Episode 9: Patient stories from my practice
I showcase 3 patients who all have neuroplastic pain/symptoms and all three have different situations they are dealing with
Hello Friends and Winning at Fibromyalgia warriors!
Please know I mean the word “warrior” in the best possible sense of the word. My vision is to help a thousand women struggling with fibromyalgia every year. IN order to do that, I do have to become a warrior. Like a superwoman or Avenger. So I am becoming one
Welcome to the Winning at Fibromyalgia podcast Episode #9!
Thank you to every single one of you who listens and downloads my podcast, it means the world to me. Thank you to those who share or spread the word. That’s how people find out about me and what I can do for them. So thank you I really appreciate it.
Today I talk about three patients from my practice this past week to showcase specific concerns and issues that come up during my encounters with real patients. It is one thing to talk theory and whole another ballgame to go out in the real world and practice what I teach.
Before I go on, I want to mention I purchased a new mike, that advertises to make my voice sound much better so as soon as next week you can assess whether that’s the case
Let’s start with my first case. Let’s call her Julie, she is a lovely lady in her early 60’s, and she lives alone because her husband died. She has had chronic right knee pain that she believed was from RSD (reflex sympathetic dystrophy). In the weeks preceding her visit with me 2 weeks ago, she has been having high amount of R knee pain that sometimes would jump to the left one for no rhyme or reason, and seem to have responded only to short bursts of steroids or pain medications. Most peculiar of all, her R knee MRI was COMPLETELY normal. The patient was not reassured by that finding.
We met twice in the last 2 weeks. At the first visit I did a thorough exam of her joints and provided reassurance that her knee was fine. I also explained the concept of neuroplastic pain and she was surprised to find out such concept even existed! We did somatic tracking, at the beginning of which she had pain in the R knee and both ankles. ALL of the three locations had less or zero pain at the end of several minutes’ long somatic tracking session! She was very excited and happy.
During the session it did come up that she did not feel safe at home because she lived alone. As we probed it further, it turns out she does feel safe when she prays. And that’s what we held onto – the feeling she has when she prays – that’s exactly the same feeling we want the brain to have in order to feel safe.
She came to see me yesterday for a follow up. She told me that initially she felt so excited and reassured and the pain stayed away. But then the pain came back and she became anxious and stressed about it again – she felt and worried she was not “doing it right”. She worked herself up to believing she was NOT doing it right, and this was re-affirmed because the pain was not going away this time. She was stressed out and worried about whether she was “doing it right”.
What I want to highlight here is that there is no such thing as “doing it right” or in another words, perfectionism. The only requirement for doing somatic tracking is that you are relaxed, and calm, and curious– which is hard to do when the pain is severe – so we don’t recommend doing it then. Perfectionism is the opposite emotion we want you to be feeling and does not allow the brain to feel safe.
So that was one aspect that we addressed. The second was attachment to the outcome. Because the pain has gotten better every time she did somatic tracking up until that point, she expected the same outcome every time. And that’s the thing with somatic tracking. It usually does produce reduction of pain but often times, especially early on, it may “only” produce “shifts” in sensation. Sometimes sensation moves to another part of the body. Or the pain changes character – e.g. from burning to tingling. Which, in itself, is another proof of the concept of neuroplastic pain and should provide reassurance.
So however paradoxical it sounds, you want to be “unattached to the outcome” when doing any of the exercises for the pain. It is clear that we want your pain gone, but it is almost as if you “surrendered” to whatever may be, and not watching things like a “hawk” and expecting pain to go away. Expectation is a signal of alert to the brain which means danger and it produces more pain or allows the pain to stick. The pain reduces when the brain is reassured and feeling safe. Meaning – when you truly feel safe and reassured in the core of your soul.
Julie had a wonderful resolution of symptoms the second visit again, yesterday. It was a wonderful encounter for me also, to have an impact on someone’s life by sharing empowering knowledge and techniques to make the pain better. The impact is tremendous and very gratifying.
My second patient is Rebecca, who was referred to me for positive ana and sensation of “pins of needles” arms and legs but basically all over. She is in her late 40’s, and lives with her supportive husband and a school age daughter. Rebecca made it really easy for me because she beautifully described how her symptoms of IBS (irritable bowel season) got worse when her business got busy in the summer. She even said this is a pattern for her! It is a perfect example of a body-mind syndrome – real physical symptoms in response to stress.
This year, something new started happening – this was pins and needles sensation. It was there all the time but not the same intensity. And also new bladder symptoms (and negative urine tests for infection). I did a thorough exam, she already had normal labs done by her referring provider. There was no evidence of lupus or other autoimmune rheumatic disease. It was clear to me that her symptoms did not have any structural basis (yet they were clearly real), and I explained to her the concept of body-mind syndrome and neuroplasticity of the brain.
She was SO relieved to hear that body-mind syndrome can give people physical symptoms that are real and that can go away. We did not have time to do the somatic tracking because that was our first visit and I spent the time obtaining all the relevant history, doing the exam and explaining the neuroplasticity. Rebecca said that just hearing this information and knowing it exists made her feel better. I gave her some tools and we are meeting next week again to follow up and do somatic tracking.
My third patient was Mary, a pleasant lady in her 70’s who has severe PTSD and long history of chronic body pain. I again did thorough exam, and reviewed labs and confirmed the diagnosis of fibromyalgia for her. I explained the concept and she was very receptive to the idea, she even was able to immediately link her long-standing history of trauma and PTSD to her pain!
When I attempted to do somatic tracking with her, within the first minute of it she informed me she is unable to continue because relaxing with me in the office, having her eyes closed meant to her that she was letting go of the control and she was not able to do that. To let go of the hypervigilance.
What I want to point out here is that if that happens to you, and you encounter feeling like you cannot focus on your breath and relax because it means letting go of the control, it is also ok. It is maybe time to thank your anxiety for being such a good protector of you. The anxiety has been there for a long time and probably for a good reason. I recognize It is hard to imagine what people with physical or sexual trauma let go of the hypervigilance, and let their bodies be completely relaxed – it feels to them like they are defenseless. That’s ok. I am going to see Mary again and I suggested she tries this even for a second every day. And then maybe she will be able to do it for a few seconds. And slowly she may be able to build this to a minute. We will work with whatever we can get. As long as we are kind and compassionate with our bodies.
There is no “right” way to do this. Everyone is different and everyone’s physical body reacts differently. And it is all ok. This is all human experience. We meet it with Love and kindness and compassion.
This is all for today. I do look forward to catching up with all of you next week, hopefully with a new mic
If you loved the episode, please let me know, or leave a review, I will appreciate it.
If you think someone else might benefit from it, please share, I will also appreciate it.
You can find me on facebook @martinalenartova and my website is: https://www.martinaziegenbeinmdcoaching.com.