A place where I can share interesting ideas and maybe get a few things off my chest

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Tramadol

Tramadol 50 mg tablets

I have been having trouble with my shoulders and even had shoulder surgery scheduled before following my son’s advice on getting a second opinion. In between scheduling the surgery and seeing Dr. Joe, I told my orthopedist that the Naprosen just wasn’t cutting it anymore (and had actually never worked that well) and was also starting to bother my stomach.

A script for tramadol was called in to my local pharmacy and it worked wonderfully. I read a little about it and saw that in addition to acting as an opioid agonist, it had properties in common with Effexor regarding serotonin and nor-epinephrine. I thought that sounded reasonable since mood and pain have related neural pathways. What I didn’t realize is that it has a high chance of habituation and really unpleasant withdrawal symptoms. I also didn’t realize that since it is a very strong pain-killer, the prescribing physician is very careful about how scripts are handled. And by very careful, I mean they make it a serious pain in the ass. Only 30 pills at a time. No pharmacy-generated refills. Every prescription has to be requested by the patient to the recorded refill line 24-hours in advance, with each request being run by the nurse for specific approval. It’s a process that has broken down often enough for me to begin experience frustration before even making the first call (sometimes the first of 3 or 4 calls before the script request is actually processed).

Now that the physical therapy has progressed to the point that I’m really feeling good and being able to use my arms a lot more and experiencing a lot less pain, I wanted to see what my pain levels would be without the pain medication. I decided to skip my morning dose and start taking it only in the evening. This turned out to be a terrible plan. By 2:30 pm, I began to experience what I later realized were atypical withdrawal symptoms associated with the neurotransmitter component of the medication. Nausea, agitation, myalgia, plus the original shoulder pain.

Once I got home, took one of the pills, and it had time to take effect, I realized I had a little bit of a problem. I had no way to truly assess my pain levels now compared to my pain levels before because coming off the drug causes all-over muscle pain, kinda like the flu. Also, the last round of trying to get a new prescription had me down to my last pill and becoming panicky. Now, just thinking about having to go through the very frustrating script request process causes a creeping anxiety the closer I am to needing more because I’m worried about not remembering to call in time (and call and call and call since their promised 24-hour turn-around somehow seems to always take me 72 hours) to get the script in time before I run out. Counting my pills on Friday, I realized I would run out on Christmas Day. Which means I would need to call on Friday, just so I would also allow myself time to call again on Monday, and possibly Tuesday, in order to get the script in early enough to get it before the pharmacy closes on Christmas Eve.

It just became overwhelming thinking about it. I came home and tried to search for information on an appropriate reduction schedule. The ones I found were “home-made” by people in addiction groups, trying to wean themselves off 4 or 5 times the amount I am currently taking after having been on it for years for chronic pain. Not something that was terribly helpful, and was actually pretty scary reading through some of their stories about how addictive it is. I think if I had chronic pain that could not be treated, I wouldn’t resent the hassle so much, but that’s not the case.

So, on Friday night, I took 1/2 the dose I had been taking, and have been doing so all weekend. I’m still having sucky withdrawal symptoms, and I’m still not able to tell how much of the pain is breakthrough pain due to my shoulder stuff and how much is myalgia due to titrating off this stupid drug. Even though I was very glad that it helped so much with the pain, I’m pretty pissed off that it was prescribed with little information concerning the drug itself and its addictive properties.

I’m really glad it’s only been a matter of a few weeks and not years, and that my condition is responding to treatment and improving. I don’t know how people truly addicted, both physically and emotionally, to pain medications are able to maintain normal lives.

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Thanksgiving in East Texas

Mother relaxing in a familiar spot

We drove to Texas for Thanksgiving this year. Part of our adventure was Thanksgiving Day in Wills Point, in the home Mom and Dad retired to in 1984. Dad passed away in 1988, but Mother lived there another 19 years, until she moved in with me in 2007. Currently my sister’s younger daughter is living there with her husband. All of my niece’s kids were there, and my sister’s older daughter and her son, too. And lots of children, including Mother’s newest great-great grandchild. It really brought back memories of when my children and their cousins were little and we would go to this same house for Thanksgiving and Christmas. Mother really enjoyed “going home”. She even got to watch the Cowboys win their football game.

Mother and a portion of her progeny

Mother and a portion of her progeny

Mother's newest great-great grandchild

Mother’s newest great-great grandchild

I thought all the noise from all the kids would stress me out since we don’t live with it day-to-day anymore, but it’s more like a slightly discordant symphony and ballet, and less like a cacophonous rabble when none of the little voices are crying specifically for you. My husband and I  just got to sit back and watch and listen and smile.

Gracie taking it all in

Gracie taking it all in

Gracie was very excited to see all the people and other dogs and had a great time socializing, but eventually even she had to take a little break.

Thanksgiving 2013 - Gracie hiding

Gracie taking refuge

We had a wonderful time. We’ve now invited ourselves to two different family members’ Thanksgiving celebrations over the last two years. I wonder who we’ll target next year?

 

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Nativities

Nativities on bookshelf 12.13.13

Miniature miniatures

I’m not sure just how long ago I started collecting Nativity scenes. I know it was after I was grown, after my kids were born and we started going to St. Paul Lutheran Church, where both of my children were baptized and later confirmed. I think the first one was the Mexican tin one, but I’m just not sure.

Mostly wooden, one from Russia, a couple from Jerusalem

Some I found at garage or estate sales. Some were given to me. Some I found at after-Christmas sales.

Mexican tin one on the far right may be the first one

I haven’t had them out on display for years. Since the kids are grown, I no longer attend church, and no one in my house but me has any kind of emotional connection or memory with them, they’ve just stayed in their boxes, surviving the gypsy times, and waiting for a chance to be seen and once again appreciated.

More kid-oriented

More kid-oriented

When my work sent out an e-mail about a decorating contest, I looked through the bins in the garage and rediscovered my collection. I thought I’d just choose one or two, but I ended up putting them all up around my office. My friends at work really seemed to enjoy them and it was nice to be able to share them and revisit each one myself.

 

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Shopping Cart Rant

Really?

Okay, listen up. When you inconsiderately leave your shopping cart in the middle of the parking lot, you:

  1. block a potential parking space (especially egregious when this is a space close-in, or even worse, the handicapped space).
  2. hazard that cart being blown by the wind into someone else’s car and possibly scratching or denting it – or both.
  3. make picking up the carts more difficult for the baggers, so they take longer and are less available inside to bag someone else’s groceries.
  4. show the world what a lazy, inconsiderate jerk you are.

And, as shown in the photo above – you don’t get half-credit for getting the cart to the BACK of the corral and then leaving it still blocking the parking space. For goodness’ sake, how hard is the extra 10 steps?

 

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Nude Nite

Several weeks ago, I saw something about Nude Nite coming to Tampa and I signed up for their e-mail list. I wasn’t sure what it would be, but I got this in my inbox this morning, and it looks wonderful. Nudes in two and three dimensions, artists creating on-site, nude performance artists, others not quite nude, but performing in celebration of the human body.

I don’t remember ever feeling ashamed of my body and always puzzled over references to people (women, mostly) feeling the need to turn off the lights before undressing. I would be naked all the time if I could. I think it would be really cool to be an artist’s model in a drawing class and I’m also intrigued by bodycasts in different materials. One of the art forms I want to explore someday is papercraft, and I think body casting with paper would produce some very nice results.

I am definitely attending when this comes to Tampa. Somehow I don’t think my husband will argue too much. Anyone else want to go?

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‘Tis The Season

2013 Xmas Tree

My concession to Christmas decorating

The holiday season always brings about a certain dilemma for me. I just don’t quite know what to do with it.

By the time I was born, my family didn’t really go to church anymore. When my brother and sister were little, I think my family attended a Baptist church, although it may have been Methodist. I vaguely remember us attending a service once or twice around Easter, although the Easter Bunny always visited our house and we hunted boiled, dyed eggs in the back yard. We always had a Christmas tree and Christmas presents, and I left milk and cookies out for Santa, and while we may have sang a few Christmas songs that actually mentioned the baby Jesus, the ones I remember most were about Santa Claus. I don’t remember a formal Christmas story or any Nativity scenes included in our holiday decorations.

When I was in grade school, I went with a neighbor child to her family’s church, and it being a Baptist church and big on outreach, they got me signed up to ride the Sunday bus and I attended church on my own until I was about 17 and became incredibly disenchanted with organized religion, Southern Baptist flavor in particular.

Fast forward a few years to when my children were very young, and their dad decided that the dad-thing to do was to attend church as a family. Never mind that I had never heard him give any opinion on religion or even knew that he had been confirmed in the Lutheran church. Fortunately, the church he chose was part of the most liberal of the Lutheran synods, we became members, and I made many very good friends in the almost two decades we attended. All through that time, when the children would ask me about religious concepts, I would answer, “Lutherans believe….” and then give an answer based on the tenets of ELCA-based Lutheranism.  Well, until they came home from Sunday School one Sunday and asked me about Hell. I told them it was a myth, a loving God would not throw anyone into a fiery abyss for eternity, and not to worry about it.

All during that time, though, in addition to the Christian inspirational books I was reading, I was reading about neo-paganism, Wicca, and other earth-based matriarchal religions, along with books on Buddhism, reincarnation, self-hypnosis, and meditation. And a bunch of other stuff, too. I loved the rituals of the church, the chanting of the Psalms and the liturgy. But sometimes I would be kneeling at the communion rail wondering how anthropologists from other worlds (I read a lot of science fiction, too) would interpret the widespread behaviors of ritual cannibalism, and if one were to fully believe in the Catholic transubstantiation, then the belief in the literal cannibalism of the half-human and half-divine God. And sometimes I would just accept the pastor’s blessing. I guess it depended on the day.

Fast forward again, and I now jokingly tell people that I am Lutheran-Buddhist-Heathen, except that it’s not really a joke; it’s actually a pretty accurate summation of the amalgam of my beliefs set. My husband is a Jewish agnostic/atheist, his  parents the same. My husband’s children were raised going to the Episcopal church with their mother, but I don’t believe they attend church anymore, either.

So, we come to the time of Midwinter Festivals and I am compelled by a sense of family to bring ours together in all their motley glory. But it seems strange to celebrate the birth of a Divine Child that I don’t believe literally existed. If there was an historic Jesus, I believe he would be quite taken aback to find that he has become raised up to Godhood and the center of quite an elaborate mythos. And since my husband has no emotional attachment to any of the traditional Jewish rituals of the season, there doesn’t seem to be much reason to attend to them, either.

This year, I have decided we will have a Festive Yule Feast, a Solstice Celebration. We have some wood from the grocery store to approximate a Yule log and I’m trying to find a market nearby that sells cabrito, as I understand a Yule goat is also a traditional festival food, although a pork roast standing in as a Yule Boar is also a possibility.

I like the idea of celebrating the point in the year where the sun changes its mind about going away and starts coming back a little more each day. Festival of Lights. Light of the World. Return of the Light. Ultimately, I guess we’re really all celebrating the same thing – our opportunity to come together to fight back the darkness of the longest night.

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Trying To Make Sense Of Senselessness

I don’t want to beat a dead horse, but I am up at 3:00 am, and there’s really not much else to do, so….

My husband and I were talking about the altered receipt above and it reminded me of the Jewish student who sent herself anti-semitic death threats via e-mail (I tried to find a link, but there were too many college-students-and-racial-threats hoaxes to pinpoint the one I was thinking about) and then the young woman from several years ago who actually smeared herself with excrement and carved a racial slur into her own body with a box cutter (again – I thought this was a singular incident – an internet search turned up multiple hits with variations and different datelines.) What thought process leads someone to do something like this?

My husband pointed out that one can’t make sense out of senselessness. But people don’t do things that don’t reward them in some way, even if it doesn’t serve them in the long run. I wonder what kind of pain these people must be experiencing that makes these behaviors rewarding. I guess before the internet, something like the altered receipt above would have just been something to try to use to get sympathy from a few people – the few that still bought every bizarre story you made up. But when this went viral, it brought way more attention than she had anticipated.

Which also reminds of the guy (the most recent one, anyway) who was charged with making a false police report when his girlfriend insisted he call the police after having been kidnapped. Except that he wasn’t kidnapped – he just wanted to have a couple of beers with the boys but didn’t want to listen to her and her mother bitch at him about it. And that story seemed like such a good idea at the time….

What is the point at which the “polite fiction” that eases social interaction becomes the unreasonable lie or even the prosecutable fraud? Is it the same every time? Kant posited that there is not such thing as a “white lie” and that deception at any time is immoral, even were one to be lying to a murderer about where to find his intended victim. Does that make the people in the examples above immoral, or merely desperate within their own peculiar situations? Or mentally ill?

I dunno. Maybe it’s time for me to try to go back to sleep….

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Pain Reduction Via Profanity

Image

Last week at work, we were meeting to develop a course outline for training foster parents who are interested in serving higher-needs children. One component of training will be what behaviors to expect from these troubled and angry kids. One of the things a foster parent must be ready for, and be ready to let go of feelings of offense over, is colorful and sometimes quite imaginative profanity. This is common to almost all the verbal children care, sometimes learned from their parents, sometimes from the other children, but almost always present.

When we were talking about this, I remembered reading about a study that seemed to point toward profanity offering relief or protection from physical pain, and I wondered if the use of profanity by children in the foster care system (or anywhere, really) indicated that it might also help dull emotional pain. Since some of our neural pathways related to mood are also related to pain, (which is why chronic physical pain is one of the red flags for depression), it certainly seems plausible to me. And if it’s true for children, I would think it would be true for adults, too. Maybe the alcohol at the local bar isn’t the only thing easing existential pain.

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Stress Inheritance

I recently read an article on Aeon.co entitled Die, Selfish Gene, Die  by David Dobbs. It talks about the work of Steve Rogers, Mary Jane West-Eberhard and Gregory Wray (among others) and how physical and behavioral traits are not just about the genes themselves but also about the variation of expression available within each gene, and how genetically similar organisms can vary widely in their physical expression based upon their environment , e.g., grasshopper vs. locust; worker or scout bee vs. queen bee.

This made me think of an article I read several weeks ago that I’m still not sure that I fully understand, about how stress factors can cause epigenetic changes that can be passed on to offspring through changes increasing CRF-1 expression in the prefrontal cortex, affecting emotional regulation and decision making, even if those stressors occurred prior to conception. This ruled out the cause of these changes being congenital due to prenatal exposure to elevated cortisol levels. Further reading introduced the concept of DNA methylation which can suppress the expression of certain genetic factors and be passed on even while the actual DNA structure remains the same.

Often family members of war veterans experience what some call Secondary PTSD. Some mental health professionals believe that there really isn’t such a thing as Secondary PTSD, but that the family members can experience PTSD due to the frightening and sometimes violent behaviors of the veteran parent. In families where the parent’s behavior is not extreme enough to be a primary cause of PTSD, it would seem to me that the epigenetic changes discussed in the articles noted above would give some credence to changes in stress response of offspring, even if they were not primarily exposed to such stressors.

I work in child welfare services, and most, if not all, of the children in care have experienced some level of trauma. In extreme cases, this can manifest as Reactive Attachment Disorder (RAD). If you’ve read about the difficulties adoptive families have had with the adoption of Romanian children from the austere and emotionally sterile orphanages there , many of their difficulties can be attributed to RAD due to their early childhood experiences. But if methylation of parental DNA prior to conception can cause such changes, then even children adopted at birth would be susceptible to stress disorders and attachment issues, and possibly their children as well, based not just on direct experience but inherited DNA expression or inexpression.

An abstract on the PNAS website states that methylation is a reversible process but doesn’t suggest that we know how it might happen naturally nor how we might positively facilitate it.

Bruce Lipton (and many other New Thought advocates) posit that “with our intentions and beliefs we can ‘reprogram’ or ‘control’ our genes and our lives”. It makes me wonder if the positive benefits I have personally experienced from meditation, affirmations, and a focus on positive and healing thoughts are things that can facilitate this demethylation and help erase the ill effects of stress inherited from previous generations.

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New Rules for Tipping?

Photo linked from Yahoo’s article

 

A Yahoo article referencing a Payscale study (how circular could I get with this if I really tried?) says that if you’re still tipping your restaurant server 15%, then you’re below the norm and too darned cheap. I posit that this could be an example of declining math skills in the U.S. populace. It’s much easier to mentally double your bill and move the decimal point over than it is to actually attempt to calculate 15% of your bill. And on larger parties, the house will often add a gratuity of 18% onto the bill, which some patrons don’t notice and then tip again, thus driving the average tipping amounts even higher.

I normally tip about 20% when the service is anything better than adequate. Part of this is the laziness of not wanting to try to do math in my head (but I could if I wanted to -really!) and part is due to the fact that my mother and sister spent a good deal of the their adult work lives waitressing. I know how hard restaurant servers work and just how much that extra bit of income can mean to someone on the lower levels of the working class.

So, okay, maybe I should give my fellow diners the benefit of the doubt and agree that we have become more generous on the whole. But I still think that math thing has a lot to do with it.

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