I love being a rural doctor. Here is a great video outlying all the joys of rural medicine.

I have received a query about Suboxone. I will try to answer it according to the rules and regulations I know from the College of Physicians and Surgeons of British Columbia. Other rules and regulations may apply to other Canadian provinces.

I have found Suboxone to be highly effective for many patients who have chronic pain. I tend to offer it if my patients have a history of prior tolerance to opioids, which may make them more likely to use more opioids than prescribed. If patients have a history of alcohol abuse or a strong risk of opioid abuse, then Suboxone is safer. 

The person has to be off opioids for a few days to avoid opioid withdrawal before starting Suboxone. The taste is horrendous to some people, but there are tricks that can make it easier, like eating sour candy before, and then holding a sour candy in your mouth while the tab dissolved. Goodness knows why the company can’t make a better tasting drug. Ew. 

In BC, physicians do not need special licensing to use Suboxone for pain. A short, easy course on the College site will enable any family doctor to prescribe it. It is a shame more doctors don’t use it, but I understand how stressed and overworked most doctors are. It may feel to them like just another burden. Perhaps you could ask your doctor to think about it. I think I spent an hour or two on the course – far quicker than the Methadone4Pain course – but the Methadone course is also very valuable.

The College is encouraging virtual visits and most certainly this drug can be prescribed by means of a virtual visit. Again, your health care provider will have to be contacted. 

I have found that patients using Suboxone and Methadone have often ended up using the tools to cope with chronic pain. Once a patient has found the tools that work for them, they may decrease or even quit the medication. Many of my patients have. Not all of them. I feel strongly that docs need to support patients to achieve the best quality of life they can, and if that means using opioids, then YES!

A shout out to rural docs who practice emergency medicine, obstetrics, anesthetics. I realize how hard they work. Less busy family doctors are in a better position to help their patients with chronic pain. Develop a good relationship with your doctor and then try to convince them to learn about these tools. Spending heaps of time with a patient in the beginning almost always pays in the end with a patient who is a perfect partner in care. Someone who makes my work easier and a pleasure.

Good luck. My heart goes out to you. I have a terrible tolerance for pain which is also one of many reasons I started the website. I thank the universe and spirits out there that so far I am lucky enough not to walk in your shoes. 

Best

Judy

What has happened in Kamloops cannot go by unnoticed and unspoken about. We cannot allow ourselves to forget the trauma we have caused a nation, parents, brothers, sisters, grandparents. We can take responsibility by recognizing the hurt we do by not learning more about systemic racism. Doing nothing is the same as doing hurt.

Colonization of Indigenous People has resulted in trauma affecting generations. Systemic racism is apparent in our institutions and in even well meaning people. Until I started writing 5 years ago, I was unaware of my own white fragility, even prejudice creeping in without me realizing it. Living a life of white privilege often blinds us to the micro and macro injustices dealt out to people of color. Below a wonderful video. 

When we struggle to survive, as children, even as adults, we often accept the branding, blaming, shaming, of people we believe are stronger than us, whether that be our parents, or a nation trampling over our rights. 

That shame can hide as thoughts that lower our self image, thoughts like, I am not good enough, I wish I wasn’t so stupid, That person doesn’t like me, I have made a fool of myself, I am ugly, I need to please this (or every) person, I am not worth it.  Here is a link to a blog on Shame. And another one for Shame.

When we ourselves are overwhelmed with stress, pain, anxiety, depression, the hustle and bustle of daily life, we often don’t stop to consider the bigger world. By stopping, breathing, and learning about others also suffering, your own suffering will lessen. We are part of a community – this community can now extend, through social media, to involve people all over the world. Take part in this community, listen, learn, and be heard.

Please do your part in learning about racism. There is no shame in admitting to having inherent racist views, but in a world where education is at our fingertips, there is shame when we don’t stand up and shout out against it. 

Take care of yourselves.

Judy

A big Thank You to all our mental health caregivers. Mental health management is complex but vital to help people who suffer from anxiety, depression, stress, addictions, complex PTSD, and chronic pain.

I think social workers are one of our most overlooked caregivers. They have a very important, but often frustrating, traumatic, and difficult task. 

Isabel Allenda, in The Sum of our Days, has written about the challenges social workers face and how their job is not one to be envied. 

(She) had to work with children who had suffered abuse and neglect, children who were shuttled from one institution to the next, who were adopted and then returned, children terrorized and filled with rage, children who were delinquent, or so traumatized they they would never lead a more or less normal life. (The social worker) fought the bureaucracy, the institutionalized negligence, the lack of resources, the irremediable wickedness of humankind, and, especially, she fought time. There weren’t enough hours to study cases, visit the children, rescue the ones in the most urgent danger, find them a temporary refuge, protect them, save them, follow their cases. The same children passed through her office again and again, their problems growing worse with the years. Nothing was resolved, only postponed. 

Please take care of yourselves even as you are taking care of others. 

All the best

Judy

Thanks to social media, and Twitter in particular, I have been sent more resources on chronic pain.

I’ve added a few of these links to Understanding Pain and in other spots.

Be sure to explore Flippin’ Pain from the UK. Chronic pain is a condition common to people all over the world, and we are trying to work as a community to help. Good luck.

Judy

When no problem has been found on CT scans or Xrays or blood tests, it does NOT mean you have psychosomatic pain. The pain is physical.

Yes – anxiety can cause inflammation – anxiety and stress makes everything worse – but it is not psychosomatic. Many people have pain for no known reason. Just because your physician can’t exactly point to your source of pain, doesn’t mean it’s in your head.

Many of my patients have vague auto-immune disease – not classified – YET. I think in years to come, we will discover more.

For now – Do NOT call your pain psychosomatic. It is somatic – in the body. The Psyche can make it worse, but it is a physical problem. Inflammation usually – and needs to be addressed accordingly.

Check out the blog on Inflammation

And Step 3

Breathing helps to calm inflammation and low impact exercise and stretching.

Doctors unfortunately have helped drive this SHAME narrative, sometimes, by making patients feel it’s all in their head or making them feel they shouldn’t need pain meds.

Best

Judy

It is important to plan for your future, especially when it comes to your health. If you have a serious chronic condition or if you are getting older, it is especially important to plan. It helps your health care provider provide better care if you are able to explain what measures you would want should you become suddenly very ill.

Have a look at this page which helps with issues of advanced decision making around health care.

Health Care Plans for the Future

Take care

judy

One of my patients has shared a lovely site she really likes. Feel free to check it out. BrainPickings.

Also try these new pages:

Stress management

Difficult Childhood

Signs and Symptoms of Chronic Disease

Premenopause

Have a great weekend

Judy

Inflammation happens in your body when your body feels under threat, like when there is a bug, like COVID, or your body is exposed to a toxin, like excess carbohydrates or glucose when you’re a diabetic. Your body responds with inflammation. 

Everybody responds different to this stress of inflammation. If the inflammation lasts for a long time, in other words it is chronic inflammation, it causes diseases. 3 out of 5 people will die from chronic inflammation because it causes diseases like heart disease, stroke, diabetes, arthritis, allergic reactions. 

Some people have chronic inflammation without knowing it. In fact many people do. The inflammation can even come from threat that exists in the Limbic System in the brain from Difficult Childhoods.

Chronic inflammation causes tissue damage. That is why stress and trauma are not only in your head. Stress causes inflammation which then damages the body. 

Stress can be physical from toxins, like Covid causing inflammation and infection or even other infections or from trauma – like repeat injuries which then damage the body long term or from toxins like alcohol or too much sugar, all causes damage on the body. 

This is why it is so important to manage Stress and to examine childhood traumas.

Have a great day. 

Check out Daily program and the links above

Judy

Reference

Roma Pahwa; Amandeep Goyal; Pankaj Bansal; Ishwarlal Jialal.Author Information

Hi Readers,

I would like to share a discussion held with a group of my brave patients and mental health clinicians. I hope you find it interesting. 

What does Complex PTSD mean to you? These were the answers from the group:

Feeling misunderstood, feelings of shame, having to deal with addictions (to food, alcohol, drugs, sex addictions), torture, exhaustion, memory loss and brain fog, not knowing myself, lack of confidence, paranoia, food hoarding, feeling unsafe, inability to sleep, isolation, OCD behaviours, overthinking, fear of reaching out to others for help or to socialize, triggered by authority – police or others, accepting abusive behaviours from others, dealing with health issues relating to complex PTSD, like diabetes, hypertension, obesity, sleep apnea. 

What helps you cope with the symptoms of Complex PTSD? These were some of the responses:

Remembering that trauma has given me symptoms, but this is not who I am, this is not my personality. I am not the problem. The problem is the problem. 

Distractions: puzzle books, crafts, going for a walk, learning a new skill, going on the internet.

Breathing, 5-step grounding technique, music, pets, taking my dog for a walk, yoga, resting or sleeping, talking to a friend.

Feeding my spiritual side. Remembering I have been created kind, generous, caring and thoughtful. 

“What I think if what I feel”- trying to be mindful of my thoughts. Remembering I am good enough. 

Reach out to a counsellor. 

Eating a proper diet and exercising. Body Work – connecting my heart to my head. Body Scans.

Writing can help, journalling. 

Thank you to our wonderful group. We are all trying to help each other. 

All the best for 2021

Judy