There is a picture of me, somewhere out there, probably still on my dad’s phone unless they’ve turned into Christmas Card people, in which case, the picture is most definitely out there in the world for all to see.
I hope it is not.
I didn’t see the picture until I was 5 months sober, staying in the unfinished basement at my parents house, grateful that I was no longer homeless, while I hunted for a job. Before this, I’d been staying there after a stint at a ramshackle, rundown motel, the kind of place you probably could dismantle a dead body, leave the head on the pillow, and no one would think anything of it. But it was my room, and despite the lice they gifted me, I loved it. Until money dried up and suddenly I was, once again, homeless. I’d moved in there after I was discharged from the inpatient psych ward, in which I was able to successfully detox after a suicide attempt. Got some free ECT to boot.
(WINNING)
Despite what you see on the After School Special’s of our childhood, I didn’t take a single Vicodin, fall into a stupor, and become insta-addict – just add narcotics! No, my entry into addiction was a slow and steady downward spiral of which I am deeply ashamed. It’s left my brain full of wreckage and ruin, fragmented bits of my life that don’t follow a single pattern. Between the opiates, the Ketamine, and the ECT, I cannot even be certain that what I am telling you is the truth; what I’ve gathered are bits and pieces of the addict I so desperately hate from other people who are around, fuzzy recollections, and my own social media posts.
About a year and a half before I moved from my yellow house to the apartments by the river, Dave and I had separated; he’d told me that while he cared for me, he no longer loved me. While we lived in the same house, we’d had completely separate lives for years, so he moved to the basement while I stayed upstairs. I’d been miserable before his confession and after? I was nearly broken. Using the Vicodin, then Norco, I was able to numb my pain and get out of my head, which, while remarkably stupid, was effective. For awhile.
Let me stop you, Dear Reader, and ask you to keep what I am about to say in mind as you read through this massive tome. I’m simply trying to make certain that you understand several key things about my addiction and subsequent recovery. I alone was the one who chose to take the drugs. No one forced me to abuse opiates, and even later, (SPOILER ALERT) Ketamine. This isn’t a post about blaming others for my misdoings, rejecting any accountability, nor making any excuses for the stupid, awful things I’ve done. I alone fucked up. My addiction was my own fault. However, in the same vein, no one “saved” me but myself. There was no cheeky interventionist. No room full of people who loved me weeping stoically, telling me how my addiction hurt them. No letters. Nothing. It was just me. I was alone, and I chose to get – and remain – sober.
The delusions started when I moved out, sitting in my empty apartment alone, paralyzed by the thought of getting off the couch to go to the bathroom. Always a night-owl, I’d wake at some ungodly hour of the morning, shaking. It wasn’t withdrawal, no, it was pure unfettered anxiety.
It was the aftermath of using so many pills, all the fun you think you’re having comes back to bite you with crippling anxiety and depression.
Which is why I’d do more.
Yes, opiates are powerful, and yes, I abused them, but things really didn’t become dire until I added Ketamine to my life.
Ketamine, if you’re unaware, is a club drug, a horse tranquilizer, and a date rape drug. You use too much? You may wake up at some hipster coffee bar, trying to sing “You’re Having My Baby” to the dude in the front row who may or may not actually exist. In other words, it’s the best way to forget how fucked you are.
The delusions worsen as time passed. I could see into the future. I could read your mind. I was going to be famous. I was super fucking rich. In this fucked-up world, I could even forget about me, and the life that I’d so carelessly shattered. I remember sitting in Divorce Class at the courthouse, something required of all divorces in Kane County, weeping at all that I’d thrown away – using a total of three boxes of the low-quality, government tissues. I left with a shiny pink face and completely chapped nose and eyes that appeared to be making a break from their sockets. I went home, took some pills, took some Ketamine, and passed out.
I retreated ever-inward. I didn’t talk to many people. I didn’t share my struggles. I was alone, and it was my fault.
The hallucinations started soon after Divorce Class ended and my ex and I split up. He’d left my house in a rage after a fight and went to live with his sister. I got scared. His temper, magnified by the drugs, the hallucinations, and the delusions, grew increasingly frightening. Once he’d moved out, the attacks began. I’d wake up naked in my bedroom, my body sore and bruised, and my brain put the two unrelated events together as one – he was attacking me. It happened every few days, these “attacks,” until I found myself at the police station, reporting them. I was dangerously sick and I had no idea.
My friends on the Internet (those whom I had left), sent me money for surveillance cameras. I bought them, installed them – trying to capture the culprit – and when I saw what I saw, I immediately called the police and told them the culprit.
The videos in my bedroom captured an incredibly stoned, dead-eyed, version of myself, violently attacking myself, brutally tearing at my flesh. In particular, THAT me liked to beat my face with one of my prized possessions – a candlestick set from our wedding, take another pill or hit up some Ketamine, then violating myself with the candlestick. It lasted hours. I’d wake up with no memory of events, sore and tired and unsure of how I’d gotten there.
I’d never engaged in self-injury before – not once – so the very idea that I’d hurt myself was unbelievable, but right there, on my grainy old laptop, was proof of how unhinged I’d become. Charged with filing a false report, I plead guilty.
In early September of 2015, I decided to get fixed, and made arrangements with work to take a few weeks off to do an inpatient detox, and, for the first time in a long time, I woke up happily, rather than cursing the gods that I was still alive.
It was to be short-lived.
Several days later, sober, I was idly chatting with my neighbor about her upcoming vacation (funny the things your brain remembers and what it does not), standing by my screen door, when karma came calling. It sounded like the shucking noise of an ear of corn, or maybe the sound that a huge thing of broccoli makes when you rip it apart – hard. It felt like a bullet to the femur. I crumpled on top of my neighbor and began screaming wildly about calling an ambulance, yelling over and over like some perverse, yet truthful, Chicken Little: “my leg is broken, my LEG is broken!”
I don’t remember much after that. I woke up in (physical rehab) and learned that my femur (hereafter to be called my “Blasfemur,”) had broken, fairly high up on the bone, where the biggest, strongest bone in your body is at its peak of strength. Whaaaa?
The doctors and nurses shrugged it off my questions, with a flippant “It just happens” and sent me home, armed with a Norco prescription, in November, to heal. I added the Ketamine, just to make sure.
A couple of weeks later at the end of November, I was putting up the Christmas tree with the kids and my mother. It was all merry and fucking bright until I sat down on the couch and felt that familiar crunch. Screams came out of me I didn’t know were possible, but I’d lost my actual words. My mother stood over me yelling “what’s wrong? what’s wrong?” and I couldn’t find the words. I overheard her telling my babies that I was “probably just faking it” as she walked out the door, my screams fading into an ice cold silence. They left me alone in that apartment where I screamed and cried and screamed. Finally, I managed to call 911 and when they asked me questions, all I could scream was my address.
I woke up in January in a nursing home. When I woke up, I found myself sitting at a table in a vast dining room, full of old people. For weeks to come, I thought that I’d died and gone…wherever it is that you go.
This time, I learned, my (blas)femur and it’s associated hardware had become infected after the first surgery, which weakened the bone, causing it to snap like a tree. They put me all back together like the bionic woman, but the surgery had introduced the wee colony of Strep D in the bone into my bloodstream, creating an infection on meth. I’d been in a coma for weeks. Once again, I learned to walk, and once again, I was sent home in late January with another Norco prescription. The nursing home really wanted me to have someone stay with me to help out, but I insisted that I was fine alone. In truth, I had nobody to help me out, but was far too ashamed to tell them.
The picture I referenced above was taken some time in May, as far as my fuzzy memory allows me to remember, after my third femur fracture in March. This time, I’d been so high that I fell asleep on the toilet and rolled off. Glamorous, no? Just like Fat Elvis. Luckily, my eldest son was there and he called 911 and my parents to whisk him away. I remember my father on the phone, telling Ben that I was a liar and I was faking it. I was swept away in the ambulance for even more hardware, and finally? A diagnosis:
HypoPARAthyroidism.
It’s an autoimmune disease that leaches calcium from the bones, resulting in brittle bones. It is managed, not treated. There is no cure.
But, I had the answer. Finally.
After my third fracture, I once again was sent to the nursing home, and quickly discharged with even higher doses of Norco, when my insurance balked, I’d used up all my rehab days for the year. By this time, I’d lost my apartment, my stuff was in storage (except the things that we’re thrown away, which my father gloated about while I was flat on my back) and my parents let me stay with them, which was about the only option I had. They couldn’t really kick me out if my leg was only freshly attached. I feel deeper into a depression, self-loathing, and drug abuse as I realized what a mess I’d made with my life. How many bad choices I’d made. How many people I’d hurt. How much I’d hurt myself. How much I loathed myself. How I once had a life that in no way resembled sleeping in my parents dining room. How I’d been a home owner. How I’d been married. How lucky I’d been. How I threw it all away. My life turned into a series of “once did” and “used to.”
The only one who hated me more was my father.
While we were once close confidants, in the years after my marriage to Dave, his disdain had become palpable. My uncle had to intervene one Christmas, after my father mocked me incessantly for taking a temp job filling out gift cards while I was pregnant with Alex. It may seem normal to some of you, this behavior, but in THEIR house, NO ONE was EVER SAD and NOTHING was EVER WRONG. WASPs to the core, my family is.
When I moved back in, broken, dejected, and high, our fights became epic. For the first time in my life, I stood UP to one of my parents. Then, I was promptly kicked out.
Guess I’m not so WASPy after all.
I want to say that the picture was taken around May of 2016, but my estimate may be thoroughly skewed, so if you’re counting on dates being correct and cohesive, you’ve got the wrong girl.
This is a picture of me, though you probably wouldn’t recognize me. I am wearing the blue scrubs that you associate with a hospital: not exactly sky blue, not teal, not navy, just generic blue hospital scrubs. These are, I remember, the only clothes I have to my name. I was given them in both the hospital and the nursing home, a gift, I suppose, of being a frequent flier, tinged with a bit of pity – this girl has no clothes, we can help. Whomever gave them to me, know that you gave me a bit of dignity, which I will never forget. Thank you.
I am wearing scrubs, the light of the refrigerator is slowly bleaching out half of my now-enormous body, as opposed to the darkness outside. There is a tube of fat around my neck, nearly destroying any evidence of my face, but if you look closely, you can make out my glasses, my nostrils, my hair cascading down. My neck is stretched back at nearly a 90 degree angle from my body, my head listlessly resting on the back of my wheelchair. My mouth gaped wide, which, should I been engaging in fly catching, would have netted far more than the average Venus flytrap. I am clearly, unmistakably, and without a single shred of doubt, passed the fuck out.
It is both me and not me.
High as i was, I don’t remember a thing about the photo being taken. But there I was, in all my pixelated glory.
By the time I saw the photo, I was once again in my “will do” and “can do” space. I’d kicked drugs in September 2016 and had found a job that I enjoyed. I stayed with my parents while I began to sort out my medical debt and save toward a new car and an apartment of my own. My spirits were high, my depression finally abated to the background, and I was tentatively happy. I’d apologized until my throat was sore, but my fragmented memory saved me from the worst of it, but I was not forgiven. I don’t think I ever expected to be. And now, I never will.
It’s okay. I can’t expect this. I know I fucked up.
My father, who’d actually grown increasingly disdainful of me, the more sober and well I became, confronted me when I came home one day after work, preparing to do my AFTER work, work.
My mother shuffled along behind him, Ben, the caboose. All three of them were in hysterics, tears rolling down their cheeks as I sat down in my normal spot on the couch. After showing them a video of two turtles humping a couple of days before, I eagerly waited to see what they were showing me.
What it was was that picture. Of the not me, me.
They could hardly contain their laughter, my father happier than ever, braying, “Isn’t this the best picture of you?” and “You PASSED OUT, (heave, heave) IN FRONT OF THE FRIDGE!” punctuated, with “I’m going to frame this picture!” The tears welled in my eyes while my teeth clenched, they laughed even harder at my reaction.
Like I said, if they’ve become Christmas Card sending people, this will be the picture of me they show, expecting others to laugh uproariously. Before I moved out, in fact, my father made certain to show the picture to anyone who came over. “Wanna see something hilarious?” he’d ask. Expecting memes or a funny cat playing the piano, they’d agree. I could see it when they saw it, my dad chortling with laughter, nearly choking on his giggles, the looks on their faces: a mixture of confusion and pity. Even in my drug-hazed “glory,” I’d never felt so low.
Maybe that picture is splashed all over the internet, in the dark recesses I don’t explore, and maybe it’s not. Maybe it’s hung on their wall, replacing all of the other pictures. Maybe it’s not.
Pain is so universal that it barely needs a definition to be understood.
What follows is a discussion of physical pain, not emotional pain.
The International Association for the Study of Pain (IASP) defines pain as: An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.
According to the IASP, pain is the most frequent reason for emergency department (ED) visits, accounting for over 70% of visits. In the US, more than 115 million ED visits occur each year with acute headache alone accounting for 2.1 million of these visits. Acute pain is also a common reason for visits to family practice, sports medicine, and internal medicine health care practitioners.
The American Academy of Pain Medicine (AAPM), in its report with the Institute of Medicine of the National Academies, Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education and Research, estimates that at least 100 million adults in the US have common chronic pain conditions.
Pain helps us to remove ourselves from damaging situations, protect an injury while it heals and learn to avoid similar situations in the future. Generally, pain resolves when the painful stimulus is removed and the body has healed, but sometimes pain may persist. Pain may also arise in the absence of painful stimuli, damage or disease.
Types of Pain:
It’s safe to say most of us are not big fans of pain. Nevertheless, it is one of the body’s most important communication tools. Imagine what would happen if you felt nothing when you put your hand on a hot stove. Pain is one way the body tells you something’s wrong and needs attention.
But pain — whether it comes from a bee sting, a broken bone, or a long-term illness — is also an unpleasant sensory and emotional experience. It has multiple causes, and people respond to it in multiple and individual ways. The pain that you push your way through might be incapacitating to someone else.
Even though the experience of pain varies from one person to the next, it is possible to categorize the different types of pain. Here’s an overview of the different types of pain and what distinguishes them from one another.
There are several ways to categorize pain. One is to separate it into acute pain and chronic pain
Acute Pain: Typically results from injury, disease or inflammation of the tissues. Acute pain is usually confined to a given amount of time and severity and can be diagnosed and treated. Acute pain comes on suddenly and is accompanied by anxiety and emotional distress. Acute pain typically comes on suddenly and has a limited duration. It’s frequently caused by damage to tissue such as bone, muscle, or organs, and the onset is often accompanied by anxiety or emotional distress.
Rarely, it can become chronic pain.
Break-Through Pain (also known as Flare-Up Pain) is transient and excruciating pain beyond the normal pain baseline. Breakthrough pain goes above and beyond the medication taken to prevent and treat persistent pain. It may be caused by changes in treatment or in the underlying disease or physical actions – sneezing or standing up. Breakthrough pain may be caused by stress, worry or anxiety.
About 70% of people with chronic pain treated with pain medication experience episodes of what’s called breakthrough pain. Breakthrough pain refers to flares of pain that occur even when pain medication is being used regularly. Sometimes it can be spontaneous or set off by a seemingly insignificant event such as rolling over in bed. And sometimes it may be the result of pain medication wearing off before it’s time for the next dose.
Chronic Pain: pain that persists over a longer period of time and is resistant to most medical treatments. Chronic pain is widely believed to represent disease itself. It can and often does cause problems for people who live with it. Chronic Pain lasts longer than acute pain and is generally somewhat resistant to medical treatment. It’s usually associated with a long-term illness, such as osteoarthritis. In some cases, such as with fibromyalgia, it’s one of the defining characteristic of the disease. Chronic pain can be the result of damaged tissue, but very often is attributed to nerve damage.
Both acute and chronic pain can be debilitating, and both can affect and be affected by a person’s state of mind. But the nature of chronic pain — the fact that it’s ongoing and in some cases seems almost constant — makes the person who has it more susceptible to psychological consequences such as depression and anxiety.
At the same time, psychological distress can amplify the pain.
Why Do People Experience Pain Differently?
Pain is real and it’s physical — there’s no mistaking that. But pain is measured and specific to one person based on that person’s perception of the pain, and that’s why everyone’s pain is different.
What the brain perceives is indisputably modifiable by emotions. That means that people who are fearful of pain, depressed, or anxious may experience pain differently, and perhaps more severely, than someone who has pain but isn’t experiencing those other emotions.
Classification for Chronic Pain:
Pain is most often classified by the kind of damage that causes it. The two main categories are pain caused by tissue damage, also called nociceptive pain, and pain caused by nerve damage, also called neuropathic pain. A third category is psychogenic pain, which is pain that is affected by psychological factors. Psychogenic pain most often has a physical origin either in tissue damage or nerve damage, but the pain caused by that damage is increased or prolonged by such factors as fear, depression, stress, or anxiety. In some cases, pain originates from a psychological condition.
Pain is also classified by the type of tissue that’s involved or by the part of the body that’s affected. For example, pain may be referred to as muscular pain or joint pain.
Chronic pain is classified by the functional changes associated with the disease or injury.
Neuropathic pain is caused by damage to the brain, spinal cord or peripheral nerves. It is typically described as burning, tingling, shooting, stabbing, stinging or “pins and needles.”
Phantom Pain – pain from a part of the body that has been lost, or from an area from which the brain no longer receives signals. This type of pain is common in amputees.
Psychogenic Pain – (also called psychalgia or somatoform pain) is pain that is caused by, increased, or prolonged by emotional, mental or behavioral patterns.
Nociceptive Pain – pain due to an ongoing tissue injury. Nociceptive pain is often divided into two categories:
Somatic Pain – pain caused by activation of the pain receptors in the musculoskeletal tissues or the body’s surface. It may be described as dull or aching.
Visceral Pain – pain caused by damaged or injured internal organs. Usually described as vague, unlocalized pain that may feel like pressure, deep squeezing, dull and diffuse.
Chronic Pain Caused by Tissue Damage (Nocioceptive Pain)
Most pain comes from tissue damage. The pain stems from an injury to the body’s tissues. The injury can be to bone, soft tissue, or organs. The injury to body tissue can come from a disease such as cancer. Or it can come from physical injury such as a cut or a broken bone.
The pain you experience may be an ache, a sharp stabbing, or a throbbing. It could come and go, or it could be constant. You may feel the pain worsen when you move or laugh. Sometimes, breathing deeply can intensify it.
Pain from tissue damage can be acute. For example, sports injuries like a sprained ankle often the result of damage to soft tissue. Or it can be chronic, such as arthritis or chronic headaches. And certain medical treatments, such as radiation for cancer, can also cause tissue damage that results in pain.
Pain Caused by Nerve Damage (Neuropathic Pain)
Nerves function like electric cables transmitting signals, including pain signals, to and from the brain. Damage to nerves can interfere with the way those signals are transmitted and cause pain signals that are abnormal. For instance, you may feel a burning sensation even though no heat is being applied to the area that burns.
Nerves can be damaged by diseases such as diabetes, or they can be damaged by trauma. Certain chemotherapy drugs may cause nerve damage. Nerves can also be damaged as a result of stroke or an HIV infection, among other causes. The pain that comes from nerve damage could be the result of damage to the central nervous system (CNS), which includes the brain and spinal cord. Or it could result from damage to peripheral nerves, those nerves in the rest of the body that send signals to the CNS.
The pain caused by nerve damage, neuropathic pain, is often described as burning or prickling. Some people describe it as an electrical shock. Others describe it as pins and needles or as a stabbing sensation. Some people with nerve damage are often hypersensitive to temperature and to touch. Just a light touch, such as the touch of a bed sheet, can set off the pain.
Much neuropathic pain is chronic. Examples of pain caused by damaged nerves include:
Central pain syndrome. This syndrome is marked by chronic pain that stems from damage to the central nervous system. The damage can be caused by stroke, MS, tumors, and several other conditions. The pain, which is typically constant and may be severe, can affect a large part of the body or be confined to smaller areas such as the hands or feet. The pain often can be made worse by movement, touch, emotions, and temperature changes.
Complex regional pain syndrome. This is a chronic pain syndrome that can follow a serious injury. It’s described as persistent burning. Certain abnormalities such as abnormal sweating, changes in skin color, or swelling may be noticed in the area of the pain.
Diabetic peripheral neuropathic pain. This pain comes from nerve damage in the feet, legs, hands, or arms caused by diabetes. Individuals with diabetic neuropathy experience various kinds of pain including burning, stabbing, and tingling.
Shingles and postherpetic neuralgia. Shingles is a localized infection caused by the same virus that causes chickenpox. The rash and associated pain, which can be debilitating, occurs on one side of the body along the path of a nerve. Postherpetic neuralgia is a common complication in which the pain from shingles lasts more than a month.
Trigeminal neuralgia. This condition causes pain as a result of inflammation of a facial nerve. The pain is described as intense and lightning like, and it can occur in the lips, scalp, forehead,eye, nose, gums, cheek, and chin on one side of the face. The pain can be set off by touching a trigger area or by slight motion.
How Pain Affects Daily Life:
Pain is pervasive. According to the American Pain Foundation, 26 percent of Americans have experienced pain that persisted for more than 24 hours at one point or another, and a third of them describe their pain as disabling.
Chronic pain is strongly linked to a greatly increased risk of major mental conditions including depression, anxiety, and post-traumatic stress disorder.
A body in chronic pain continually sends stress signals to the brain, leading to a heightened perception of not only the pain itself but also the perceived level of threat.
Pain can greatly impact quality of life and functioning for those affected by it.
Chronic pain actually changes the way the brain processes emotion and the pain itself. Patients with chronic pain are more likely to experience depression because the pain acts on the sense-data areas of the brain that regulate not only emotion but also sleep. When sleep becomes unsatisfying (too long, too short, poor quality, etc.), feelings of depression, anxiety, and pain become more intense. The brain also begins to anticipate pain, leading to anxiety and a hypervigilance that is normally associated with post-traumatic stress disorder.
Just as chronic pain can lead to depression, depression itself can lead to chronic pain. This is a vicious cycle that can be very difficult to break.
For those without chronic pain, there are a good many things taken for granted. Tying shoelaces, making breakfast, walking the dog, balancing the checkbook: there is a seemingly endless supply of time, energy, and attention (TEA) for these tasks.
With chronic pain, time, energy, and attention are often in limited supply. This means that decisions must be made and priorities set daily depending on the level of pain. This is often described using spoon theory. “Spoonies” are people with chronic pain who have a limited amount of TEA for daily tasks, represented by a number of spoons. Getting dressed in the morning might take up two of that day’s ten spoons, making the rest of the day instantly problematic.
Considering the prevalence and extent of chronic pain, it’s understandable that a wide range of coping mechanisms may be part of your pain management plan. However, you might be doing yourself more harm than good, especially if you rely on tactics such as smoking, drinking, overeating, or using drugs.
Chronic pain touches every aspect of daily life, arguably none more powerfully so than in the area of relationships. Family and friends alike can be greatly affected by a loved one’s chronic pain in ways that can last long after the pain is diagnosed and treatment begins.
For chronic pain sufferers with a partner, chronic pain can be the cause of frustration with things like daily parenting and household chores. Partners of people in pain may resent the fact that they are often the primary breadwinner, main caretaker (or children and the pain patient), and head of household chores.
Financial strain is often the cause of conflict in any relationship, and chronic pain patients may incur more than their share of medical bills. Sexuality and intimacy may suffer as well, due to the pain itself and the frustrations experienced due to unequal distribution of responsibilities.
Parenting with chronic pain can be even more of a struggle, as young children don’t always understand a “boo-boo” that isn’t visible and doesn’t go away. Pain patients may not be as patient with their children as they would like. These difficult relationships with children can lead to feelings of inadequacy as a parent, which can then turn into depression or deep sadness or low self-esteem as a person and a parent.
At work, it can be difficult to feel comfortable in a setting where colleagues may resent frequent absences or what is perceived as special treatment for an invisible illness. When just getting to the job every day is a nearly insurmountable task, this resentment at work can make a chronic pain patient want to quit.
People who experience both acute and chronic pain also see impairments in working memory, attention span, mental flexibility, information processing speed, and problem solving.
Coping With Acute and Chronic Pain:
Remind yourself that you can cope with your pain
Try your best to remain calm – remind yourself of the ways you can help yourself, you could take medication designed for flare-ups
Get help with housekeeping and other chores.
Remind yourself that if you need it, you can go to the ER.
Pain can disrupt sleep on a nightly basis, and chronic pain sufferers have been known to make major lifestyle adjustments, including taking disability leave from work, changing jobs, getting assistance with activities of daily living, and even moving to a home that is more user-friendly in order to help cope with their pain.
Uncontrolled pain is a stressful experience and as the stress generates, perpetuates, and amplifies your pain. Using pain medication can both feel better and make you more likely to recover quickly.
However, pain medication can also lead to rebound pain for some. Pain medication can also cover up pain enough that you “keep going” when what your body needs is some rest and recuperation.
You may end up needing to balance these pros and cons.
Use many methods to manage your pain rather than solely relying on pain medication such as heat/ice packs, meditation, yoga, breathing techniques, or whatever is recommended for your condition.
Live Your Life
It’s easy to feel social anxiety when you’re experiencing pain. Sometimes pain will make you cry or grimace at a social function which may make you feel ashamed. While highly unlikely, people worry that will pain will become so bad that you may not be able to drive home. This is a part of the thinking of people who have panic disorder or anxiety disorder and it’s all related to being scared that you’ll lose control of your body, or trapped and unable to escape a situation.
However, avoiding social situations makes these anxieties and fears worse. So, get out there!
Re-evaluate your priorities
Many people enjoy working hard and pushing beyond what’s truly necessary. These may be self-imposed rules along the lines of “I have to get X done today.”
Break tasks into smaller tasks. Remember that many of the things you want to do are just that – wants, and just because you’d LIKE it to be done does not mean it must.
Focus upon the most basic needs and don’t feel guilty when you need help through these texts.
Experiment With What Works For You
Experiment with different types of coping to see what works for you There might be particular kinds of self-talk you find useful. That might work for you, or it might backfire. You’ll need to experiment for yourself.
Anything that involves a small amount of physical exertion and is methodical provides a helpful distraction, especially if it’s not mentally taxing.
Eating enough is important Pain makes many not hungry, but not eating is worse overall.
Enjoy lessened pain
You probably have periods when my pain was only mild rather than intense. During these moments, relax into them and enjoy the relative calm. This is a similar principle to relaxing between contractions when you’re in labor. Make sure you notice when you’re feeling good, or at least less terrible.
If you find yourself catastrophizing, consider the opposite – your pain episode might be shorter than you’re expecting. If you’re going to worry about worst case scenario, make sure to think of the best case scenario.
Pain In Different Age Groups:
Pain In The Elderly:
Chronic pain is extremely prevalent in the elderly population.
Addressing and treating pain in the elderly is a difficulty for health care professionals due to the following:
The elderly are reluctant to report pain symptoms as they believe pain is a normal part of aging. The elderly may also be hesitant to “bother” their physician with complaints of pain.
The elderly may be concerned by side effects of pain management as well as fear addiction to these drugs.
Older adults have a higher likelihood of cognitive and sensory impairments.
The elderly may be more concerned about the cost of treatment for pain management.
Common Pain-Inducing Conditions in Older Adults:
Nociceptive pain:
Osteoarthritis
Lower back pain
Osteoporosis
Prior bone fractures
Rheumatoid arthritis
Paget’s disease
Polymyalgia rheumatic
Coronary artery disease
Neuropathic Pain:
Herpes zoster
Peripheral neuropathies
Trigeminal neuralgia
Central post-stroke
Nutritional neuropathies
Pain in Children:
Chronic pain is a significant problem for the pediatric population and their caregivers. The social and emotional consequences that result from pain and disabilities may be devastating. Financial costs of childhood pain may be significant in some families, as well as losing salary for time off to care for the sick child. Also, the physical and psychological issues with chronic pediatric pain can have an impact on health as well as predisposing the child for chronic pain in adulthood.
Pain Management: Treating Mind and Body
Most pain specialists stress the importance of approaching pain both physically and emotionally and addressing “people as entire human beings.” So while chronic pain medication can be effective and important for pain management for many people, it isn’t the only tool available when it comes to pain treatment, and it shouldn’t be the only tool that’s used.
Medications. There are a lot of medications that are prescribed for pain and that opioids (narcotics) and benzodiazepines may not be the best options. Those treatments have their own problems, and there are no good studies on using opioids for long periods of time for the treatment of chronic pain.
The most common way that pain is treated is with the use of pain relievers. Pain relievers may be useful for certain patients in chronic pain; however, they are not universally effective. Pain relievers may, for certain individuals, worsen their condition or cause dangerous side effects.
Short-term use for pain medications is seldom concerning, although side effects are most problematic during the initial phase of treatment and tend to diminish after long-term use.
Long-term use – and misuse – of pain medications can lead to many adverse reactions.
Addiction should be distinguished from physical dependence. Any individual that takes sufficient doses of certain types of drugs for a significant length of time can have withdrawal symptoms if the drug is suddenly stopped or reversed by another medicine. This shows the presence of physical dependence but does not constitute addiction.
Therapy. Therapy can be aimed at both the mind and the body. Your pain management team should look at any of these therapies as not being purely physical or purely psychological — we are always a mixture of both of those things.
Physical therapy is a very important part of any pain management program. Pain can be worsened by exercise that isn’t done correctly (or interpreted incorrectly as pain rather than overuse), and a physical therapist can tailor the right exercise regimen for you. Proper exercise slowly builds your tolerance and reduces your pain — you won’t end up overdoing it and giving up because it hurts.
Cognitive-behavioral therapy allows people to learn and have a better understanding of what the pain is from, and what they can do about it, This therapy is really about understanding the role of pain in your life and what it actually means for you.
Each person should have an individualized care plan for managing chronic pain. With the help of a doctor, each medication – the pros and cons, the benefits, other medical problems and potential side effects – should be weighed before beginning any treatment plan.
Discuss all medications and treatments with your doctor before deciding on any treatment plan.
Managing Pain with Medications:
Over-The-Counter Pain Relievers:
Over-the-counter drugs are those that may be purchased without prescriptions. The two most common types of over-the-counter pain relievers are acetaminophen and non-steroidal anti-inflammatory drugs (also known as NSAIDs).
The most important thing for individuals to remember while purchasing over-the-counter drugs is to read the labels. People must be mindful and read the labels, understand what they are taking and how much of it.
Both acetaminophen and NSAIDs reduce fever and relieve pain caused by muscle aches and stiffness, but only NSAIDs can also reduce inflammation (swelling and irritation). Acetaminophen and NSAIDs also work differently. NSAIDs relieve pain by reducing the production of prostaglandins, which are hormone-like substances that cause pain. Acetaminophen works on the parts of the brain that receive the “pain messages.” NSAIDs are also available in a prescription strength that can be prescribed by your physician.
Using NSAIDs increase the risk of heart attack or stroke and have also been known to cause stomach ulcers and bleeding. They can also cause kidney problems.
Safety And Over-The-Counter Medications:
When used sparingly, over-the-counter medications generally do not cause health problems. Occasionally, because they are drugs like any other, they are dangerous.
NSAIDs and acetaminophen are both used to prevent pain. Long-term use can lead to gastric bleeding, kidney failure, liver failure, as well as other conditions.
The most concerning over-the-counter pain medication is acetaminophen, which – even at fairly low doses – can be toxic to the liver, especially for those who have liver problems or are heavy drinkers.
Prescription Pain Killers
Chronic pain management is a public health concern with significant increases in the use of opioids for pain relief. There is a corresponding growth in the number of opioids prescribed in the U.S. and the overdose from those drugs. Family physicians and other primary care providers play a vital role in balancing patients’ pain management needs with the risk of drug misuse and abuse.
The American Academy of Family Physicians (AAFP) is dedicated to finding solutions to the crisis of pain management and opioid abuse. We recognize that long-acting and extended-release opioids are powerful drugs that require oversight, but these drugs can be controlled without unduly limiting their proper use. Creating additional prescribing barriers for primary care physicians would limit patient access when there is a legitimate need for pain relief.
What opioid medications do
Opioids are a broad group of pain-relieving drugs that work by interacting with opioid receptors in your cells. Opioids can be made from the poppy plant — for example, morphine (Kadian, Ms Contin, others) — or synthesized in a laboratory.
When opioid medications travel through your blood and attach to opioid receptors in your brain cells, the cells release signals that muffle your perception of pain and boost your feelings of pleasure.
When opioid medications are dangerous
What makes opioid medications effective for treating pain can also make them dangerous.
At lower doses, opioids may make you feel sleepy, but higher doses can slow your breathing and heart rate, which can lead to death. And the feelings of pleasure that result from taking an opioid can make you want to continue experiencing those feelings, which may lead to addiction.
You can reduce the risk of dangerous side effects by following your doctor’s instructions carefully and taking your medication exactly as prescribed. Make sure your doctor knows all of the other medications and supplements you’re taking.
People with chronic pain will often initially consult their family physician for treatment. Treatment may include subspecialists, but it is often the family physician’s role to coordinate and manage care, including the use of opioid pain relievers. The AAFP views the goal of pain management to be primarily improvement and maintenance of function. We urge family physicians to individualize treatment based on a review of a patient’s potential risks, benefits, side effects, and functional assessments, and to monitor ongoing therapy accordingly.
Invasive Pain Interventions:
Viscosupplementation – lubricating substances are injected into the knee joint in patients suffering from osteoarthritis of the knee. These substances restore lubrication of the joint and decrease pain while increasing motility.
Intra-Articular Steroid Injections – for those suffering osteoarthritis, steroid injections may be injected into the joint for short-term relief.
Spinal Cord Stimulation – a small device is implanted under the skin – usually in the abdomen or buttocks – to deliver mild electrical signals to an area near the spine. The electrical signals can be adjusted by the patient via remote control to provide optimal pain relief.
Epidural – a steroid is injected into the epidural space in the neck or lower back, with or without a numbing agent.
Nerve Blocks – combination of local anesthetic and steroids used diagnostically to identify pain generators. These can also therapeutically blog a painful condition, although only for the short-term.
Rhiztomy – a probe is inserted to destroy the nerve that supplies the facet joint (a small joint that connects the back of the spine and cause neck or back pain).
Intrathecal Drug Delivery Systems – also known as pain pumps, these implanted devices deliver prescribed amounts of pain medication directly to the spinal cord and nerve roots.
Non-Invasive Pain Interventions:
Acupuncture – thin, metallic needles are inserted along acupuncture sites on the body to restore balance. These needles are manipulated or stimulated electrically and has gained a wide following of chronic pain sufferers.
Hyperbaric Oxygen – oxygen is administered in a pressurized chamber to increase the oxygen delivery to the tissues, but its efficacy is still largely undetermined.
Passive Therapies – passive therapies, such as massage, ultrasound, heating pads, and wax treatment or traction, can be useful for managing short-term pain but have limited benefit in chronic pain conditions.
External Stimulation Devices – a common device used to treat chronic pain is transcutaneous electrotherapy (TENS), in which electrical stimulation is applied to the surface of the skin.
Trigger Point Injections – a short-term solution for those with myofascial pain syndrome.
Monotherapies to Manage Chronic Pain:
Education – Patient and family education should be the primary focus of treatment and management of chronic pain conditions. It is crucial that the healthcare team work in conjunction with the family to develop strategies to cope with and manage chronic pain.
Exercise – The treatment for chronic pain almost universally suggests that the patient with chronic pain be kept as active as possible. The overwhelming evidence suggests that exercise programs are beneficial to those who suffer chronic pain.
Psychological Approaches – While talking to someone trained in “talk therapy” will not cure chronic pain, it can aid in the development of coping strategies to manage and fully live life.
Mind-Body Approaches – There are many mind-body approaches to living with chronic pain, including meditation, relaxation, hypnosis, biofeedback and imagery.
In Summation:
Chronic pain, while a difficult and frustrating condition to manage, is something unique to each individual, which means that each person will respond uniquely to differing approaches to chronic pain. The most important things for those in pain is to advocate for themselves and not be afraid to stand up for a treatment that isn’t working.
Additional Pain Resources:
Clinical Trials for Pain may be utilized for certain individuals who meet the standards for participation.
American Academy of Pain Medicine (AAPM) is a medical specialty society for physicians who practice in the field of pain medicine. The organization provides education, training, advocacy, and research in the specialty of pain medicine.
Outside the working world, those most prone to burnout are caregivers. Caregivers are unpaid workers who devote themselves to the care of a chronically ill or disabled person. The constant stress of caregiving can lead to burnout and damage both physical and mental help. If you are helping your family member or friend through treatment, you are a caregiver. This may mean helping with daily activities such as going to the doctor or making meals. It could also mean coordinating services and care. Or it may be giving emotional and spiritual support.
We define a caregiver as the person who most often helps the person and is not paid to do so. Professional care providers are paid to give care. They tend to have more limited roles and are not discussed in detail here. Caregivers may be partners, family members, or close friends. Most often, they’re not trained for the caregiver job. Many times, they’re the lifeline of the person who is ill.
Caregivers have many roles. These roles change as the patient’s needs change during and after treatment. Today a lot of care is done in outpatient treatment centers and doctors’ offices. This means that sicker people are being cared for at home.
As a caregiver, you have a huge influence – both positive and negative – on how the cancer patient deals with their illness. Your encouragement can help the patient stick with a demanding treatment plan and take other steps to get well, like eating healthy meals or getting enough rest.
A caregiver is a person who devotes themselves to help another person in need. Typically, the patients who require care have conditions such as cancer or dementia that prevent them from performing activities of daily living.
Caregivers provide support by doing grocery shopping and cooking, paying bills, giving medicine, assisting with bathing, using the toilet, dressing, and eating.
Caregivers are part of the team
The caregiver is part of a care team made up of the patient, other family and friends, and the medical staff. As a caregiver, you may find yourself working closely with the care team, doing things like:
Giving drugs
Managing side effects
Reporting problems
Trying to keep other family members and friends informed of what’s happening
Helping to decide whether a treatment is working
As part of the team, you’ll help coordinate the patient’s care. Caregivers often have to keep track of prescriptions, know which tests are to be done and make sure all involved doctors know what’s going on. They often find themselves preventing mix-ups and keeping track of paperwork.
A good caregiver is a vital health care resource. In many cases, the caregiver is the one person who knows everything that’s going on with the patient. Don’t be afraid to ask questions and take notes during doctor visits. Learn who the members of the care team are and know how to contact them. Getting the right support and information can help both you and your loved one with cancer.
Caregivers are problem solvers
The person with the disease faces many new challenges. As the caregiver, you can help the patient deal with these challenges and get through any problems that come up.
For example, suppose the patient’s white blood counts drop, they develop a fever, and as a result, need to be in the hospital. This can be very upsetting and may be seen as a setback by the family and the patient. The caregiver can:
Help address their concerns by pointing out that the patient will need to be in the hospital for only a short time until antibiotic treatment has the infection under control.
Make sure that the patient has everything they need while in the hospital, including doctor’s prescriptions for non-cancer related medicines taken at home, such as thyroid or blood pressure medicine.
Call all the doctors involved in the patient’s care and tell them about the infection and that the patient is in the hospital.
Check that arrangements have been made for the patient to stay on the antibiotics at home or as an outpatient after leaving the hospital. If daily visits to the outpatient clinic for IV (intravenous) antibiotics are needed, the caregiver can coordinate people to help the patient get to the clinic or hospital and back each day.
These kinds of tasks may be too much for the patient to tackle while fighting infection. This kind of help is valuable. It’s a reassuring sign for the patient that this short-term problem can be managed and solved.
Caregivers take care of day-to-day tasks
There are other day-to-day tasks a caregiver might do. Here are a few things caregivers might help the person with cancer do, or in some cases even do for them:
Shop for and prepare food
Eat
Take medicines
Bathe, groom, and dress
Use the bathroom
Clean house and do laundry
Pay bills
Find emotional support
Get to and from doctor’s appointments, tests, and treatments
Manage medical problems at home
Coordinate cancer care
Decide when to seek health care or see a doctor for new problems
All of this work costs caregivers time and money. There may also be a cost to the caregiver’s health and well-being, but often the caregiver just keeps doing what needs to be done and may suffer in silence.
You may be glad to put the well-being of the person with the illness above your own well-being. And your love for this person may give you the energy and drive your need to help them through this difficult time. Still, no matter how you feel about it, caregiving is a hard job! And many caregivers are there for their loved one 24 hours a day for months or even years.
Caregivers involve the patient
Good communication with the person you are caring for is the most important part of your role. It may be hard for the patient to take part in daily planning and decision-making because they’re dealing with the physical, emotional, and social effects of illness and treatment. Your job is to involve the patient as much as possible, so they know they’re doing their part to get better. Here are some things you can try to do to keep the patient involved:
Help them live as normal a life as possible. To do this you might start by helping them decide what activities are most important. They may need to put aside those that are less important in order to do the things enjoyed the most.
Encourage them to share feelings and support their efforts to share. For instance, if they begin talking to you about their feelings about their illness, don’t change the subject. Listen and let them talk. You might want to share how you’re feeling, too.
Let the patient know you’re available, but don’t press issues. For example, if they’re trying to do something, such as dress themselves – they might be struggling, but it’s important for them to be able to do this. You may want to do it for them but don’t. Let them decide when they need help.
Remember that people communicate in different ways. Try sharing by writing or by using gestures, expressions, or touch. Sometimes, it may be really hard to say what you’re feeling, but a gesture such as holding hands might show how you feel.
Take your cues from the person who is ill. Some people are very private while others will talk more about what they’re going through. Respect the person’s need to share or his need to remain quiet.
Be realistic and flexible about what you hope to talk about and agree on. You may need or want to talk, only to find that the patient doesn’t want to do it at that time.
Respect the need to be alone. Sometimes, we all need time alone – even you.
You might find that the person you’re caring for is acting different – angry, quiet and withdrawn, or just sad. If you think they aren’t talking to you because they want to spare your feelings, make sure they know that you are always open to listening, even about tough topics. If they keep acting very sad or withdrawn, you might want to talk to the cancer care team about what could be causing it and what can be done.
Long-distance caregiving
Caregiving at a distance can be even harder to do and can cost more, too. The cost of time, travel, phone calls, missed work, and out-of-pocket expenses are higher when the caregiver doesn’t live close to the person needing care. Sometimes paid “on-site” caregivers are needed, and this can be another large expense.
There is often increased stress and greater feelings of guilt with long-distance caregiving. You may worry, “What if something happens and I can’t get to them right away?” Or, “Who’s going to make sure they ______ (take their medicine, eat, don’t fall, etc.)?” And if you do have family living close to the person who is ill, you might feel guilty that the burden falls on them and you aren’t doing your share.
Along with this, there’s the guilt felt while you’re with the person with cancer: “Who’s going to ______ (pick up the kids from school, cook dinner, walk the dog, etc.) at home while I’m gone?”
You also may feel left out of decisions made by the person with cancer and those who do live nearby. But there are things you can do to help your loved one and take an active role in their care – even when you’re far away.
When you visit the patient check the house for safety issues like cluttered walkways, loose rugs, or bad lighting. Maybe grab bars in the bathroom or a shower seat would be helpful. Help make improvements or arrange for someone else to do so.
Is the house clean? Is the yard cared for? Is there food in the house? Arranging help for chores like these can be a big help to the person with cancer.
Get in touch with people who live near the person who is ill. This may be other family members, friends, neighbors, or the doctor. Call them. And make sure they know how to reach you.
Plan for a crisis. Who can you count on to check on your loved one any time, day or night?
Keep a list of all the medicines and treatments the patient is getting (include doses and schedules), and update it regularly.
Make sure the person who is ill can reach you and others who help with care. This might mean buying a cell phone for your loved one or arranging for a long distance plan on their landline phone. You can also program important numbers into their phones. This can serve as a phone number directory and help with speed dialing.
Use a website that lets people sign up for different jobs or tasks, such as Lotsa Helping Hands. Then you can keep an eye on what’s needed and what’s being done.
Try to plan your visits. Once you get there you may be overwhelmed by everything that needs to be done, but having a plan keeps you focused and less stressed. Talk to the patient ahead of time about what’s needed and set clear goals for your visit. And don’t forget to visit! Remember to just spend time with them and do some activities together – things that you both enjoy.
If other family members are doing most of the hands-on work, you can step in for them to give them some time off. Maybe you can plan a visit so they can go on vacation or just take a much-needed break.
From a distance, it may be hard to feel that what you’re doing is enough or important. But sometimes the distant caregiver is the one who ties things together and keeps everything organized. You may be the one called because you know what to do or where to go for help when something is needed or a problem comes up.
Coping With Changing Roles:
Whether you’re younger or older, you may find yourself in a new role as a caregiver. You may have been an active part of someone’s life before, but perhaps now that they are a patient, the way you support them is different. It may be in a way in which you haven’t had much experience, or in a way that feels more intense than before. Even though caregiving may feel new to you now, many caregivers say that they learn more as they go through their loved one’s experience. Common situations that they describe:
Patients may only feel comfortable with a spouse or partner taking care of them
Caregivers with children struggle to take care of a parent too
Parents may have a hard time accepting help from their adult children
Caregivers find it hard to balance taking care of a loved one with job responsibilities
Adult children with diseases may not want to rely on their parents for care
Caregivers may have health problems themselves, making it physically and emotionally hard to take care of someone else
Whatever your roles are now, it’s very common to feel confused and stressed at this time. If you can, try to share your feelings with others or a join support group. Or you may choose to seek help from a counselor.
What is Caregiver Stress?
Giving care and support during this time can be a challenge. Many caregivers put their own needs and feelings aside to focus on the person with cancer. This can be hard to maintain for a long time, and it’s not good for your health. The stress can have both physical and psychological effects. If you don’t take care of yourself, you won’t be able to take care of others. It’s important for everyone that you give care to you.
Caregiver stress is the emotional and physical strain that caregiving causes and it may take many forms. Caregiver stress can cause depression and anxiety, and long-term medical issues. Caregivers can be more susceptible to illnesses, have slower wound healing, as well as be at a higher risk for mental decline.
Those suffering caregiver stress may feel:
Frustrated and angry
Guilty, because they do not feel the care they provide is good enough.
Lonely because caregiving has impacted social life.
Tired all the time.
Overwhelmed
Easily irritable or angered
Constantly worried
Physically ill, with frequent complaints like headaches, aches, and other problems
Weaker immune system (poor ability to fight off illness)
Sleep problems
Slower healing of wounds
Higher blood pressure
Changes in appetite or weight
Headaches
Anxiety, depression, or other mood changes
Don’t Forget To Ask for Help
Many caregivers say that looking back, they took too much upon themselves. Or they wish they had asked for help from friends or family sooner. Take an honest look at what you can and can’t do. What things do you need or want to do yourself? What tasks can you turn over or share with people? Be willing to let go of things that others can help you do. Some examples may be:
Helping with chores, such as cooking, cleaning, shopping, or yard work
Don’t be afraid to ask family members for financial help if necessary.
Taking care of the kids or picking them up from school or activities
Driving your loved one to appointments or picking up medicines
Being the contact person to keep others updated
Keep a running list of ways others can help and when help is offered, give specific manners in which they can help.
Similarly, when people offer to help, say “YES!”. Let them take care of you if you are not able to let them care for your loved one.
Accepting help from others isn’t always easy. But remember that getting help for yourself can also help your loved one—you may stay healthier, your loved one may feel less guilty about all the things that you’re doing, some of your helpers may offer useful skills and have extra time to give you.
Be Prepared for Some People Not to Help
When someone has a serious illness, friends and family often reach out to help. And sometimes people you don’t know very well also want to give you a hand. But it’s important to realize that there are others who may not be able to help you. You might wonder why someone wouldn’t offer to help you or your family when you’re dealing with so much. Some common reasons are:
Some people may be coping with their own problems
Some may not have the time
They are afraid of the illness or may have already had a bad experience with it. They don’t want to get involved and feel pain all over again
Some people believe it’s best to keep a distance when people are struggling
Sometimes people don’t realize how hard things really are for you. Or they don’t understand that you need help unless you ask them for it directly
Some people feel awkward because they don’t know how to show they care
If someone isn’t giving you the help you need, you may want to talk to them and explain your needs. Or you can just let it go. But if the relationship is important, you may want to tell the person how you feel. This can help prevent resentment or stress from building up. These feelings could hurt your relationship in the long run.
How To Prevent or Relieve Caregiver Stress:
All family caregivers need support. But you may feel that your needs aren’t important right now since you’re not the cancer patient. Or that there’s no time left for yourself. You may be so used to taking care of someone else that it’s hard for you to change focus. But caring for your own needs, hopes, and desires can give you the strength you need to carry on.
Make Time for Yourself
Find Time to Relax. Take at least 15-30 minutes each day to do something for yourself. For example, try to make time for a nap, exercise, yard work, a hobby, watching tv or a movie, or whatever you find relaxing. Do gentle exercises, such as stretching or yoga. Or, take deep breaths or just sit still for a minute.
Don’t Neglect Your Personal Life. Cut back on personal activities, but do not cut them out entirely. For example, look for easy ways to connect with friends.
Keep Up Your Routine. If you can, try to keep doing some of your regular activities. If you don’t, studies show that it can increase the stress you feel. You may have to do things at a different time of day or for less time than you normally would, but try to still do them.
Ask for Help. Find larger chunks of “off-duty” time by asking for help. Find things others can do or arrange for you, such as appointments or errands.
Understand your Feelings
Giving yourself an outlet for your own thoughts and feelings is important. Think about what would help lift your spirits. Would talking with others help ease your load? Or would you rather have quiet time by yourself? Maybe you need both, depending on what’s going on in your life. It’s helpful for you and others to know what you need.
Identify things that may be changed and those which cannot.
Don’t dismiss feelings as “just stress” as caregiver stress can cause future problems down the line.
It is okay to grieve the situation; you’ve lost something, too.
You may also be able to find some comfort by reading the emotions section of our website.
Support groups can meet in person, by phone, or online. They may help you gain new insights into what is happening, get ideas about how to cope, and help you know that you’re not alone. In a support group, people may talk about their feelings, trade advice, and try to help others who are dealing with the same kinds of issues. Some people like to go and just listen. And others prefer not to join support groups at all. Some people aren’t comfortable with this kind of sharing.
If you can’t find a group in your area, try a support group online. Some caregivers say websites with support groups have helped them a lot.
Ask the doctors office if they have any ideas for community support resources.
Learn More about The Illness
Sometimes understanding your cancer patient’s medical situation can make you feel more confident and in control. For example, you may want to know more about his stage of cancer. It may help you to know what to expect during treatment, such as the tests and procedures that will be done, as well as the side effects that will result.
See if your local hospital has classes to teach caregivers to cope with the demands of caregiving for a person with a specific illness.
Be open to assistive and adaptive technologies that may help your loved one regain some independence.
Educate yourself about your loved one’s condition, and talk with your loved one’s medical team.
Talk to Others about What You’re Going Through
Studies show that talking with other people about what you’re dealing with is very important to most caregivers. It’s especially helpful when you feel overwhelmed or when you want to say things that you can’t say to your loved one. Try to find someone you can really open up to about your feelings or fears.
Stay in touch with family and friends.
Write a post for Band Back Together. Connect with a greater community, and know that “we are none of us alone”.
You may want to talk with someone outside your inner circle. Some caregivers find it helpful to talk to a counselor, such as a social worker, psychologist, or leader in their faith or spiritual community. These types of experts may be able to help you talk about things that you don’t feel you can talk about with friends or family. They can also help you find ways to express your feelings and learn ways to cope that you hadn’t thought of before.
Connect with Your Loved One
Illness may bring you and your loved one closer together than ever before. Often people become closer as they face challenges together. If you can, take time to share special moments with one another. Try to gain strength from all you are going through together, and what you have dealt with so far. This may help you move toward the future with a positive outlook and feelings of hope.
Write in a Journal
Research shows that writing or journaling can help relieve negative thoughts and feelings. And it may actually help improve your own health. You might write about your most stressful experiences. Or you may want to express your deepest thoughts and feelings. You can also write about things that make you feel good, such as a pretty day or a kind coworker or friend.
Look for the Positive
It can be hard finding positive moments when you’re busy caregiving. It also can be hard to adjust to your role as a caregiver. Caregivers say that looking for the good things in life and feeling gratitude help them feel better. And know that it’s okay to laugh, even when your loved one is in treatment. In fact, it’s healthy. Laughter releases tension and makes you feel better. Keeping your sense of humor in trying times is a good coping skill.
Be Thankful
You may feel thankful that you can be there for your loved one. You may be glad for a chance to do something positive and give to another person in a way you never knew you could. Some caregivers feel that they’ve been given the chance to build or strengthen a relationship. This doesn’t mean that caregiving is easy or stress-free. But finding meaning in caregiving can make it easier to manage.
Day To Day
Find out -and use – caregiving resources within your community.
Stand up for your rights as a caregiver. You are a caregiver, not a doormat or a servant.
Set realistic goals and break larger tasks down to smaller steps.
Remember, there are no “perfect caregivers.”
Say no to any requests that may be draining.
Listen to your gut; trust your instincts.
Caring for Your Body
You may find yourself so busy and concerned about your loved one that you don’t pay attention to your own physical health. But it’s very important that you take care of your health, too. Doing so will give you the strength to help others. It’s important to:
Stay up-to-date with your medical needs Keep up with your own checkups, screenings, and other appointments.
Caregiving is a job – you’ve earned a break. Give yourself a respite.
Watch for signs of depression or anxiety Stress can cause many different feelings or body changes. But if they last for more than two weeks, talk to your doctor.
Take your medicine as prescribed Ask your doctor to give you a large prescription to save trips to the pharmacy. Find out if your grocery store or pharmacy delivers.
Try to eat healthy meals Eating well will help you keep up your strength. If your loved one is in the hospital or has long doctor’s appointments, bring easy-to-prepare food from home. For example, sandwiches, salads, or packaged foods and canned meats fit easily into a lunch container.
Get enough rest Listening to soft music or doing breathing exercises may help you fall asleep. Short naps can energize you if you aren’t getting enough sleep. Be sure to talk with your doctor if lack of sleep becomes an ongoing problem.
Exercise Walking, swimming, running, or bike riding are only a few ways to get your body moving. Any kind of exercise (including working in the garden, cleaning, mowing, or climbing stairs) can help you keep your body healthy. Finding at least 15-30 minutes a day to exercise may make you feel better and help manage your stress.
New stresses and daily demands often add to any health problems caregivers already have. And if you are sick or have an injury that requires you to be careful, it’s even more important that you take care of yourself. Here are some changes caregivers often have:
How Do I Take A Break?
In-home Respite Care. Someone will come into your house to provide care for your loved one while you take a break. This can range from companionship to nursing services.
Adult Daycare Centers – many local churches or community centers provide daycare centers for the elderly and children. During the day, these groups meet together and share activities.
Short-Term Nursing Homes can be used for occasional nursing care while you are out of town for a couple of weeks.
Day Hospitals – some hospitals provide medical care for patients during the daytime and the patient returns home at night.
Additional Caregiver Resources:
Administration on Aging – information about age and aging including links to local programs to aid elders and their caregivers.
US National Respite Locator – helps parents, family caregivers, and professionals find respite services in their state and local area to match their specific needs
National Family Caregivers Association – educates, supports, empowers and speaks up for the more than 65 million Americans who care for loved ones with a chronic illness or disability or the frailties of old age
Eldercare Locator is a nationwide service that connects older Americans and their caregivers with information on senior services. From the US Administration on Aging.
Most people will have the strong desire to conceive a child at some point during their lifetime. Understanding what defines normal fertility is crucial to helping a person, or couple, know when it is time to seek help. Most couples (approximately 85%) will achieve pregnancy within one year of trying, with the greatest likelihood of conception occurring during the earlier months. Only an additional 7% of couples will conceive in the second year. As a result, infertility has come to be defined as the inability to conceive within 12 months. This diagnosis is therefore shared by 15% of couples attempting to conceive. We generally recommend seeking the help of a reproductive endocrinologist if conception has not occurred within 12 months. However, there are various scenarios where one may be advised to seek help earlier.
Infertility means not being able to get pregnant after one year of trying (or six months if a woman is 35 or older). Women who can get pregnant but are unable to stay pregnant may also be infertile.
Pregnancy is the result of a process that has many steps. To get pregnant:
A woman’s body must release an egg from one of her ovaries (ovulation).
The egg must go through a Fallopian tube toward the uterus (womb).
A man’s sperm must join with (fertilize) the egg along the way.
The fertilized egg must attach to the inside of the uterus (implantation).
Infertility can happen if there are problems with any of these steps.
Infertility is a disease of the reproductive system that impairs the ability to conceive a child. Infertility may be diagnosed after a couple has been having well-timed, unprotected sexual intercourse for a full year.
Infertility may also be diagnosed if a woman is under age thirty-five and has suffered multiple miscarriages (also called “recurrent pregnancy loss” or RPL).
While infertility can be one of the most isolating challenges a couple can face, being infertile is not uncommon. In fact, 10-15 percent of couples in the US are infertile.
Infertility can be caused by one single problem in either partner, or a combination of factors that lead to a couple being unable to conceive – or carry – a pregnancy to term.
There are many safe treatments that can help a couple overcome infertility and successfully carry a child to term.
What About Infertility Treatments And Insurance?
Fifteen states have either an insurance mandate to offer or an insurance mandate to cover some level of infertility treatment. Eight of those states have an insurance mandate that requires qualified employers to include IVF coverage in their plans offered to their employees: Arkansas, Connecticut, Hawaii, Illinois, Maryland, Massachusetts, New Jersey, and Rhode Island.
A study published in the New England Journal of Medicine (August 2002) found that the percentage of high-order pregnancies (those with three or more fetuses) was greater in states that did not require insurance coverage for IVF. The authors of the study noted that mandatory coverage is likely to yield better health outcomes for women and their infants since high-order births are associated with higher-risk pregnancies.
The Affordable Care Act (ACA) does not require coverage for infertility treatments. Those states with an infertility mandate that covers IVF may have chosen an Essential Health Benefits (EHB) benchmark plan that includes the IVF mandate. The EHB impacts the individual and small group markets only in each state.
What Are The Types of Infertility?
For many couples, having a child or children is one of the most important goals in their lives. Many people long to be parents and understandably so. Having children can bring great joy and purpose to our lives. Unfortunately, it is not easy for every couple to get pregnant and have a child.
In other cases, a couple may be able to have a child but then struggle to conceive or carry a second child. When a couple struggles to have a child, it is called infertility.
Infertility can take two forms: primary and secondary, but many of the causes and treatments are the same for each type of infertility.
They vary slightly, but overall are caused by the same problems and treated in the same ways. The biggest difference with these two different forms of infertility is the way that they may be perceived by others and the way that they may make you, as a couple, feel.
This resource page will focus upon Primary Infertility.
1.Primary Infertility is a diagnosis for couples who haven’t been able to conceive after a year of well-timed, unprotected sexual intercourse without any other children. Primary infertility refers to the type of infertility that a couple would be diagnosed with when they are unable to have a child at all. A couple suffering with primary infertility is a childless couple that has never been able to conceive a pregnancy or has never been able to carry a pregnancy in order to achieve a live birth.
Having primary infertility can often lead perspective parents into a truly hopeless feeling. If you are unable to have a child, you may feel like it is impossible for you and that you will never have a child at all. You may long desperately to know what it is like to be a parent and have a child, and it is likely that you fear that you will never know that feeling.
These are all completely normal and understandable feelings.
2.Secondary Infertility occurs when couples have been pregnant at least once, but are unable to become pregnant again. This is the type of infertility that many people are unaware of. It is not uncommon to not realize that a couple that already has a child or children can suffer from infertility which is exactly what secondary infertility is.
Secondary Infertility is diagnosed when a couple has conceived a pregnancy and achieved a live birth before but is unable to achieve another pregnancy and live birth. Basically, the couple has a child or children, but is now unable to continue having children.
Secondary infertility comes with its own specific set of problems. It is not uncommon for people to lack understanding of what you are going through. Many people may look at it like since you already have a child or children, that it isn’t a big deal that you aren’t able to have more.
You even may struggle with a feeling of guilt for being unhappy about not being able to have more children. You may feel like you should be happy just having the child or children that you already have. It is important to remember that just because you want more children, it does not mean that you aren’t happy with the child or children that you do have.
It is still hard and unfair when you are unable to choose the size of your family, even if you are able to have one or some children.
Risk Factors for Infertility:
While these are all risk factors for infertility, many times, couples find that none or many of these apply to their situation
Age. A woman’s fertility gradually declines with age, especially in her mid-30s, and it drops rapidly after age 37. Infertility in older women may be due to the number and quality of eggs, or to health problems that affect fertility. Men over age 40 may be less fertile than younger men are and may have higher rates of certain medical conditions in offspring, such as psychiatric disorders or certain cancers.
Tobacco use. Smoking tobacco or marijuana by either partner reduces the likelihood of pregnancy. Smoking also reduces the possible benefit of fertility treatment. Miscarriages are more frequent in women who smoke. Smoking can increase the risk of erectile dysfunction and a low sperm count in men.
Alcohol use. For women, there’s no safe level of alcohol use during conception or pregnancy. Avoid alcohol if you’re planning to become pregnant. Alcohol use increases the risk of birth defects, and may contribute to infertility. For men, heavy alcohol use can decrease sperm count and motility.
Being overweight. Among American women, an inactive lifestyle and being overweight may increase the risk of infertility. A man’s sperm count may also be affected if he is overweight.
Being underweight. Women at risk of fertility problems include those with eating disorders, such as anorexia or bulimia, and women who follow a very low calorie or restrictive diet.
Exercise issues. Insufficient exercise contributes to obesity, which increases the risk of infertility. Less often, ovulation problems may be associated with frequent strenuous, intense exercise in women who are not overweight. Too much exercise can lead to ovulation problems.
Stress – unfortunately, we all face an enormous amount of stress in our lives and stress is thought to be a factor in infertility for some
Poor diet – eating a proper diet is imperative for both partners in order to achieve – and maintain – pregnancy
Sexually transmitted infections (STIs) – many times a person has an STI and is unaware of it. Unfortunately, some of these STIs can lead to infertility if left untreated
Hormonal Issues – Health problems that cause hormonal changes, such as polycystic ovarian syndrome and primary ovarian insufficiency
What Are The Symptoms Of Infertility?
Most couples are able to conceive a pregnancy within the first six months of well-timed, unprotected sexual intercourse. After 12 months of well-timed, unprotected sexual intercourse, about 90% of couples will achieve a pregnancy.
The remaining 10% will eventually conceive – with or without ART (assisted reproductive technology).
The primary symptom of infertility is the inability for a couple to become pregnant after a year of well-timed sexual intercourse. Other symptoms – such as abnormal menstrual cycles or hormonal problems – may not be noticed until after a couple has been unable to achieve pregnancy.
It’s time to make an appointment to see a doctor (begin with your normal gynecologist who may refer you to a doctor who specializes in fertility treatments) if any of the following symptoms are noted:
Maternal age is over 34 and the couple has been trying to conceive for at least six months.
You’re age 35 to 40 and have been trying to conceive for six months or longer
You’re over age 40
You menstruate irregularly or not at all
Your periods are very painful
You have known fertility problems
You’ve been diagnosed with endometriosis or pelvic inflammatory disease
You’ve had multiple miscarriages
You’ve undergone treatment for cancer
Past history of endometriosis or pelvic inflammatory disease.
Men should see a doctor if he has:
Known low sperm count
History of testicular, sexual, or prostate problems.
You have a low sperm count or other problems with sperm
You have a history of testicular, prostate or sexual problems
You’ve undergone treatment for cancer
You have testicles that are small in size or swelling in the scrotum known as a varicocele
You have others in your family with infertility problems
What Causes Infertility?
Conception involves a complex process of ovulation and fertilization. Conception is not an isolated event but part of a sequential process involving ovulation (release of egg from ovary) gamete formation, fertilization (union of sperm and egg) and implantation into the uterine wall.
All of the steps during ovulation and fertilization need to happen correctly in order to get pregnant. Sometimes the issues that cause infertility in couples are present at birth, and sometimes they develop later in life.
Infertility causes can affect one or both partners. In general:
In about one-third of cases, there is an issue with the male.
In about one-third of cases, there is an issue with the female.
In the remaining cases, there are issues with both the male and female, or no cause can be identified
What Are The Causes of Male Factor Infertility?
There are a great deal of things that can affect production of sperm, sperm count, sperm motility or the ability of the sperm to effectively fertilize the egg. The most common causes of male factor infertility are:
Paternal age over forty. Fertility may decrease with age for some men.
Abnormal spermatogenesis (creation of sperm) or function of the sperm. This can be caused by genetic defects, scarring from infections, or undescended testicles.
Issues with sperm delivery, which can include premature ejaculation, painful intercourse, retrograde ejaculation, genetic diseases, or structural problems with the male reproductive system.
Environmental overexposure to things like chemicals, pesticides
Heat (such as frequent use of a sauna or hot tubs) which can lower sperm count and impact sperm production.
Lifestyle issues: obesity, poor nutrition, smoking, substance abuse, or overuse of alcohol.
Abnormal sperm production or function due to undescended testicles, genetic defects, health problems such as diabetes or infections such as chlamydia, gonorrhea, mumps or HIV. Enlarged veins in the testes (varicocele) can also affect the quality of sperm.
Problems with the delivery of sperm due to sexual problems, such as premature ejaculation; certain genetic diseases, such as cystic fibrosis; structural problems, such as a blockage in the testicle; or damage or injury to the reproductive organs.
Overexposure to certain environmental factors, such as pesticides and other chemicals, and radiation. Cigarette smoking, alcohol, marijuana or taking certain medications, such as select antibiotics, antihypertensives, anabolic steroids or others, can also affect fertility. Frequent exposure to heat, such as in saunas or hot tubs, can raise the core body temperature and may affect sperm production.
Damage related to cancer and its treatment, including radiation or chemotherapy. Treatment for cancer can impair sperm production, sometimes severely.
What Are The Causes of Female Factor Infertility?
While the causes may overlap or vary, these are the most common cause of female infertility:
Ovulation disorders, which affect the release of eggs from the ovaries. These include hormonal disorders such as polycystic ovary syndrome. Hyperprolactinemia, a condition in which you have too much prolactin — the hormone that stimulates breast milk production — may also interfere with ovulation. Either too much thyroid hormone (hyperthyroidism) or too little (hypothyroidism) can affect the menstrual cycle or cause infertility. Other underlying causes may include excessive exercise, eating disorders, injury or tumors.
Uterine or cervical abnormalities, including abnormalities with the opening of the cervix, polyps in the uterus or the shape of the uterus. Noncancerous (benign) tumors in the uterine wall (uterine fibroids) may rarely cause infertility by blocking the fallopian tubes. More often, fibroids interfere with implantation of the fertilized egg.
Fallopian tube damage or blockage, often caused by inflammation of the fallopian tube (salpingitis). This can result from pelvic inflammatory disease, which is usually caused by a sexually transmitted infection, endometriosis or adhesions.
Primary ovarian insufficiency (early menopause), when the ovaries stop working and menstruation ends before age 40. Although the cause is often unknown, certain factors are associated with early menopause, including immune system diseases, certain genetic conditions such as Turner syndrome or carriers of Fragile X syndrome, radiation or chemotherapy treatment, and smoking.
Endometriosis – the tissue lining the uterus grows and implants itself outside of the uterus, causing damage to the major organs, including the reproductive organs.
PCOS (Polycystic Ovarian Syndrome) – is a condition in which the hormone androgen is elevated and causes ovulatory disorders.
Hyperprolactinemia – elevated levels of the hormone that stimulates lactation in women who aren’t pregnant or nursing can also affect ovulation.
Uterine Fibroids – benign tumors in the wall of the uterus are common – rarely they can cause blockage to the Fallopian tubes, inhibiting ovulation. More frequently, fibroids interfere with the implantation of a fertilized egg into the wall of the uterus.
Pelvic Adhesions – bands of scar tissue from previous surgeries, appendicitis, or other infections of the pelvic region can impair fertility.
Thyroid Problems – Hypothyroidsim or hyperthyroidism can impact fertility by interrupting the normal menstrual cycle of a woman.
Cancer and Cancer Treatment – cancers – especially those that affect the reproductive system, can severely impact a woman’s fertility. And the treatment of cancers – radiation and chemotherapy – can affect a woman’s reproductive function.
Medications – certain medications can temporarily affect fertility in women. Generally speaking, when the medication is stopped, fertility returns to normal.
Early Menopause – defined as the absence of menstruation and depletion of ovarian follicles prior to age 40. While it’s unknown why some women enter early menopause, it can be caused by disease, radiation, smoking, or chemotherapy.
Other conditions. Medical conditions associated with delayed puberty or the absence of menstruation (amenorrhea), such as celiac disease, poorly controlled diabetes and some autoimmune diseases such as lupus, can affect a woman’s fertility. Genetic abnormalities also can make conception and pregnancy less likely
How Is Infertility Treated?
Treatment of infertility depends on the root cause for the infertility. Up to 60% of those considered technically infertile became pregnant (numbers do not include IVF) upon receiving fertility treatments of treatments aimed at curing the underlying cause.
One out of every five couples diagnosed as infertile eventually becomes pregnant without treatment.
Treatment for infertility may be as simple as education about the proper timing for sexual intercourse to become pregnant.
Medications may be prescribed to promote ovulation, treat infections, or clotting disorders.
Assisted Reproductive Technology Procedures like IUI (intrauterine insemination) and IVF (in vitro fertilization) may be used.
How Is Infertility Prevented?
It’s extremely important to remember that most causes of infertility have nothing to do with you and your partner not practicing proper habits. Most of the time, infertility is not preventable. However, here are some things you can try to do to prevent infertility:
Couples
Have regular intercourse several times around the time of ovulation for the highest pregnancy rate. Having intercourse beginning at least 5 days before and until a day after ovulation improves your chances of getting pregnant. Ovulation usually occurs at the middle of the cycle — halfway between menstrual periods — for most women with menstrual cycles about 28 days apart.
Men
For men, although most types of infertility aren’t preventable, these strategies may help:
Avoid drug and tobacco use and excessive alcohol consumption, which may contribute to male infertility.
Avoid high temperatures, as this can affect sperm production and motility. Although this effect is usually temporary, avoid hot tubs and steam baths.
Avoid exposure to industrial or environmental toxins, which can impact sperm production.
Limit medications that may impact fertility, both prescription and nonprescription drugs. Talk with your doctor about any medications you take regularly, but don’t stop taking prescription medications without medical advice.
Exercise moderately. Regular exercise may improve sperm quality and increase the chances for achieving a pregnancy.
Women
For women, a number of strategies may increase the chances of becoming pregnant:
Quit smoking. Tobacco has multiple negative effects on fertility, not to mention your general health and the health of a fetus. If you smoke and are considering pregnancy, quit now.
Avoid alcohol and street drugs. These substances may impair your ability to conceive and have a healthy pregnancy. Don’t drink alcohol or use recreational drugs, such as marijuana or cocaine.
Limit caffeine. Women trying to get pregnant may want to limit caffeine intake. Ask your doctor for guidance on the safe use of caffeine.
Exercise moderately. Regular exercise is important, but exercising so intensely that your periods are infrequent or absent can affect fertility.
Avoid weight extremes. Being overweight or underweight can affect your hormone production and cause infertility
How To Cope With The Emotional Aspect of Infertility:
Whether you are coping with infertility or someone you love is trying to ride the roller coaster of infertility, there are a lot of emotions associated with infertility and the inability to get pregnant easily.
Here are some tips for coping with infertility:
Find and locate others (perhaps through a support group) that are experiencing the isolation and challenges of infertility. It’s a very lonesome time for many couples – having someone(s) around who are able to understand exactly what you are going through can be a lifesaver.
Don’t be afraid to tell others what you are going through – if they do not know, it’s impossible for them to be sensitive to what you are going through.
Be prepared to deal with the assholes who don’t understand WHY you feel so saddened about being unable to easily conceive. Prepare a list of comebacks to dish out to anyone who wants to trivialize what you’re going through.
Protect your feelings. If going to a baby shower is going to be tremendously challenging for you, simply do not go. Send a gift card and be done with it. You have enough things to deal with – don’t borrow trouble.
Be honest with your partner about your feelings, but do not expect your partner to mimic your feelings exactly. No two people grieve alike.
Speaking of grief, infertility is a loss and is allowed to be mourned. Being unable to conceive a child can be one of the greatest losses you will ever face.
If your grief and sadness become too powerful, don’t be afraid to talk to a mental health professional. He or she can help you as a sounding board and help to teach you coping strategies.
Additional Infertility Resources:
Resolve provides timely, compassionate support and information to people who are experiencing infertility and to increase awareness of infertility issues through public education and advocacy.
The InterNational Council on Infertility Information Dissemination, INC. (INCIID – pronounced “inside”) is a nonprofit organization that helps individuals and couples explore their family-building options. INCIID provides current information and immediate support regarding the diagnosis, treatment, and prevention of infertility and pregnancy loss, and offers guidance to those considering adoption or child-free lifestyles.
March of Dimes – Guidance and information for couples who are trying to get pregnant.
Trying Again: A Guide to Pregnancy After Miscarriage, Stillbirth, and Infant Loss – a book focusing on encouraging women, men and even children to embrace life, connecting hearts around the world who have similar life experiences and becoming a resource for friends, family and even medical professionals, to know how to support someone enduring child loss and/or infertility.
For very many veterans, returning from military service also means dealing with symptoms of post-traumatic stress disorder (PTSD). You may be having a hard time readjusting to life out of the military. Or you may constantly be feeling on edge, emotionally numb and disconnected, or close to panicking or exploding. But no matter how long the V.A. wait times, or how isolated or emotionally cut off from others you feel, it’s important to know that you’re not alone and there are plenty of things you can do to start feeling better. These steps can help you learn to deal with nightmares and flashbacks, cope with feelings of depression, anxiety or guilt, and regain your sense of control.
Post-traumatic stress disorder impacts 11-20 percent of Iraq and Afghanistan War veterans, approximately 12 percent of Gulf War veterans, and 15 percent of Vietnam veterans. In addition to the combat-related PTSD, roughly 1 in 4 women and 1 in 100 men utilizing the VA report instances of sexual assault, which can also result in prolonged traumatic stress.
What Causes PTSD in Veterans?
Post-traumatic stress disorder (PTSD), sometimes called “combat stress” or “shell shock,” happens after you experience severe trauma or a life-threatening event. It’s normal for your mind and body to be in shock after such an event, but this normal response becomes PTSD when your nervous system gets stuck between fight and flight syndrome. Post-traumatic stress disorder (PTSD) can occur after you have been through a trauma. A trauma is a shocking and dangerous event that you see or that happens to you. During this type of event, you think that your life or others’ lives are in danger.
Your nervous system has two automatic or reflexive ways of responding to stressful events:
Mobilization, or fight-or-flight, occurs when you need to defend yourself or survive the danger of a combat situation. Your heart pounds faster, your blood pressure rises, and your muscles tighten, increasing your strength and reaction speed. Once the danger has passed, your nervous system calms your body, lowering your heart rate and blood pressure, and winding back down to its normal balance.
Immobilization occurs when you’ve experienced too much stress in a situation and even though the danger has passed, you find yourself “stuck.” Your nervous system is unable to return to its normal state of balance and you’re unable to move on from the event. Immobilization is PTSD.
Recovering from PTSD involves transitioning out of the mental and emotional war zone you’re still living in and helping your nervous system return to normal.
Going through trauma is not rare. About 6 of every 10 men (or 60%) and 5 of every 10 women (or 50%) experience at least one trauma in their lives. Women are more likely to experience sexual assault and child sexual abuse. Men are more likely to experience accidents, physical assault, combat, disaster, or to witness death or injury.
PTSD can happen to anyone. It is not a sign of weakness. A number of factors can increase the chance that someone will develop PTSD, many of which are not under that person’s control. For example, if you were directly exposed to the trauma or injured, you are more likely to develop PTSD.
PTSD And The Military:
When you are in the military, you may see combat. You may have been on missions that exposed you to horrible and life-threatening experiences. These types of events can lead to PTSD.
The number of Veterans with PTSD varies by service era:
Operations Iraqi Freedom (OIF) and Enduring Freedom (OEF): About 11-20 out of every 100 Veterans (or between 11-20%) who served in OIF or OEF have PTSD in a given year.
Gulf War (Desert Storm): About 12 out of every 100 Gulf War Veterans (or 12%) have PTSD in a given year.
Vietnam War: About 15 out of every 100 Vietnam Veterans (or 15%) were currently diagnosed with PTSD at the time of the most recent study in the late 1980s, the National Vietnam Veterans Readjustment Study (NVVRS). It is estimated that about 30 out of every 100 (or 30%) of Vietnam Veterans have had PTSD in their lifetime.
Other factors in a combat situation can add more stress to an already stressful situation. This may contribute to PTSD and other mental health problems. These factors include what you do in the war, the politics around the war, where the war is fought, and the type of enemy you face.
Another cause of PTSD in the military can be military sexual trauma (MST). This is any sexual harassment or sexual assault that occurs while you are in the military. MST can happen to both men and women and can occur during peacetime, training, or war.
Among Veterans who use VA healthcare, about:
23 out of 100 women (or 23%) reported sexual assault when in the military.
55 out of 100 women (or 55%) and 38 out of 100 men (or 38%) have experienced sexual harassment when in the military.
There are many more male Veterans than there are female Veterans. So, even though military sexual trauma is more common in women Veterans, over half of all Veterans with military sexual trauma are men.
What Are Some Of The PTSD Symptoms of Veterans?
While you can develop symptoms of PTSD in the hours or days following a traumatic event, sometimes symptoms don’t surface for months or even years after you return from deployment. While PTSD develops differently from veteran to veteran, there are four symptom clusters:
Being on guard all the time, jumpy, and emotionally reactive, as indicated by irritability, anger, reckless behavior, difficulty sleeping, trouble concentrating, and hypervigilance.
Recurrent, intrusive reminders of the traumatic event, including distressing thoughts, nightmares, and flashbacks where you feel like the event is happening again. Experiencing extreme emotional and physical reactions to reminders of the trauma such as panic attacks, uncontrollable shaking, and heart palpitations.
Extreme avoidance of things that remind you of the traumatic event, including people, places, thoughts, or situations you associate with the bad memories. Withdrawing from friends and family and losing interest in everyday activities.
Negative changes in your thoughts and mood, such as exaggerated negative beliefs about yourself or the world and persistent feelings of fear, guilt, or shame. Diminished ability to experience positive emotions.
Suicide Prevention For Veterans With PTSD
It’s common for veterans with PTSD to experience suicidal thoughts. Feeling suicidal is not a character defect, and it doesn’t mean that you are crazy, weak, or flawed, it simply means that you are overwhelmed and need some help. If you are feeling suicidal, please seek help immediately. If you don’t feel you can talk to your friends and loved ones, there are a great number of suicide hotlines available that offer free, non-judgemental, confidential counseling. Here are some of the following suicide help lines. You are not alone, no matter how you feel. Things can get better. Please call:
Learning To Live With And Heal From PTSD In Veterans:
Step One: Regulate Your Nervous System
PTSD can leave you feeling completely vulnerable and totally helpless. However, you have more control over your nervous system than you may know. When you feel agitated, anxious, or out of control, these tips can help you change your arousal system and calm yourself.
Sensory input: We know that loud noises, certain smells, or the feel of sand in your clothes can instantly transport you back to the combat zone. Sensory input quickly calm you. Everyone responds a bit differently, so experiment to find what works best. Think of your time on deployment: what brought you comfort at the end of the day? Perhaps it was looking at photos of your family? Or listening to a favorite song, or smelling a certain brand of soap? Or maybe petting an animal quickly makes you feel calm?
Mindful breathing: To quickly calm yourself, begin by taking 60 breaths, focusing your attention on each breath. Breathe in, hold for a couple of seconds, breathe out. In with the good air, out with the bad. Count them – it helps your mind to focus on something other than your anxiety.
Reconnect emotionally: If you can react to uncomfortable emotions without becoming overwhelmed, you can make a huge difference in your ability to manage stress, balance your moods, and take back control of your life
Step Two: Move Your Thing
Making time for regular exercise has always been one of the keys to cope for veterans with PTSD. Not only does physical activity help to burn off adrenaline, exercise can release endorphins and improve your mood. And by really focusing on your body and how it feels as you exercise, you can even help your nervous system become “unstuck” and move out of the immobilization stress response.
Exercise that is rhythmic and engages both your arms and legs—such as running, swimming, basketball, or even dancing—works well if you stop feeling your feelings and focus your thoughts upon how your body feels.
Try to notice the sensation of your feet hitting the ground, for example, or the rhythm of your breathing, or the feeling of wind on your skin. Many veterans with PTSD find that sports such as rock climbing, boxing, weight training, and martial arts make it easier to focus on your body movements – obviously, if you don’t, you could get injured. Whatever exercise you choose, try to work out for 30 minutes or more each day—or if it’s easier, three 10-minute spurts of exercise are fine.
One of the great parts of being outside is that pursuing outdoor activities in nature like hiking, camping, mountain biking, rock climbing, whitewater rafting, and skiing can help challenge your sense of vulnerability and help you transition back into civilian life.
Seek out local organizations that offer outdoor recreation or team building opportunities, or, in the U.S., check out Sierra Club Military Outdoors, which provides service members, veterans, and their families with opportunities to get out into nature and get moving.
Step Three: Take Care of Yourself
The symptoms of PTSD in veterans, such as insomnia, anger, concentration problems, and jumpiness, can be hard on your body and eventually take a toll on your overall health. That’s why it’s so important to take care of yourself.
You may be drawn to activities and behaviors that pump up adrenaline, whether it’s caffeine, drugs, violent video games, driving recklessly, or daredevil sports. After being in a combat zone, that’s what feels normal. But if you recognize these urges for what they are, you can make better choices that will calm and care for your body—and your mind.
Relax: Relaxation techniques such as massage, meditation, or yoga can reduce stress, ease the symptoms of anxiety and depression, help you sleep better, and increase feelings of peace and well-being.
Find safe ways to blow off steam: Pound on a punching bag, pummel a pillow, go for a hard run, sing along to loud music, or find a secluded place to scream at the top of your lungs.
Support your body with a healthy diet: Omega-3s play a vital role in emotional health so incorporate foods such as fatty fish, flaxseed, and walnuts into your diet. Limit processed and fried food, sugars, and refined carbs which can exacerbate mood swings and energy fluctuations.
Get plenty of sleep: Sleep deprivation exacerbates anger, irritability, and moodiness. Aim for 7 to 9 hours of quality sleep each night. Develop a relaxing bedtime ritual (listen to calming music, take a hot shower, or read something light and entertaining), turn off screens at least one hour before bedtime, and make your bedroom as dark and quiet as possible.
Avoid alcohol and drugs: It can be tempting to turn to drugs and alcohol to numb painful memories and get to sleep. But substance abuse can make the symptoms of PTSD worse. The same goes for cigarettes. If possible, stop smoking and seek help for drinking and drug problems.
Step Four: Connect With Others
Connecting face-to-face doesn’t have to mean a lot of talking. But for any veteran with PTSD, it’s important to find someone who will listen without judging when you want to talk, or just hang out with you when you don’t. That person may be your significant other, a family member, one of your buddies from the service, or a civilian friend.
Volunteer your time or reach out to someone in need. This is a great way to both connect to others, feel good about yourself, while reclaiming your sense of power.
Join a PTSD support group. Connecting with other veterans facing similar problems can help you feel less isolated and provide useful tips on how to cope with symptoms and work towards recovery.
Connecting with Civilians
You may feel like civilians in your life can’t understand you since they haven’t been in the service or seen the things you have. But people don’t have to have gone through the exact same experiences to relate to painful emotions and be able to offer support. What matters is that the person you’re turning to cares about you, is a good listener, and a source of comfort.
You don’t have to talk about your combat experiences. If you’re not ready to open up about the details of what happened, that’s okay. You can talk about how you feel without going into a blow-by-blow account of events.
Tell the other person what you need or what they can do to help. That could be just sitting with you, listening, or doing something practical. Comfort comes from someone else understanding your emotional experience.
People who care about you want to help. Listening is not a burden for them but a welcome opportunity to help.
If Connecting Is Too Difficult
No matter how close you are to someone, PTSD can mean that you still don’t feel any better after talking. If that describes you, there are ways to help the process along.
Exercise or move. Before chatting with a friend, either exercise or move around. Jump up and down, swing your arms and legs, or just flail around. Your head will feel clearer and you’ll find it easier to connect.
Vocal toning. As strange as it sounds, vocal toning is a great way to open up to social engagement. Find a quiet place before you meet a friend. Sit straight and simply make “mmmm” sounds. Change the pitch and volume until you experience a pleasant vibration in your face.
Step Five: Flashbacks, Nightmares, and Intrusive Thoughts
For veterans with PTSD, flashbacks usually involve visual and auditory memories of combat. It feels as if it’s happening all over again so it’s vital to reassure yourself that the experience is not occurring in the present. Trauma specialists call this “dual awareness.”
Dual awareness is the recognition that there is a difference between your “experiencing self” and your “observing self.” On the one hand, there is your internal emotional reality: you feel as if the trauma is currently happening. On the other hand, you can look to your external environment and recognize that you’re safe. You’re aware that despite what you’re experiencing, the trauma happened in the past. It is not happening now.
State to yourself (out loud or in your head) the reality that while you feel as if the trauma is currently happening, you can look around and recognize that you’re safe.
Use a simple script when you awaken from a nightmare or start to experience a flashback: “I feel [panicked, overwhelmed, etc.] because I’m remembering [traumatic event], but as I look around I can see that the event isn’t happening right now and I’m not in danger.”
Describe what you see when look around (name the place where you are, the current date, and three things you see when you look around).
Try tapping your arms to bring you back to the present.
Tips For Grounding Yourself During A Flashback:
If you’re starting to disassociate or experience a flashback, try using your senses to bring you back to the present and “ground” yourself. Experiment to find what works best for you.
Sight – Blink rapidly and firmly; look around and take inventory of what you see
Movement – Move around vigorously (run in place, jump up and down, etc.); rub your hands together; shake your head
Sound – Turn on loud music; clap your hands or stomp your feet; talk to yourself (tell yourself you’re safe, you’ll be okay)
Taste – Suck on a strong mint or chew a piece of gum; bite into something tart or spicy; drink a glass of cold water or juice
Touch – Splash cold water on your face; grip a piece of ice; touch or grab on to a safe object; pinch yourself; play with worry beads or a stress ball
Smell – Smell something that links you to the present (coffee, mouthwash, your wife’s perfume) or a scent that has good memories
Step Six: Work through survivor’s guilt
Feelings of guilt are very common among veterans with PTSD. You may have seen people injured or killed, often your friends and comrades. In the heat of the moment, you don’t have time to fully process these things as they happen. But later—often when you’ve returned home—these experiences come back to haunt you. You may ask yourself questions such as:
Why didn’t I get hurt?
Why did I survive when others didn’t?
Could I have done something differently to save them?
You may end up blaming yourself for what happened and believing that your actions (or inability to act) led to someone else’s death. You may feel like others deserved to live more than you—that you’re the one who should have died.
This is survivor’s guilt.
Healing from survivor’s guilt:
It’s important to remember that healing doesn’t mean that you’ll forget what happened or those who died. And it doesn’t mean you’ll have no regrets. What it does mean is that you’ll look at your role more realistically.
Is the amount of responsibility you’re assuming reasonable?
Could you really have prevented or stopped what happened?
Are you judging your decisions based on full information about the event, or just your emotions?
Did you do your best at the time, under challenging circumstances?
Do you truly believe that if you had died, someone else would have survived?
Honestly assessing your responsibility and role can free you to move on and grieve your losses. Even if you continue to feel some guilt, instead of punishing yourself, you can redirect your energy into honoring those you lost and finding ways to keep their memory alive. For example, you could volunteer for a cause that’s connected in some way to one of the friends you lost. The goal is to put your guilt to positive use and thus transform tragedy, even in a small way, into something worthwhile.
Step Seven: Seek professional treatment
Professional treatment for PTSD can help you confront what happened to you and learn to accept it as a part of your past. Working with an experienced therapist or doctor, treatment may involve:
Cognitive-behavioral therapy (CBT) or counseling. This involves gradually “exposing” yourself to thoughts and feelings that remind you of the event. Therapy also involves identifying distorted and irrational thoughts about the event—and replacing them with more balanced picture.
Medication, such as antidepressants. While medication may help you feel less sad, worried, or on edge, it doesn’t treat the causes of PTSD.
EMDR (Eye Movement Desensitization and Reprocessing). This incorporates elements of CBT with eye movements or other rhythmic, left-right stimulation such as hand taps or sounds. These can help your nervous system become “unstuck” and move on from the traumatic event.
Effects of PTSD On Relationships:
PTSD can affect how couples get along with each other. It can also affect the mental health of partners. In general, PTSD can have a negative effect on the whole family.
Male Veterans with PTSD are more likely to report the following problems than Veterans without PTSD:
Marriage or relationship problems
Parenting problems
Poor family functioning
Most of the research on PTSD in families has been done with female partners of male Veterans. The same problems can occur, though, when the person with PTSD is female.
Effects on marriage
Compared to Veterans without PTSD, Veterans with PTSD have more marital troubles. They share less of their thoughts and feelings with their partners. They and their spouses also report more worry around intimacy issues. Sexual problems tend to be higher in combat Veterans with PTSD. Lower sexual interest may lead to lower satisfaction within the relationship.
The National Vietnam Veterans Readjustment Study (NVVRS) compared Veterans with PTSD to those without PTSD.
The findings showed that Vietnam Veterans with PTSD:
Got divorced twice as much
Were three times more likely to divorce two or more times
Tended to have shorter relationships
Family violence
Families of Veterans with PTSD experience more physical and verbal aggression. Such families also have more instances of family violence. Violence is committed not just by the males in the family. One research study looked at male Vietnam Veterans and their female partners. The study compared partners of Veterans with PTSD to partners of those without PTSD. Female partners of Veterans with PTSD:
Committed more family violence than the other female partners
Committed more family violence than their male Veteran partners with PTSD
Mental health of partners
PTSD can affect the mental health and life satisfaction of a Veteran’s partner. The same research studies on Vietnam Veterans compared partners of Veterans with and without PTSD. The partners of the Vietnam Veterans with PTSD reported:
Lower levels of happiness
Less satisfaction in their lives
More demoralization (discouragement)
About half have felt “on the verge of a nervous breakdown”
These effects were not limited to females. Male partners of female Veterans with PTSD reported lower well-being and more social isolation.
Partners often say they have a hard time coping with their partner’s PTSD symptoms. Partners feel stress because their own needs are not being met. They also go through physical and emotional violence. One explanation of partners’ problems is secondary traumatization. This refers to the indirect impact of trauma on those close to the survivor. Another explanation is that the partner has gone through trauma just from living with a Veteran who has PTSD. For example, the risk of violence is higher in such families.
Caregiver burden
Partners have a number of challenges when living with a Veteran who has PTSD. Wives of PTSD-diagnosed Veterans tend to take on a bigger share of household tasks such as paying bills or housework. They also do more taking care of children and the extended family. Partners feel that they must take care of the Veteran and attend closely to the Veteran’s problems. Partners are keenly aware of what can trigger symptoms of PTSD. They try hard to lessen the effects of those triggers.
Caregiver burden is one idea used to describe how hard it is caring for someone with an illness such as PTSD. Caregiver burden includes practical problems such as strain on the family finances. Caregiver burden also includes the emotional strain of caring for someone who is ill. In general, the worse the Veteran’s PTSD symptoms, the more severe is the caregiver burden.
Why are these problems so common?
The exact connection between PTSD symptoms and relationship problems is not clearly known. Some symptoms, like anger and negative changes in beliefs and feelings, may lead directly to problems in a marriage. For example, a Veteran who cannot feel love or happiness may have trouble acting in a loving way towards a spouse. Expression of emotions is part of being close to someone else. Not being able to feel your emotions can lead to problems making and keeping close relationships. Numbing can get in the way of intimacy.
Help for partners of Veterans with PTSD
The first step for partners of Veterans with PTSD is to gather information. This helps give you a better understanding of PTSD and its impact on families. Resources on the National Center for PTSD website may be useful.
Some effective strategies for treatment include:
Education for the whole family about the effects of trauma on survivors and their families
Support groups for both partners and Veterans
Individual therapy for both partners and Veterans
Couples or family counseling
VA has taken note of the research showing the negative impact of PTSD on families. PTSD programs and Vet Centers have begun to offer group, couples, and individual counseling for family members of Veterans.
Overall, the message for partners is that problems are common when living with a Veteran who has been through trauma. The treatment options listed above may be useful to partners as they search for better family relationships and mental health
How PTSD Can Affect The Family:
When a loved one returns from military service with PTSD, it can take a heavy toll on your relationship and family life. You may have to take on a bigger share of household tasks, deal with the frustration of a loved one who won’t open up, or even deal with anger or other disturbing behavior.
Family members may feel hurt, alienated, or discouraged because your loved one has not been able to overcome the effects of the trauma. Family members frequently devote themselves totally to those they care for and, in the process, neglect their own needs.
Sympathy: You may feel sorry for your loved one’s suffering. This may help your loved one know that you sympathize with him or her. However, be careful that you are not treating him or her like a permanently disabled person. With help, he or she can feel better.
Negative feelings PTSD can make someone seem like a different person. If you believe your family member no longer has the traits you loved, it may be hard to feel good about them. The best way to avoid negative feelings is to educate yourself about PTSD. Even if your loved one refuses treatment, you will probably benefit from some support.
Avoidance: Avoidance is one of the symptoms of PTSD. Those with PTSD avoid situations and reminders of their trauma. As a family member, you may be avoiding the same things as your loved one. Or, you may be afraid of his or her reaction to certain cues. One possible solution is to do some social activities, but let your family member stay home if he or she wishes. However, he or she might be so afraid for your safety that you also can’t go out. If so, seek professional help.
Depression This is common among family members when the person with PTSD causes feelings of pain or loss. When PTSD lasts for a long time, you may begin to lose hope that your family will ever “get back to normal.”
Anger and guilt: If you feel responsible for your family member’s happiness, you might feel guilty when you can’t make a difference. You could also be angry if he or she can’t keep a job or drinks too much, or because he or she is angry or irritable. You and your loved one must get past this anger and guilt by understanding that the feelings are no one’s fault.
Health problems: Everyone’s bad habits, such as drinking, smoking, and not exercising, can get worse when trying to cope with their family member’s PTSD symptoms. You may also develop other health problems when you’re constantly worried, angry, or depressed.
Helping a Veteran With PTSD
Social support is extremely important for preventing and helping with PTSD. It is important for family members to take care of themselves; both for their own good and to help the person dealing with PTSD.
Family members may feel hurt, alienated, or discouraged because your loved one has not been able to overcome the effects of the trauma. Family members frequently devote themselves totally to those they care for and, in the process, neglect their own needs.
Social support is extremely important for preventing and helping with PTSD. It is important for family members to take care of themselves; both for their own good and to help the person dealing with PTSD.
Don’t take the symptoms of PTSD personally. If your loved one seems distant, irritable, angry, or closed off, remember that this may not have anything to do with you or your relationship.
Don’t pressure your loved one into talking. Many veterans with PTSD find it difficult to talk about their experiences. Never try to force your loved one to open up but let them know that you’re there if they want to talk. It’s your understanding that provides comfort, not anything you say.
Be patient and understanding. Getting better takes time so be patient with the pace of recovery. Offer support but don’t try to direct your loved one.
Try to anticipate and prepare for PTSD triggers such as certain sounds, sights, or smells. If you are aware of what causes an upsetting reaction, you’ll be in a better position to help your loved one calm down.
Take care of yourself. Letting your loved one’s PTSD dominate your life while ignoring your own needs is a surefire recipe for burnout. Make time for yourself and learn to manage stress. The more calm, relaxed, and focused you are, the better you’ll be able to help your loved one.
Additional PTSD and Veterans Resources:
Real Warriors: A website to support the promotion of psychological health, reduce stigma of psychological health concerns and encourage help seeking behavior for service members, veterans and their families.
Call the VA Caregiver Support Line: 1-855-260-3274
Sierra Outdoors Club: Military Outdoors organizes outdoor trips for veterans, other service members and their families, because we know that time spent in nature provides a unique experience to foster mental and physical health, emotional resiliency, and leadership development. For many veterans, spending time in the outdoors can also help ease the transition to civilian life.
VA Peer Support Groups: Peer support groups are led by someone like you who has been through a trauma. Groups often meet in person, but many groups also provide online (Internet) support.
There is a picture of me, somewhere out there, probably still on my dad’s phone unless they’ve turned into Christmas Card people, in which case, the picture is most definitely out there in the world for all to see.