Mullygrubs

That’s what a dear friend of mine calls an ugly cold or stomach bug. Mullygrubs. Fitting, don’t you think? Well, maybe you have to be there. I am.

Late in the afternoon yesterday I started feeling urgh. By early evening I was spending a fair amount of “quality time” in the bathroom, so I gave up the fight and went to bed at 8:30 p.m. I thought I’d never sleep the night through — and I didn’t. My mullygrubby tum forced me up twice in the night, but I slept soundly in between. I finally woke at 7:30 this morning. I believe that’s a Wren-record for hours in bed, completely dead to the world.

For a few minutes after I got up I thought I was over the ‘grubs, but … no. So I’m making myself eat a slice of dry toast and a boiled egg. No, it really doesn’t sound very good to me, either, but the egg is packed with protein and the toast shouldn’t cause much in the way of more nausea. Maybe it will even soak up random mullygrubs, neutralizing them.  I can hope, can’t I?

I also hope this is just a 24-hour sort of bug, and that I’ll be feeling normal again before tonight. I don’t get sick very often; I’m not a very patient patient. I’m used to coping with rheuma pain; in fact, unless it’s really nasty pain, I just bull on through it, doing as much as I can manage and not worrying too much about what I can’t. But nausea just knocks me on my butt. Always has.

So here are my plans for the day: _____________. That’s right. None. I’m not going out unless I have to. I’m going back to bed with my Kindle and the cat (who thinks this whole thing is just wonderful and has been sticking to me like Velcro). My hands and wrists are still giving me the what-for, so they’re sheathed in Thermagloves and wrist supports, and, if I can muster up the oomph, I’ll give that new TENS unit a little workout after a while.

Agh, The loo’s calling my name. Later, alligator!

Yet another positive appointment

I just got home from my fourth rheuma-related appointment this week. Each has been, fortunately, positive. Monday was the occupational therapist. Tuesday was acupuncture paperwork day. Wednesday was the actual acpununcture session, which left me with very sore, swollen hands today, particularly my right.

This morning, my physical therapist coached me on how to use a TENS (Transcutaneous Electrical Nerve Stimulation) unit. What an interesting device! Dorrie showed me how it worked and had me try it on my right hand while I was at her office. What a strange sensation that is — it feels both good and bad at the same time. She send it home with me.

There are two theories as to how and why it works, she said. The first is that it opens “gateways” to the brain’s pain centers and gives it something other than pain to concentrate on — in this case, weak pulses of electricity. The other is that the electrical sensations stimulate the brain to release endorphins, the body’s “feel good” hormones. It’s entirely possible that both theories work together to bring pain relief.

It occurs to me that this is really very similar to acupuncture, which also seeks to open “gateways” along the body’s “meridian lines,” which also ultimately end up in the brain. Acupuncture may also stimulate the release of endorphins.

Both methods of pain relief seem to work for some people  to varying degrees. Some people don’t respond to either one. But I’m happy to try them both. If they work, they’ll be much better than taking narcotic pain meds or steriods, which can relieve pain but have very definite drawbacks. The good thing about acupuncture and TENS is that neither is addictive and neither  has any adverse side-effects.

So, I’m smiling today. And on Saturday, I’ll be seeing my rheumatologist again. It’s been a busy week!

I always loved hedgehogs, Part 2

So. What is acupuncture? Does it work? Or is it just another hoax designed to separate hopeful rubes from their money?

Acupuncture is, according to Wikepedia, “the procedure of inserting and manipulating fileform (cylindrical, filament-like) needles into various points on the body to relieve pain or for therapeutic purposes. The word “acupuncture” comes from the Latin acus, ‘needle’ and pungere, ‘to prick.’”

Also from Wiki: “According to traditional Chinese medicine, acupuncture points (on the human body) are situated on meridians along which qi (or ‘chi’) (a “life energy”) flows.”

Does acupuncture work? One practioner, Bill Reddy of the American Association of Acupuncture, opines on the website Opposing Views (http://www.opposingviews.com/questions/does-acupuncture-work) that “1.3 billion Chinese are hard to argue with. The system of healing would not last over 5000 years if it weren’t effective.”

Arguing against acupuncture’s efficacy is Steven Novella, MD, a member of the New England Skeptics Society. “Proponents often cite acupuncture’s ancient heritage as a virtue, but I see it as a vice. Acupuncture was developed in a pre-scientific culture, before anything significant was understand about biology, the normal functioning of the human body, or disease pathology. The healing practices of the time were part of what is called philosophy-based medicine, to be distinguished from modern science-based medicine. Philosophy-based systems began with a set of ideas about health and illness and based their treatments on those ideas. The underlying assumptions and the practices derived from them were never subjected to controlled observation or anything that can reasonably be called a scientific process.”

Yet according to the NIH consensus statement on acupuncture (http://consensus.nih.gov/1997/1997Acupuncture107html.htm ), “Many studies in animals and humans have demonstrated that acupuncture can cause multiple biological responses. These responses can occur locally, i.e., at or close to the site of application, or at a distance, mediated mainly by sensory neurons to many structures within the central nervous system. This can lead to activation of pathways affecting various physiological systems in the brain as well as in the periphery. A focus of attention has been the role of endogenous opioids in acupuncture analgesia. Considerable evidence supports the claim that opioid peptides are released during acupuncture and that the analgesic effects of acupuncture are at least partially explained by their actions. That opioid antagonists such as naloxone reverse the analgesic effects of acupuncture further strengthens this hypothesis. Stimulation by acupuncture may also activate the hypothalamus and the pituitary gland, resulting in a broad spectrum of systemic effects. Alteration in the secretion of neurotransmitters and neurohormones and changes in the regulation of blood flow, both centrally and peripherally, have been documented. There is also evidence of alterations in immune functions produced by acupuncture. Which of these and other physiological changes mediate clinical effects is at present unclear.” (my emphasis)

So the answer to the question “does it work?” is rather amorphous. Since it seems that stimulating acupuncture points does cause the release of beneficial, analgesic-like chemicals in the brain, one could argue that it does – or at least, that it can. And yet it seems there have been no conclusive studies thus far, so even the U.S National Institutes of Health would rather not give acupuncture a strong thumbs-up or thumbs-down. Yet they do encourage its practice for the relief of pain and for therapeutic purposes.

My first experience with acupuncture – an unplanned, rather spontaneous event – was very positive. I can say without hesitation that yes, for me it worked. I’m not really the woo-woo type, so I started out skeptical. I was interested in it and intrigued by its claims, but I put acupuncture on the same woo-woo list as crystals, dream catchers and faith healing. By the time I left the acupuncturist’s office, it was off that list.

My second experience was today, roughly 15 years later. Did it work? The jury is still out. It was quite different from the first. My acupuncturist, Adina, practices “community acupuncture,” which places patients in a group room and allows her to treat several people at once, rather than one at a time. She charges clients for her expertise on a sliding scale between $15 to $40, rather than a higher, single price for one-on-one sessions. What her clients pay for each session is up to them – basically, it’s whatever they can afford. Here’s the link to her website.

It was reading about this relatively new way of offering acupuncture to the public over at sarahketurah’s Gentle Hugs Café blog – she wrote about her experience with a local acupuncturist – and that got me interested in trying it again. While I would have liked to continue acupuncture treatments after my first experience, the cost, at $60 per session, was prohibitive for a small-town journalist like myself. The acupuncturist back then explained that the effects of the technique built over time, so I’d have better results if I could take treatments at least once a week for a period of time. Unfortunately, my medical insurance didn’t cover acupuncture and I simply couldn’t afford it.

Now, with rates as reasonable as these, I can. Adina welcomed me with a smile and led me to her treatment room, where there were four comfortable, reclining chaise lounges. Understated Chinese and Buddhist decorations and statuettes gave the room a serene ambiance. Soothing music issued quietly from a small CD player. She explained that for this first treatment, she wanted to be conservative and use a small number of needles at various points on my hands, lower arms, calves and feet. “We’ll see how this first session goes and how your body reacts, and then in later sessions we’ll make changes as necessary.”

I had no objection to that. I’d worn a T-shirt to make access to my hands and lower arms easy, so now I took off my shoes and socks, pushed my pants legs up to my knees, and sat down on one of the lounges. Adina put a soft pillow on my lap to rest my hands on. The room was pleasantly warm. She took a small tray filled with acupuncture needles, each one in a sterile, protective sleeve, from a table and knelt down next to me.

“This shouldn’t hurt, or if it does, only a very little,” she said, “but everyone has different tolerance levels for pain. If it hurts, please tell me. I can try a different spot or manipulate the needle to lessen any discomfort.”

She got started. There seems to be a difference in the manner in which the practitioners insert the needles. My first acupuncturist sort of “tapped” the needles into my skin – meaning that I also felt a light pat from his fingers at the same moment the needle penetrated. I believe the “pat” was what I registered as a sensation, rather than the small sting of the needle, and so it was painless. Adina, on the other hand, just placed the needles, no accompanying pat. She was very confident and very gentle, but this time there was a little discomfort. Nothing awful – there was perhaps one needle that stung and even ached a little for awhile. After that, nothing. The rest were just tiny stings that faded almost instantly.

I ended up with seven needles in various places on the top of my right hand and one on the top of my forearm, near the elbow; and five in the top of my left hand and one in the top of that forearm. Another needle was inserted in each calf near my knees, and then four (I think, because I couldn’t see down there) in various spots on both feet. As I said before, only one of the needles continued to hurt past the initial, tiny sting. It was the one that was placed on the large knuckle joint of my right index finger, but it didn’t hurt enough to make me ask her to remove or reposition it. When I mentioned it, she said it might be because the knuckles on that hand were tender and swollen – and indeed, they were.

Another difference was that the first acupuncturist had continued to manipulate the needles after they were placed, twisting them very lightly now and then. He also connected a couple of the ones in my feet to a machine that sent very, very light electrical pulses through the needles. Again, painless. There was almost no sensation. Adina didn’t do either, but she did tell me she was being conservative for this first session.

Once all the needles were placed, she made sure I was comfortable – I was – encouraged me to relax, and left the room. I listened to the music. Closed my eyes. Decided to try meditating. Gazed at the needles sticking out of my hands and felt very calm. None of them hurt. I was even a little bored.

A few minutes later she came back in with another patient, an older woman. A. got her comfortable in one of the other lounges and went about placing needles, whispering to her client as she did. I closed my eyes again, not wanting to intrude on their privacy. She left again.

When she returned, she came over and crouched next to me. “How are you doing?”

“I’m fine.”

“It’s been about 40 minutes,” she whispered. “Can you go a little longer?”

 I was surprised it had been that long. It surely didn’t seem like it. “Sure,” I said.

She gave me a big smile. “I’ll be back in a little while.”

And then it was over. Adina removed all the needles. It was painless. I put my socks and shoes back on and followed her back out to the lobby. The clock on the wall showed that an hour had passed since I’d arrived, and frankly, I was a little disconcerted. I’m sure I didn’t sleep – I had during that first, long-ago session, in spite of myself. But perhaps I did this time, too. How odd. I felt like time had folded in on itself.

She asked how my hands were.

“They’re a little sore,” I said. It was true; since she’d removed the needles, the old ache was back. “Maybe even a little worse.”

She nodded. “That does happen sometimes. Sometimes people have an increase in symptoms for several hours, even up to a day or two. That’s why we like to have you come back – the treatments are cumulative, over time. And eventually you should notice an improvement.”

This went along with what I’d read recently, so it wasn’t unexpected. Naturally I’d hoped that I’d walk out with the same or better results than before, but I wasn’t disappointed.

I thanked Adina, paid her for the session, made another appointment for early next week, and went on my way. Since I’ve been home, my hands have continued to be sore and sensitive, but not any worse than most other days. My right hand is considerably more red and swollen than the left. The needles in my feet and calves seemed to have no effect at all; it’s as if they weren’t even inserted there. And none of the needles left any mark at all on my skin.

I experienced no euphoria today. No lightheadedness. Is acupuncture a hoax? While I’m sure there are unscrupulous practioners out there, I don’t think so. I believe that like many treatments for RA in both Western and alternative medicine, acupuncture may be helpful to some people and not to others. It’s an individual thing.

Finally, will acupuncture successfully lessen my pain? I don’t know. Time will tell. But I have no qualms at all about continuing it long enough to give it a sporting chance. It was a pleasant, very relaxing hour out of my day, and even if that’s all I get out of it, I’ll be happy. If acupuncture does, indeed, reduce the amount of pain I feel from day to day in my wrists and hands, I’ll be ecstatic. I’d much rather be stuck with needles than take pain medications anyday.

And that’s saying something.

I always loved hedgehogs …

Acupuncture models

… now I get to look like one. Sort of.

I’m leaving in a few hours for an appointment with an acupuncturist, hoping that this alternative treatment will help to alleviate some of the rheuma pain I’m experiencing in my hands and wrists.

I believe that it will, although I know that it isn’t a cure. Years ago I did a story on a local acupuncturist in our small, rural town. He was the first the area had ever had, and acupuncture was exotic enough to warrant a story in the local newspaper.

On the day of the interview my hands and feet were hurting me. A medium-sized flare — I was mobile, I was working, but the pain was ever-present. I was very curious about acupuncture, of course. I wondered if it might work for rheumatoid arthritis, whether it was affordable, and whether it hurt. The idea of having someone stick needles in me was shudder-worthy, however. I’ve never had a phobia of needles like some people have, but it still didn’t sound like it could be in the least bit pleasant. And the whole thing seemed a bit woo-woo, if you know what I mean.

A local chiropractor was sharing his office with the new acupuncturist, a Chinese man who had little English. So for the first half-hour of the interview, I spoke mainly to the chiro, who was well-informed about acupuncture and who could explain, in laymens terms, what it involved and who could conjecture as to why it worked. I also spoke with the acupuncturist’s wife, a sweet, round lady who acted as his assistant and who could speak considerably more English. Once I had enough information, they invited me back to his treatment room so I could see the needles and other equipment.

As we walked back there, the acupuncturist said something to his wife. She turned to me and asked if I was in pain — they’d both noticed that I was limping. “Yes,” I said, a little embarrassed. “I have rheumatoid arthritis.” I shrugged. “My hands and feet are flared up today. It’s not bad, though.”

She translated this. Her husband smiled. “You?” he said. “You want to try?”

I looked at the photographer that had come with me. She grinned. “Great pictures,” she said. The chiropractor chimed in. “Do it!” he urged. “What a great way to learn about it! It could help, you know. And it doesn’t hurt. Really.”

Wow. The things I’ll do for a story … “All right, then. Yes.” I was a little scared; needles! Sticking in me! Needles!

Well, I’m here today to tell you that I lived through the experience. Just as the chiro said, it didn’t hurt. Not even a little. In fact, the whole thing was so relaxing that I actually dozed off on the table with those thin, threadlike needles sticking out of my hands and feet. The photographer got some great photos.

And when I left, my pain had been reduced to about 30 percent of what it had been when I walked in. In addition, I felt wonderful. Almost euphoric. It’s a good thing the photographer was driving that day.

I would have liked to become a regular client to the town’s new acupuncturist, but the cost was prohibitive and my medical insurance didn’t cover it. Still, I never forgot that experience. It was the only time anything other than narcotic painkillers ever relieved the pain of a rheuma flare. I was deeply, deeply impressed. And of course, I wrote a nice story for the paper. I hope it brought the acupuncturist and his wife a decent living.

So. I have to get ready to go to this new acupuncturist and try it again. I’ll report back with results, I promise!

A helping hand

I had an appointment this morning with an occupational therapist at the VA, referred by the physical therapist I’d seen a few weeks ago. I came away from today’s appointment both pleased and thoughtful.

The appointment was focused on my hands and wrists, since that’s where I’m having the most trouble. Jennifer was friendly and welcoming; this has been my experience, almost without exception, since I first started getting my medical care through the VA. We hear all kinds of terrible things about universal health care – about having to wait months for appointments, possibly years for elective surgery, and (as my Mom warned me the other day) about  indifferent, on-the-cheap care that might do little good and perhaps some great wrongs. Mom watches Fox News religiously; sadly, she’s been convinced that health care reform will lead to, at the best, poor quality care for everyone and, at the worst, wicked socialism for America.

This, however, has not been my experience with the VA.

Jennifer the OT spent an hour with me, showing me ways to do things around the house and in the kitchen that will help me use the joints in my hands, fingers and wrists more gently. Ways that will, hopefully, help me to maintain the integrity of my hands as time passes.

Fortunately, I have little deformation thus far. I cannot curl the fingers of my right hand into a tight fist anymore, and my ring finger on that hand is beginning to sway to the right just a bit. I still have a decent grip in both hands when they’re not terribly sore.

But Jennifer said she was glad that I’d come to see her now, before my hands get bad. “You wouldn’t believe the number of older people I see whose hands are terribly deformed and weak,” she said. “I work with them and teach them ways to be more comfortable, and to be more safe, but I wish they could have come to me sooner. Maybe they wouldn’t be quite so disabled now.”

She pulled out a catalog – North Coast’s Functional Solutions – and went through it with me, pointing out the many kitchen implements and gadgets, redesigned for people with arthritis, that are available for purchase. Then she excused herself, saying she’d be back in a couple of minutes.

Some of what she taught and showed me I’ve either learned on my own the hard way or I’ve read about over the last year or so. Things like using both hands to pick things up; using the palm or the back of my hand or forearm to close drawers and cupboards; tying loops of cloth or yarn to drawer pulls and the refrigerator door so that I can slip my hand through and pull them open with my arm, rather than with my hand.

But there were some things I’d never thought of, so it was good to learn about them. While she was out of her office I browsed through the catalog, noting the high prices with a sinking heart. Well, some of these things, I thought, I might be able to budget for. A lot of them, though, not so much.

Jennifer returned with a an Oxo jar opener. A knife, fork and spoon with thick rubber handles. A buttoner-thingy, for times when my fingers are too stiff and sore to button a jacket or jeans or a shirt.

“You can take these with you today,” she said with a big smile. “Even when you’re not hurting, try to use them, because they’ll reduce the everyday stress on your joints. Now, let’s check out that catalog and see if there are others things you can use. There’s a limit, but we can order some of them for you through the VA.”

My mouth dropped open. “REALLY?”

She nodded and opened the catalog to the kitchen section. “Do you cook a lot?”

I said that I do. In fact, I love to cook, but it has become a much more difficult chore now that I’m fighting painful, stiff hands most of the time. So she suggested a chef’s knife with an upright handle; a cutting board with spikes sticking up that help hold a vegetable in place for slicing; and a rocking chopping blade. And she showed me how to stir a pot using my whole arm, rather than my wrist, and ordered a fat holder I can put on a long spoon.

And then, for other parts of daily life: a set of fat, easy-to-grasp holders for keys. Little thingies to put on lamp knobs to make them larger and easier to twist. A hair brush with a 22-inch handle for those times when my shoulders flare and I can’t raise my arms very high.

Finally, she suggested that along with my Thermagloves, I should wear soft wrist-and-thumb splints. “Wear them all the time,” she said. “That way, your joints are kept warm and protected, and just having them on will remind you to be careful.” She ordered those for me, too.

Then she told me what a pleasure it was to work with me. “You’re so open!” she said. “So many of my patients are so negative. They think that they don’t need to do things differently, and they’re resistant to change. But really, I think it’s all a matter of attitude. You get out of OT and PT what you put into it, and a good attitude really makes a difference.”

I agreed. Mr Wren is one of those people who goes to the VA for his health care with a negative attitude. For years, he’d come home after appointments there, telling me how this went wrong, or that doctor was stupid, or how his records were misplaced or how he had to wait for hours, and how rude the doctors and nurses were. So when I decided to apply for VA health care myself after being laid off and losing my health insurance, I did so with some some trepidation. Still, I figured even if it wasn’t very good, VA health care sure would be better than no health care at all.

But you know, it’s almost like we’re going to two different places. I’ve had very few problems. And while I’ve had to wait for some appointments, like this one with Jennifer, and PT, and an upcoming eye appointment, none of them has been for something that I couldn’t wait a couple of months for. If I need immediate care, they have an urgent care center attached to their emergency room. Sure, I’ll have to sit and wait if I don’t have a life-threatening problem. That’s just fine. The point is that if I need to see a doctor urgently, I can.

As I was leaving, Jennifer handed me the things she’d gathered for me, along with a copy of the catalog to take home, and her card. “If you have questions, call me,” she said. And then, with a little grin and a tip of her head, she said, “welcome to universal health care.”

I’ve said it before and I’ll say it again: If the care I’ve received at the VA Medical Center in Sacramento is “universal health care,” then I’m all for it. Sure, it’s not perfect. And there are definitely a lot of VA facilities across America that need to be renovated, upgraded and better staffed. But that’s happening, slowly, under the Obama administration. We could do a lot worse than to look to the VA as a working model of health care that could be available to all Americans who need it.