless. Obviously everyone’s ten is subjective, but I spent my active youth crashing from one accident to the next. I’ve crashed into the ditch trying to make an S turn with an open throttle on a bike. I’ve had a horse pile drive me into the dirt at a dead gallop. I’ve fallen down a mountainside with a ski that didn’t pop off the way it should have, almost ripping off my foot as I fell. I had a man bash my face in with his fists to the point that one eye completely swelled shut and the other only open a sliver.

 

Compared to that pain, what I experience on the day-to-day is a three or four at best. But that’s for acute pain, not pain that goes on and on and on. And on and on and on. I’d keep going, but this article has a word limit. Chronic pain is the squeal of a brake pad telling you it needs to be fixed but in a world where there is no replacement parts. It leaves you gutted and gasping for air on the pier of life. Instead of a simple line scale, a three-dimensional chess board is needed.

 

Finding a doctor willing to help can be a major struggle. I found life got easier once I had a diagnosis, but the eighteen months that passed between me waking up in agony and some technician looking at my results and saying I had the MRI of someone sixty years my senior was miserable. My doctor was a very nice lady, but she spoke out of both sides of her mouth. She would say that she believed me and would do all that she could to help and then tell me that I was much too young to have that much pain. Worse, while the pain manifested itself in my arm, the damage was done in my neck. So for the first year they were looking at the arm from the shoulder down. Since there was nothing wrong with my arm, all the ultrasounds, Xrays and conduction tests came back negative.

 

Some doctors will try to believe you. Others won’t give you the benefit of the doubt. Scheduling the MRI took six months and before I could have one done, our family doctor moved away. One of the interim doctors told me I had tennis elbow. When I asked why it was that my shoulder hurt if it was in my elbow, he templed his fingers and said, “Ooooh, so it’s your shoulder that hurts now?” in an obvious “gotcha” tone. A week later the MRI results came in and the damage to my neck was obvious, but I’ll never forget how helpless I felt in that moment.

 

I’m in a much better place now and I’ll get to how I got there in a moment, but you can’t talk about chronic pain without talking about the medications involved in treating it. They’re currently working on a painkiller derived from a particular spider’s venom. It’s completely non-addictive or euphoric and if it’s strong enough to allow a spider to liquefy your insides and suck them up through their fangs without kicking up much of a fuss, it should manage chronic conditions, but that’s years away.

 

For right now we have opiates and opioids. Conventional wisdom used to say that pain patients using their medications correctly only have a 2% chance of addiction. Recent studies have brought that number up to 35%. More people die of prescription medication abuse than they do from any other form of opiate. Purdue, the company that makes OxyContin, lied to the doctors about not only the addiction rate but also the length of time the pills were effective. After selling medical grade heroin for so long, they then switched the formula so that they couldn’t be tampered with and while on paper that sounds like a good thing, it’s the reason why you now know what fentanyl is and how high its butcher’s bill costs.

 

So finding a pain specialist who cares about finding the dose that allows you function day-to-day with a clear head is vitally important to both your health and your well-being. The solution to managing pain is not going to be found in a prescription bottle with endless refills, but proper pain management will greatly improve your quality of life. Pain levels and your emotional state go hand in hand, so if an anti-depressant helps with that, give it a chance.

 

Back in elementary school the teachers used to hand out those morbid life or severe injury insurance pamphlets for us to take home. We poured over them, trying to figure out exactly what we could lose that would impact our lives the least but pay out the most money. Losing your thumb, for example, earned you ten grand while losing an index finger was slightly less and losing your pinky was barely worth breaking out the hacksaw. The naïve idea that there was anything more valuable than health was beyond us.

 

It’s easy to fall into the trap that allows the pain to define you. Chronic pain can challenge the most optimistic outlook on life. It can test the best relationship and alter your path from where you thought you were going to be to where you end up. The surgery that might be able to fix the constricted nerve channel and shave off the bone spurs has a one percent mortality chance, and another one percent chance of either being a paraplegic or a quadriplegic. Both specialists I’ve seen have assured me that the risk/reward is just too high. I’ve also talked a lot of people who went the surgery route, and not one of them would happily go back to the amount of pain they were in before the surgery. One person had five corrective surgeries to correct the first one, and her pain level was exponentially increased. With so many nerves and blood vessels located at C3 and C4, the best the specialists could say was take the pills, try not to get too addicted, and come back in a decade to see if there were any advances on the procedure.

 

But the drugs are just one of the tools I’ve used to greatly enhance my quality of life. Studies of children in hospitals have shown that being creative is as effective for dealing with the pain as some opiates. Being a writer, I can attest to this. When the pain is out of control, simply being in a far off land in my head works better than handfuls of medication. Meditation, yoga, hobbies, anything that takes your mind off the pain can raise your pain threshold. I pace myself using the Spoon Theory, https://en.wikipedia.org/wiki/Spoon_theory, a brilliant way to visualize your new normal. While I have the objectively have greatest partner in the world, being your own self-advocate and speaking up for yourself is vital. Assembling the right Team You makes all the difference in the world. From your doctors to the pharmacist to your friends or your therapist should all be on your side. You don’t have room in your life for people who aren’t there to make the world a better place.

 

At the start of this journey, I wanted to take enough pills that I could close my eyes and wake up when the pain’s gone. I lost three years of my life to pharmaceutical zombification. Life will continue, and the sooner I accepted that this was my new normal, the happier I’ve been. Chronic pain does what it says on the tin, but in the long list of things that make up who you are and what you’re going to be, it is not your main ingredient.

NaNoWriMo 2016

I didn’t think I was going to do NanoWriMo this year. I just started a new job teaching ESL to new Canadians, and I find that writing and teaching draw from the same well of creativity.

And then I was thinking last night about Halloween and how the doorbell ringing gets to me, and how much worse it would be if I worked in a grocery store and the beep of the check-out till set off the same reflex. Now I have 1,500 words about an ex-con working as a bag boy at a grocery store, and I think it might be a restart of a werewolf story that stalled out on me earlier this year.

Okay, so we’re doing this. (Bonus points to anyhow who caught the Hamilton reference. I like Burr. He’s Shakespearean in his tragedy.)

This is, I think, year eleven of Nano for me. Last year and the year before, I had assorted writing-related things to say. (But when don’t I?) Here are some handy links…

Good luck, everyone! Happy writing!

Fortune Favours The Bold — some guy Aristotle taught

I got into a discussion today about why characters have to be empathetic, if not likeable. And the guy I was talking to said he would rather try to break the rule than play it safe. It made me think of Alexander’s quote. I also spent some time talking about the Donner party and marvelling over how many times they were told to turn back. At each point they could have, half the party turned back and went the long route. Some looked at the first mountain range they had to cross, some of them were told by a rider who had just taken the pass and the guy who said the path existed told them twice, once in writing, once in person to go the long way. Each time, more people turned back until it was just a handful of families.

Every wagon that went the long way around that year made it to their destination but the Donner Party. If fortune favours the bold and the well educated, failure favours the foolhearty.

Don’t save the cat. But don’t kill it, ironically or otherwise.

We went to go see Kubo and the Two Strings and it was beautifully done, but yet another “kids'” movie with terrifying moments that all the “kids'” movies are hip to. For a while there in the 90’s through to the early 2010’s the most physical contact you could have with the baddies was hugging it out. Now we’re back to death and dismemberment, but instead of 80’s beta tapes we have in HD detail. It wasn’t gratuitous, but there were a lot more toddler-sized kids in the audience than we expected

The movie was awesome. I took a comparative literature course in my second year that dealt with pre-confederation Canadian literature, and all the French books boiled down to “fuck the English” and all the English books boiled down to “Damn, winter’s cold”, most Japanese stories boil down to “life is fleeting”.

The art design should clean up the Oscars if there’s anything right and just in this world. I didn’t appreciate the one nisei guy (first foreign-born child of Japanese immigrants–in this case, George Takei) getting fourth billing, but I laughed at several places,  alone in my mirth in the theatre. When death came, the screen faded to white. The first time it happened, I thought, huh, that’s an interesting choice, but the second time it was like oh, right. Death in Japan is associated with white, not black. It was very southern Japan, though. I lived in northern Japan, and regionally, it’s as different as the east and west coasts of Canada, if not more so.

Take a look…

And even without seeing it, you could feel the beats of the story. For every up beat, there’s a downturn. Every easy looking path turns into an almost unpassable trail, and I blame Save the Cat 100%.

Save the Cat might have been great for 90’s buddy-cop movies (Like in Lethal Weapon…2? Where they *actually* saved a cat? I’d go back and rewatch but Mel Gibson literally makes me ill now) but it’s been thirty years since cats have been saved. We’ve seen every combination and permutation of it done honestly, aware, on the nose, ironically. The cat is probably as sick of it as we are. When your audience members know the beats of your story as well as you do, it leaves nothing amazing. It’s like going to a haunted house, knowing where the jump-scares are going to come from.

So leave the cat alone. I know this means someone else is coming up with a new formula and eventually in 30 years or so I’ll be saying don’t eat the banana, but at least I’ll have 20+ years of the permutations of that method to get tired of.

It wasn’t perfect and it wasn’t without its flaws, but it was interesting and engaging for older kids and adults. One day we’re going to look back at our casting choices in the future and roll our eyes. And the stop motion art was breathtaking. Take a glimpse behind the scenes. Sugoi!

The gluten-free pancake recipe that makes you forget it’s gluten-free

Tragedy usually strikes when you’re craving pancakes and you have just enough milk for coffee in the morning. Sacrifices are made and regret steams out of no matter what you had to settle for.

But we had a can of coconut, so I was feeling pretty confident about my choices when Elisabeth came home for lunch and the pizza that she had been planning on having for lunch somehow disappeared in the past 36 hours. But let’s not dwell on that. Instead, I offered to make the pancakes gluten-free, making what I thought was going to be a full circle massive compromise. Instead, I may have to change my 32 year old pancake recipe.

Wet ingredients:

4 duck eggs or 5 chicken eggs

1 can coconut milk

2-4 tbs brown sugar or to taste (if you can find coconut sugar use it here)

1-2 tsp vanilla

1 tsp cinnamon

dry ingredients

2 cups flour (I used 50% bob’s 1:1 and 50% of some featherlight mix I had (50% rice and 50% tapioca starch, but I would use all 1:1 the next time)

1/4 tsp salt

2 heaping teaspoons baking powder

Directions are pretty simple, mix wet with wet and dry to dry.  There’s no gluten in the batter so mix well. Cook on medium heat on a grill or frying pan until the edges are dry and the bubbles in the centre of the pancakes pop and don’t fill back in. The other side cooks in half the time.

Immediately serve to the person you love. Everyone else can hope you remembered to preheat the oven.

Between the coconut milk and the cinnamon, these are fantastic. I had completely forgotten they were gluten-free. My old recipe is for the big fluffy pancake. These are much more crepe-y, even with the leavening. I’d make these again in a heartbeat even if I had enough milk for pancakes and coffee.

 

Coffeeshop panna cotta — easy and amazing

Panna cotta is one of those things that looks wickedly difficult and fancy but really is one of the simplest desserts out there and cheating even more by getting the base at your favourite coffee shop makes it even easier. Panna cotta is so simple that if you’re comfortable working with gelatine, it’s just bloom, heat and mix well.

The hardest part of making a panna cotta is making the flavourful base, but you can cheat here and just go to your favourite coffeeshop (mine’s Cuppers here in Lethbridge) and ordering your favourite drink. There are a few extra steps — ask for it extra sweet and a breve (brev-ah). That means they’ll use cream instead of milk. If they have 18%, that’s ideal. Most recipes call for a cup of heavy cream and a cup of milk, and that balances that out. Purists may have a heart attack, but with the small serving size, you probably won’t.

Personally, I like a large, cold, extra sweet decaf white chocolate breve with no ice for this, but you do you. I get both the syrup and the powdered chocolate added, and to make it mix, they usually have to blend it a bit. They may charge you for extra dairy for the cream and the extra syrup, but that one cup can make six servings, so it’s still a great value. You can always swap out dairy for soy or coconut milk, but it won’t be so mouth pleasing.

Try not to sip it on the way home. The base is very, very rich. You can use 1 package of gelatine to a twenty ounce drink. Pour out 1/2 a cup of the liquid into a microwave safe bowl and sprinkle your gelatin over the surface. It will take 5 minutes to bloom, so while you’re doing that, heat up the drink on the stove or microwave while you’re waiting. Don’t let it boil, but it should be hot. Nuke the bloomed gelatin for 30 seconds in the microwave and then add it to the hot liquid. You know your gelatin is melted when you rub the liquid between your fingers and can’t feel graininess. This is the only really difficult step. You should stir until it’s completely combined. If you don’t like the way jello can sometimes separate into two different densities, it’s because the crystals weren’t completely melted.

For easier pouring, a measuring cup allows more control. You can get super fancy here; try putting glasses at an angle into muffin tins if you want it slanted in the finished cup or pour into fancy glasses. This is traditionally served in a ramekin — just pop into hot water for a few seconds and invert it onto a plate. Fresh fruit, whether whole or in sauces go really well with a good vanilla base. You can dress this up or down. Whatever you do, let it set completely up, overnight if at all possible.

There’s so much you can do to this. You can use the coffee as half the base and make up your own flavours. Melt chocolate into light cream to make it less of a coffee flavoured base. Starbucks makes you a breve with heavy cream, which will allow you to add 50% of the base as coffee shots. Bringing home espresso and add condensed milk for vietnamese panna cotta coffee. Add gelatine to sweetened espresso on its own to make a rich, dark layer on top.

Cinnamon Buns with Fireball Icing

Photo 2016-06-12, 1 25 51 PM
We went out for brunch today for our friend Ashley’s monthly potluck. Normally I make waffles because they’re easy, but last night, despite how busy we’d been, I decided to make cinnamon buns. I divided the buns up a bit for baking, partly to leave a few at home, and partly because they didn’t all fit in the big baking dish. The picture is of the small pan left at home, pre-icing.

First make an enriched dough.

Dough:

  • 30 ounces of flour (I use AP)
  • 10-11 ounces of bottled or water that has sat out for an hour (to declorinate it)
  • 1-2 cups of sourdough starter (if you don’t have starter, you can plan on making your dough 2-3 days before hand and let rest in the fridge. It won’t be a perfect match, but it will have a lot more depth of flavour)
  • 1 tsp yeast
  • 1/3 cup sugar
  • 1 1/2 tsp salt
  • 2 eggs
  • 1/4 cup melted butter

Filling:

  • 1/4 cup butter
  • 1/4 cup white sugar
  • 1/4 cup brown sugar
  • 1/2 tablespoon of cinnamon

Fireball Icing:

  • 1 cup icing sugar
  • 1/4 cup heavy cream
  • 1 tsp vanilla
  • 1-2 tablespoon Fireball Whiskey

Mix everything for the dough together. Add as little water as you can get away with. The dough should be shaggy. I’ve made this as no knead dough multiple times, but I needed it to be ready for the morning so I put 2/3 of the dough my stand mixer to knead for seven minutes. I let it rise for 2 hours, then patted it out into a rectangle on a cookie sheet that had a greased piece of parchment on it. I greased the top as well with the last of the melted butter, put another sheet of parchment on top of it, covered it with a tea towel, and put the sheet in the fridge.

This morning I mixed up 1/4 cup of butter with the same amount of brown and white sugar, added a 1/2 tablespoon of cinnamon and spread it out onto the dough. Chilled, it was a lot easier to work with. Rolling it up was a breeze. I cut into 1 1/2 inch buns, laid them out in a parchment lined baking dish and let them rise for an hour on the counter. I preheated the oven when the hour was up, so all in they had about 80 minutes rising. They baked for 30 minutes at 350 degrees.

We didn’t have cream cheese, but we had heavy cream and fireball whiskey. So I mixed 1 heaping cup of icing sugar with 1/4 cup of cream, a splash of vanilla, and then 2 tablespoons of Fireball. I’m sure I could have doubled the amount of whiskey and they would have been fine, but I probably would have scaled back on the cream somewhat to keep the icing from being too runny.

They were amazing. Soft, fluffy, and rich. The icing was amazing. A little sharp and yet still creamy. The sourdough wasn’t just there for the yeast, it provided a depth of flavour that just yeast can’t provide. The enriched dough can sit in your fridge for up to a week, and each day it will be better for the extra time. I couldn’t plan anything five days in advance, though, so there is so much richness in the dough the extra time or starter isn’t necessary. This made thirteen huge buns and an extra little loaf, and the eight that went along to brunch with us did not last!