I'm Kirstie, the movie star. I will be your Speech Pathologist today.

So I haven't posted in a while...I've been pretty whiny lately and I thought you'd appreciate it if I kept the whininess to myself for a while. But, I've called a WHAmmmbulance and am feeling much more like myself today, so I will attempt to provide an update without too much whine.

It has been a tough few weeks in terms of knee pain. The last time we chatted, I explained how I really believe that  my pain is neuropathic - my brain is interpreting threat and sending amplified pain signals to my knee. It was enlightening to gain awareness and accept that my knee is likely structurally as good as it will ever get; however, it's frustrating when you understand why and where the pain is occurring, yet feel helpless to make it stop.

Anyways, I ended up taking some time off of work in an attempt to settle down this pissed off knee. It was ok for a few days, but by day 3, I was losing my marbles, ready to kill Dr. Phil and his messed up guests, and really eager to get back to the hospital - easier said than done. Because of some checked boxes on a form, I was told by HR that I could come back to work as long as I didn't sit, stand, or walk. Um? Ok? How's that gonna play out people? Speech therapy via stretcher?? Luckily, my family doctor is a very accommodating man and he was able to meet me in the operating room before he performed surgery just so he could uncheck those pesky boxes so that I could return to work. For real. Awesome system.

Although I am frequently experiencing pain at work, I find it much easier to distract myself in that environment. When you're dealing with people who've just suffered a stroke, or a family who is questioning how to keep a loved one comfortable at the end of life, you gain perspective and spend a lot of energy attempting to reassure and comfort patients. You also get to chat with families, hear about the patient's wedding in 1945, the new great-grandchild, and discuss current events. There is no doubt in my mind that I get my energy from people. I really need to be surrounded by people, especially when I'm struggling. I am also very lucky to work with really fabulous co-workers. They sense when I'm having a rough day (most of them are physios, so they can spot an "off" gait anywhere!) and are so supportive and kind.

One of my fabulous co-workers, Kelly, has begun acupuncture with me. Kelly is one of those people who is constantly observing, processing, and problem-solving. She came up with a great plan: we're going to pair my acupuncture session (in which I should feel relaxed and pain-free) with music. The idea is to classically condition myself, so eventually, if I am feeling pain, I can listen to a specific song/songs and instantly feel relaxed. You know, just like Pavlov's dog. If "Pour Some Sugar on Me" suddenly makes me excessively salivate, you'll know we've gone wrong somewhere. Haha. It's totally worth a try and I'm open to everything right now.  In addition, I'm trying a new medication that targets nerve pain. I'm crossing my fingers that this combination of therapy makes a difference for me. I just really want to be happy and pain-free again - consistently.  Fake it 'til you make it has some merits; however, it's exhausting to constantly be smiling through clenched teeth.

Yesterday, for example, around 2pm, I had hit my limits for the day. My knee was aching, the "shocks" were starting up again, and I felt old and disabled as I limped into my patient's room. My 75 year old patient with dementia, who had been in the hospital for over a month, was facing the wall in his wheelchair as I entered the room.

"Mr Smith? Hello! I'm Kirstie, the Speech Therapist."

Mr. Smith turned his head slowly and his eyes widened in surprise, "Wow! You look like a movie star!"

A huge grin appeared on my face and I instantly felt...well, I'm not gonna lie - I felt awesome.

"You have no idea how great that makes me feel,"  I responded, "Are you getting tired of being in the hospital?"

"I'm in the hospital? Jesus, when did that happen?" he responded.

Oh dear. He was definitely confused. He was confused, but man, did he ever make my day.

...And someone will mistake you for a movie star. 

Pain is Painful

"On a scale of 0 to 10, 0 being no pain and 10 being the worst pain you've ever felt, please rate your pain right now."

Ugh.

I hate that damn pain scale. I understand its merits. It helps patients think more objectively and rationally about their pain. It also helps health professionals determine the effectiveness of treatments. But, it kinda sucks. Whenever I'm asked this question, I go into a long complicated self-talk session before giving away my response, "Like 10 minutes ago, when I had a shock, it was a 9, but then the shock settled and it's a 5...so I do I take the average? I don't want to overestimate my pain, but I need my doctor to know that this legit pain. What do I pick? aggggghhhh!"

If I am in quite a bit of pain, I usually go with a 7. It's a solid number. It gives me room to grow - you know, if the pain gets worse - In retrospect, 7's a good call. I have vivid memories of laying in room 406 of the hospital yelling, "It's a 10. The pain is now a 10 people. For real!"

Sometimes, I hear outpatients in our therapies department, patients who've dressed themselves, driven themselves to therapy, and participated in idle chitchat in the waiting room respond with outrageous pain claims.

"Oh the pain is terrible. I'd say at least a 15."

Ok. Wait just a minute. 15 is not an option. And if your pain was worse than the worst pain you could ever felt, than how the hell did you just scarf down that Tim's breakfast sandwich? Ya, I saw you. I call bullshit. Funny enough, that statement is usually followed by, "And I have a really high tolerance for pain." REALLY? And who decided that one?

But maybe that person actually believed his pain was 5 points worse than the worst pain he's ever felt? Who am I to say? Pain is personal. Pain is subjective.

This past week, I've been struggling with pain. "The shocks" came back with a vengeance. They caused me to drop my clipboard, grab my knee and yell, "SHIT!" on an hourly basis. Super inconvenient. I finally gave up on attempting to be a productive member of society and went home and laid in bed for a week. It sucked. When I began feeling a bit better later on in the week, I decided to sort out why the hell this is happening. After numerous knee inspections by both my fabulous ortho and my stellar family doc (both of whom I trust completely), it would appear that although my knee is swollen and slightly "angry," all the tests that indicate my cartilage is damaged, a tear exists, or anything really sinister came back negative. Which is a relief; yet, makes me question why I am feeling such intense pain, and how the hell do I ease this debilitating pain (other than drugging myself into that drooling, mindless state).

Then I saw a video. It was a really awesome explanation of pain and the brain's role in pain. You see, the brain is smart. Duh, it's a brain. When something is aggravated in your body, your peripheral nerves send a message to your brain, "Hey, brain, we've got a situation here. The knee is angry. Please advise." The brain's job is to collect all the information - it evaluates every piece of credible information including past experiences - to determine if you are in danger. In my situation, my brain would see that in the past, an angry knee indicated danger, typically resulting in ripped cartilage and surgery to repair. My brain immediately sends a message back to my peripheral nerves, "This is bad! I repeat, bad. THREAT!" (After all, it's in my brain's best interest to keep me safe and alive). My nerves respond by sending the message back to my knee, resulting in a sharp, attention-getting pain. My brain wants me to notice so it's amping up my signal!

So simple, yet so complicated. My brain is conditioned, given my past experience, to signal severe pain when my knee may just be slightly angry.

I'm not saying that the pain is "in my head." That's not the message here. Oh, I can tell you that the pain is real. It causes my teeth to clench and my eyes to tear. What I am saying is that although my brain is merely trying to protect me, it's a bit misled...and I have the power to help change that. And anything that puts the control back in my corner is music to my ears. But..it's easier said than done. I can't just tell my brain to stop, although awareness is definitely a good first step. My anxiety has definitely decreased simply by knowing that my knee cartilage is fine and that I do NOT require more surgery.

The literature recommends that you create a "safe" environment for your nervous system. Initially, it sounded like a bunch of hokey bullshit to me, but hey, I have nothing to lose. I determined that for whatever reason, heat eases my knee pain. So I've taken approximately 12 hot baths this week (sorry environment!) and constantly keep a heat pack on my knee. Basically, I'm telling my brain, "Heat helps. We're heating. We're safe."

Haha, you think I'm crazy, don't you? Ya, so the big question is: Has it helped? Is this helping?  Um....not, yet. But I'm gonna keep going with this. I'll let you know. I mean, the brain's not a dog. It can't be trained in 3 days, people!

Now when I receive "the shocks," not only do I drop my clipboard, grab my knee and yell, "SHIT!" but I also follow it up with, "Brain, we're safe. This is not a threat. I repeat, this is NOT a threat." Oh man, I'm gonna get locked up for sure.

Anyways, it's an interesting theory and worth a good 'ol college try (what does that mean? Did you try harder in college? I didn't.)

I highly recommend that you check out this video. Not only is it extremely informative if you are experiencing pain or living with someone in pain...but it's pretty entertaining as well (and I love a good Aussie accent!)

Frostbite? No thanks, had that for breakfast

Warning: this is an overly dramatic post because THAT's the kind of mood I'm in. As I write this, I am eating raw brownie batter from a bowl and drinking wine out of a box - I may have mixed a painkiller in there as well...You have been warned. 

So it's cold. It's so cold that it's completely necessary and appropriate to use the "f word" in all caps as an adjective to describe the cold. It's really FUCKING cold. For those of you who don't live in a bitterly cold environment, it's difficult to communicate to you just what -60 degrees Celsius with a windchill feels like. Let me try. Ever hear of frostbite? You know, where like your face or toes freeze, turns blue, and falls off. Frostbite is not even the main concern anymore. Frostbite is imminent. It's a daily occurrence. It's just a way of life, "Hey Bob, looks like you got a little frostbite walking from your car into work. Might wanna get that looked at. Frostbite amputations are at 10 this morning in the boardroom." You see, at -60 degrees what we should be worried about is the state of our internal organs. Don't they stop working when the temperature is no longer safe for human habitation? Like, humans can't survive on Jupiter, right? "Someone" deemed Jupiter unsafe. What makes us think we can survive this? Don't quote me on that one, but I swear to god, I felt my right lung freeze up yesterday when I attempted to inhale this so called "air" (Is it really oxygen anymore if it's frozen?) So you catch my drift - it's FUCKING cold and at this moment, I have NO idea why I make a conscious decision to live here. Obviously, I am an idiot.

You know who else really hates the cold (other than Dundee, the dog, who is now on a pee strike until the temp warms to -30)??? My knee cartilage. The poor cartilage is so traumatized that we are living in such an abrasive climate, that it has begun shocking me again with the tazer-like vibrations that run violently under my kneecap and almost cause me to pee my pants every 20 minutes. And I can't even blame the Biebs this time. Shitty. It's especially frustrating because the knee was so solid on our holiday in Bali. It loved the hot, humid weather. It walked, it swimmed, it climbed stairs, and I even took it surfing! It felt great and did wondrous things for my confidence. It has the potential of being a really stable, dependable knee. I just need to sort out the recipe of climate, activity, and diet (perhaps?), that maximizes its potential. -60; however, is not conducive to healing/functioning/thriving of any sort for man or machine.

To my fellow Saskatchewanians  Saskatchewanites friends from Saskatchewan: Congratulations on continuing to function - working, buying groceries, breathing, etc despite the fact that if NASA landed here, they would deem this arctic tundra "unfit for human habitation." Carry on. Good luck. Stay warm. Only 78 more days until the May long weekend.