LIVING WITH PAIN: PET THERAPY

The central California sun beat down relentlessly on the parking lot. Most of the curious, and a few buyers confined their excitement to the shade of the awning extended from the pet store out over the sidewalk.

After going to several kennels oohing and awing over the many puppies we came to a kennel with a shaggy frightened puppy described to us over the net as a golden-doodle. He was clearly a rescue dog.

I knelt down in front of the kennel and tried to coax the pup to come to me. He shivered and stretched while eyeing me suspiciously. But after repeated tries he did come forward towards me. I could read the hope and despair in those gold eyes.

I stayed with him for about 10 minutes while my wife stood above us. We disagreed right away. She wanted to take a pass on him as he was too frightened and maybe traumatized. I saw that, too, I thought we could bring him out of that and he’d probably make a wonderful pet.

An hour later driving north through the central valley, Judie was in the back seat with our new shaggy, somewhat leery puppy. We immediately discovered the kennel cough and began ringing up the dollars we’d likely have to spend.

Judie agreed with me to call him Dylan after my favorite 20th century Irish poet, Dylan Thomas, most famous for his poem, “Do not go gentle into the night/ rage, rage against the dying of the light.”

Dylan spent the first month with us under our bed, only to come out to eat, what little he did, and  taken outside 3 or 4 times a day. We had all sorts of medicines we had to feed him to route all the disease pups pick up in the wild. Dylan was found wandering the streets.

From the beginning I felt an unusual draw to Dylan as we quickly fell in love with him. As he began to trust that we weren’t going to abuse him he began to warm to us.

He was a skinny 25 pound 6 month old pup with shaggy light brown fur that covered him from muzzle to tail with gold rings around the black pupils of his haunting eyes. And Dylan was amazingly calm and after warming to us, incredibly loving.

It wasn’t long before I began taking him on my daily 4 mile walks along the water works canals near us. On the trails I would keep up a running patter about whatever entered my mind, a kind of free association a patient engages in during psychoanalysis. The bond between Dylan and I grew ever stronger.

After about six months we recognized that Dylan was really a therapy dog for me. He had the uncanny ability to sense when the pain in my body began to ratchet up. It took me a while to notice, but whenever I began to feel badly, Dylan would stand next to me patiently waiting. It finally occurred to me that he wanted me to pick him up and put him on my lap.

He would lie across my lap and chest with his muzzle buried against my neck and stay in that position for nearly an hour. After a time, it slowly came to me that his presence on my lap gradually diminished the pain that started before he came to stand next to me.

As it became clear how Dylan related to me we obtained the papers and tags designating him a therapy/companion dog for me, including a recommendation from my pain physician.

Shortly after this, we decided to move back to Chicago. In talking with the airline about transporting Dylan we learned that as a Therapy dog we could buy a seat for him on the plane. On the four-hour flight to Chicago from San Francisco, Dylan lay on the center seat between my wife and me with his sleepy head on my lap for the entire trip.

It wasn’t until a month after we moved to downtown Chicago that we began to hear from people on the street about Dylan. Whenever went down the elevator in our high-rise other residents would ask us about him while fawning all over him. He clearly garnered attention as he seemed like “every” dog, a compilation of all beloved dogs.

Every few weeks someone, usually an out-of-town tourist, asks me if he or she can take a picture of Dylan. It happens so often we had a hard time understanding what it was about him that attracted such attention.

On my daily walks up the lakefront and through the Gold Coast parents with small children stop me every few blocks asking to pet him. If I’m walking along and hear a small child squeal “doggy” I always stop and let the child and parent pet Dylan. Dylan, for his part stands still and patiently takes in all the petting and admiration as if it is his due.

At night when we tumble in to bed Dylan hops up on the mattress to lie between us. In a way it reminds us of having our young son occasionally sleep with us. For me, his presence for is a combination soporific and analgesic. Like many of us, lying in bed isn’t always pain-free. With Dylan lying next to me and my arm draped over his body, the pain along my spine gradually subsides to the point where I can, with the help of modern chemistry fall asleep.

Over the last 2 years when I’m writing in our spare bedroom, Dylan lies quietly on the on the corner of the bed just off my left shoulder. Every 30 minutes or so, he stands up. reaches out with his right paw and drops it on my shoulder. I’ve learned that he does this when he senses I’ve been sitting at my computer long enough and it’s time for me to take a break and let the pain dial back.

I don’t know how to recommend how to find such a therapy dog other than to advise to follow your heart. If your heart reaches out to the pet, that pet just might be the one.

 

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UNCHECKED PAIN IN THE GAZA STRIP

It is a mind numbing reality throughout the world that there are many countries that do not have, for various reasons, the capacity to treat their citizens suffering from chronic severe pain with the benefit of opioid therapies. This is hard fact of life for many of our fellow sufferers across the globe.

Right now a horrible war is taking place between Israeli soldiers and the fighters of Hamas, the ruling party for Palestinians in the Gaza Strip. I ask readers to put aside  political passions about this conflict and focus with me on the human dimension of this tragic, never-ending conflict.

Most news reports indicate that there have been over 700 deaths of Palestinians and 32 deaths of Israelis in this war. Most of the dead in Gaza are civilians.  More worrisome are the reports of the number of Palestinian children killed in this conflict, now more than 100.

We are faced with a huge number of Palestinians wounded and suffering terrible pain. We can make a guess at that number in that almost all armed conflicts produce far more wounded than killed.

The years long Israeli blockade of Gaza has limited not only suspect building materials, but of most commodities including health care supplies has intensified the suffering of the Palestinians.

Just today, NBC reported an attack on a school housing Palestinians from the war. Bombs detonated there and left behind the dead and wounded including a 6 month old wounded baby. The report showed doctors removing the shrapnel from the baby’s back without any available anesthetics.

Will that child enter the world of chronic pain for which in his country there are few resources for good care?

This paints a humanitarian catastrophe for the Palestinians. The closed border between Gaza and Egypt makes the suffering worse. The military government in Cairo refuses to support the Hamas led government in the Strip as they believe Hamas is equivalent to the Muslim Brotherhood whom the military leaders in Cairo ousted from power.

I am not trying to make a political case for the Palestinians sequestered in the Gaza Strip. The lack of adequate medical care and pain care in particular is widespread throughout the Middle East, South America, Africa, Eastern Europe, Russia and most of Asia.

The plight of the Palestinians echos in the prolonged and ghastly warfare in Syria and Iraq and in Sub Saharan Africa. In these conflicts it is impossible to write only about those who now, and in the future, will suffer the ravages of untreated chronic pain, from the immediate pain suffered by people trapped in these conflicts.

It’s axiomatic that immediate humanitarian medical aid is provided to the thousands upon thousands of victims in these war ravaged parts of the world.

But we need to look beyond the current wars to the future of these countries, to the future of the thousands of people who will be cast into the pit of chronic pain as result of ghastly wounds.

What medical care will be available to these people in pain? It is, I’m afraid, not to difficult to imagine. But for a moment, I’d like all of us who suffer from grinding chronic pain to imagine ourselves as refugees being repatriated to our homes while living with shrapnel wounds, high velocity ammunition wounds, the horrid pain of amputations and all types of neurological pain. Imagine living in such madness with no hope of surcease.

Wars are raging all around the globe daily. Pick up the paper or log onto the internet and chose your horror. The endless ubiquity of it dampens our natural inclination to help those suffering worse than we. The people surviving these wars are foreign to us, across the world and out of sight. We are numb to the suffering of the other .

This begs the question of what to do.

First, we need to acknowledge our commonalities with those who cannot who don’t have the same access to care we have, however flawed it be. We need to see pain care in a broader way, not as a problem confined to us, but an international problem which we all share and have some responsibility to address.

Since this is an enormous problem, I’ll only focus on the continuing disaster in the Gaza Strip. Even this focus has deep and lasting difficulties. Without taking a political stand for or against either side in this conflict, I believe we should respond to the Palestinians who have been and likely will continue in chronic pain.

We need to tell our stories to the United Nations through our representative there. It might be prudent to tell our stories to Doctors Without Borders. It is on us to contact our Representatives and Senators telling them our stories and asking them to press for general medical assistance to the beleaguered Gaza Strip while advocating an emphasis on short and long-term pain care.

I’m not just asking that the Palestinians have access to opioid pain care, but all aspects of good pain care practice.

Finally, I think it would be wise for our pain groups to consider reaching out to the Palestinians through the United Nations. After the conflict comes to an end and rebuilding the Strip begins, contact might be established through the internet. For example, we might try establishing Facebook groups with the Palestinians.

It is well-known that one of the ways we can care for ourselves is by reaching out to others in similar circumstances. I’m not for a second comparing our lives with those around the world forced into refugee camps, but our pain is similar.

Please, let’s join together and reach across the divide. Who know what healing ripple effects` might ensue.

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LIVING WITH PAIN

My latest column can be read @ http://americannewsreport.com/nationalpainreport/living-with-pain-prejudice-and-mistreatment-8824038.html

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This is What “Open Carry” Has Brought Us

Check out this link for an idea of where open carry laws has brought us: http://www.dailykos.com/story/2014/06/17/1307546/-Open-Carry-incidents-at-my-place-of-employment-The-cops-got-involved?detail=email

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LIVING WITH PAIN: THE SEARCH FOR MEANING

My latest column on the search for meaning can be read @ http://americannewsreport.com/nationalpainreport/living-with-pain-the-search-for-meaning-8823972.html

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A RE-IMAGINED LORDS PRAYER FOR OUR DAY

THE ORIGINAL

 

Our father who is in heaven

Hallowed be thy name.

Thy kingdom come

Thy will be done

On earth as it is in heaven.

 

Give us this day our daily bread

And forgive us our tresspasses

As we forgive the tresspasses of other.

And lead us not into temptation

But deliver us from evil

Amen.

 

RE-IMAGINED

 

Our source of love that struggles among us

Hallowed be thy name.

Your love uplifts us all

Thy will be done

Always and everywhere especially to the wounded among of us.

 

Give us this day our daily bread

And forgive us our hate and indifference

As we forgive the same in others.

And lead us not into temptation

But deliver us from the evil of hubris.

Amen.

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Insurance Companies: A Rant

If you, like me, have struggled with a chronic, diabolical medical condition that’s robbed you of the most precious things of your life, requiring you to look for new meaning, new reasons to go on, you, like me, probably thought the medical field was in your corner.

For the most part you wouldn’t be wrong. Yes, there’s a smear of shit to wade through with doctors, medical staff, specialists and all, but the biggest hemorrhoid  in the mix are the health insurance companies.

Yes, I hear the laughter of recognition as you read that last sentence. I know, I’m not saying anything particularly new or creative when speaking of the mother fuckers who own, operate and get fabulously wealthy on the backs of people like us who have to rely on them, but let me, just for a few moments rant about the latest experience I’ve had with these nitwits, and I’m sure the crescendo of recognition and laughter will follow.

To be clear, the experience I’m going to describe has happened repeatedly to me and to others. This isn’t a one-off experience.

But first, let me put this into a familiar frame. Everyone who is in this position along with me knows the drill. You’ve gotten the prescription from your doc, taken it to your local pharmacy, dropped it off, answered all the questions and are then given a date and time to return to pick up said medicines.

After long and bitter experience you know right away that you have a 50-50 chance of getting that much-needed medicine when you return at the promised time. In other words, 50% of the time you’re fucked. The pitfalls: your doc failed to date the prescription; s/he failed to sign the script or enter his/her DEA number. Or, your told that the medicine isn’t in stock and unavailable until early next week, the reasons are legion: but the most maddening is the “Prior Authorization.” Oh, yes, the stab in the back from the insurance industry.

I was just informed by my pharmacist that a medicine I require to stay upright was denied due to the fact that my lovely insurance carrier has changed its formulary. Even though for months they approved my medicine to taken twice daily. Sometime since my last refill they have changed their policy on this particular med to the effect that they will only cover the cost at one dose daily, not two. Did they bother to notify me in a timely manner?

Is this a considered medical call based on the evidence that this med is best effective at one dose daily, instead of the two doses that, by my experience, work best for me? I’m waiting for your laughter to die down. No, no, no. It’s simply a way to put heat on my doc and me to cut back the effective dose so these ass hats can make more money than they would if I take the med twice daily.

Their possible solution?  The tried and true hoop for me and my doc to hop through? Yes, that’s right, children, the PRIOR AUTHORIZATION (PA). This dreaded phrase is the bane of existence to those of us suffering with daily, grinding pain.

PAs don’t just appear over night. No. First the pharmacy has to inform me that the insurance company wants the PA, the pharmacist informs my doc, then I call the doc’s office to make sure the request for the PA is being handled, the doc has to justify in writing why I’m taking the med twice daily. S/he sends the PA request back to the insurance company and some benighted douche bag either denies the request or approves it.

This is harassment. Why you might ask? The answer lies in the fact that I have never, not once had an application for a PA denied. I wonder if anyone has. It is simply an obstacle thrown down in our paths time and again to get us to give up and not take the drug, take it less, take a cheaper less effective med, or, most egregiously, stop taking the medicine altogether.

Hang on, there’s more. The only way you’re notified that your insurance carrier wants you to jump through this hoop is at the point of refill. Yes, there you are, if your like me and take skads of meds daily, you can’t always get your scripts refilled in advance because there are so many to track and we’ve all experienced the keepers of insurance smacking down a refill request if we are even so much as a day early. In reality there is only a small window of opportunity.

So there you are at home after calling into your pharmacy’s automatic phone refill for the meds you are out of or nearly out of when you get the automated call back from your pharmacy later that there is a delay in filling the request as the pharmacy has to contact my insurance carrier for clarification. Your heart sinks as it’s late Friday afternoon and there will be no communication on the needed refill until the following Monday. This is often a disaster.

Here, besides the reprehensible greed of insurance companies, is a small point. With all the high-tech communication at their finger tips, why can’t they install a program that tracks the users of particular meds and send out an email blast to those affected patients:  a PA is required at the very next point that the patient is low on, or out of the medicine. Why create such a cluster-fuck when we are at, or nearly or near the point of running out of the medicine? Why create such anxiety or panic among vulnerable patients?

The answer is, I’m afraid is as apparent as my salty language in this rant–moola, yes, money, always the holy grail. This is nothing more than harassment to keep us from utilizing our insurance thus filling the coffers of the managers and stock holders.

Come the revolution, with Madame DeFarge looking serenely on, the first in the tumbrels headed for the blade and basket will be the insurance executives.

May I pull the lever?

 

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Suicide Bubbles up when Depression Boils Down

Against Hanna’s will, a smile spread unevenly across her features. Gone were the dark clouds surrounding her pale eyes. Her voice was stirring, audible, and she no longer, with ivory knuckles, hugged her knees protectively against her fear, her vulnerability.

Her short hair, newly washed, ruffled under the ersatz spring breezing gently through my open windows next to her. It was after all March in Chicago and the warmth was an impostor wheedling us to lock away our coats, hats: our protection.

I shouldn’t have been afraid of her bolting again from my office for the nearest lethal instrument to end the growing disaster of her despair.

Her winter was lifting. Mine just began.

Her smile spread its inchoate terror through me and I shuddered as if a wild fire pushed by maniacal Santa Anna’s blistered a blackened swath through my heart. I Listened to Hanna’s rising hope, a hope I’d never heard from this young woman before, a hope lifting the dark lethargy strangling her for years, propelling her towards a new…what? I was afraid to know.

All I could see out there was the roiling nimbus of psychosis relentlessly stalking her, an unseen single minded stalker ready to carry her off.

Sounds dramatic, doesn’t it? Although I’ve changed identifying information, the immediacy of her stalker palpably remained, demanding and insistent, outwitting Hanna, laughing at me.

While Hanna didn’t suffer from physical pain, she did suffer the equivalent psychically and emotionally. I had been working with her twice weekly for 3 years and kept preparing myself for her ultimate suicide. I was as infected by her despair as she was. It felt like we were fighting a rear guard action until Hanna found the ignition for hope. Time ran fast and low.

As I sat with her, Hanna became agitated and the agitation grew as she refused to talk with me. After several attempts she bolted up from her chair and ran from my office out into the hall and down to the elevator where I met her. I was surprised by this as she was doing, against odds, much better. I attempted to get her to come back into my office by she met my entreaties with the silence of marble, cold and mute.

Two hours later I got a panicked call from her mother saying that Hana had swallowed the whole bottle of her anti depressants. I then helped her hospitalize her daughter.

This same scene repeated itself several times over the next year. As the year went on with Hana keeping to her schedule to with me I was convinced that she would, after all our efforts went for naught, would finally end her life. It was as if I was mourning her death even as she sat before me.

It took me months to remember an essential piece of working with people in a life or death struggle with psychotic depression. It also took me months to realize that the mourning I felt for her impending death was a reflection of the mourning Hana was experiencing for all the wasted years gobbled up by the depression. She was also mourning a death that had already ocurred in her. The early death of her sane self. The Hanna that briefly flourished before the depression darkened her world and sent her careering from one angry explosion to the next and always followed by a severe attempt on her life.

I had forgotten that many people with severe disturbances often project onto the therapist those things they don’t like thinking or feeling. It was through Hana’s behavior that I felt that her death and my mourning were close at hand. These were things Hanna couldn’t on her own feel or thing.

Her explosive rages had two origins but one trigger. The rage was the hyperattenuated anger that she felt towards the behavior of her family towards her while also representing the anger that people eventually feel as they pass through the mourning process. I was the trigger. If I wasn’t completely attuned to her, or mildly distracted by my body, she would be exquisitely aware of my temporary withdrawal and experience it like the prolong withdrawal as she saw it of her parents.

It was my job to help her figure out the sequence of events with me after the storm and suicidal behavior spent itself. It was the breaks in empathy with me and the healing of the rift with me accepting and explaining my part in the interaction. It was this very process that led to her improvement and then her extended retreat into psychosis.

What I failed to remember, and this is so important in the lives of those of us struggling with the depression and despair of pain, is that as we begin to recover from the lethargy of depression and despair, we see clearly the wreckage of our lives.

What is so lethal about this is that we genuinely begin to mourn while the snarl of the depression and despair is still very audible but now, as unlike before, we have enough energy to kill ourselves.

When someone is in the grip of a major depression, it’s difficult for them to organize themselves to actually commit the act. But when their minds just begin to clear so they can see the damage they’ve left in their wake while their energy begins to return, the actual act of suicide becomes a real possibility.

This is also a part of the process of mourning.

It’s by way of example of Hanna’s struggles that I want to make two points. First, mourning is always a part of depression and the suicidal aspect of that mourning appears often with people suffering major depression. For those in therapy for major depression, this entity that can haunt many of us. It shows itself through urgent suicidal thoughts that intrude on us any time, anywhere.

The second point is that cognitive therapy is proven to be quite helpful. But also helpful are therapists trained in psychoanalysis who know in their bones the process of projection and the power of the therapeutic relationship to bring about change.

Taken together, these two notions can go a long way to helping us recover from the unspeakable power of what Churchill named as the black dog of depression.

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My Assassin. Yours?

Dying leaves scuttle along the sidewalk in front of me as I walk along a Chicago street after dusk.

I’m following me.

The wind is up off the lake. I have on a battered trench coat with the collar pulled high under my swept back crazy hair, like Christopher Walken on a bad trip.

I step up behind me at the mouth of a dark alley and shove my .45 against my spine. My body, surprised, jumps forward but I follow and keep the barrel pressed hotly against my spine. “Turn in here,” I growl.

I say nothing when I ask me what’s going on.

Between two reeking dumpsters I shove my body face first into a grimy brick wall, place the barrel of the .45 against the base of my skull and, KGB style, squeeze the trigger.

In the cordite haze I see the gun lying in the grease next to my right hand. I back out and walk away as a cold mist weeps from the lowering clouds…

I expect readers familiar with me are saying to themselves, “I knew it, Maginn is a fruit loop lying in a puddled gutter.” You might be right, but, please, read on.

I have over the last year lost my stepfather, my dad, my cousin and am waiting for the call to tell me my delightful stepmother, who just after my father’s death is ready to follow him. My mother who just left rehab today after 6 months due to first a broken pelvis then a broken hip, has been recently diagnosed with mid stage dementia. 18 months ago my best friend who I saw several times a week died in his sleep.

It’s been one of those years.

That might make Maginn suicidal, you think. And again, you might be right. But read on.

In the last year my wife and I moved back to our home town of Chicago and as soon as we got here I fell on some unseen ice that drove all of the hardware in my spine-3 plates and 6 bolts, not to mention the battery and wires of a spinal cord stimulator plunged deeply into the surrounding swelling muscles.

It was the worst most sustained pain I’ve ever encountered, which, I’m afraid to say, is quite a statement. For months while I was in and out of the hospital trying to control the pain, I was on an enhanced dose of my usual opioid as well as morphine for breakthrough pain. Some joke, I was in breakthrough pain 24/7.

There was no way to beat the inflammation other than 4 surgeries to remove the technology and hardware. I had two surgeons perform all the surgeries in the ridiculous speed of 75 minutes. I returned home with the miracle of the horrible pain gone. Recovering from the 4 incisions was my only task.

Child’s play, I thought.

During my brief recovery the health of my elders began to plummet out of sight. Anxiety shrouded Judie and me.

Long ago when the pain was at is periodic worst, I sat around when not looking after my young son,  or while writing, I’d pause and think of ways to kill myself that wouldn’t look like the suicide it was. I wanted to make sure my small family got my insurance payout. During the day, in the middle of the night when fugitive sleep abandoned me, I wrote in my journal about the pain and my plans for destroying myself. I could tell myself no matter how bad the pain got, I always had a way out, even if by my own hand.

But I knew better, even then.

Now with the death and dying tour still extant, I’m back where I started. But now I no longer think of killing me.

No, I had something new; I had become my own stalking assassin; I wanted to murder my body and simply walk away, free and clear.

My problem, maybe yours, too, huh?

Here’s the problem with my assassin and I’ve seen it in others as well. When I begin to objectify myself like this over and over the space between the me as assassin and the me as the body my assassin wanted dead, grew. As that gap widened it’s became entirely too easy to see that body as not belonging to me.

This dreadful fantasy can grow into a delusion where the assassin loses touch with the body that is his or hers. That’s, unfortunately, when the assassin loses touch with reality and the murder seems logical. My assassin doesn’t realize he’s killing himself.

What’s happening to me with all the losses and the downturn in my health is the rise of me as my assassin. It’s a delusion. This is an entirely unconscious process that we need help in bringing to the surface to examine.

Suicide isn’t always about despair alone. It’s about holding onto the one way out when things go terribly sideways.

If you start thinking of yourself as an assassin, get help. Preferably with a therapist who knows something of Jungian therapy and symbolism, as well as being, unfortunately, familiar with pain. Cognitive therapy may also be really effective in looking at this delusion that settles on those of us in constant pain.

Still with me? Good.

Don’t let your assassin walk you, unsuspecting, into a dead-end alley.

Most of all, get help sooner than later.

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LIVING WITH PAIN: LIGHT A MATCH TO PUT OUT A FIRE

My latest column on pain and the family can be read @ http://americannewsreport.com/nationalpainreport/living-with-pain-lighting-a-match-to-put-out-a-fire-8823810.html  All comments are welcome.

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