| T O P I C R E V I E W |
| weatherman |
Posted - 02/01/2008 : 20:26:45
Alexis
Haven't seen you out here for awhile. Last summer we excahnged a few posts about achilles issues, after quite a few good months I'm dealing with another episode. Like the last, it was brought on by a (logically) insignificant trigger. I'm increasingly thinking that if I really want to put this to bed once and for all I need to deal with it exclusively as TMS. I'm thinking the achilles is getting hit because it's the only remaining place that really scares me, for obvious reasons. I'm very curious to know how you dealt with/thought about yours when it was all said and done, since we seemed to be in a similar place at the time.
Regarding your stuttering post, I don't recall any mention of that in the TMS books. HOWEVER - I note that John Stossel has a stuttering probelm, and that he is also a big Sarno advocate (because his approach cured his back pain). So, maybe there is a relationship there.
Weatherman
"Good judgement comes from experience. Experience comes from bad judgement." |
| 9 L A T E S T R E P L I E S (Newest First) |
| armchairlinguist |
Posted - 02/12/2008 : 09:03:38
quote:
And it's the need to be sure and know the unknowable that I think a lot of us struggle with
Absolutely. I was talking with my therapist about this. It's hard to be in the "don't know". We want to resolve it. This is something that I've also seen in the meditation literature I've read, where mindfulness meditation is about being where you are, even if it's unanchored, and not trying to grab for the nearest thing.
--
It's not 100% belief that's required, but 100% commitment. |
| weatherman |
Posted - 02/12/2008 : 08:49:02
quote:
Have you done the eccentric exercises lately? I just found the July thread where you mentioned having done them, but here you just mentioned rest for the latest round. I found that those exercises and research gave me a lot of confidence that the achilles wasn't that fragile.
Earlier discussion:
http://www.tmshelp.com/forum/topic.asp?TOPIC_ID=2980
Study reference:
http://ajs.sagepub.com/cgi/content/abstract/26/3/360
http://www.springerlink.com/content/52whjglldmelxy09/
Funny you should mention that. During the initial 5 weeks or so I did do the eccentrics. It didn't really make the achilles area feel any better, but it unquestionably made it stronger (I had progressed to more weight and more repetitions, at a level I was incapable of when starting out). During the subsequent rest period I pretty much laid off them just in case the eccentrics were contributing to the problem. I've been debating whether to start into them again. As you noted, the very ability to do them does give one a certain level of confidence that the area - even if painful - is not fragile. With this "injury", it's not dealing with the pain that's the issue, so much as the concern you're damaging something.
When researching the whole issue last year I found a claim that the exercises were actually invented by an amateur. There was a lady in Sweden who had dealt with chronic achilles trouble for years, and was ready to attack the problem surgically. However, in their health care system such surgery would be considered elective. So, she decided to do the eccentrics (before they were known as such) in an attempt to get it to tear - so that surgery would be approved. Much to her surprise, instead of tearing the problem resolved.
You could look at it two ways: maybe her problem was entirely TMS, and the exercises just gave her confidence that there was nothing wrong with it. Or, maybe it was real and that approach fixed it. In the final analysis, it doesn't really matter.
I ran across one letter from an Army doc who actually tells his patients to do th eccentrics, and to continue to run while doing the therapy. I don't think an Army doc can be sued, so that may be part of it. But, as you point out even civilian docs are starting to advise patients to stay active - some even to the point of running and jumping.
Weatherman
"Good judgement comes from experience. Experience comes from bad judgement." |
| alexis |
Posted - 02/12/2008 : 06:51:46
quote:
Originally posted by armchairlinguist
If you treat something that you're unsure of as possibly real, that doesn't necessarily mean that you panic and obsess.
Great summary. It's nice to "believe it's TMS" if you really can be sure. And sometimes you're lucky, and you spot all the tell-tale signs, and really can be pretty sure. But sometimes you just can't, and it's the obsession that'll suck you back in to TMS mode. And it's the need to be sure and know the unknowable that I think a lot of us struggle with -- in health, politics, life, and general ontological theorizing...
quote:
Originally posted by weatherman
After that time it was still bothering me, so I bit the bullet and took it easy (what an oxymoron!) for 5 or 6 weeks, doing nothing but daily walking, with no steep hills. Even if the injury was real, it just doesn't make sense that it wouldn't be healed now. I.e., after 3 months it would either heal, or - if things were hanging by a thread - progress to something dramatic.
Have you done the eccentric exercises lately? I just found the July thread where you mentioned having done them, but here you just mentioned rest for the latest round. I found that those exercises and research gave me a lot of confidence that the achilles wasn't that fragile.
Earlier discussion:
http://www.tmshelp.com/forum/topic.asp?TOPIC_ID=2980
Study reference:
http://ajs.sagepub.com/cgi/content/abstract/26/3/360
http://www.springerlink.com/content/52whjglldmelxy09/ |
| weatherman |
Posted - 02/11/2008 : 23:14:52
Alexis - you make a couple of good points
quote:
I agree there is a difference (though less now for achilles than thought previously, due to changes in recommendations). But really I'm talking a bigger picture than that. If you genuinely accept that a) the world won't end if your achilles is a worst case and b) worst case is damned unlikely then you are in a position where fake pains simply won't survive anyway -- so the whole distinction is irrelevant. Fake pain and illness can only play a role when you are still obsessively afraid of real pain and illness.
I'm probably more concerned about "worst case" (i.e., a complete tear) than I need to be. The stories I've heard about those events involved basketball and/or running, neither of which I do. My sports are hiking, backcountry skiing and mountain biking - all strenuous but not associated with dramatic injury to my knowledge, barring an unexpected awkward crash or fall. The doc I saw did offer that he didn't think I was in any extra danger of a tear given my apparent condition.
quote:
Still accept the possibility of either answer, and say "Scew it, even if it is real I'm not going to let it mess up my life anyway." And then go on to thinking about something else.
If I'm reading this correctly, it sounds like you're saying to just go about my business and don't worry about it. That is the direction I've started to head. Call it the Dave approach. The hanging/firing squad analogy is a form of gallows humor, roughly equivalent to damned if you do, and damned if you don't.
The original "injury" (quotes to reflect my doubt) happened 3 months ago. In the following 5 or 6 weeks my activity level was somewhat reduced, maybe 2/3 of normal. After that time it was still bothering me, so I bit the bullet and took it easy (what an oxymoron!) for 5 or 6 weeks, doing nothing but daily walking, with no steep hills. Even if the injury was real, it just doesn't make sense that it wouldn't be healed now. I.e., after 3 months it would either heal, or - if things were hanging by a thread - progress to something dramatic.
I've pushed through a couple of past episodes by telling myself that I may HAVE tendonitis, but I'm not going to DO tendonitis. As you note, fear is a huge part of all this, and I'm convinced it's why this is my area that gets attacked.
Armchairlinguist wrote:
quote:
It's the panic and obsession that makes a TMS comeback likely, less than, say, taking a few days of lighter exercise while seeing if the thing goes away on its own.
That's also a good point. As I noted above, I took 5-6 weeks of lighter exercise which really should have resolved any real issue. I can obsess with the best of them, that's for sure.
Weatherman
"Good judgement comes from experience. Experience comes from bad judgement." |
| armchairlinguist |
Posted - 02/11/2008 : 20:59:20
quote:
I.e. if something is fake and you treat it as real (activity restriction etc.), then you are strengthening the whole TMS process and guaranteeing another episode.
I think alexis's larger point is very useful here. If you treat something that you're unsure of as possibly real, that doesn't necessarily mean that you panic and obsess. It's the panic and obsession that makes a TMS comeback likely, less than, say, taking a few days of lighter exercise while seeing if the thing goes away on its own.
--
It's not 100% belief that's required, but 100% commitment. |
| alexis |
Posted - 02/11/2008 : 17:45:53
quote:
Originally posted by weatherman
What kind of activity level did you keep while recovering?
Walking but not running. I had started using hand weights anyway when recovering from "RSI" so I decided to focus on upper body strength for a while. I do a lot of walking/light hiking with my dog, but am not a huge exerciser, so the moderate amount of exercise now recommended for most achilles was just fine. As it got better I started reintroducing longer hikes and bollywood dance exercises and other stuff I generally find entertaining.
quote:
Originally posted by weatherman
The reason I make such a distinction between fake and real (or what you call Stage 1 and Stage 2) is that it has HUGE implications on how you would/should deal with something.
I agree there is a difference (though less now for achilles than thought previously, due to changes in recommendations). But really I'm talking a bigger picture than that. If you genuinely accept that a) the world won't end if your achilles is a worst case and b) worst case is damned unlikely then you are in a position where fake pains simply won't survive anyway -- so the whole distinction is irrelevant. Fake pain and illness can only play a role when you are still obsessively afraid of real pain and illness.
quote:
Originally posted by weatherman
Conversely, if it's real and you treat it as fake you could risk a serious injury.
Yes, with achilles I agree -- if you do really hard core exercise on it and the injury is already pretty bad (near tearing -- which is not all that common).
The latest recommendations for achilles certainly don't recommend complete rest and even use over-extension exercises to intentionally strain the tendon. So unless your livelihood is dependent on repeated and strained use of the achilles, you should be able to temporarily find less extreme exercise and hobbies to entertain yourself. And accepting the possibility it's real shouldn't be playing into anything. The fact is, for this, and a lot of things, it just might be real.
But it's how you think about that possibility that you have to change -- not (in this case) whether or not you think it is real. The thing is, you can't know. You just can't. Thinking you have to know is just another obsession. I thought I had to know everything. I had to let that go. And yet you can still change the way you think about it. Still accept the possibility of either answer, and say "Scew it, even if it is real I'm not going to let it mess up my life anyway." And then go on to thinking about something else.
quote:
Originally posted by weatherman
I certainly do obsesss about the whole issue, though not dealing with it at all isn't an option. One is forced to choose to either 1) Exercise with discomfort, or 2) Stop doing things you love to do. Kind of like choosing between hanging and a firing squad.
I agree that there's some level of choice, but the extreme nature of your analogy that is a little worrying (though this may just be writing style). Lot's of people who don't go running or rock climbing or play basketball or whatever it is you associate losing to facing a "firing squad" live perfectly happy lives. Can you really not imagine being happy without whatever activity this is?
quote:
Originally posted by weatherman
With regard to aging, I believe that slowing down is certainly inevitable, but pain isn't. I had a good illustration of this a couple of years ago, when I was in top shape - better than I had been in for several years. I hiked up a local mountain at a pretty good clip, pushing myself a bit. No pain whatsoever, but it took me 15 minutes longer to get to the top than it did when I was in great shape 28 years ago. That is legitimate aging.
I do agree that many pains people associate with aging may be TMS. But I'm not much talking about aging at 50. I'm talking about 70 and 80 and the pain that I've seen the very least TMS-type personalities experience as they reach these ages. The suffering I've seen in many, though certainly not all, is not TMS. I'm not going to argue with folks here who feel a need to belive it is, but I've had TMS and what I've seen in people walking on a badly, and painfully degenerated hip is not it. And the complete change I've seen many times when that pain is removed by surgery is also not indicative of TMS. |
| weatherman |
Posted - 02/11/2008 : 11:22:30
Alexis - thanks for the response. What kind of activity level did you keep while recovering? The reason I make such a distinction between fake and real (or what you call Stage 1 and Stage 2) is that it has HUGE implications on how you would/should deal with something. I.e. if something is fake and you treat it as real (activity restriction etc.), then you are strengthening the whole TMS process and guaranteeing another episode. Sarno, Sopher et. al. are unanimous in that the worst thing about TMS isn't the pain, but the resulting activity restriction. Amen to that!
Conversely, if it's real and you treat it as fake you could risk a serious injury. The achilles is pretty unique in that regard - the worst that can happen from pushing through a sore back is you get a sorer back (I was there once). A back will not physically break while you're running, for example. Unfortunately, doctors aren't much help. Even if they can't feel anything physically wrong with an achilles, they will always conjure up "microtears" or inflammation to explain pain - after all, if there's discomfort it MUST be injured. I did have it looked at a month ago and the doc couldn't feel anything abviously wrong, the tendon looked normal etc. At times the discomfort seems less about the tendon itself, and more the area between the tendon and outer ankle (which probably argues in favor of TMS). You're probably well aware that any pain within a mile of the back of your heel automatically gets diagnosed as achilles tendonitis - maybe it's a liability thing.
I certainly do obsesss about the whole issue, though not dealing with it at all isn't an option. One is forced to choose to either 1) Exercise with discomfort, or 2) Stop doing things you love to do. Kind of like choosing between hanging and a firing squad.
With regard to aging, I believe that slowing down is certainly inevitable, but pain isn't. I had a good illustration of this a couple of years ago, when I was in top shape - better than I had been in for several years. I hiked up a local mountain at a pretty good clip, pushing myself a bit. No pain whatsoever, but it took me 15 minutes longer to get to the top than it did when I was in great shape 28 years ago. That is legitimate aging. I think way too many people wind up in rocking chairs before their time, and a lot of it starts with doctors.... Patient: "Doc, it hurts when I do that" Doctor: "So, don't do that! And by the way, that'll be $200" Two of the people I do lots of strenuous hiking/skiing with turn 60 this year, so there's more to it than age. I'm a relative yougster.
Weatherman
"Good judgement comes from experience. Experience comes from bad judgement." |
| art |
Posted - 02/10/2008 : 10:25:47
Alexis, these are the philosophical underpinnings of my own approach to TMS as well as illness in general...Without some sort of basic understanding and acceptance of the nature of life and the inevitability of suffering, there's no end to the kind of fear and pain that made many of us sick in the first place. |
| alexis |
Posted - 02/09/2008 : 07:42:14
Hi weatherman-
After dealing with manufactured pain, my next big step (and one I think a vital next step for all TMS sufferers) was dealing with pain that is, or might be, real. Because sometimes it is real, and sometimes you can't know, and in both cases there are a mass of healthy people out there who live with real illness which doesn't take over their lives. So as described a bit here:
http://www.tmshelp.com/forum/topic.asp?TOPIC_ID=2978&whichpage=1
I came to accept the Achilles issue may or may not be real, but that it was the focusing on the issue that was the problem -- not the manufactured nature of it or the “is it or isn’t it manufactured”. If one doesn't focus on illness, the manufactured forms should cease to have purpose and the real ones should cease to have disproportionate weight.
I think a lot of people get stuck at the "recognition TMS symptoms are manufactured" stage (speaking in general here -- not about your situation to which this may not be applicable). A lot of folks feel they have finished their recovery with this realization and the dissipation of their current symptoms. Then they come back here all panicked again about "Is this real or TMS?" But true recovery, I think, is at a level where this question ceases to have significance. Because the panic and/or obsession are gone -- whether real or TMS.
So I don't know for sure how the tendon thing cleared up. There was definitely a bump. I don't even know if it's there now, because I don't go poking around. OK, just checked and I don't feel anything. But the key is I really don't care that much. And the pain is gone.
And sometimes I have stuff I think is real – like a shoulder issue recently I wasn’t sure about for a day or two. I couldn’t turn my head even. But I didn’t worry about it, and within a couple of days it was gone as it should be. And if it had been more serious I would, I hope, have dealt with it. Because I know there are people out there with no legs or terminal illness or whatever who are living fulfilling happy lives – and the key to their happiness is that their lives don't revolve around their conditions. Those folks are my role models.
So I know I’m getting a bit more general than your question. But to me the important message it that realizing you can manufacture symptoms is only step 1. You have to keep going after that. You have to be prepared for a time (almost certainly in old age) when you *will* be sick. I’ve seen people on this board try to convince themselves that Alzheimer’s and arthritis (regular degenerative arthritis) are TMS. That’s because they are still at stage 1 and can’t yet deal with the reality of real illness. When still in this fantasy they are ill equipped to deal with the realities of what will, with near certainty, occur in their lives. This board is very useful for helping get to stage 1 - but stage 2 is something that probably takes place better with less contact with this forum, because the emphasis on stage 1 thinking risks sucking you back in.
So sorry for going a bit off topic to your question. More immediately to the Achilles issue it did help to read the latest research indicating that extreme rest is not the answer for most Achilles (not that marathon running is recommended). For me this was helpful not only in the Achilles area, but in understanding of “RSI”. For some this would be difficult – especially the many runners on this board for whom running is often at the level of obsession, and likely serves the same purpose as TMS. In those cases I think there is a whole other conflict that needs to be recognized and resolved.
Alexis
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