Hernia Surgery -- Finally!

I went through outpatient surgery yesterday to repair a double inguinal hernia.

I was surprised by my doctor's advice about lifting heavy objects.  I expected the weight limit to be 16 ounces (or 12 ounces as my cousin said while pretending to quaff a beer).  But no, my limit was 15 lbs!  That's a good surprise.

Another good surprise was that I didn't have any trouble lifting my legs or taking a deep breath.  I was especially concerned about the latter.

Another surprise, not so good, was that the Percocet caused hiccups.  The first episode began about 90 minutes after the first dose.  The experience was so disturbing that I decided not to take anymore.  Hiccups recurred about seven and a half hours after, waking me and keeping me awake from about 1:30 to 4:30 this morning.  Sometimes I'd have a "double hic" -- two in quick succession.  I found a paper online that said a 5mg dose of baclofen helped get rid of hiccups in a 64 year old patient.¹  I cut one of my wife's 10mg pills in half, took it, and was able to get to sleep about 20 minutes later.  So I found that to be true in my case, too.

The surgery involved a robotic laparoscopic device, and the procedure required inflating my abdomen with air.  Unfortunately, someone left the air inside!  My waist measures one inch more, but it's so firm that I walk around with my pants wide open and the belt loosened three inches.  I wear a hoodie to cover the indecency.

But aside from the bloating, I get pretty good pain control by alternating 1000mg Tylenol and 600mg Ibuprofen every 4 to 6 hours.  So I'm getting by without an opioid.

---

¹https://doi.org/10.1080/15360288.2022.2157070

Meditation as Medicine

"Scientific evidence from well-designed studies shows that meditation can increase attention span, sharpen focus, improve memory, and dull the perception of pain."

- Neurology Now Magazine

And Now Fibromyalagia

This November posting frenzy would not be complete without an update on my wife.

The medical weirdness started when she was pregnant with a severe rash that covered her entire body but not her face. She described it as intensely itchy. To me, it looked like an episode of Star Trek when one of the "Away Team" contracts an alien virus and morphs into another humanoid species. There was no clear definitive diagnosis on that -- just some sort of vague reference to "pregnancy rash" and that it only happens once. It reoccurred four months later, although not a severe.

The next episode happened in 2006. Both parotid glands swelled. Again the medical community was stumped. One doctor even suggested that it was a stone, forgetting (or ignoring) the fact that both sides of her face were affected. Antibiotics were prescribed and taken with no improvement. Then it was determined to be viral, so treatment involved alleviating the pain. Then when she complained of dry mouth, a doctor suspected Sjögren’s Syndrome and prescribed prednisone. The symptoms went away but came back. The test for Sjögren’s Syndrome was negative.

We're still dealing with the after effects of the next event, the attack of Transverse Myelitis. It started when she woke me up to tell me that she couldn't pee. She was released from hospital four weeks later barely able to walk and with severe pain.

Fed up with allopathic medicine, we consulted with a Naturopathic Doctor who made a diagnosis of Hashimoto's Thyroiditis. Although he couldn't treat her pain, he suggested a variety of supplements, two of which were NatureThroid, non-synthetic thyroid extract, and Isocort, a non-synthetic adrenal extract. The supplements had a terrific effect on her mood.

Still, we needed pain relief so we stuck with the neurologist at the hospital that she was initially treated in. Concerned about leg weakness, they mentioned spinal stenosis and MS.


Well, I'm getting angry and upset again. Suffice it to say, some more bumbling doctors made some more diagnoses. And the latest of these is fibromyalgia. This diagnosis was based on tenderness of all the pressure points and a negative test result for anything else. (Thank goodness that she never got a false positive for Lyme disease as I did. Otherwise, she'd get a two-week course of antibiotics and a pronouncement of being cured.)

I think her fibromyalgia is due to improperly managed pain. She was given too few quick-acting opioid pills and then left with no coverage at night. Thus she has been suffering from insufficient sleep for several months.

In his 2004 book, "Arthritis: Fight it with The Blood Type Diet Dr. Peter D'Adamo writes about people with type A blood, such as my wife,

One of the effects of high cortisol is a disruption of the sleep cycle, which, in turn, places extra stress on the body. Studies show that many people with arthritic conditions such as fibromyalgia experience a type of sleep disturbance called alpha delta sleep disorder. People with alpha delta sleep disorder experience a disruption in sleep patterns. They don't obtain enough deep sleep -- the phase in which muscles are repaired.

Anyway, even though this is yet another incurable disease that no one understands, maybe it will at least allow my wife to get better pain management.

Notes on the Pain Chronicles

These are my personal notes from The Pain Chronicles: Cures, Myths, Mysteries, Prayers, Diaries, Brain Scans, Healing, and the Science of Suffering, by Melanie Thernstrom....

"There are interesting differences in male and female opioid receptors. (The differences are also present in male and female rats.) There are three types of opioid receptors, most notably mu and kappa; most opioid drugs such as morphine target mu receptors. Few drugs that target kappa receptors have been developed, because early trials found them ineffective. The research, however, was conducted largely on men, and it turns out that women are more responsive to kappa-receptor drugs. One study of a rarely prescribed kappa-receptor analgesic (Nalbuphine) on postoperative pain in men and women ... found that the drug had the opposite effects on the two sexes, ameliorating female pain and exacerbating male pain." - page 175

Writing about a patient named George who scoffed at the idea of taking the anti-depressant Cymbalta, the author describes how he changed his mind when she told him that "antidepressants mitigate pain in rats as well as humans." She writes, "It had not been enough for him to be told that antidepressants effectively mitigate pain in humans, because he believed they worked in the wrong way. But to work for a rat -- that was really working." - page 223

"I used heat therapy with an ingenious product called ThermaCare [by Proctor and Gamble] -- pads that adhere to your neck or back that interact with the air in some way that makes them stay hot for hours." - page 253

Botox is used to paralyze neck muscles in order to relieve spasms that contribute to migraines. - page 256

Omneuron develops real-time functional neuroimaging. One application with fMRI is to help patients learn to lower activity in their rACC, "the part of the limbic system that gives pain its emotional valence. The pain of pain, as it were, is the way it's suffused with particular unpleasantness -- the sadness, anxiety, distress, and dislike that researchers refer to as dysphoria -- a reaction so fierce that you are instantly compelled to try to make the stimulus cease, not in five minutes, not in five seconds, now." - page 313, 316.


Further reading:
The War on Pain, a book by Dr. Scott Fishman

It's Hard Work Behaving as a Credible Patient, paper by Dr. Anne Werner & Dr. Kirsti Malterud, details "the ways in which women with chronic pain symptoms try to discern and comply with the hidden rules of the medical encounter in order to get the help they need. The women described struggling to present their pain in a way that others will feel is "just right": to make their symptoms "socially visible, real and physical" and to achieve "a subtle balance not to appear too strong or too weak, too healthy or too sick." - page 148 - 149

The Color of Fibromyalgia

In a brief discussion with her mom about Fibromyalgia awareness products, Jenny Ryan complains that "other diseases TOOK all the good colors."

Maybe Fibromyalgia marketing people have to diversify into patterns or shapes.  Autism took the puzzle-piece shape, which, perhaps not coincidentally, is also used as the logo for MS Office.

So what shape or pattern should Fibromyalgia be?  I'd go with some combination of sharp angles, irregularly-spaced, fuzzy, amoeba-like blobs, and question marks.

The sharp angles would, of course, represent the pain.  The irregularly-spaced, fuzzy, amoeba-like blobs would be the side effects from the meds, particularly the cognitive impairments.  The question marks would symbolize the fact that medical science doesn't know how to diagnose it or cure it, or even what the fuck causes it.

On Finding (and Keeping) a Pain Management Doctor

Five days ago, Jenny Ryan posted the following Tweet:

Has anyone here ever seen a pain management specialist? If so, do you have any advice on how to find one, what to ask, etc.?

This is my response:
Pain management doctors (PMDs) purposely try to avoid calling attention to themselves lest they attract drug seekers, fond of self-injury, carrying altered prescriptions. But you can ask for referrals to PMDs at the usual places you'd find folks who are familiar with drugs: your PCP, health insurance providers, support groups, and your local high school parking lot.

Your PMD will refuse to call in prescriptions for you. And every prescription he/she will write will have no refills, even though he will go on vacation when a refill is needed and forget to tell you. He/she has no idea how you will react to a certain med, so some experimentation is in order initially. The dose is intended to "manage" pain, not cure it, and PMDs tend to think that pain at 5 or below is good.

You must be a delightfully compliant patient, with an alert yet relaxed disposition. During your appointments, you should endeavor to make good eye contact and resist the urge to glance furtively at your watch or the window or especially the cabinet that houses the drug samples. Suppress all nervous tics, hand wringing, rocking, scratching, tapping, shaking, etc. Otherwise you will be suspected of an addiction.

It's okay to ask for a specific drug. But when the PMD mentions the name of a drug, "Vicodin," for example, it's not a good idea to respond with, "OOOh yeah, that's good stuffcanigetthatpleaseohpleaseohplease!" Perhaps you should not bring your husband with you.

Some of this is in jest, but not all of it.

One last thing. My wife despises her PMD.

Your Choice: Rocks, or a Dull Blade

"Would you rather die by having your head struck by rocks, or by having your head cut off with a dull blade?" asked my wife.

This was in response to my asking which was worse: her pain, or the nausea caused by the pain med.

She had suffered from nausea since May 29. We only recently figured out that the nausea was a side effect of the opioid that she started in February, an opioid that brought pain down from 6 - 8 to 1. After multiple visits to her primary care doctor, and referrals to a rheumatologist, an endocrinologist, and a gastroenterologist, each one involving either a blood draw or an endoscopy (and a one-week wait plus a co-pay), the answer was to simply stop taking a medication.

Yet it's not so simple. Now off the pain med, her nausea was indeed gone, but the pain was back. And the Pain Management doctor was away on vacation with no backup.

To me, it seemed a no-brainer -- I'd endure nausea to get rid of that much pain. But apparently the nausea is severe enough even to wake her from a deep sleep.

"Rocks" I answered, thinking that a severed neck was just too invasive for me at this time in my life.

"Well, that's the pain that I have to experience for the rest of my life."

"Maybe you could go back on the nauseating med just until the doctor comes back. It probably won't make you nauseous right away."

"And that Dickwad of a doctor went on vacation leaving me without enough pain meds."

It is said that there are times when it's important to just listen and not try to offer solutions. This was definitely one of them.

The Blood Type Diet

It's been two years since I first heard about The Blood Type Diet, or BTD.

I was at my first appointment with a naturopathic doctor. I was concerned about excessive appetite and sugar cravings, weight gain, plus brain fog, especially after lunch when I'd sink into a semi-vegetative state. I had already started to buy pants two sizes larger.

But I knew a bit about nutrition. I had already realized that cereal for breakfast was not good enough. It was pretty obvious, actually. I'd eat breakfast and then shower and shave. By the time I was heading out the door, I'd have a terrible empty gnawing feeling in my stomach, plus a case of the shakes. I figured my blood sugar was on a roller coaster ride.

When the ND found out that I have type O blood, he urged me to try the Blood Type Diet. I borrowed his copy of the Peter D'Adamo book, "Eat Right 4 Your Type", which described this new way of eating, which involved red meat and fish and certain vegetables and a little bit of "ancient grains." Some foods such as beef, lamb, cod, broccoli, kale, were classified as "Highly Beneficial;" others such as wheat, diary, corn, were classified as "Avoids."

The first change I made was to eliminate bread. Lunch changed from a sandwich to some slices of roast beef and salad greens. The result -- I no longer dozed off after lunch.

As I avoided wheat and corn, the pain in my joints went away. Without dairy, my sinuses were clearer and my allergy symptoms were much milder. We decided to get a cat, and, with the help of "Allergies: Fight Them with The Blood Type Diet," the usual symptoms of watery eyes and runny nose and asthma failed to materialize.

Best of all, my waist line shrunk. I lost a little weight and had fewer cravings. The weight-loss increased the more compliant to the diet I became.

I feel like I've gotten my life back. I managed to reverse a collision course with decrepitude, and I'm looking forward to living out my best years with health and strength!

---

2025-10-25 Updated links, which were broken due to the obsolete affiliate system.

April is Sjögren’s Syndrome Awareness Month

Last year, I wrote that April is Autism Awareness Month. It still is. But April is also Sjögren’s Syndrome Awareness Month.

Sjögren’s Syndrome is an autoimmune disorder. It's characterized by dry mouth and dry eyes, because the body's immune system attacks the moisture-producing glands. But it can affect other organs and the central nervous system as well. Click here to read more about Sjögren’s Syndrome. The FAQ may be helpful, too.

About six months before my wife had her attack of Transverse Myelitis, she had swelling of both her parotid (salivary) glands. This was very painful, and it baffled her primary care doctor. Eventually, she found herself in the care of a rheumatologist who suspected Sjögren’s Syndrome. But the tests were negative. Researchers now know that Sjögren’s can cause Transverse Myelitis.

So the Grand Unifying Theory of What's Wrong With My Wife is most likely that she has Sjögren’s Syndrome. This would explain the dry mouth and the parotid gland swelling, the Transverse Myelitis, the instances of joint and muscle pain, the fatigue, the brain fog, the neuropathy. My guess is that it will eventually be linked to PUPPP (Pregnancy Rash), which my wife had about nine years prior to the start of this Nightmare.

As more patients and especially doctors become aware of Sjögren’s Syndrome, folks with Chronic Fatigue Syndrome and/or Fibromyalgia might be properly diagnosed and find some relief with immunosuppressive drugs.

From Spinal Stenosis to Tendonitis

In a previous post, called From MS to Spinal Stenosis, I described how three neurologists told my wife that she had MS before they finally ordered MRIs and noticed the narrowing of her C5-C6 vertebre. This ultimately led to the diagnosis of Stenosis.

The last neurologist referred us to a neurosurgeon who pointed out the narrowing in the MRIs and said that there's a good chance surgery would eliminate the bi-lateral arm pain she was experiencing.

We went to another doctor for a second opinion, a highly-regarded neurosurgeon. He looked at the same MRIs and examined / interviewed my wife. His conclusion was that the narrowing was not significant enough to account for the problem. At best, surgery would have a 25% chance of relieving the pain. His opinion made sense to us because my wife has no neck pain, and significant narrowing of the spinal column would certainly cause neck pain. (Also, his waiting room was way more crowded than the first.) But he did recommend that we get an EMG test (Electromyogram).

Taking a different tack, we went to an Interventional Radiologist who dealt a little with pain management. At this point, we were starting to suspect that this had nothing at all to do with the spine, and that it was a more severe case of Tendonitis in both shoulders, with pain radiating down into the arms. This Radiologist injected the more severe shoulder with a steroid, which actually helped.

But this isn't the last round of musical diagnoses....

American Pain Foundation

Paraphrasing their website: The American Pain Foundation aims to serve people in pain through information, advocacy, and support. Their mission is to raise public awareness, provide practical information, promote research, and advocate to remove barriers and increase access to effective pain management.

Husbandic Therapy

My wife was especially despondent after she realized the pain management doctor wasn't interested in treating her. So after assuring her that we'll find another one, as well a new neurologist, I suggested she go for another visit with the psychologist.

"Oh, he's no help at all. All he does is talk about his own problems."

"Well, yes. That's special 'Talk about yourself' therapy that's designed to make the patient forget about her problems."

It drew a chuckle, at least.

Biological Barometers

Last week, Kerry shared an excerpt of an article that discussed how seasonal changes in weather can affect our bodies and our health. Read it.

On Friday, I had accompanied my wife to her first appointment with a pain management specialist, which was where we witnessed the Ominous Sign. Armed with the knowledge in the aforementioned article, I told the doctor that my wife has the most trouble in the winter. He made a brief guffaw-like sound and said, "Move to Arizona."

I persisted. "A lot of times the pain is worse during low pressure weather. Wouldn't a hyperbaric chamber help out?"

This elicited an unmistakable laugh, which was followed by, "Try to get that one by the insurance company."

I wasn't aware that I was joking about my wife's pain. How could I have been so insensitive?

To make amends, I cleaned out our bedroom's ionizing air purifier, so now it works without sounding like a bug zapper. I just wish I had one in this office right now -- the dog is farting up a storm.