oh my blood pressure!

Oh my blood pressure!

I had about 4 hours of sleep last night. I just couldn’t sleep. My brain couldn’t turn off and then pain started. I couldn’t get comfortable. I was talking to one of my British friends and she was telling me about strong tea. She gave me the brand she uses and in my Painsomnia state, I ordered it. I have been making a lot of purchases while I am up all night. I told my psychiatrist and she said that if my spending got out of hand, to let her know. I said I would.

I had six shots of espresso and that wasn’t a good idea for my appts as I was kind of jittery. My emotions were all over the place because I didn’t sleep. I lost track of when I was supposed to take my pain meds so was late by the time I got home. I saw my psychiatrist and all I did was cry out of frustration. She read the notes from the pain doc and it said what I told her. She encouraged me to collaborate with the pain doc. So I settled down and said I was going to try. That was the plan. Should have worked, right?? Yea, like a snowball in hell!

I met with this fellow that I swear is stalking me. Nearly every new appt I have had the last few months, he has been there. Today he was the fellow I saw before the attending. We chatted for a bit and then he went to get the attending. I told him I wanted to be put on methadone before leaving. He said he would relay the message. The attending comes in and said he had a long conversation with my PCP about what to do. Now it becomes a three ringed circus, because these two doc (pain and pcp) will collaborate with my psychiatrist before deciding on what to do. WTF!! I asked what I was to do in the meantime. He didn’t say anything. He did say that if I had continued bone pain, to let my PCP know so he could order a bone scan to check for a bone infection. I have been having this pain for more than a year. I had a bone scan in November that didn’t say a thing about infection. I am so fucking pissed. I am done. I was speechless. As I walked to the train station, I put on Pearl Jam and listened to it LOUD.

My psych wanted me to let her know how the appt went. I told her I would page her when I got home. I emailed her because I was watching the game and didn’t feel like talking. I came home, made dinner as I watched the ball game, tweeted or posted on Facebook on the plays. I was so exhausted. I still am. I feel so lifeless. I have decided to put my plan into motion. Monday I will be making some phone calls. Soon as I have my affairs in order, I plan on going through with my plan.

Pity Party

Pity Party

I rarely have pity parties. But tonight, something embarrassing happened to me that has been happening for a while and it just hit the wrong nerve. It depressed me because despite recovering from cauda equina syndrome (CES), not once but twice, I was ultimately disabled because of CRPS and chronic pain. Whether CES had a hand in it, I don’t know. It is doubtful as my last surgery was four years before my injury, a sprained ankle that was caused by intense spasms of my foot and ankle. That surgery was higher up the spine than my first surgery so I am not sure it affected my ankle and foot. There are a lot of what ifs, and I was pondering them today. Then the embarrassing incident happened and it hit me in the gut.

I can’t do much over what I have been dealt. I try to move on as best I can despite horrible pain. I am grateful my hands and upper extremities are not affected by pain. I don’t know what I would do if I couldn’t write anymore. I know there are speech to text things but I like the feel of pen on paper or the keys of the keyboard. I have my outlet with my blog to talk about how crappy the pain is and how it brings on my suicidality.

I was talking to my voices today, as I often do. We were discussing the use of testosterone and the effects of what they would do to me. That is if I don’t kill myself when I plan on it, which is soon. It all depends on how next week goes. I am nervous about it. I have even thought about assisted suicide, which may mean leaving the state and going to Oregon where it is legal there. It might take me a few months to save up for it, but what the hell. I can’t seem to get it right on my own. If a doc can prescribe me something to end it, that will help me. I don’t want to be in this level of pain or worse as I get older. It’s bad enough that just making my bed hurts. Making breakfast should not cause pain and I’m not talking something fancy, just making scrambled eggs and toast is a chore. I wanted to go to Starbucks today but my back was too painful because of the shitty weather, which is going to continue until tomorrow afternoon/evening. I’ll probably be in pain the rest of the week, more than my usual pain.

Right now my foot feels like it is being crushed. I’ve had to take my strong pain pill to quiet it down. That was an hour ago and I am still hurting. I am so frustrated that I have to wait for meds to work. Sometimes it’s 45 minutes. Others, up to two hours. I play with the Neurontin dose because I don’t want to be foggy the next day. I’ll take anywhere from 600 mg to 1200 mg a night. Some nights I don’t need it. It all depends. But when I flare, all the guns need firing. Pain today has been mostly in my foot. But my ankle hurt briefly. It piggybacks going up and down, from foot to ankle and back again. Sometimes it is the same pain, sometimes it’s a different pain in the different area of my foot or ankle. I never know what kind of pain I will get. The bone pain is the worse because that is harder to treat. It can be my malleolus or the metatarsals. And is always severe, like can’t move at all severe. I wish there was just one pill I could take for all of the CRPS pain. But there isn’t. And then there is an MGH resident that says opioids don’t work on pain at all. I like him to have CRPS. The meds might not take away my pain 100% but it brings it to a bearable level and that is all I need. Lately my pain has been rampant, a 7 or higher. Used to be a 6, now a 7 is my new “normal”. Before then, it was a 3. That was at least two years ago, maybe? What happens when my pain is a 10 every day? I probably won’t be alive to know. I hope so, anyway.

My Thoughts on Zero Suicide as a Person with Lived Experience

My thoughts about Zero Suicide as a person with Lived Experience

There has been a lot of talk on Twitter about Zero Suicide and it’s mission to reduce the suicide rate to zero, because 1 is just too many. At first, I was appalled that clinicians think that is possible. I for one think that it is outrageous because there is always going to be someone who dies by suicide. Maybe not in their organization but outside their organization. But then I learned that it’s not an individual’s practice but an organization or health system that strives to achieve this goal. They have trainings and meeting with those in the suicidology world.

Something kept bugging me about this. I kept quiet because I didn’t want to anger those that are for it, though I think there are a few blogs that I wrote about it before I understood the mission. While talking to a friend that is a suicide loss survivor, the bells went off. She said that it goes against Shneidman’s questions, where do you hurt and how can I help?

I am a big supporter of Dr. David Jobes work with his framework called CAMS (Collaborating, Assessment, and Management of Suicidality). I don’t know if Dr. Jobes trains these Zero Suicide clinicians. And even if they are trained, I am not sure it will be used. Most clinicians have the attitude that their skills on suicide risk are good enough when it could be faulty. Worse, they go through the training yet don’t use what they are taught. That drives me up the wall. Why bother going to a training (unless it’s a mandatory thing) if you aren’t going to take away from it?

I really think CAMS is a tried and true framework to prevent suicide based on my experience of using it in my former therapy. I also used the Suicide Status Form. Unfortunately, my therapist did not want training in CAMS and we drifted apart, thus ending our relationship. We did, while we worked together, use the initial and tracking forms but unfortunately, we never got to the outcome form. She wasn’t committed enough to see it through and that kind of pissed me off. Every time I had a suicidal episode, she just wanted to know one question on the form, The one thing that would help me no longer feel suicidal. It is an open ended statement where the client fills in their thoughts on the matter. Unfortunately, I could never come up with a satisfactory answer as I really didn’t know the reason for my suicidality. I just wanted to die and that was that. I wrote a blog about CAMS if you would like more information about how it is formed and the use of the Suicide Status Form.

I went on the website for Zero Suicide but could not seem to find the specific training that they went through. From what I gathered on Twitter from their live tweets, some of it is CAMS and some of it is using risk factors for suicide. Unfortunately, risk factors alone are not predictive of a suicide attempt. CBT has been useful in reducing suicide attempts but not all clinicians are trained in this modality. The book by Craig Bryan on CBT for preventing suicide attempts is a good book to learn more about it. I also wrote a review on the book that you can see here.
The other thing that gets me is that no where among Zero Suicide is there talk of a person’s psychological pain. There are measures, if you look for it. Dr. Holden at Queen University in Canada has created a scale to measure what Dr. Shneidman calls psychache. See my review on the research article for more information. I think it is a good psychometric to gauge a person’s level of suicidality and pain, which ultimately leads to thoughts of suicide. This must be included in any talk of preventing or intervention of suicide and also postvention, should a suicide attempt occur.

My final thoughts of Zero Suicide is that it is a novel idea but as Dr. Shneidman says, “How many suicides do you want, and I say I don’t want any, but I want there to be the freedom to do it. I study suicide but I am not pro-suicide. I’m for suicide prevention.” I share his sentiments. I do not like the talk of “suicide is not an option”. To me, that is hindering free will. I do hope the rate of suicides goes down, but the way that health care and mental health are going, I think there will be more before it lowers, especially among the chronic pain patient population.

Chronic Pain Patients and Suicide

Chronic Pain Patients and Suicide

I was reading my tweets on Twitter. One of the chronic pain people that I follow retweeted something from a pain doctor. It was about suicides and the CDC guidelines that want to cut opioid prescriptions or limited them to only certain doctors. The article was badly editing as there were plenty of typos and I did not like the use of the word “committed” for every suicide he listed. It is sad and I know that more suicides are going to happen as the government tries to control doctors due to basically peer pressure. They have no idea what kind of havoc they are doing to those suffering from chronic pain and lead good lives because their pain is controlled.

Most of you all know I suffer from chronic pain and suicidal thoughts. My only saving grace at times is that I know after taking my meds, even though it takes a while to work, my pain will go away and be better in the morning. My suicidal thoughts will also be better when I wake up. If I no longer have my meds, I am as good as dead. There will be no point in living. I can see what all those people mentioned in the article go through. They died within weeks of being either taken off their meds or having them reduced. Some docs just stopped prescribing out of fear of losing their medical license. Some pain clinics closed their doors, leaving the patients to find other docs to just turn them down and having no where to go. This isn’t right. Taking away pain meds from patients who are not addicted and have adequate control is doing harm and causing deaths by suicide. Here is the article if you want to read it: https://medium.com/@ThomasKlineMD/here-is-a-list-of-suicides-as-of-9-9-17-caused-by-governmental-recommendations-to-educe-opioid-903c460abbc

Sometimes I think I need to end my life before my meds are taken away from me. I don’t know if my state will pressure docs to reduce their opioid prescribing privileges or number of scripts they write a year. I’m not on a lot of pain meds and I don’t abuse what I take. I take my meds in the manner they are prescribed to the letter. The sad thing is, even though my pain is somewhat managed, I still am disabled because I can’t walk that far or stand for any length of time. Just waiting for the bus or standing on the train is enough to cause me wicked bad pain at night. I remember what my pain was like when I was working. I wouldn’t be able to sleep at night and then would only have a few hours to start my next shift. It would be a really long day and then half way through my shift, I would start feeling excruciating pain that would sometimes land me in the ED. It was terrible. I know now that I will never be able to work again because my pain is just becoming unpredictable and too severe. There are some nights where all I can think about is ending my life because the pain is so severe I don’t think it’s ever going to go away or lessen. I am lucky, in a sense, that I can’t walk to where I want to die in these moments. Hell, sometimes I can’t even go to the bathroom.

Living with chronic pain is terrible and if people without a medical degree continue to dictate what a person with a medical degree does with their patients, the suicide rate is going to go up. There is no way it can go down, even with the best suicide prevention out there. There will be no stopping someone from taking their life because of untreated chronic pain. I am not talking about psychache, but I know those with chronic pain also have that too and can contribute to their suicidal thinking. I also know that if a chronic pain patient starts thinking about suicide, they should be referred to a mental health counselor or treatment center. Their pain meds should not be reduced or played with because of suicide risk. I know in my situation I was fortunate to have doctors that knew me well enough and knew that I would get help should my depression or suicidal thoughts got worse. Some patients don’t have that luxury. Always take suicidal thinking seriously. If that person owns a firearm, ask to hold it for them until their suicidal crisis is over. Make sure they get the mental health help they need. Also makes sure their pain is being properly treated or it’s not going to matter if they get that mental health help or not.

If you or someone you know is thinking of suicide please call the National Suicide Hotline at 1-800-273-8255 or text START to 741741, if in the US. Unfortunately, I don’t have access to other countries hotlines but they are available. I know Austrailia has a bunch and the UK has Samaritans 116 123 is their number off the top of my head. You matter and are important and enough, always!

Shneidman’s greatest questions: Where do you hurt and How can I help?

Shneidman’s greatest questions: Where do you hurt and How can I help?

After I had a meltdown in late 2005 and was slowly recovering in 2006, I was taking a psychometrics class at college to earn my psychology degree. Psychometrics is a fancy name for psychological testing and validating tests and assessments on various things. As I was recovering from a deep suicidal depression, I was curious to see if there were any measures on psychological pain in suicide. I wrote my first draft of the term paper with 20 some odd articles all doing various risk assessments and testing of suicide ideation but none of them dealt with psychological pain, which was what I was aiming for.

The professor tore my first draft apart and even, however vaguely, accused me of plagiarism. I wanted to get a good grade in this class because it would help my further advancement in psychology. I went back to the drawing board. I searched for pain and psychological pain in the library databank. About only 5 articles showed up, at the time. I am sure I was doing it wrong. I looked up the articles and found Shneidman and Holden. Dr. Holden was based out of Queen’s University in Canada. He came up with a psychache assessment that I found useful in my therapy. I kept that article and shared it with my therapist. Then I queried everything on Shneidman and hit the jackpot. His work was in psychache, psychological pain. I read everything I could on him and his followers. I saw my idol David Jobes’s early work on the Suicide Status Form. It wasn’t appealing to me at that time. I was more interested in the psychache of the matter.

I read Dr. Shneidman’s book, The Suicidal Mind. Holy crap! This was about “me”. I knew I had to read everything this guy wrote but it measured in the hundreds so I focused on what was available now. I tried to read his books that were solely written by him but they were few and outdated. He wrote many chapters. The two questions that I kept coming across were “where do you hurt” and “How can I help?” No one had ever asked me those questions all my years in therapy. Not even my current therapist at the time asked until I brought it up to her.

These questions were the basis of how he helped suicidal people over his career. He brought them other options for suicide by learning things about their predicament. Then he ranked them in order of importance. As he slowly worked with them, suicide became less of an option on the list, which was good. It didn’t mean their risk of attempting was any lower but they could see that it wasn’t something that had to do right then and there as there were other options. That is what suicide prevention is, finding other solutions to the problems someone is facing other than suicide. Sometimes it works, sometimes it doesn’t. There was a case in which Shneidman talked to a Hispanic male who attempted suicide by gun shot. He blew off half his face and needed multiple surgeries and was in intense pain from his injuries. Dr. Shneidman counseled this man until he was well enough to leave the hospital. They kept in touch but as time went on, the contact got fewer and fewer. The young man died by suicide by that method a few years later. It was a sad case. The importance of the story is that contact is useful even after the initial attempt has passed, be it with postcard or phone calls or text messages. This isn’t an entire protective factor but it can be. Some people who think of suicide and even go to plan it, get through their circumstances never to think about it again. Others make an attempt and it is a kind of “wake up” call and they never think about doing something like that again. Then you have the people that are chronically suicidal, who make multiple attempts. These are the people most at risk of ending their lives by their own hand. It is these people that need the most help and patience. This is where the framework CAMS (Collaborating, Assessment, and Managing Suicidality) comes in handy. Check out their website https://cams-care.com/?pgnc=1