Health Self Management ... 2

Thanks for your letters and you are most welcome for any support that I can give you.

Please ask more ... after you have had a chance to read what I have written ...

DISCLAIMER ... I have nothing of any nature to gain by recommending any product to you ... all are my personal choices ... all are endorsed by many professionals ... all have been evaluated for me personally ... Please use this information as only one of your thingys for evaluating and preparing a personalized program for you!

You are encouraging me to write more on my web site

and my first health page ... on Self Managing my Health.

It may take a while ... to write up the pages I mean ...

Here in a nutshell (must be a derned big nut ... prolly a coconut) is my outline ...

MY MAIN REFERENCE MATERIALS are

Devin Starlanyl's books and web site. Books are noted very clearly on her web site.
For those with Chronic Myofascial Pain and/or triggerpoints, this part of Devin's website is helpful.

I have two of Devin's books, both the first and second editions of the workbooks on Fibromyalgia and Chronic Myofascial Pain. and

Clair Davies' book, Trigger Point Therapy Workbook. in which Clair also refers to the fact that Twenty or so years ago, Doctors Janet Travell and David Simons solved the mystery of referred pain with the publication of their monumental medical text, Myofascial Pain & Dysfunction; The Trigger Point Manual.

The Arthritis Helpbook by Kate Lorig and James F. Fries.
as I was an Arthritis Self Management Program, ASMP, facilitator for the Canadian and Ontario Arthritis Societies.

With these references captured since 1997 ...

I started my pain relief with Codeine Contin on the recommendation of my GP (family doc or General Practitioner here in Canada.) and approval of Codeine Contin and Codeine Phosphate (over Morphine Contin, and Morph Sulphate) from my Rheumatologist, dosing worked up to Codeine Contin 50mg. twice daily with Codeine Phosphate 30mg. i or ii prn (sometimes as the need was up to ii every four hours) at my discretion but prescribed as i or ii ever 8 hours. My family doc and I entered into a signed agreement that I would not use Codeine Phosphate except as needed, Codeine Contin as prescribed and that I would keep the meds off the street. ... always the possibility that I could consult with him when I needed more Codeine Contin because my use of Codeine Sulphate was HIGH ... This agreement was my suggestion to cover my GP from any major problems with his licensing college here in Ontario and as I was then and still am registered with my own college of nursing and my professional association, we both understood the importance of this for each of our professional statuses.

This is an individualized chemical (drug) regimen that was individualized to me! Please remember this when discussing it with your family, support systems and your docs. I have no problem with your copying anything I have written for your own use.

I was already on massive Aspirin, up to highest of 1300mg. enteric coated ASA four times daily (total 4 x 1300mg = 5200mg) for my Rheumatoid Arthritis (as well as Methotrexate, Plaquenil and now Sulphasalazine) and as I was one who could tolerate ASA (I had no need for acetaminophen,) coupled with Prilosec twice daily for stomache protection ... I switched to Celebrex from ASA in about June of 2002, as I was starting to get ringing in the ears that was interfering with my hearing.

I have had, over the years, since diagnosed with RA and Fibro and CMP, in 1987 had monthly blood work as in Blood Chemistry, ESR and all that good stuff with every three months liver function tests thrown in to check on my liver and once in a while kidney function Lab work as well. I now am on a slightly different regimen of blood tests as I have developed anaemia and am working on that after a really bad flare of Fibro with chest and sinus infections in 2002.

As my pain was now mostly under control and the need for break through pain treatment was diminishing, I started on my own, with a Registered Massage Therapist as mentioned on my first health web page.

Years ago (I was born in 1941), I had learned to elicit a relaxation response and was reminded to revive this process very actively by my mainland China trained and licensed Family Doctor who is also a licensed Acupuncture professional. My family doc, has not used Acupuncture with me although he has offered it and has helped me find pressure point areas that I was having difficulty with.

My GP, RMT and I started with little going for us except some exceptional insights into Holistic Health from my Health Care Team, with me as the pivotal point and Team Leader.

First I started with an Acutens, Acuhealth Professional 900 machine which I bought on my own as I thought I might be using it in my own professional practice so got a professional discount from the originator of this machine, Bruce Hocking DAc. and his Canadian Acuhealth machine.
Unfortunately I found that this machine became a bit too harsh for me and I was getting relief from my Trigger Points from my Registered Massage Therapist. I sometimes still use it when TrPs are uncomfortable but not unbearable ... I have switched now to using (covered by my Insurance) on the recommendation of my RMT and approval of my GP, an Empi, Epix XL TENS machine ...

I started with the usual small (about 1.5" square) electrodes but find that the 2" by 3.5" Superior Silver Uni-Patch, Self-Adhering TENS/NMES/FES stimulating Electrodes with Perma Gel to be the best for me now.

Sometime I will probably try a butterfly electrode for my lower back.

I found the higher end TENS to be better as there are many different patterns and depth of stimulation or frequency or somesuch, that can be set.

There is always the possibility that one will become acclimatized or accustomed to a lower priced TENS without the different modalities... this is a caution that all of my colleagues, friends and Health Care Team warned me about. At a low setting I can get massage type relief for hours ... continuously attached electrodes ... and at higher settings for only 15 to 20 minutes at a time, muscle twitching and endorphin production and Electro Muscle Stimulation and that sorta stuff. All this extra stuff came about because of support and trial and error both by McNeice TENS inc. which is our local Canadian Distributor and Educator in the use of TENS machines, the Physiotherapist who introduced me to this machine and was using it in his clinic before I purchased one, my RMT and my family doc. Ramping and Dual modalities as described on the Empi, Epix XL TENS web site have been of help to me at times between visits to my Registered Massage Therapist when generalized pain and Trigger Point pain has been bad.

This is actually where I purchased my TENS and where I go for service and supplies.
McNeice TENS INC
962 Leathorne Street, London, Ontario N5Z 1K6, CANADA
Tel: 519-681-8367 ...
1-800-681-8367 (may be toll free for Canada only, I don't know)
Fax: 519-681-2129 ...

There will probably be a TENS distributor much closer to you but these folk are just around about three blocks from me. They also have a Windsor, Ontario address, phone number etc.

Here is another distributor of the TENS machine that I use. On one of the pages of this company they have a description of what TENS machines are.

In the States I understand that a TENS machine is only available on a docs prescription. Here in Ontario, my work insurance covered my getting the machine and the electrodes on a letter of recommendation from my doc and a PhysioTherapist. TENS themselves, here in Ontario anyway if not in Canada, do not require a doc's prescription to purchase.

My RMT has now learned (from professional colleagues and Continuing Ed Programs) to apply Trigger Point release pressure in a pulsed sort of way and his procedure now really feels like the TENS machine or maybe it is the other way around! The direct, prolongued or even direct, for 20 seconds or so pressure, is more difficult for my RMT to sustain than the pulsed or vibrational pressure that he now applies ... easy does it ... if the pressure or stimulation causes pain STOP and retry at a lower intensity after a while.

When we first started this work, my RMT would only direct me to use the machine every other day but with the encouragement of a Physiotherapist and McNeice people I started using the machine for prolongued, light intensity, use and yupper I did often, in the first few months leave it on over night to assist me to sleep. I use it during pain flares and have seldom had to use Codeine Phosphate for pain. I may well be the exception but this is me and pain since the middle of 2002.

I was asked to evaluate a MicroAce Unit for help in relieving pain. After two or three months of constant use, I found it helpful for my Rheumatoid Arthrits symptoms, and I found it too harsh in the way it was preprogrammed for my Fibromyalgia and Chronic Myofascial Pain and Trigger Points.

A few words about using a Thera Cane or some such massaging gadget should be mentioned now I think.

May I suggest that you read Claire's Book before ordering a Thera Cane. The pressure from a Thera Cane may be too much for you. You can test this, I think, by whether or not you can use the tandem tennis balls that Devin mentions. I do encourage caution with pressure as I bruise easily and at first my massage therapist was afraid he was really doing damage by his work ... but with the ok of my Family Doctor (who is a Chinese Acupuncturist and knows his stuff) Rob was encouraged to release my trps.

I am not sure that there is actually more than one ...Thera Cane is the one I use ...

Do a web search for it of course to find the best price available and check locally too.

But I have heard of another type on thingy that includes both warm water and the ability to get at awkward places to apply massaging water pressure ... Waterpik Massagers ... either one of the massagers noted here ... I have not used a waterpik massager so cannot comment on it although I imagine that it might work well. Especially with the information I now have about using warm water to help relax the knot and pressure to release the knot or Trigger Point.

I think it might be determined as to when and where one wishes to use trigger point pressure to release the trps. I find it most beneficial when I am in bed so the theracane works very well for me after a nice warm bath or shower. I can then either place my TENS machine on to assist me to fall asleep and in the morning I usually wake well rested and ready to go ... comparatively pain free that is!!!!

And Yes, I still use my Thera Cane to assist in releasing those Trigger Points that pop in to visit me when I least expect them. This has been a constant practice for me since 1999 or so.

My whole health care team has learned lots about the use of warmth and pressure and all that good stuff to release trps. I am so thankful that my Registered Massage Therapist was able to get started releasing my trps and got me looking for more help and teaching others in this here city of London, Ontario about what has helped me so tremendously. He also has increased his knowledge of Trigger Point Release and now uses a pulsed pressure which I find much faster and more comfortable that a constant continuous pressure.

Haven't tried spray and stretch either but that one frightens me somewhat as my skin is soooooo sensitive.

It is not so much that the releasing of trps is hard work but rather that it is persistent and consistent work. Remembering also to explore the precipitating factors if at all possible and I am encouraging anyone I talk with this about to enter into a Posture Retraining program ... Pilates is but one ... to help correct posture.

If i can be of further assistance please do not hesitate to ask.

The Muscle Balance function work that I have referred to on my first health page ... and other Posture Training programs, individualized, have also been paramount in my dealing with my pain. Devin mentions in her written material that posture correction may well be a pivotal point in reducing perpetuating and precipitating Trigger Points and related and cascaded or radiated pain.

With an individualized Muscle Balance Program, my TENS machine, relaxation and lots of encouragement, I went off all my codeine cold turkey ... no withdrawal symptoms at all ... to me this just shows ta go ya, that for those with non-malignant pain that dosing with codeine is not addicting!!!! ... and only use a bit of codeine once in a very long time when and if I get some pain that I would previously, as in ten years ago, have taken some Aspirin with codeine to take the edge off.

This is way too long as it stands now but you have encouraged me to put this up on my second health page on my web site.

Not something to be entered into by the faint hearted ... but with the support of your family and your docs and other Health Care Professionals and self education you will succeed! It is a life long process and I am still learning.

My anaemia ... possibly of chronic illness or maybe just malabsorbtion or low intake of Iron ... and my weight are the next for me to work on.

Take care and all the best ...

... as I say this is way too long to digest at one sitting so please take in a byte ... errrrrrr ... bit at a time ... ;)

Susan N. Dunbar

in London, Ontario, CANADA

Health Self Management...2

Health Self Management
...2