Saturday, 30 June 2012

The Only One I'll Ever Have

Back pain.  I cannot remember when I didn't have back pain. Maybe before an tobogganing accident at the age of 18. I was hospitalized and told that I had broken my sacrum.  I knew a lot of other people with back pain so it didn't seem to be a big deal.

I lived the life of taking over-the-counter pills and seeking distraction from pain; two aspirin sort of coped with pain when distraction didn't work.

When I was 36 years old, I was diagnosed with arthritis. Both of my knees had became hot, painful and swollen. I was told that it could be rheumatoid arthritis; all the symptoms settled on regular enteric coated aspirin and, given available treatments in 1976, I couldn't see any reason to investigate further. (Time has not confirmed the rheumatoid. My hand deformities are osteoarthritic.)

In 1988, my pills and distraction were no longer working. I was taking what I considered an inordinate amount of antiinflammatories and had progressed to using 292's (aspirin and codeine).  I was chronically grouchy because of the pain and the pills. Mainly back pain, but other “hot joints” were sometimes painful too. The pain was at the level of 3-4/10 where 10 (on my scale) is a broken bone.

A physiotherapist had recommended exercises in 1983 after the birth of my third child and I'd do them for a few weeks and decide that they “weren't working”.  I had never done focussed exercise over a length of time. A masseuse helped loosen up some of the stiff muscles and I started slowly, adding exercises from a Safeway check-out booklet called “exercises for your back”. When I sought her advice again in 1991, I could say, “I don't think that the exercises have altered my pain but I feel better.”

She examined me. Poked me in the belly and said, “what are you doing for your abdominals?” She described the layers of muscles and the exercises that built strength in each layer and left me with assortment of core strengthening exercises.

Nine months later, the second week in April 1992, I had a painfree week without pills. It was awesome.

I never stopped doing back exercises. The routine included 1 hr/day 5/7 days with back exercises and free weights plus about 12 minutes of yoga daily. When I could, I attended drop-in exercise and yoga classes. A few days are painfree, most days are tolerable at 2-3/10 and some days aspirin and naproxen came in handy. Twenty years of this routine.

November 2011, I slipped on ice and landed on my sit-bones (ischial tuberosities). My sacrum, the flat place at the bottom of the spine, propelled by gravity kept going and the SI joint ligaments were painfully injured; there was pain in my pubic symphsis (the bump just below the abdomen). I was practically bedridden.  It healed like ligamentous injuries, five days of excruciating pain, five days of severe pain and then four weeks of slow motion, massage, heat, physio, gentle exercise anti-inflammatories. Two chiropractic treatments at two months completed recovery.

Then, four months later, in Mali during a military coup, it was re-injured and the pain and disability were worse that previously. This time there was pain radiating into the thigh and across my butt muscles.  This was serious – twice laid up for weeks within the same twelve months. Time to quit being my own doctor.

When I got home, appointments were made with a mental health counsellor, physiotherapist, chiropractor, and a back specialist (xrays). In my absence, Bill had assembled a ten centimetre pile of reading material on backs from which two books spoke to my condition.

Two of the messages was consistent through all practitioners (and the written material) – 1. healing takes time and the November injury to ligaments was going to take at least a year to heal and 2.  focussed exercise was the mainstay of the healing process.

The physician. “We should look at that xray together” he said. “Oh no”, I thought, “this doesn't sound good.” What did we see? A fully compensated 60 degree scoliosis in the lower thoracic-lumbar region accompanied by “extensive severe osteoarthritis”; furthermore the bones appeared osteopenic (thinned).

I was stunned. All these years, my belief was that I was treating mechanical back pain, not structural chaos. For the next two weeks, every twinge bought the image to my inner eye. I felt old and deformed. I was depressed over the thought that “this is as good as it gets”. Visions of spontaneous vertebral fractures threatened my activities. The paraesthesias (sort of a numbness) of the lateral nerve of the right thigh (I had diagnosed it as idiopathic), the almost constant discomfort in my lateral quadriceps (I just thought that I wasn't “conditioned”) - both of these originated from the back.

Yet, there was no treatment other that what I was already doing. I was already taking calcium and vitamin D (in the winter), salmon oil and the occasional aspirin or naproxen (even with a stomach protector like omeprazol, my gut eventually hurts so they have to be stopped intermittently).

More exercises were recommended, increasing to two hours daily with more core involvement. I was drinking more than my share of alcohol (good for pain, bad for osteoporosis) – I stopped that. The chiropractor recommended glucosamine and increasing my salmon oil capsules; the physician gave me a prescription for a SI stabilizing belt for use in severe SI joint pain.

I could not get that awful xray out of my mind.  It haunted me – I woke my housemate in Ottawa screaming in a nightmare! Every twinge added to my depression. I had proven to myself time and again that going more than two days without “the routine” was never worth it – now it was two hours a day!! How was I ever going to find time to do this?

I needed an attitude change.  First, was the importance of exercise.  I realized that I had internalized the impression that my exercise routine was sort of an indulgence, like painting my toenails, when, clearly I had to think of exercises more like brushing teeth or washing armpits. Absolutely essential to my health.

Second eureka occurred in a Yin class of hot yoga (very slow stretches in a heated room).  I spontaneously envisioned my back as it was from the outside, what it could do and how well it had performed all these years in spite of its deformities. I could and would work on being thankful for the twenty years of routine – and for my advance planning.

In 1987 when we were building our house, I had the carpenter create a pair of raised garden boxes at the side of the deck so that I could garden in the event that I could no longer bend. They stand slightly higher than waist height, are arm-reach width and deep enough to hold the roots of most garden plants. Last year we began construction on a ramp for the entrance. Instead of walk-in closets, the master bedroom has a dedicated space for back exercises and yoga. My free weights are part of the living room furniture (if they are handy, they are more likely going to get used). For years, I have done exercises in public parks, stairwells in hotels and airports. Sometimes watching a video makes exercises more interesting.

In short, I have a crappy back bone but I am a lucky woman! There are many to whom even getting started is the biggest barrier.  I have cleared that hurdle by years!