Ankle Chronicles 13

Ankle Chronicles 13

It’s after midnight and I can’t seem to settle down. And it’s not because the Sox won tonight. I wish it was from my excitement but the game ended like two hours ago. Nope, I am up because of pain. My foot started hurting me and the pain has now spread to my toes. It’s excruciating. I just took some Neurontin and some pain meds. I have to wait for them to kick in before I can think about lying down.

I think it’s time I try something like CBT (cognitive behavioral therapy) to help me deal with pain. It’s not a cure but it might help me manage in better ways. There was a place in Brookline but they don’t accept chronic mentally ill patients like me, specifically those that have suffered any type of abuse or need long term care. So I am going to try and find a therapist where my psychiatrist works. I have to call the intake and be put on the “CBT wait list”. I don’t know how long that will be. I have no idea how this is going to do down. I am going to have to enlist the help of my psych to see if she can expedite the process. CBT is not something I believe in, but it has been shown to help those with chronic pain, so I might as well try it again. I just hope it isn’t a bunch of paperwork and shit. I can’t imagine filling out papers while in the middle of a flare up. I already want to rip what little hair I have on my head (I have short hair) or cut off my damn ankle.

If the list is a long wait, I might not last. I have 3 weeks before my death date comes. I am willing to postpone it if the wait is not longer than say two months. I don’t think I can hold out longer than that as the flare ups have become so unbearable. I hope that my suicidality doesn’t hinder me getting in to see someone. That will really fucking suck and I will feel so dejected. I also hope that because I have an established therapist, they don’t say see ya. This is a specific treatment and one I am willing to give a try if they will just give me a chance. I am really nervous about this because it has been so long since I have gone through an intake process. That is why I am hoping my psych can help with the process a little bit.

I am so damn tired and really want to lie down and sleep. But I know that if I lie down, the pain could get worse and then I will have to sit up again. I kind of wait until I can no longer keep my eyes open and then I lie down. I am usually out by that time. I don’t really sleep very well or very long, but it beats having to lie down and then sit up. It’s a game I play most nights and it’s not fun. It drives the voices crazy because they want to keep talking to me and if I keep popping up, they want to talk more. Or the music in my head gets really loud and I have to play music to drown it out, which then keeps me up for at least another hour or so.

I can’t escape this stupidity. It drives the suicidality all the more because I just want to escape from it all. The pain, the voices, the depression, everything. I was writing to a friend about my troubles and she said that I need to do something, like get involved in something or get a pet. I couldn’t handle being responsible for a pet. It’s a big responsibility, even if my mother allowed it to happen. I know my friend meant well and all, but she just wants me to stick around for a long time. She also doesn’t want to lose me. She understands my suicidality. She knows that my suicidal ideation is not over something trivial.

Chronic Pain, CBT, and suicide

Chronic Pain, CBT, and Suicide

I recently read an article written by Psychology Today that stated “opioids are not useful for chronic pain”. Where this psychologist got his information from I have no clue. He says the CDC has “studied the data for years” yet didn’t quote or reference this data in his article. Yet based on this stupid article, my life and well being are in jeopardy. I am so angered by this article that calls for CBT (cognitive behavior therapy) as a treatment to cope with pain. The problem lies in many factors. CBT doesn’t work for everyone for every condition. It certainly didn’t work for me when I tried it many years ago for my depression. It was too complicated and I didn’t have the patience to sift through a packet of 30 or so pages of the treatment homework. I wanted relief, like most patients/clients do, NOW. Second, coping with pain doesn’t mean that it goes away. And in the mist of a flare up, do you really THINK I am going to go through a packet of 30 odd pages to find relief? Thirdly, not all therapists are trained in cognitive behavior therapy. There is only ONE psychologist that I know in the Boston area that is specialized in pain, let alone trying to find a CBT therapist. You have to seriously try and find out if they do this specialized therapy. But there lies the rub that if you are suicidal, like I am, you could be denied this treatment.

I understand there are many deaths from overdoses due to opioid medications and that is a sad fact that I am not trying to minimize. But denying these life saving drugs to patients and telling them to go to therapy to cope is negligent and harmful as well as may lead to MORE suicides. New York state recently is denying up to 10,000 patients pain medication/treatment because the doctor treating them is indicted for charges that I don’t know about. My friend is one of his patients and she is screwed because a pediatrician has stated that anyone that gives pain meds to these patients will be drummed up on charges. Three patients have died by suicide since this has happened. And that is only the ones we know about.

In my response to the article, which I publicly made at my own risk, I asked, how many deaths do you want? Try suicides. I have been afraid of admitting being a chronic pain patient because I am frightened that the DEA will charge through my door, though I do not abuse, sell, or misuse my medication. I barely take the 4 pills a day that I am allowed to take because sometimes I just am not in that much pain that day. Other days, I am taking it around the clock to ease my pain. And guess what, it works for my pain in combination with the other meds that I take.

The preface of this whole article was the death of Prince. But it still has not been discovered, least to my knowledge as of yet, that what he was taking was prescribed or illicit. If anything, Fentynal is a dangerous drug when used with other opioids. I had a friend’s neighbor die of an overdose with this medication. There were other circumstances surrounding her death, such as seeing other providers who had no clue she was taking other pain medications. Now there are network of pharmacies that are cracking down on this practice. I only use one pharmacy for ALL my meds because of convenience. I also see one provider for my medication in their respective specialties. I don’t see my PCP’s NP for my psych meds nor do I see my psychiatrist for my blood pressure meds. That is just silly.

This article had me so upset that I was almost to the point of being suicidally paranoid. I was developing a delusion that my pain meds were going to be taken away from me and if that ever is the case, the doctor will have to sign my death certificate. I will die by suicide and I don’t need medications to complete it. I am in therapy. It is more psychodynamic than another specialized modality. It is what keeps me sane at times. But the threat of losing my pain medication is real. If I am ever forced to stop my medication and be subjected to therapy other than what I am already in, I will kill myself. The pain is just too great, too torturous. And I won’t have a piece of paper telling me to cope with the pain when a pill can do just fine.

Twitter Rant: CAMS and Suicide

I wrote this at 0400 today. excuse the hashtags

Twitter rant CAMS and Suicide

I wonder if there will ever come a day when there isn’t a hierarchical relationship between client and clinician in the matters of #suicide. That clinician and client work together to deal with #suicide and all that it portends, without judgement, stigma, or fear. These are the musings I have at this hour. Anyone can be trained for suicide prevention but do they go with that training or own prejudices. I have seen that changing clinicians’ minds about how they deal with #suicide training doesn’t change their perception of it. The old stigma of “they’re going to do it anyways” so why bother helping them is prevalent. If it doesn’t change their perception of #suicide, why then bother spending hundreds of dollars for training if you aren’t going to use it?? Case in point, at the Menninger clinic, they had a CAMS study where the authors noted the clinicians resistance to this easy framework. Again, it was hierarchical, the clinician knows best, the client knows nothing, This truly needs to change if we are to prevent #suicides. CAMS was designed to work with all disciplines (SW, PhD, PsyD, MD, etc.) Yet these clinicians had their biases & stigma preventing an open mind. CAMS is unlike any other theory, is quick to learn, and has less paperwork. Along with the SSF, it really help deal with #suicidal clients. I might be biased for CAMS only because it saved my life and I think it is the most superior #suicide assessment out there. Here is my blog about #CAMS. #CAMS is also NOT a replacement or new treatment but a theory that working collaboratively helps someone who is #suicidal. my musings started when a therapist was complaining about the use of the CBT paperwork and stayed away from it in her practice. As a patient, I can totally understand why the CBT paperwork is so daunting. I never liked it and don’t think it is helpful but others have found it helpful. And you have the CBT nuts that swear by it. I just wonder if it is because that is all that they were trained to be like DBT therapists. You don’t have to change disciplines to work with #CAMS, after the assessments, the client will need that discipline for treatment. I still would love to replicate the study in the Boston area about therapists and their attitudes toward suicide and training. Final thoughts are that #suicide training is under utilized in this country and not mandated. when is that going to change??

Article Review: Working with Suicidal Clients

Article Review: Working with Suicidal Clients

I have to say that this article was not what I expected. It was an overview to the special issue the journal Cognitive and Behavioral Practice was having. The authors of the article described briefly what each article was about, which left me looking for more articles to add to my collection. But the take away message was that suicidal clients are to be treated as individuals and not as a “one size fits all” treatment modality.

Cognitive therapy has been moving up in the suicide chain as being helpful to suicide clients (Jobes, 2015 presentation AAS). DBT is also as it has helped a lot of clients with borderline personality disorder.

I found it interesting that there was a safety planning section. I googled it to try and learn more and there was a website for it. I downloaded the form as well as the training manual. It might come in useful in my therapy. I didn’t need the article to get to the form. It is similar to many other planning tools used by cognitive therapists. The thing I don’t like about it is that it is a sheet of paper that can get lost or misplaced. It also has the potential of not being used if the client is not near the paper when a crisis is at hand (e.g., at school versus at home). The author for the brief article has stated that therapists are slowly moving away from “no harm” contracts and moving toward safety planning. The reason being that “no harm” contracts have not been shown to be effective and may increase the likelihood of suicide. Also, simply making a promise not to kill yourself doesn’t really hold up well legally.

Ellis, T.E. and Goldston, David B. Working with Suicidal Clients: Not Business as Usual. Cognitive and Behavioral Practice (2012) 19: 205-208