Brain Space – Pain Mastery

Brain Space of Sensory Strip = Amount of Neuron Cells = Sensitivity

Here is an image of the sensory strip. The view point is as if you are looking at a person’s face, right into this particularly cross-section of their brain. The body drawing on the outside demonstrates the region of that strip that is typically devoted to sensations from those body parts. Thus, you can see just how weird the proportions really are with very large face and hands compared to everything else! When we introduce this skill we also choose to add the option of a focus on the feet. Although the sensations from the feet don’t take up a huge amount of brain space, they are are still proportionally larger and on such a different part of the sensory strip that it can really move the attention away from other painful parts.

Lessons from this week’s lesson

In this week’s lesson on managing pain, I learned some new concepts about how pain functions in the brain, as well as on how to take something I already knew, and provide a better and more purposeful way to use it to reduce my experience of pain in my body.

The main points of this lesson are as follow:

  • Pain is experienced in the brain, after information is sent to the brain through neurons transmitted through the spinal cord.
  • Passively attending to something in your body, other than the pain, will reduce the experience of pain to some degree or other. Sometimes this reduction in the experience of pain is significant, sometimes not.
  • Actively creating a mechanical distraction, especially in the area of the body which is experiencing the pain, can have a positive effect on that pain.
  • Interestingly, by creating a mechanical action, such as shaking your hand if you injure a finger or burn yourself, will reduce significantly the amount of pain actually experienced, by actively reducing the signal from the pain receptors in getting to the brain. This takes place in the spinal cord itself, rather than in the brain, so the reduction in the pain can be very effective.
Concentrating your attention on some part of your body not currently experiencing pain can help reduce that pain.

Now, lets stop thinking about the theory of pain, and think about what the theory of pain is teaching me. If I can move my attention from focusing on a specific cause of pain to focussing on some other part of my body, such as my face or ears, for example, I can significantly reduced my experience of the pain. This reduction is my experience of pain is relatively mild, for me, at this point, but it serves to reduce my experience of neuropathic pain from excruciating to merely troubling, a huge gain since when it is only troubling I can often drift off into sleep, which is nearly impossible when my neuropathic pain in my feet is most extreme.

Through practice and the investment of some time I hope to increase the effectiveness of this pain strategy, which holds out some promise in being an active tool to improve my current experience of pain.

The second strategy in this chapter of the course on Mastering Pain, is about a more physically active method, and requires some mechanical actions to be taken. So, when the pain in my hands or feet is most severe instead of mentally focussing on another part of my body, I use an action to draw my attentions elsewhere. This action can be pretty simple, such as playing with my car keys or making a cup of tea, and really paying attention to what I’m doing, rather than dwelling on my neuropathic pain.

Doing something physical, like washing a load of dishes in the sink, can sometimes be an effective distraction to even quite severe pain. It won’t make it go away, but it may help make it more bearable.

You’d be surprised at how often this helps reduce the experience of pain, sometimes by a lot, depending on how absorbing the actions being taken are, and depending on how seriously I focus on them.

Before I started taking this program I think I intuitively already knew some of this information, without knowing the underlying physiology of the spinal cord and the part of the brain responsible for experiencing pain.

A significant part of the benefit of taking this program is the development of a more organized and deliberate strategy for dealing with my everyday pain, in ways that improve my experience of life through my own conscious efforts, without taking opioids or other pain killers to deal with the pain. A major goal of Mastering Pain is to create a Personal Toolbox of resources to assist with what has become a major preoccupation of my life, the toleration and management of chronic pain.

For me, the alternatives to doing this program seem few and very unattractive. I have no willingness to go down the road of pharmaceutical solutions for my pain, unless I absolutely have no choice, in order to tolerate the ever increasing amount of pain in my life. It may be that at some point I won’t be able to function, whatsoever, without pain medications, but I intend to push that day off as long as possible.

Note on formatting

Up until this week I was using a Drop Cap for the first letter of each paragraph in my blog. I recently received feedback from a mobile reader, using her cell phone, that said that the Drop Caps were screwing up her ability to follow my blog, by throwing text all over the place, when viewed on her phone. So I’m not going to use them in this blog from now on.

Obesity Week 2019: Why is it So Hard for Doctors to Admit Their Failure?

By Dr. Tro Kalayjian

doctortro.com/obesity-week-2019-why-is-it-so-hard-for-some-doctors-to-admit-their-failure/

It’s Thursday night, and I’m sitting in an airplane, about to take off for New York. I’m heading home from Las Vegas after attending Obesity Week 2019, the world’s largest obesity medicine conference, a collaboration between The Obesity Society and The American Society of Metabolic and Bariatric Surgeons.

I don’t quite know how to express my feelings and thoughts about this event, but the words ‘anger’ and ‘hopelessness’ immediately come to mind. My anger and hopelessness are best exemplified by the first keynote speech, delivered by Dr. William Cefalu, who is chief scientific and medical officer of the American Diabetes Association.

After accurately describing our country’s spiralling healthcare costs, and the morbidity and mortality associated with diabetes and obesity, Dr. Cefalu went on to discuss the benefit of low-calorie approaches for diabetes reversal. He also highlighted bariatric surgery and medications. But ultimately, he harped on one point, that is frequently repeated at conventional obesity medicine conferences: 

“There is no best diet. The best diet is one that a patient can adhere to.” 

The above article by Dr. Tro Kalayjian the physician behind Dr. Troys Medical Weight Loss and Direct Primary Care is a discussion about why it is so difficult for the medical profession to accept fundamental changes in medical understanding about diabetes and current treatments for it. It is why patients continue to get contradictory advice from doctors who really ought to know better than to recommend any number of established and well known dietary strategies that simply don’t work. It’s not that they don’t work anymore, it’s that they never worked, and there is no scientific basis for any of them.

This sounds pretty revolutionary to me. The esteemed Canadian doctors is joined by a number of US based colleagues who are challenging the status quo in the treatment of diabetes, and sending a message to their profession. Just stop! Stop misleading the public! Stop lying to patients! Stop killing your clients!

Closeup on medical doctor woman giving a choice between apple and donut

Of course, they are doctors and they don’t quite put it that way. But what else can you say when so many health professionals and authorities continue to promulgate misleading information, such as “moderation is the best strategy” when clearly, based on current information that is simply not true. Moderation will kill you if by moderation you include relatively mundate advice about carbohydrates and sugar. What sciences know is that consuming carbs in excess of certain pretty limited amounts leads to metabolic syndrome, metabolic syndrome leads to insulin resistance. Insulin resistance leads to diabetes. Diabetes leads to lots of really bad stuff that can kill you, or at the least, make you really really sick.

Stop being so gullible. Doctors aren’t necessarily up to speed on the current information about your health.

If you or someone you love is fat, obese, or has diabetes or prediabetes follow the link on this blog entry to the above article and understand what is being said. Doctors are willfully ignoring solid medical evidence in favor of standing by old, disproved theories because they are afraid of rocking the boat. Read Dr. Fung’s book, the Diabetic Code.

Stop believing anyone who says that eating many small meals a day is ok. Stop following advice so far heard that has led you to being overweight and obese. If you want to live and healthy, long life, fire your current endrochronologist if he or she disparages the most recent research and tells you not to follow Dr. Fung’s advice. Run away from anyone who says that carbs and sugars are not the cause of diabetes, metabolic syndrome, and many many many other life threatening diseases.

Pain Mastery – Evaluation

How has pain been a complex problem in your life? How has pain interacted with your movement, energy, sleep, social life, finances, identity, memory, and mood?

Mastering Pain Institute

After listening to and reading the materials in the 1st leasson of the Pain Mastery Class it asks the student to answer the above questions.

Movement

How has pain interacted with my movement? As pain from various causes has increased over the past few years I have observed that my ability and willingness to move has undergone an uncomfortable metamorphosis. Simple tasks like walking, bending over, picking up items, getting dressed, doing my toe nails, making the bed… etc. have all become much more difficult.

Neuropathic pain has combined with arthritis to make steering the car for long periods increasingly painful. I alternate from my left to my right hand constantly as I drive, because the pain builds up in each as it is used. Eventually the pain is too great in both hands and I have to take a break. The pain in my legs and feet make driving hard as well, and certainly limited my pleasure from doing so. Driving a car is one of my great pleasures, or, it used to be one of my great pleasures and it represented a kind of freedom that is now gradually disappearing from my life.

The same can be said for a lot of routine physical tasks, all the way from making the bed to cleaning the mirrors in my bathroom. I didn’t used to mind housework or gardening but it is now so painful to mow the lawn that I’d rather let it grow twice as long as I used to. These type of restrictions have inevitably reduced my freedom of movement, and my interest in and willingness to do routine, simple life tasks.

How has pain affected my energy? Anybody who suffers from chronic pain will attest to the fact that constant, unrelenting pain is exhausting. There is almost no time when I’m not tired and so sore I feel like I really just want to lay down and sleep for a while. Even a nap would seem like a relief, if I can sleep, that is.

The net available energy is a function of pain in my body. The more severe the pain becomes, the less energy I have. And not only to do life in general, but in having the interest and energy to participate in the things of life. A lack of energy is behind so many other deficits experience by people with chronic pain that it tends to blind us to how serious it actually is. Without sufficient energy to function properly nothing actually works the way it is supposed to work. How the hell am I supposed to do my job at work, when I hardly have enough energy to get there in the first place every day?

How does pain affect my sleep? To most of us with chronic pain sleep is seldom deep or really very restful. Not a single night of sleep goes by without being disrupted, again and again by waking fully or partially because of pain in the body. For me it is all sorts of different parts of the body and different types of pain, but it all hurts, and it all makes me awaken at some point during sleep. If I wonder why I’m so damned tired all the time, I simply have to remind myself that I really haven’t had a decent night’s sleep in years.

I’ve been diagnosed with sleep apnea, but sleep apnea really isn’t the reason I’m awake half the night. It’s the pain, the pain. Snoring is a part of it. Blocked airways aggravates it. But pain causes sleep interruption, over and over again, every single time I go to sleep.

How does pain affect my social life? What social life? Who really has the energy to maintain a social group or friendships when you’re in constant pain? It takes energy I don’t have and mobility that is a constant struggle, simply to get out and visit with people. I’m no longer the happy go lucky guy I used to be. I try not to spread my pain around, or make my kids and grandkids suffer from my experience of pain. But I wonder if my increasing isolation from them is at least partly because I do longer know how to overcome my pain for long enough to actually properly engage with people.

And being socially isolated also increases my experience of pain, because lacking real human contact with others is not only uncomfortable, but it’s also actually harmful physically because it encourages inactivity and passiveness. Instead of getting out and doing things with the people I love, I stay at home, watching television, at least partly because it’s less painful than the alternatives of getting out of the house, and doing the things necessary to have a life.

How does being in pain affect my finances? This is one of the things that is most humiliating about being in pain. Instead of being vibrant and capable, I’m tentative and withdrawing from challenges. I used to love going to the office and taking on new challenges, meeting new people, creating new financial opportunities for myself, and for my staff. Now I have no staff, and I’ve been afraid for years of taking on jobs that I know I’m qualified to do because I’m afraid that I’m going to let them down, or worse, prove myself to be incapable of handling the physical and emotional demands of the work.

In addition, my increasing health problems cost a lot of money, which I am now having to pay with a lot less income, due to my reduced employment capabilities. I struggle to manage my prescription deductibles and copays. And that’s for the prescriptions, which doesn’t actually include any pain medications I can trust. Nothing the doctor has prescribed for pain has actually helped very much, if at all. I know that opioids would be more effective than OTC drugs but I also know that they are highly addictive, and have major other problems that I don’t need to add to my pain.

And being chronically short of money, as well as in pain, means that I can’t take advantage of one of the things I used to do a lot, which was going out to nice restaurants and have good meals with friends. Shortage of money means that I’m socially isolated by it, as well as by my resentment over finding myself in this situation. I never wanted to be dependant on anyone else but I find myself in a situation that make this every more a fact of life.

How does pain affect my sense of identity? Truthfully, I don’t really recognise myself any more. I no longer feel like the man I used to be, and I certainly don’t have the confidence I have always had. I’ve always thought of myself as a highly charged, somewhat hyperactive and oversexed Type A personality. If I had faults they were likely the faults of thinking that I could do anything, be anybody, accomplish anything. A little bit of humility probably wasn’t a bad thing for me to learn, but pain has driven me to distraction. The amount and persistence of pain has now reached proportions that are disabling my sense of self to a point of no return. I don’t actually know what it would look like for me to be me, the way I have always been. So damage to my sense of identity is a real cost of being a victim of chronic pain.

How does pain affect my memory? My partner says that I’ve become a lot more forgetful than previously. I’m not sharp anymore, and I don’t automatically pick up on things so quickly. I don’t think I’ve lost my marbles, but I get confused more easily and mix things up, despite my best efforts to not do so. It means I slow down, because I can no longer count on my memory for important information. I’m a lot more cautious than I used to be, if for no other reason than I hate being unable to remember even the simplest facts or common words.

I’ve always been a prodigious reader, at one point reading more than a book a day, not to mention newspaper and magazines. Now it takes me a week to read a novel, and a month to work through a non-fiction title, no matter how interested I am in the subject. I don’t remember names very well, I never did, but I’m also losing the ability to remember what books I’ve read or which ones I liked or didn’t like. I find myself half way through the first chapter of novels only to realize that I read the damned thing six month ago. So yes, memory is being affected negatively, if only because I’m so distracted by the constant pain interrupting the flow of my thoughts and feelings.

How does pain affect my mood? I was diagnosed as being bipolar when I was about thirty years old, after a major breakdown and depression. After being hospitalized for six months I came out of the hospital with somewhat better emotional management tools than I had previously. Relatively quickly I abandoned the prescriptions for bipolar I had been given, because they made me feel like I was living in a fog. And I reconciled myself to living with vivid emotional ups and downs. So depression and mania have long been a part of my nature, and my life. I’ve done well in managing to live a full life despite these problems, but now it feels like depression stalk me, without the accompanying manio to provide any balance to it.

There are two kinds of depression with which I struggle, one of which is a direct result of serious and chronic pain. It’s tough to get out of being depressed when you feel like you’re under a constant pressure cooker caused by physical and mental pain. This past weekend, in addition to chronic neuropathic pain in my hands and feet, arthritic pain in my shoulders, fingers, hands, I was also slayed by a serious migraine headache. I haven’t suffered from migraines on a regular basis for years, ever since I started practicing a form of self-hypnosis that seemed to be effective at shortening their duration, and eventually led me to being able to predict and prevent the worst of them.

Even that ability seems to be beyond my control these days, because it’s pretty hard to meditate when I’m in so much pain that I can hardly sit still.

I don’t know if this exercise in counting the ways that pain affects me is supposed to make me feel better, but it hasn’t yet. I also suppose that to defeat an enemy I first have to understand the enemy and all the territory it has staked out in my life. This is the exercise from Chapter 1 in my program to begin to manage my pain. I hope the next exercises don’t leave me here.

Is Heart Disease really diabetes?

Ivor Cummins is an Irish medical professional who is leading a charge to redefining the causal relationship between metabolic syndrome, insulin resistance, diabetes and a whole slew of diseases including heart disease and cancer.

In my pursuit of better health I am committed to radically reducing the amount of carbs in my diet, as well as resetting the hormonal imbalance in my liver and pancreas. Dr. Jason Fung is doing his work as a doctor in Toronto, as well as publicizing the real risks of abdominal fat.

The real crisis in today’s world is a crisis in lifestyle and diets, which is putting millions and millions and millions of people all around the world in grave danger. More people die every years in the world NOW from diabetes and related illnesses than are predicted in the worst 50 year estimates of global warming. The people dying today are dying because science has been systematically ignored by government policy makers and medical professionals for 50 years.

Dr. Fung argues that the conflict of interest between industry and medical professionals, including government agencies is at the heart of this global crisis. It is time to stop mollycoddling international business interests, and get on with the business of teaching future generations how to improve the quality of their lives, while also radically extending the length of their lives, simply by learning new lifestyle choices.

Diabetic Pain – Neuropathy

Neuropathy

DIABETIC NERVE DAMAGE (neuropathy) affects approximately 60-70 percent of patients with diabetes. Once again, the longer the duration and severity of diabetes, the greater the risk of neuropathy.

There are many different types of diabetic nerve damage. Commonly, diabetic neuropathy affects the peripheral nerves, first in the feet, and then progressively in the hands and arms as well, in a characteristic stocking-and-glove distribution. Damage to different types of nerves will result in different symptoms, including

• tingling,
• numbness,
• burning, and
• pain.

The incessant pain of severe diabetic neuropathy is debilitating, and the symptoms are commonly worse at night. Even powerful painkillers such as narcotic medications are often ineffective. Instead of pain, patients may sometimes experience complete numbness. Careful physical examination reveals decreased sensations of touch, vibration, and temperature, and a loss of reflexes in the affected parts of the body.

While a loss of sensation may seem innocuous, it is anything but. Pain protects us against damaging trauma. When we stub our toes or lie in the wrong position, pain lets us know that we should quickly adjust ourselves in order to prevent further tissue damage. If we are unable to feel pain, we may continue to experience repeated episodes of trauma. Over the years, the damage becomes progressive and sometimes deformative. A typical example is the foot. Significant nerve damage can lead to the complete destruction of the joint-a condition called Charcot foot-and may progress to the point where patients are unable to walk, and may even require amputation.

Dr. Jason Fung, The Diabetic Code p.28

Diabetic neuropathy has led directly to my willingness to undergo a radical lifestyle change, including intermittent fasting, and major changes to my overall dietary behavior. In particular, major pain to my hands and feet has increased exponentially in the last couple of years.

This type of pain is almost invisible to the people around a diabetic. They often wonder, I’m sure, what the hell is wrong with me, as I stumble from step to step, at times looking for all the world like a drunk after one too many.

Despite my best efforts to appear normal, it is sometimes impossible for me to avoid an outburst from a sudden onset of sharp pain in my hands or feet, without any advance warning that my chronic pain will suddenly become extreme, even if only for a few moments.

Dr. Fung mentions that it is worse at night while a diabetic sleeps or rests. Well, there are many times when neither is really possible, and my partner lays across from me worrying as I toss and turn in pain. And neuropathic pain is only one of the causes of pain in my body at night. Others are arthritis, bursitis, and severe muscle cramps.

Combine these with fibromyalgia and I guess that I have won the sweepstakes of pain, so far without winning the big prizes, premature death or paralysis. Even without the immediate threat of dying, chronic intense pain is exhausting, often leaving me so tired that days go by without being able to accomplish even the smallest things. Even I tend to feel like a lazy sonofabitch because my progress in so many things is fractional or even non-existent.

I wish I were faking it, of which I have been accused at times. If I could make it go away, I would indeed. The best thing my doctor ever told me about neuropathy is while I can still feel the pain, it is still at least possible that my nerve damage may partially recover as I reduce my diabetes and stop making it worse. Once the nerves are deadened to the point where my feet are simply numb, there would be no hope of ever recovering any of the la\ost sensitivity in my feet or hands.

This is one of the reasons why I am so determined to take any measure that has even a promise of helping me eliminate or radically reduce the effects of diabetes in the future.

Letting go doesn’t hurt, either.

Egmong, BC – Museum

Today is Canadian Thanksgiving Day. This is the day when I’m supposed to be grateful for all the good things in my life, and emotionally let go of whatever negative things are holding me back from a happy and productive life.

All of that is good. In theory.

But it’s hard to do. It’s a lot easier to list the things I’m mad about, or for which I’m resentful, than to account for all the good things in my life, for which I’m grateful. That’s not to say that I’m not, that is, not grateful.

I’m grateful for the people in my life who go out of their way to make my life better, of which there are any number, including my domestic partner who puts up with my frustrations and anxieties, and continues with me in her life, despite no longer wanting to be married to me, or believing that there is any romantic future for us. She’s probably right but still has simply accepted me as I am, despite my faults. So the two of us struggle to go forward in this fundamentally undefinable relationship and cause each other, and ourselves, the least emotional damage possible. And although this relationship isn’t what either of us imagined forty years ago, it continues to sustain me in the present. She still inspires me with her generosity of spirit towards.

I am grateful to my family, including my kids and my siblings, trying not to let resentment fill my heart for all the things I’d hoped would be, but are not. When people love me its hard when its not exactly the way I’d like to be loved. But who am I kidding? The fact that they are willing to be a part of my life is what is important, and I am appreciative when they do spend some time with me.

I’m also happy with my progress towards a healthy future. Intermittent fasting and lifestyle changes I’ve already made are making a real difference in my health, even just a few months into the process began with my decision last spring to reevaluate my medications and side effects. My son’s consistent input about carbs and sugar has encouraged me to stick to my guns when comes to fasting, and has helped me to lose 35 pounds. I do feel better, and I’m grateful for that.

But I still have a hard time not being angry about the things I’m facing in the future. It doesn’t matter really if they are a direct result of my own actions, or not. Chronic pain is very difficult to ignore, especially when it is quite severe, most of the time. I’m taking it on faith that losing weight will improve matters a little, but I’m not counting on it. Pain has become my constant companion, and it’s damned hard not to complain about it. Not that it does any good, but saying something does relieve some of the pressure of feeling so isolated and alone in the pain. Sometimes people think that I resent them because they don’t really express much sympathy, or even really seem to understand what the hell I’m talking about. Actually I don’t resent them, what I resent is the pain itself, and the fact that nothing really helps.

I’m also really resentful about the total destruction of my business and professional career, as a result of having made some stupendously stupid mistakes which cost me everything, including putting limits on my future I’m not quite sure how to endure. It doesn’t actually help to know that there were things I could have done differently that might have made all the difference. I didn’t do those things, so here I am. I’m critically broke, impoverished by the consequences of these mistakes. I also resent being ashamed of my mistakes and lack of better judgment. How can I be sure that I’ll do any better in the future?

International Symbol of gratitude

But today is Thanksgiving Day, so I’ve thought a lot about those things that matter to me. There is a better future ahead, even if I’m not quite sure how to get there. I’m still alive, and I’m in better health than for a long time, and have more energy than for probably ten years. So I grateful for that.

I’m also grateful for my blog. Expressing my deepest feelings helps me come to terms with them. So I’m also grateful for my faithful readers, who have been so encouraging to me as I have been on this fasting journey. Thank you.

My fasting journey has just begun.

Amazon Digital Services, Inc.

No matter how far we are going on a journey, each step is a new beginning. When I began intermittent fasting, back in July, I knew from the start that it is a long term project, and progress measured in weeks, months and even years. My incentives for giving it my best shot are huge – better health, a longer life and a more enjoyable and energetic present.

What I didn’t know, at least not in my heart, is that every day would require a new, fresh commitment to the plan. I sort of thought that my inertia would carry me along long enough to sustain me until I reach my goals, which are tangible, measurable and, hopefully, achievable.

Well, no such luck. Almost every day I fast I find myself feeling extremely positive about what I’m doing. Almost every day I’m not fasting I find myself haunted by doubts. I feel like I’m not losing weight fast enough, I’m not managing my insulin and medications well enough, and whatever I’m eating is working directly against my goals. I see a perfectly normal person walk by and I think to myself, “What a fat slob”. Because I’m afraid that somehow I’ll lose my commitment and indulge myself in foods that I don’t even really like or want anymore.

And I’m still less than a half the distance to my weight loss goal, and still unsure about how long it will take me to get to the point where I don’t need my diabetes medications and insulin any longer. I guess I’ll know when I get there, because both goals are measurable, and there is external evidence that I’m making good progress on both fronts. But in the meantime, I feel a little bit lost at sea, from time to time. The worst times are when I’m eating, and wondering if I can really afford this whatever.

I tried to pretend that I wasn’t obese. It didn’t work, and I still became more and more seriously ill with diabetes and its complications. Something had to change, or I would die of the disease and complications from the disease.

I also know that even when I reach my weight goal, and my ambition to defeat metabolic disorder, and eliminate my diabetes, that I will then have to undertake another journey. Maintaining my healthy body will require vigilance, and committing to a healthy low carb diet, not for a while, but for the rest of my life. So the change I am currently experiencing through intermittent fasting will only be sustainable if I commit fully to the change in lifestyle needed to maintain the results.

Intermittent fasting is a little like travelling through a very long tunnel, at the end of which is new territory I’ve never seen before. There’s also probably more intermittent fasting in the future, if I really intend to maintain my health gains and not go back to obesity and diabetes.

This doesn’t discourage me, but it does present me with a challenge in the present, which is that my level of commitment to a certain and achievable weight and health goals must be followed by an endless journey, if the effort being made now isn’t to be completely wasted.

At that’s just a little intimidating. Well, maybe not just a little. Maybe a lot.