Muscle doesn’t build itself

I was talking to my therapist the other week, trying to describe to them the pain that I’m in on a regular basis. They were (understandably) concerned, and I found it difficult to relate the information objectively without alarming them.

I hate when I alarm people, simply by being and living the way I do. I’m not trying to shock them, but when folks become acquainted with my interior life, yes, it can be shocking.

Anyway, they recommended plenty of exercise (which I’m doing), and they suggested physical therapy might be useful.

Now, I can’t imagine that anyone is going to offer me physical therapy that can help my situation. What exercises could I possibly do, to address the myofascial all-over pain that wreaks havoc with my sanity? What specific routines could anyone recommend to ease the aching scream in my joints and the connecting points in my lower back, hips, knees, elbows… you name it…?

It’s not that I dispute it can be addresed — this pain, I mean — it’s just that I’m skeptical of the ability of others to prescribe a suitable solution for me. I’m just not that easy. Or easily explained. Besides, the pain tends to travel. Where is it today? Only today will tell.

What I do not dispute is the benefit of exercise. Daily. Routinely. As part of my waking-up ritual. I get up, and the first thing I do, is get on that exercise bike. Then I stretch. Then I lift. Not a lot of weight, but enough to notice it’s there. Enough to make my muscles burn in a good way, get my heart pumping and my skin sweating. Enough to remind me how far I’ve come, and how far I have to go.

One of the things my therapist mentioned was that physical therapy can help the knees. This I know. You help the knees — joints which can’t be helped directly — by strengthening the muscles around them. You don’t fix the joint. You fix what’s around it, what’s supporting it, what’s holding it together.

And it works. It took physical therapists years and years to figure that one out, and now we can all benefit.

From where I’m sitting, the rest of me benefits in the same way. The weak and crackly shoulders I have, the weak and crackly back I have, the weak and complaining legs I have — hips, knees, ankles — are all improved when I strengthen the muscles around them. Even my neck, which is a wreck, most of the time — pain and stiffness and the third vertebra from the top turning out to be pushed out of place every time I pay close attention to it — is helped by a good dose of concentrated lifting. In fact, when I was doing a lot of heavy weights, back about 10 years ago (and pretty much built of solid muscle, thank you very much), my neck always felt better when I did 70 lbs worth of shrugs.

You should have seen the looks on the faces of the other cubicle dwellers I worked out with, when I walked over and grabbed two 35-lb dumbells off the rack and started shrugging away. Priceless. But it worked like a charm. By the end of three sets of 12, my neck felt 200% better than it had before. And the benefits lasted for days. And the same was true of the rest of my body. I always felt so much better when I lifted regularly. And one of the things I resent losing the most, after my last fall in 2004, was the ability to go to the gym and work out without overwhelm or anxiety. I miss it. I still miss being able to go out and work out. But for now I’m doing what I can in the privacy of my own home.

I do what I can to build muscle. And it doesn’t get built on its own. It takes work and concentration and dedication to a greater cause. It takes persistence that defies logic and human resolve. It takes tenacity and a small dose of fear of what might happen if I don’t do it. Muscle doesn’t get built on its own. But when you do build it, it works for you.

Sometimes you gotta give a whole lot, before you can expect to get anything (no matter how small) in return.

I guess this is what I’m doing with my life, these days –giving a lot to get something back. Building up the proverbial muscle around the weak spots in my life — building up routines and strategies and techniques and tactics, to support the weak parts of my brain, the parts that got broken, the parts that won’t be fixed, no matter how determined I am. I’m re-routing around the burned-out shells of my old domains. I’m blazing trails through the jungle, to skirt the blown-up bridges in my neural network. I’m carving out new pathways in uncharted territory, and I’m moving what deadfall I can from the paths I must tread.

A blown-out knee, in and of itself, cannot be strengthened. It’s just bone and cartilage and connective sinews. But the muscle around it can — and should — be strengthened, and function can be restored to the leg and the body. A broken brain, in and of itself, may or may not heal. The neural connections that get shredded, are frayed for good, and nothing can return them to their original pristine state. But there are other ways of connecting disparate regions, and there are plenty of strategies and techniques available to get from Point A to Point Z in fine style.

I can sit around and bemoan my fate as an mtbi survivor with a whole truckload of residual issues… I can feel sorry for myself and worry about whether I’ll ever get back exactly the capabilities I had before… or I can take the focus off specifics and focus more fully on results — achieving the same sorts of things I did before, but now through different means.

A lot is possible, if we consider alternatives. But the alternatives won’t come out of the woodwork and make themselves known to us without our direct involvement. And we’ll never find out what does and does not work for us, if we sit around waiting for someone else to tell us what our next steps are.

It was a real struggle for me to get out of bed this morning, and I resented most of my workout with a begrudging resignation. But I did what needed to be done, and by the time I was finished, I felt ten times better than when I started. Day by day, bit by bit, I make headway and I find my way further down the path I wish to tread. Work doesn’t do itself. Workouts don’t do themselves. Muscle doesn’t build itself.

That’s all on me. And I’m glad of it.

Connections between pain and PTSD

The past couple of weeks have been crazy for me, and it’s taken somewhat of a toll. I’ve been busy with work, busy with other activities, busy, busy, and more busy. I also did some traveling for about a week to out-of-state relatives, for a big family get-together. In and of itself, it was a great time. But the change in my schedule, the long hours of driving — over 30 hours, all told, in the car — not being able to get enough sleep, and the change in food choices (how do they eat that stuff?) all threw me off, big-time.

I managed to keep it together and not completely blow-out/melt down during the trip, or immediately afterwards, which often happens when I travel to this particular branch of the family tree. But the past few weeks have been packed full of crazy-busy-ness that I now realize has been a pretty concerted effort to dull the pain of the trip.

I’m not talking about emotional pain… though it’s never easy to spend time as an outsider, when everyone else is connecting and having a wonderful time being together — I’m the oddest bird in the family, and between my difficulties in keeping up with what’s going on around me and my narrow and intense interests that aren’t run-of-the-mill, people often don’t know what to do with me.

What I’m talking about is physical pain.

Yes, physical pain — the kind that burns, that aches, that throbs, that stings. The kind that makes my clothing hurt me, that rakes my legs when my pants rub against them… the kind that makes me jump whenever someone touches me… the kind that sends a shock wave of smacking ache to the marrow of my bones when my spouse puts their hand on my forearm… the kind that keeps me from sleeping, because I can’t stand the feel of sheets on me, but I also can’t stand the feel of air-conditioning blowing across my skin… the kind htat gets worse when I am stressed or tired or upset or all of the above… the kind that I often don’t even know is there until someone makes contact with me, and I jump, and they feel like they’ve done something to hurt me. They have. They didn’t mean to, and they would never do it on purpose. But they hurt me.

It’s not just the emotional pain of family visits that gest me. It’s the physical pain, as well.

Here’s the deal — for as long as I can remember, I have had issues with a whole slew of sensory problems, the most disruptive of which was body-wide pain. I can remember, ever since I was a little kid, feeling like I was being hit, when people would just reach out to touch me in very innocent, social, appropriate ways. I would shrink back from them, and they would often take offense or get angry with me for “rejecting” them. It sorta kinda messes with your head, when the people who love you the most cause you intense pain when they try to show their affection for you. And it tends to muck up your relationship with them, when you can’t accept their (appropriate) affection, but they don’t understand why.

To tell the truth, I didn’t even understand why. It’s hard to explain, unless you’ve been there, but the experience of painful touch is such a visceral, physical thing, it sometimes doesn’t translate into words. It’s just there. You can’t describe it, you can’t even really pinpoint it. Sometimes you have no idea it’s there, until someone makes contact with you. Then, all you know is, it hurts, and you pull away to avoid it, so you can just get on with your life.

And you do things to avoid/mitigate it. You steer clear of expressive people. You avoid demonstrative friends. You always keep more than arms’ length away from other people, just in case they reach out to you. You spend time with people who either don’t like you or couldn’t care less about you, because the chances of them touching you is small to none — and it’s easier to be around those types of people, than the friendly ones who like to make contact.

These things are done on a subconscious, instinctive level, and sometimes they don’t even register with you when you’re doing them. Like pulling away from people when they come close. Like shrinking back from a hug someone is trying to give you. Like jerking away quickly when someone touches you accidentally.

And depending on how sudden or shocking the pain is, it can trigger a whole cascade of other sensations/symptoms/reactions that look a whole lot like PTSD.

Over at Helpguide.org, I found this list of symptoms

Re-experiencing the traumatic event

  • Intrusive, upsetting memories of the event — memories of past painful contact tend to show up suddenly
  • Flashbacks (acting or feeling like the event is happening again) — yes, it does feel like it’s happening all over again
  • Nightmares (either of the event or of other frightening things) — sometimes nightmares do follow an extremely painful episode, tho’ that’s rare
  • Feelings of intense distress when reminded of the trauma — yes, it is intensely distressing to be reminded of it, it just sends me in a downward spiral
  • Intense physical reactions to reminders of the event (e.g. pounding heart, rapid breathing, nausea, muscle tension, sweating) — my heart sometimes starts pounding, I tense up, and I feel sick to my stomach, when people touch me, sometimes

PTSD symptoms of avoidance and emotional numbing

  • Avoiding activities, places, thoughts, or feelings that remind you of the trauma — I tend to avoid physical human contact of any kind; women frighten me, because they tend to be so tactile, and it’s literally too painful at times, to interact with them
  • Inability to remember important aspects of the trauma — I tend to block out the particulars of painful experiences. All I know is, it’s hurt me before, like it’s doing now
  • Loss of interest in activities and life in general — Why should I get involved, if it’s just going to hurt like the dickens?
  • Feeling detached from others and emotionally numb — Oh, yes… ’nuff said.
  • Sense of a limited future (you don’t expect to live a normal life span, get married, have a career) — how precisely am I supposed to live fully, if the experience of basic human interactions promises me pain?

PTSD symptoms of increased arousal

  • Difficulty falling or staying asleep — could have something to do with my insomnia?
  • Irritability or outbursts of anger — yet one more contributing factor
  • Difficulty concentrating — it’s tough to concentrate, when you’re on high alert. Especially if you’re working with tactile people.
  • Hypervigilance (on constant “red alert”) — someone might be approaching…
  • Feeling jumpy and easily startled — but of course

Other common symptoms of post-traumatic stress disorder

  • Anger and irritability — not being able to establish comfortable human contact makes me nuts and pisses me off
  • Guilt, shame, or self-blame — why can’t I just be normal like everyone else and tolerate a hand on my shoulder?
  • Substance abuse — been there. Thank heavens that’s behind me.
  • Depression and hopelessness — my occasional visitors
  • Suicidal thoughts and feelings — once upon a time, occasional visitors. Now, very rarely.
  • Feeling alienated and alone — not just feeling… BEING alienated and alone
  • Feelings of mistrust and betrayal — it’s hard to not feel that way, when everyone around you might possibly cause you pain
  • Headaches, stomach problems, chest pain — the first two, yes. The third, not so much

So there we have it — PTSD arising from chronic body-wide pain. Painful touch. There’s even a word for it — Allodynia (meaning “other pain”) — a painful response to a usually non-painful (innocuous) stimulus. I haven’t been formally diagnosed. That would require that I talk about it to my doctor. And talking about it out loud to anyone has never really been an option for me, except for with my last therapist who is long gone by now. It’s just too painful. Emotionally and physically.

I’d rather keep my own counsel and just live my life. Pain-free. Alone, but pain-free.

Being alone not only keeps me out of arms’ reach (literally) from people who may hurt me, but it also keeps emotional upheaval at a minimum. It’s hard to get worked into a state, when you don’t have much contact with people who affect you emotionally. I can block out all the politics and social drama pretty well. But the emotional connections I have with people… well, they’re trickier. So, I steer clear of them, by and large. And I steer clear of emotionally charged subjects with people — like avoiding talking about my chronic pain issues with my doctor.

It’s wild, how emotional distress can heighten physical pain. Emotional pain sets off an alarm state with me, and that alarm state unleases a whole avalanche of stress hormones and hypersensitive biochemical agents into my system. And the buildup of all the stuff that gets “stuck” in my system does not help me. Not one bit.

Over at Healthjourneys.com, Belleruth Naparstek quotes from her book Invisible Heroes and describes it well:

Chronic Pain Conditions
This constant activation of the alarm state leads to an accumulation of metabolic waste products in the muscle fibers, and the release of kinins and other chemical pain generators in the tissue, resulting in myofascial pain and the appearance of those seemingly intractable chronic conditions such as fibromyalgia, chronic fatigue, irritable bowel syndrome, chronic headache, TMJ and more.

And because these conditions are generated in the brain stem and the motor reflex centers in the spinal column, and routed through a perturbed, automatic, arousal circuitry, peripheral forms of treatment provide only temporary relief.  Constantly activated by everyday sensory cues, normal muscle movement and spontaneous memories, symptoms grow and become more and more entrenched over time.  In other words, this is one nasty gift from the kindled feedback loop that, if not interrupted, will just keep on giving.

Our epidemiology research has already shown us an astounding percentage of people with baffling chronic pain conditions and “functional” diseases that have no obvious causes, who have been found to have prior histories of severe trauma.  Probably if we could tease out the subset of traumatized people who experienced substantial dissociation during their trauma, and a truncated freeze response in the midst of it, we might find closer to one hundred percent suffering from posttraumatic stress.  Unfortunately for them, they are often assumed to be malingering or engaged in attention-seeking behavior for neurotic reasons, instead of suffering from a very serious, self perpetuating condition with a potentially worsening trajectory.

Included in this group of maligned and misunderstood patients would be scores of people suffering from pelvic and low back pain, orofacial and myofascial pain, genito-urinary and abdominal pain; interstitial cystitis; and the previously mentioned headache, fibromyalgia (FM), chronic fatigue syndrome (CFS), and reflex sympathetic dystrophy (RSD); irritable bowel syndrome (IBS), inflammatory bowel disorder (IBD), multiple chemical sensitivity (MCS) and migraine.

And there it is — in part, anyway. The post over at Belleruth Naparstek’s blog asks Is There a Connection Between Fibromyalgia and Traumatic Stress? but it’s not just about Fibro, to me. It’s about the “and more” she mentions. It’s about the “whole lot more”.

So, what the hell can I do about this? I’m of the mind that the best reason to talk about anything difficult, is to figure out what to do about it to make it better. To reduce the quotient of human suffering in the world. That includes my suffering (I’m in the world, after all). What can I do about this pain business?

Well, first, I need to get back on my schedule. I need to get back to my sleeping routine, which I’ve been doing pretty well with. I need to get back to eating the right kinds of foods at the right times of day — and I’ve been doing that pretty well, too. I also need to exercise and do other things that will enable me to discharge some of the built-up stress from the trip. I tried explaining to my new therapist how disruptive that sort of travel is to me, but they didn’t seem to “get” the intensity of it, so I’m not getting much support there. Screw it. I’ll support myself. I’ve been having a lot of good long cries, in the privacy of my own company, over the past few days, and that seems to be helping me. I also need to get back to my regular work schedule and just get some stuff done. Being productive has a way of chilling me out nicely, so I’ll do that.

And drink plenty of water. Take some Advil before I go to sleep. Listen to the Healing Trauma CD from Belleruth Naparstek to deal with the PTSD. Have a good cry. And another. And another. And make sure I let loose in my own company, away from others who neither understand nor want to understand just how hard things are for me… and end up minimizing and negating and invalidating my feelings about what I really go through, and tell me I’m fine and I don’t have a problem and I shouldn’t worry about this stuff,  just because they either don’t have the emotional resources to hang with me, or they’d be too traumatized, themselves, if they knew what it’s really like to live in this body.

Most of all, I need to keep it simple. Count my blessings. Remember just much good there is, along with the bad. And remember, tomorrow is another day, and all things considered, I’m pretty lucky to be alive.

Ouch

Physically, I’m in a lot of pain, these days. Ouch! Someone touched my arm the other day, and it was like they were driving a hot poker into my skin. Crazy. I hate when it happens, and the stupid thing about it is that my reaction time is slow, so I end up having a thorough pain experience, before I can pull away. How annoying.

The pain has gotten a lot worse in the last couple of weeks. I’ve been working outdoors which is great, BUT I’ve also been eating sugar and “cheap” carbs, which is such a bad idea. I really can’t make a move without some kind of pain, but I manage to keep my mind off it, so it’s not wrecking my life. Still, it might be nice to not have this stuff with me 24/7.

And then there’s that pineal cyst I’ve got. It’s a small one, but who knows what will happen with it? I think that one of the reasons that I’m just motoring along with this pain, is that I’m trying to acclimate to the constant presence of pain. Pineal cysts are notorious headache-producers, and there’s no know “fix” for it other than surgery… which I don’t want. I’d rather just live with the side-effects, I guess.

It’s not like I’m going looking for pain, but it seems to have no trouble finding me. I have headaches that do not respond to medication. Or relaxation. Or stress management techniques. I have blazing joint pain that’ s unpredictable and variable. My hands and neck and back and shoulders and knees and… well.. all of me, hurts.

Oh well. I don’t have much hope that it’s going to change anytime soon. I used to think it would, but that was 20 years ago, and I’ve sort of given up on that idea.  So I’m getting in the habit of just being functional while in pain. And coming up with other ways of addressing pain, like learning.

That helps. It keeps me interested. It keeps me alive.

So there.

What keeps me going

coffee and notepad and pen on a table

11/10/18 – Ha! I just discovered this old post from 2009. I’m not sure why I unpublished it, but I like it.  So, I’ll republish it. Here you go.

Ever since I read about how the ‘Thirst For Knowledge’ may be a kind of opioid craving, my thinking about how my mind manages my physical pain has really changed. Actually, it jumped ahead in a big way, when I read about Mary Meagher’s work on how fear and anxiety have different affects on physical pain. But having the kind of associational brain I do… a brain which isn’t very good at sticking with linear, sequential tasks, but eagerly hops around from one related topic to another… I did end up here, thinking about how the human brain craves novelty, and why that might be.

I’ve come to realize, in the past months, that many of my patterns of risk-taking and danger-seeking behavior, not to mention my constant stream of distractions that keep me all jazzed up, have a lot to do with relieving my constant levels of discomfort, distress, and pain. Not only that, but they seem to be linked to a sort of depressed state in my thinking — not necessarily emotionally depressed, but functionally slowed. My history of TBIs has not helped my cognitive processing speed, and there are parts of my brain (as evidenced on my EEG) that physically work more slowly than would be expected.

Actually, come to think of it, emotional depression sometimes follows on my cognitive depression/slowing, so I can’t discount that part of my experience.

Now, when it comes to getting on with my everyday life, risky decision-making and flawed judgment are just part of my problem. Chasing conceptual chimeras — such as my all-consuming obsession with my MRI, as well as new and emerging neuroscience research, which I may never fully understand but which fascinate me to no end — and commencing projects that I will never actually finish — like that 500-page documentation set for one of my favorite software programs of the day — are actually more disruptive and pose more of a risk to my adequate functioning than outright risk-taking behavior.

And yet, I chase after these new ideas and take up new projects, left and right, neglecting the real parts of my life that suffer from my lack of attention. I’m so busy researching and reading and exploring my MRI in 3D, that I forget to pay bills. Or do paperwork. Or make calls I need to be making.

I don’t think I fully understood the impact that my intense need for mental stimulation had on my life, until a little over a year ago, when I came across one of my old notebooks that had plans and details and milestones for all these projects I had once been utterly consumed by. There were no less than seven different highly involved, complex projects that filled different parts of that three-ring notebook. And then I found more in another notebook. I uncovered a whole bunch of different projects that I’d started… then got distracted from and completely forgot about.

Discovering those notebooks opened my eyes in several ways.

First, I realized that I had so completely forgotten about those projects, that they might as well have never existed. And that happened, after I had invested literally hundreds of hours scoping and planning in great detail for each of them. It seemed impossible that I would forget even one of these projects. But I had lost track of more than ten.

Second, I realized just how irrationally compulsive I was about my projects, and it occurred to me that someting might be very wrong in my thought processes. The majority of people I know don’t do this sort of thing… why was I?

Third, I realized that even if I had all the time in the world, I never could have finished all of these Very Important Undertakings. But that didn’t matter to me. What mattered to me, was the doing. The “journey”. The process of pursuing these things. It went against every fiber in my pragmatic being and seemed like a total waste of time. Yet, part of me didn’t care. It would create with abandon and not give a crap about what might actually come of it all. And that troubled me. Because it didn’t seem like me.

Or maybe it did. All my life, I’ve been fascinated by fringe interests and I’ve pursued them with gusto.  When I was a kid, I had a lot of projects going on all the time, and my parents and teachers used to just writhe with frustration at how I could never take any of my projects to a higher level, where they would develop fully and be shareable with others. I would read all about certain subjects and discourse on them at great length, but I could never seem to develop my interests in other directions. I had a “chemistry set” in the basement, where I did extensive studies on the interactions of vinegar and baking soda, and I mixed leftovers from my father’s aftershave with my mother’s talcum powder. But my interests never went much farther than that, for all I learned about fizzy cooking ingredients and the crackle patterns of dried personal care products.

In my adulthood, the intensity of my interests increased substantially, as has their esoteric “quotient”. Over the past 20 years, I have frequently found myself deeply engulfed in studies that interested maybe 5 other people in the world, but my devotion ran to the very core of my being. I’ve also found myself utterly consumed with a topic that was probably well beyond my ability to understand — quantum physics, biophysics, medieval history, and more — all sorts of information-intensive subjects that require years of training (which I didn’t have) to understand completely. My interest has intensified and evolved over the years, but the shareability of my learnings actually decreased. I would read and take in and then recount what I had taken in, but my writing was dense and obfuscated by way too much detail.

Then I fell in 2004 and hit my head and found myself unable to focus and sustain the same level of attention to my old areas of study. My office is filled with books I’d bought, intending to read them in my line of study, but it could be that will never happen.

Still, I do crave my distractions. And between 2004 and 2008, the number and kinds of projects I was consumed by increased exponentially. I just careened from project to project, spending long hours scoping and planning and thinking and noodling. I got so swamped in the details, I couldn’t see my way clear to completion on any of them. But I didn’t care. I just wanted the high of that novelty. The newness, the freshness, the rush that came from a bright new idea.

While I was in the thick of my planning and dreaming and scheming, all was well. But when I stepped back and took a closer look at how much energy I was expending, and how it was getting me nowhere, it just didn’t sit right with me. And I’ve been trying to figure out what the underlying mechanism of that is, ever since.

I think I’m closer now to figuring it out, than I’ve been in quite some time. I can’t speak for anyone else, but what I’ve found makes sense in my own personal context. It’s neurological. It’s biochemical. It’s ingrained. And it’s essential for my mental health and general well-being. I need my distractions, my rushes, my “pump” in order to feel normal. In order to feel human. And the thing that delivers a better rush and pump than just about anything else, is novelty. A new idea. A fresh concept. It’s a tonic to me… and an essential one at that.

Dr. Irving Biederman has some really interesting things to say about this stuff. It’s my understanding that he specializes in things like the neurology of face recognition (which, it occurs to me, could be really useful to folks who study autism/Asperger’s Syndrome and are trying to understand why ASD folks have a hard time decoding facial expressions). This “info junkie” track he occasionally writes about seems like a lesser area of interest for him, from what I’ve read. But it’s much more practically useful to me, than shape and face recognition.

So, that’s what I dwell on, vis-a-vis his reasearch.

Here’s an article about the sensual lure of mental novelty, which I swiped in its entirety from the LA Times:
From the Los Angeles Times

The 411 to avoid boredom

As ‘infovores,’ information is the fuel that keeps our brains all fired up.

By Irving Biederman

July 19, 2008

Crackberry. Only a metaphor for our addiction-like urge to check e-mail? Or does the term shed light on a deep biological truth about our hunger for information?

Human-motivation studies traditionally stress well-established needs: food, water, sex, avoidance of pain. In a culture like ours, most of these needs can be satisfied easily. Just open the refrigerator door, or blow on that spoonful of hot soup. (Satisfying the need for sex may require a bit more doing.)

What’s been missing from this scientific research is humans’ nonstop need for more information.

We are “infovores.” The human eye makes three fixations a second on the world around it, and not at random. Our gaze is drawn to items we suspect have something new to tell us — posters, signs, windows, vistas, busy streets. Confined to a featureless physician’s examination room, we desperately seek a magazine, lest we be reduced to counting the holes in the ceiling tiles. Cornered at a party in a banal conversation, we seek to freshen our drink.

Without new information to assimilate, we experience a highly unpleasant state. Boredom. Conversely, at one time or another, each of us has felt the joy of information-absorption — the conversation that lasts late into the night, the awe at a magnificent vista.

Cognitive neuroscience — the science that seeks to explain how mind emerges from brain — is beginning to unravel how this all works. At USC, my students and I use brain scanning to specifically investigate the neuroscience behind the infovore phenomenon.

The explanation involves opioids, one of many neurotransmitters — which are molecules that the neurons in our brain release to activate or inhibit other neighboring neurons. The effect of opioids is pleasurable. In fact, the same neural receptors are involved in the high we get from opiate drugs, such as heroin or morphine.

In the past, these opioids were believed to exist primarily in the spinal cord and lower brain centers, where they reduced the sensation of pain. But more recently, a gradient of opioid receptors was discovered in a region of the cerebral cortex, humans’ enormous outer brain layer that is largely responsible for perception and cognition.

In the areas of the cortex that initially receive visual or auditory information, opioids are sparse. But in “association areas,” where the sensory information triggers memory and taps into previous knowledge, there is a high density of opioid receptors. So the more a new piece of information tickles that part of your brain where you interpret the scene or conversation, the bigger the opioid hit.

Staring at a blank wall will produce few, if any, mental associations, and thus standing in a corner is punishment. Looking at a random mass of objects will produce strong activation only in the initial stages, where there is little opioid activity to be had.

Gaze at something that leads to a novel interpretation, however, and that will spur higher levels of associative activity in opioid-dense areas. We are thus thrilled when new insights tap into what we have previously learned. We seek ways to feed our opioid desires; we are willing to endure the line at the movie theater in anticipation of the pleasure within. We pay more for a room with a view or a cup of coffee at a Parisian sidewalk cafe.

But if we get more opioids from making connections to our memories and knowledge, why do we then prefer the new? The first time our brains take in a new perception — a scene, a movie, a literary passage — there’s a high level of activity in which a few neurons are strongly activated but the vast majority are only moderately or weakly activated. The strongly activated neurons inhibit the weak — so there’s a net reduction of activity and less opioid pleasure when our brain is exposed to the same information again. (Don’t feel sorry for the inhibited neurons, the losers in this instance of neural Darwinism. They are now freed up to code other experiences.)

No wonder we can’t resist carrying a BlackBerry 24/7. Who knows what goodies it will deliver? A breaking news item. A piece of gossip. An e-mail from a long-ago girlfriend. Another wirelessly and instantaneously delivered opioid hit.

I hope you got a few opioid hits, too, in learning about your inner infovore.

As for me, I’m starting to feel separation anxiety. Where’s my BlackBerry?

Irving Biederman directs the Image Understanding Laboratory at USC, where he is a professor in the departments of psychology and computer science and the neuroscience program.

I did indeed get more than a few opioid hits while I was reading this. As Dr. Biederman says, in “association areas,” where the sensory information triggers memory and taps into previous knowledge, there is a high density of opioid receptors. So the more a new piece of information tickles that part of your brain where you interpret the scene or conversation, the bigger the opioid hit. And because I’ve devoted so much of my life to acquiring and taking in information… data… knowledge and what memories I am able to create and maintain are quite intact (my info absorption during memory creation is about around 60%, but my retention is close to 100%, so I have very detailed recollections of a little more than half of what I am exposed to), that my association areas are well-disposed to getting high off this information.

I suspect that’s what makes the internet so addictive for me — and others. It’s not about the movies and games and pictures. It’s about the novel information that I can read and take in and assimilate and use to feed my inner needs, which are more than just an information addiction.

And I suspect this is what makes my world of projects so fascinating and compelling for me. It’s not about commercializing or publicizing my work. It’s not about profiting from it or getting famous from it. It’s not about taking the projects public, or even actually finishing them. It’s just about doing them. Creating. Being. Doing. Having at it and seeing what happens. Learning. Driving. Getting energized. And cutting the pain I’m usually fighting, in the process.

It’s not about the projects. It’s not even about my progress. It’s about the pain. Getting rid of it. Doing away with it. Keeping my mind off it. Not being debilitated by it. It’s about relieving the distress that comes from the daily difficulties I have with the most basic shit on earth — getting out of bed, taking a shower and using soap and shampoo, making sure I don’t lose my balance and fall in the tub, getting dressed in clean clothes that I didn’t wear yesterday, making a breakfast that will get me through the morning, feeding the cat and gathering my work stuff, making sure I have my wallet and car keys and my daily minder, and getting in the car without bumping against it and getting my work clothes covered with salt and dust that’s leftover from the winter and I haven’t gotten around to cleaning off my car, just yet.

There is so much that others can take for granted, when it comes to everyday life. How hard can it be? Well, if you don’t know… trust me, you don’t want to know. All I can say is, when I look at my distractions, my intellectual compulsions, my wide array of Beloved Projects That Will Probably Go Nowhere, I see a pattern of analgesic activity that may not serve a higher purpose and come to much, in terms of published papers or fame and glory and prizes, but which is utterly essential to my daily functioning as a “regular” person. Without my all-consuming interests, my fascinations, my cognitive compulsions, my life would be a lot more painful, my mind would be a lot less clear, and I’d be a lot less useful — not only in advanced ways, but in the most fundamental ways one can imagine.

Now, where are those printouts I’d gotten on the long-term biochemical effects of post-traumatic stress? I’ve got work to do…

More evidence of analgesic stress in my life

A quick note before I head off for my day…

One of the big, unmentioned pieces of the past few weeks has been the pain I’ve been in. My body has been really aching a lot — and I did a bunch of yard work last weekend, which threw me out of whack. My shoulders are giving me trouble, and my knees were acting up, too, which kind of sets me off.

Back in the late 1980’s and early 1990’s, I had real problems with chronic, debilitating pain. It just seemed to come out of nowhere. I didn’t connect it with the car accident I’d had in late 1987, but now it seems like the two were more than co-incidental.

I was never able to get help for that condition, and I spent years trying (in vain) to find a treatment that worked. Ultimately, the only thing that has helped me has been getting plenty of rest, taking hot baths, and keeping my stress level down.

But when I’m flaring up, as I have been for the past few weeks, it starts to drive me. I start to get increasingly anxious about it and I don’t do well with managing myself and my situations. I feel absolutely driven – propelled – through life, with sudden flashes of interest in things that don’t normally catch my attention. I feel compelled to pack each day full of as much interesting stuff as I can find. And I push myself beyond my means.

When I push myself hard, I feel better. I really do. Physically, I feel better… mentally, I feel clearer… and my self-esteem isn’t in the crapper. I feel like I can function, for once. The pain is gone. The anxiety subsides. I have an outlet for all my energy, and the stress I put myself under has a strongly analgesic effect on me.

I’m writing about this in greater detail in A Perilous Relief, and the past few weeks have been a great illustration of my underlying premise — namely, that risk-taking and danger-seeking behavior isn’t just a psychological compulsion. There are actually physical reasons for why people test their limits in extreme and sometimes dangerous ways, and those physical reasons are just as valid and vital as the psychological ones.

They’re also intimately connected — the psychological and physiological reasons for risk-taking/danger-seeking behavior. And in my own personal, daily experience, they feed each other… and soothe each other, too.

The stress I’ve been under has been taking a toll on me. But I’ve been compelled to push even harder. Why?

Because it cuts the pain.

Learning as pain/stress relief

I’ve been giving a lot of thought to the article I read the other day about how the ‘Thirst For Knowledge’ may be a kind of opioid craving… thinking about how that has held true in my own life.

I have to say, it really rings true for me. And I while I was having dinner with a friend the other night, they were telling me how they’ve always loved to learn. They’ve just eaten up new information and they’ve always gotten a charge out of taking in new information and putting it to good use in their life.

Interestingly, they also have a lot of problems with chronic pain — low back pain, especially. The pain pretty much derailed their life for many years, keeping them from getting decent sleep, and probably taking a few years off their life. They are in their 50’s, but they look like they’re 10 years older. It could be that their biological age — due to their chronic pain problems — is just that.

I never would have guessed that they’ve got this pain thing, which they only started really talking about with me recently. They’re one of those people who seeks out all sorts of new and novel information, and they seem to have a genuine thirst for living large, when it comes to heady stuff. Sure, they have other issues, and when they get pissy, they’re no walk in the park, but the way I’ve always seen them, is more as a hungry mind than an aching body.

It’s funny — I rarely discuss my own pain with other people, too. I don’t really get into it — there doesn’t seem to be much point. It’s just depressing, to go into the details about how my shoulders and elbows and hips and knees and back are all on fire, screaming with pain, keeping me up at night, waking me up early… and there’s precious little I can do about it. Even ibuprofin (which is the only anti-inflammatory, including prescription NSAIDs that I’ve used in the past) doesn’t always help. So, I just have to tough it out.

In fact, I rarely devote much time to thinking about my pain when it’s around. It’s just always there. In the background. Nudging me, every now and then, when I step out of line. Twinging or stabbing or whatever. Headaches. Neck aches. Back aches. Joint aches. It never entirely goes away, and I try not to dwell on it, when it comes up. Very little seems to fix it, other than scaling back on my activities and trying to get more rest and steering clear of foods that I know don’t sit well with me.

Now, when I do think about it, it just makes matters worse. I start to notice it. I start to get bothered by it. I start to get crazed and anxious and frustrated and beside myself. It’s a little like being stalked — it’s always there, lurking in the background. Not directly assaulting me so violently that I cannot function, but always reminding me that it just might step up at any time and do just that. And that drives me nuts. Feeling like I cannot escape this shadow, this constant reminder, this ever-present phenomenon that refuses to respond to medication or management techniques or even diagnosis… As Charlie Brown would say, Aaaaaaaauuuuuggggghhhhh!

One of the reasons I realize I haven’t been doing my self-assessments lately is because there are a bunch of places where I track my pain.  And when I do the entire sheet and include my pain(s) in the assessment — rating its severity and impact on my life from 1-10, describing it and its impact, detailing what I am doing about it, and recording whether that worked or not — well, I can see how poorly my coping mechanisms work. And I get depressed. Really down. Just despondent.

So, I don’t self-assess. Which tells me that I need to come up with a different self-assessment approach — probably break out the different areas into separate pieces, and only focus on one type of issue at a time — the cognitive OR the behavioral OR the emotional OR the physical — not lump them all together in one place, which gets overwhelming.

But when I don’t self-assess, I get into trouble with my thinking and my behavior and my attitude. So I need to do something about this. Soon. Today, in fact.

And so, I shall.

But back to my main topic, which is about learning as a pain/stress reliever… No matter how badly my pain is, no matter how much stress I’m under, I find that learning things provides an almost other-worldly relief for me. I’ve been going through some very heavy job stuff, lately — in this economy, talk about stress — and I’ve sorely needed a break from all the intensity. I don’t want to lose my house. I don’t want to be out of work. I don’t want my health to go spiraling downhill, because I’ve taken on more than my body and mind can handle, and it all gets to me and sends me over the edge. Times like this, my PTSD and TBIs rear their ugly heads, and my thinking gets foggy, my reactions get “dumb”, and my whole system starts to go haywire. Which is about the last thing I need, when my home and my family and my future are on the line.

I need some serious stress relief, but I’ve been having a lot of trouble with being outside in the open — lots of anxiety comes up, and I start to freak out with the bombardment of all the stimuli, especially sounds, as my hearing has been hypersensitive to a point that’s starting to drive me nuts. So, I have to find something to do inside that not only takes my mind off my physical discomfort, but also provides serious relief.

That relief comes from learning. Learning new things I need to know for my job. Learning new things from the world wide web. Learning new things from friends. Learning new things from books and white papers. Learning new things that may not be all that practical, but really interest me and keep me engaged. Focusing my attention on things that fascinate me and that enlarge my store of available knowledge does something amazing for me… it cuts the pain. It not only takes my attention off it, but it seems to physically ease my suffering.

And that’s huge.

So, I’m learning everything I can, these days, about things that interest me. And I’m also learning how to pass what I learn along to other people. I come from a family of teachers — professors, elementary school teachers, Sunday school teachers, tutors, instructors. I also worked my way through what college I could manage to complete by tutoring folks in subjects that interested me. And I did a good job. I would probably be a teacher now, if I could have finished college, but that wasn’t in the cards. But I can do it now, in my own way, without the limitations of administrative types who are looking over my shoulder, breathing down my neck, saying, “You can’t say that to those kids!”

Online, in this blog, I can share and teach and instruct. And I’m figuring out new ways of getting information across. It’s my hope that I can do a better job of communicating the stuff that’s in my head to folks who can use it. ‘Cuz I’ve spent an awful lot of time figuring out how to be highly functional and “normal” as normal can be, despite a history of head trauma, chronic debilitating pain, not to mention considerable sensory issues that — when they’re at their worst — turn me into an automaton of sorts.

The information and experience has been invaluable to me, in just living my life. And others might find it useful, too. If I can use what I’ve learned to ease others’ pain — through the process of learning, as well as the experience of using what I relate — then my own difficulties have all been worth it.

Stress So Bad It Hurts — Really (From WSJ)

Stress So Bad It Hurts — Really

“I think your real problem is stress,” the doctor said when I complained that the muscle injections he was giving me hadn’t relieved my neck and shoulder pain. “You can’t blame me for everything that’s hard in your life,” he said.

My bursting into tears only seemed to confirm his diagnosis.

It’s not like I hadn’t heard this before. During earlier bouts of low-back pain, irritable-bowel syndrome and temporomandibular joint disorder, plenty of doctors have used the stress word with me. And each time, I’ve become indignant. It sounded like “it’s all in your head” or “you’re malingering.”

That’s an outdated view, says Christopher L. Edwards, director of the Behavioral Chronic Pain Management program at Duke University Medical Center. Decades ago, when doctors said a condition was psychosomatic, it was the equivalent of saying it wasn’t real, since there was little evidence that the body and the brain were connected. “Now, we recognize that what happens in the brain affects the body and what happens in the body affects the brain,” he says. That knowledge gives us the tools to try to manage the situation, he adds.

Dr. Edwards says his pain-management program in Durham, N.C., is seeing a rise in patients amid the current economic crisis: “There’s a very strong relationship between the economy and the number of out-of-control stress cases we see.”

From Stress to Pain

Psychological stress can turn into physical pain and illness in a number of ways. One is the body’s primitive “fight-or-flight” mechanism. When the brain senses a threat, it activates the sympathetic nervous system and signals the adrenal glands to pump out adrenaline, cortisol and other hormones that prime the body for action. Together, they make the muscles tense up, the digestive tract slow down, blood vessels constrict and the heart beat faster.

That’s all very useful for outrunning a mastodon. But when the threat is a tanking stock portfolio or an impending layoff, the state of alarm can last indefinitely. Muscles stay tense and contracted, which can make for migraine headaches, clenched jaws, knots in the neck and shoulders, and pangs in the lower back. Some of those body parts are already under pressure from long hours at the computer, restless sleep, grinding teeth and poor posture.

The Gut Brain

The digestive tract has its own extensive system of nerve cells lining the esophagus, stomach and intestines — known as the gut brain — that are extremely sensitive to thoughts and emotions. That’s what creates the feeling of butterflies in the stomach. When anxiety persists, it can set off heartburn, indigestion and irritable-bowel syndrome, in which the normal movement of the colon gets out of rhythm, traps painful gas and alternates between diarrhea and constipation.

“Stress does not necessarily cause pain, but it exacerbates the [physical] situation that may already be there. It diminishes your ability to cope,” Dr. Edwards says.

Stress also creates biochemical changes that can affect the immune system, making it underreact to viruses and bacterial infections, or overreact, which can set off allergies, asthma and skin disorders like psoriasis and eczema. And stress can raise the level of inflammation in the body, which has been associated with heart disease. A recent study in the journal Psychosomatic Medicine found that stressful conditions even in the teenage years can raise the level of C-reactive protein, a marker for inflammation that increases the likelihood of cardiovascular problems later.

There are plenty of ways to short-circuit these harmful effects of stress. One of the best is physical exercise, which not only releases the feel-good neurotransmitters called endorphins, but also helps use up excess cortisol and adrenaline. Under stress, “there’s a large amount of negative emotional energy in your system that is trying to find a way to discharge,” says David Whitehouse, a psychiatrist and chief medical officer for OptumHealth Behavioral Solutions, a unit of UnitedHealth Group Inc. He adds that “stress kills brain cells. The body responds by making new ones, and exercise can help activate them and make new connections between them.”

Sleeping and Eating

Many experts also recommend getting plenty of sleep, eating regular, balanced meals and keeping up social connections — all things that people tend to forgo in times of stress.

Biofeedback, once considered alternative medicine, is now accepted in mainstream medical circles as a way for people to reduce the impact of stress. Dr. Edwards runs a biofeedback laboratory at Duke, where patients monitor their heart rates, respiration, temperature and other vital signs and learn to control them with relaxation techniques. “The goal is that once we teach you to do that, you can use it the rest of your life,” he says.

Another form of biofeedback is called Heart Rate Variability Training, which teaches people to adjust their breathing to maintain an optimum interval between heart beats that induces a feeling of calm throughout the body. “It’s probably similar to what happens in yoga and meditation,” says Dr. Whitehouse.

He adds that there is much new research going on in the field of “emotional resilience training” to help people learn to lower their anxiety levels and recover from setbacks. “People spend huge amounts of money, time and energy training their cognitive brains. What we now know is that the emotional brain can be trained as well to become more resilient,” Dr. Whitehouse says.

Emotions play a major role in how pain is perceived in the brain. In the 1960s, Ronald Melzack, a Canadian psychologist, and Patrick David Wall, a British physician, offered a groundbreaking theory after observing soldiers in World War II. “Two soldiers with nearly identical injuries from the same bomb blast would be sitting side by side in a hospital ward,” Dr. Edwards explains. “One soldier would be saying, ‘Hey doc, can you sew me up? I need to get back to my unit.’ And the other would be crying, moaning and writhing in pain.”

Drs. Melzack and Wall determined that chemical gates in the spinal cord control pain signals from the body to the brain, depending largely on patients’ emotional states. Positive emotions diminished the perception of pain, while negative emotions kept the gates open — sometimes continuing the pain even after the initial cause had disappeared.

Fear Versus Fact

There’s a growing consensus that cognitive behavioral therapy can be very effective at diffusing negative emotions. It works by examining, and challenging, the thoughts behind them. “We’d say, ‘I understand your fear, but fear is not a fact. Let’s look at the reality in your life,'” says Katherine Muller, a cognitive therapist and director of psychology training at Montefiore Medical Center in Bronx, N.Y.

It’s no surprise that being told that pain is stress related feels like an affront, Dr. Muller says. “There’s this idea among high-functioning people that ‘I’m a good coper,’ and these symptoms suggest that you’re not,” she says. Indeed, many successful people find that low levels of stress and worry help them function. “But in periods of high stress, that worry takes over and becomes the dominant feeling. You’re still going to work. You’re still doing stuff for your family, but it’s taking a toll. And suddenly your body is saying, ‘Whoa — I can’t take the tension any more,'” Dr. Muller says.

One technique she uses is to have patients keep a diary evaluating their stress level on a scale of zero to 10 several times a day and note what was happening at the time. Patterns may emerge — that headache may set in every Thursday afternoon, after the staff meeting — and there may be ways to change the situation. “The message I’m trying to send is that you are responsible for your own stress,” says Dr. Muller. “The way you are looking at it and feeling about it is more up to you than you realize.”

So is stress-related pain all in your head after all? “All pain, and all human experience, is in your head,” says Dr. Edwards. But that’s a message of hope, he adds, since there are now ways that weren’t available 60 years ago to ease pain by managing thoughts and emotions.

All right. Sew me up, doc. I want to get back to my unit — I think.

Nap a little now… Sleep a lot later

I finally was able to get a bunch of sleep over the past 12 hours. I got home from work yesterday, and I was utterly exhausted. I could barely stop at a gas station to top off the air in my car’s left rear tire (which has been low for some weeks, but didn’t fully catch my attention till I really took a close look at it yesterday). Once home, I took a long, hot shower to take the edge off the pain I’ve been in and help me relax, then I debated whether to stay up and spend time with my partner and hit the hay early, or just take a little nap to take the edge off my fatigue.

Not feeling particularly … “viable”… I opted for the nap. I would have been lousy company had I stayed up, anyway, and why do that to someone who’s also had a really long day? I crawled into my “cave” — the quiet guest bedroom that’s at the back of the house that is my own little retreat at home — and lay down around 6:30 last night. I planned to get up in an hour or so, when supper was ready, but when my partner came to rouse me, I couldn’t budge. I couldn’t even fully wake up. This was probably around 8:30 or so… My beloved decided to let me sleep, as I’ve been so edgy and antsy, and it was abundantly clear to them that I needed to rest.

‘Round about 10:30, I woke up a bit — had to use the bathroom — and I joined the rest of my household for a little warmed-up dinner. I generally try to eat supper before 8 p.m. (which I know is probably too late — should probably be before 7) but last night was different. I was a little concerned that I might not be able to get back to sleep, if I stayed up and had “dinner” and watched a little television, but I gave it a whirl.

And wonder of wonders, I was actually tired — yawning — the rest of the evening. I headed back to bed in my cave around midnight (I have a long day ahead of me today, and I need uninterrupted sleep all by my lonesome in my cave when I’m having trouble with insomnia). I did write a little in my journal about some PTSD stuff that’s been coming up for me, lately, but when I lay down and relaxed, I went right to sleep, which is nothing short of a miracle.

I did wake up earlier than I wanted to, this a.m. — I had hoped to sleep till 7:30, but I was up before 6:00, as usual. Oh, well. At least it was closer to 6:00 a.m. than 5 a.m. Maybe my body is preparing for Daylight Savings Time, which begins this weekend. And this way, I have time to post some info before my day starts. Not a bad thing. At least I got another 5-1/2 hours of sleep between my nap last night and right now.

One thing I noticed when I woke up this morning, was that I was extremely tense. My body felt like it was spring-loaded and ready to spring into action. This is not new for me. I usually feel this way when I’m waking up, and try as I might, I cannot seem to release the tension, first thing in the a.m. I think that’s what’s been waking me up — being really tense and tight, first thing in the morning. It’s almost like my body is gearing up for the day, in advance. Like it knows I’m going to be waking up soon, and it’s getting all charged up in advance.

I have a hard time, sometimes, getting out of bed. Literally and figuratively. Not only do I have to muster the courage to get out of a warm bed into the cold air, but I tend to not be very coordinated, first thing in the a.m. Especially when my vestibular system/balance is off, I can be very wobbly and sick-on-my-stomach, when I get out of bed. I am sometimes not very coordinated about it — I hit the floor a lot harder than I intend, and I wake up my partner, which is a PITA for both of us. So, I tend to tense up and gather myself physically — and mentally — before rolling out of bed.

You wouldn’t think getting out of bed would be such a challenge, but some days it’s just the first of a long series of difficult things I’ll have to do.

Another thing that I noticed this a.m., when I was waking up very tense, was that when I relaxed, my body started to ache and throb. My joints have been giving me a lot of trouble, lately, as has my lower back. It’s not really muscular — it’s along the areas where my muscles connect with my bone, like along the top of my pelvis in my lower back — the iliac crest, I think it’s called. My shoulders and neck and hips and back just ache and throb and burn. And it gets worse when I relax.

About 20 years ago, after a car accident that didn’t seem like that big of a deal (but sent me spiraling downward — I couldn’t understand what people were saying to me when they talked, and I couldn’t keep my job and I started drinking pretty heavily). I started having terrible, awful problems with debilitating pain. It started in early 1988 and persisted for about five years — eventually the pain got to the point where I couldn’t hold down a permanent job, and I literally couldn’t get out of bed in the morning. At the time, fibromyalgia (as well as chronic fatigue syndrome) was not widely recognized or well-understood, so even though I had a lot of the symptoms of it, then, I was never diagnosed. Comparing notes with others with FMS (or “fibro”), I see an awful lot of similarities, so I’m “lumping” my experience under the FMS banner, sans official diagnosis. I’m not sure I’ll be able to work up the nerve to see a doctor about these symptoms — my ordeal 20 years ago was pretty gruelling and debilitating in and of itself, and nothing the doctors told me or subscribed for me really helped. Ultimately, I made some lifestyle changes — stopped smoking, started taking better care of myself, quit pushing myself so hard all the time, changed my shoes from hard-soled boots to soft-soled loafers, and I started eating right — and the pain dissipated considerably. I’ve been in pain, off and on, over the years, and I tend to use it as a barometer for how well I’m taking care of myself. I must not be doing a very good job of that, lately, ‘cuz I’m in terrible pain, these days.

Then again, it could be the weather, too. All I know is, I’m in a lot of pain, these days, and it’s keeping me from sleeping. And relaxing. I think in some ways, the relaxing problems bother me even more than the sleeping ones.

How much does that suck… I mean, it’s bad enough that I haven’t slept, and that my days have been crazy-busy, and I’m having trouble with figuring out how to deal with my work. But when even the simple pleasure of relaxing is off-limits to me, and it actually increases my pain and discomfort, well, then I start to feel like the Universe is really out to get me.

I hate to be a whiner, so I’ll stop right now. But let the record show that I’m not really happy about not being able to relax without pain. I’ll have to work on that. Use my acupressure points, drink more water, exercise more… maybe work some exercise into my morning routine to release some of the tension before my day starts. And quit eating so much sugar!

Well, the day is waiting. I would prefer to not be in pain and to be able to get through the day without exhaustion and tension, but you can’t have everything. At least I’m able to get through the day on my own steam, and I have plenty of activities to distract me from my discomfort.

Life, on the whole, is not bad at all. Onward…