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Monthly Archives: January 2016

Up and Down The Empathy Spectrum

 

I am a sensitive person and likely you are as well. How do I know that? Because insensitive people aren’t that interested in what others have to say and presumably don’t read blogs (just a hunch). Also because if you’re reading this, you’re likely in recovery or care about a person in recovery, so you are trying to understand yourself and others better; a sensitive objective.

It isn’t easy being sensitive. Emotions are more intense than necessary: I am overjoyed when happiness would suffice. If I’m sad I’m devastated and when angry I can become obsessed with proving a point.

I notice and react to the world around me constantly, and can’t seem to help but take in everything. If strangers are having a disagreement within earshot, fight-or-flight kicks in. When I witness someone behaving badly, a weight of shame descends onto my shoulders as if by proxy. I can cry over a dog food commercial.

It isn’t all bad. Constant thoughtful observance can lend an advantage – we sensitive types are often two steps ahead of everyone else around us – but it’s also exhausting.

Part of alcohol’s appeal was its ability to take the edge off of the sensory overload; to give me a break from the running tickertape of responsive feedback, criticism, and anxiety. What we sensitive people need is a good intake filter, and alcohol appears deceptively effective at first.

In recovery, we learn new ways to comfort ourselves and to change our perspective so that the world feels less prickly. Recently, I was tearing up over a television program, so I challenged myself: These emotions do not belong to me. Experiencing them will not change the situation. I choose not to feel this sadness. Then I pictured my chest as a Teflon-coated frying pan that tilted up and slid the feeling of heaviness away like eggs onto the floor and POOF – the feeling went away. HOLY SHIT. I was so excited I tried it again and again in the days to come, and it worked! Organic, real emotions are useful and powerful, but unfiltered empathy can be accepted or discarded.

I must confess, though, that as much as I claim to absorb others’ feelings, I am also the same person who believed wholeheartedly that the people around me did not really love me (because I believed myself unworthy and unloveable). How could I be so intuitive and connected, yet apathetically block the reality of the loving emotions of my friends and family? I drank to numb the pain of that disconnection as well, and recovery has allowed a new capacity for accepting that I am both lovable and loved.

apathyIt helps to understand empathy as a spectrum that we may move along, landing at different points depending on the circumstances we find ourselves in at any given moment: experiencing more apathy in some settings and yet feeling highly empathetic (and emotional) at other times. By developing emotional intelligence (sometimes referred to as “EQ”), we learn to harness the power of our experience and empathy to respond appropriately to situations. We choose whether to slide the emotional eggs off the pan, or if there is a benefit to continuing to experience those emotions as a means of connection.

Midway through the spectrum are behaviour patterns like Narcissism and Codependency. Although they are often presented as opposite extremes, in many ways they are closely related. Narcissism is a self-centredness that relies on others to feed a grandiose facade, whereas Codependent behaviour involves self-worthlessness that seeks identify through serving the needs of others. Narcissism obliterates others for the sake of self, while codependency obliterates the self for the sake of others. It’s hard for good things to come of relationships where someone is always obliterated, for whatever reason.

For me, recovery has involved self-awareness of both behaviours and an effort to shift towards empathy, which ultimately leads greater emotional intelligence or “EQ”. It isn’t always easy, but sometimes the temporary discomfort of self-awareness and change leads to a greater overall happiness with myself and my behaviour towards others. Harnessing sensitivity and establishing better patterns as a result reinforces a stronger mindset that is less likely to look for comfort in unhealthy ways.

 

 

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More Thoughts on Pain Management in Sobriety

The other day I wrote about my experiences with prescription pain meds following surgery and I have been inundated with comments and emails since. You can read the post here and please be sure to read the comments because there’s some important information added by readers.

So many readers indicated they planned to save the list of recommendations that I’ve put them into this graphic that can be saved or printed:

image

After absorbing all the feedback, it hits home that we really can’t expect anyone else to care about our recovery more than we do. Even the most well-meaning health as professional can be wrong, misinformed, or blasé about the risks of prescription pain medications.

Many of us who have struggled with alcohol have codependent tendencies, meaning we are inclined to care a little too much what other people think of us. We tend to be people pleasers and we want to be liked, especially by those in positions of authority. It can, therefore, be very uncomfortable for us to challenge or question a doctor who might be more concerned with solving the immediate problem of pain relief rather than the unseen (and often self-diagnosed) matter of ongoing sobriety.

We don’t have to treat these encounters as confrontation, but we do need to stand firm. “I am really enjoying sober life and I want to do everything I can to protect it” is a powerful yet positive stance. If you’re worried you won’t have the courage to speak up when required, practice saying that sentence in the mirror a few times a day. This will increase the likelihood that the words will come more easily in an unexpected situation (I’ve also practiced ordering soda and juice, or saying no thank you to offers of alcohol, which came in handy on many occasions!)

Finally, one more suggestion. Bringing a “wing man” to the doctor can be helpful, someone who might assume the role of “chief question asker” and who will reiterate your position if necessary. It’s important to keep a respectful tone and to value a doctor’s experience and expertise, but us “pleaser” types occasionally need some extra help to be heard.

My most sincere hope is that each of you enjoys such good health that you never find yourself in a position of pain management, but since life is unpredictable we must be prepared for anything. Take care, friends.

 

 

 

5 Essentials for Pain Management in Sobriety

Ten days ago I came face to face with a problem that most of us in recovery eventually have to reconcile: pain management. In my case, the situation involved post-op pain from emergency gallbladder surgery that was thankfully short-lived, but even so I knew enough to be aware that prescription pain medication can be extremely dangerous for people in recovery.

When I quit drinking nearly five years ago, my only concern was to avoid alcohol. For years, I had started each morning with two extra-strength Tylenol (for aches and pains, I’d tell myself, because I certainly wouldn’t acknowledge I was hungover every morning). I had no worries about prescription painkiller addiction because I did not use them, and the need for morning Tylenol mysteriously (*wink*) disappeared within a few months of living alcohol-free.

I’ve since listened to enough Dr. Drew podcasts to know that prescription pain medication is a gateway to opiate addiction, and interviewed enough people on The Bubble Hour to be aware that kicking a pill habit is a serious bitch. I’ve learned so much about addiction basics – the hijacked pleasure-reward circuitry, the genetics, and the personality traits – to know that I am in a higher risk category, and respect that good protocol for me includes avoiding anything potentially harmfully addictive.

So when I found myself in the local emergency room, exhausted and weak from painful Choledocholithiasis (a big word I had to Google meaning gallstones in the bile duct), I mustered both courage and strength to appraise the attending doctor that as a person in recovery, I have to be careful with pain medication.

Whew. I get flutters just thinking about it! It was hard to utter those words because:

a) I had never seen that doctor before and had no idea how he would respond

b) I actually really wanted to escape from the pain

c) I was not 100% certain how to self-advocate.

The doctor was very positive, beginning with a slightly patronizing “Alright, high-five! Good for you!” Then, in a more serious tone, he said,”There’s some misinformation about that. When you have pain, the meds treat the pain and you don’t get high. It’s when people take more than they need or take them without pain that a euphoria occurs. But we have something that should work well for you and you don’t need to worry.”

I’d like to tell you that I sat up and asked a dozen insightful questions, but the truth is I just cried with relief and trusted. Sometimes that’s the best we can do.

Following my surgery, I was given a drug called Tramadol for pain. It was mixed with acetaminophen, like a T3 but without the opiate. Tramadol is said to behave opioid-like for pain relief but without the euphoric side effects, and is sometimes used to treat depression. (A quick internet search shows, however, that addiction to Tramadol is, in fact, a concern for many.) My experience was that it did relieve my pain and made me sleepy. I took it every 4 hours in hospital, and once I went home I took it only at night for the first two nights. After that I found that regular strength Tylenol was effective for my pain around the clock, and within a few days I needed nothing at all.  I am not giving a recommendation or endorsement for any medication, but simply relating my experience for information.

In the days since, I have reflected on what I did to help me successfully navigate the dangerous waters of pain management in recovery. I was fortune that my situation was resolved within a matter of days, and recognize that this issue becomes much more complicated for chronic conditions and complex injuries.

Here are five things I did that contributed to my success:

  1. Be aware of the dangers. Simply understanding that some medications could pose a threat to my sobriety, especially narcotics for pain. Although the doctor I spoke with may have been correct in his assertions about pain negating euphoria, I’ve since discovered a recent study from McMaster University showed that 52% of female patients at Ontario methadone clinics indicated that their opioid dependence began with doctor-prescribed pain medication. It seems the problems begin after the pain begins to subside, and the patient is by then at home and left to figure out appropriate dosages without medical monitoring and guidance.
  2. Speak up. I told the doctor I was in recovery. I asked the nurses each time they brought me the meds to confirm that it was, in fact, Tramadol. I told my husband I was concerned about having pain medications in our home, even ones that the doctor had deemed to be a safe option. Yes, I felt vulnerable – especially with the nursing staff for some reason – but I also felt fiercely protective of my sobriety. I never EVER want to be dragged back into addiction and especially not into that death spiral of pills.
  3. Enlist an accountability partner. I kept the pills where my husband could see them and kept him posted when I used them. I have heard that some people even hand their meds over to someone else to administer them. I think the hole in the system is that patients are sent home with those little bastard pills to figure things out alone. No education, no written protocol, no follow up.
  4. Do not use them longer than absolutely necessary. Pain relief is proven to speed healing, but I made a conscious effort to get off of painkillers as soon as possible. Because much of my discomfort was from the gas that is put into the abdomen during surgery, often just a bit of gentle movement and walking around the house was enough to reduce pain. I rested more than I wanted to, whereas the old me would have tried to do too much too soon and then I would have medicated the resulting pain. Instead, I did relaxation exercises and short meditations which also alleiviated a surprising amount of pain.
  5. Get the leftovers out of the house. When I finished with the meds, there was more than half a bottle remaining. I knew those had to get out of the house, despite temptation to keep them around for the next migraine. Even though Tramadol is said to be less addictive and non-euphoric, I knew I might want to use them to escape a bad mood or feeling because they put me right to sleep. When I drank, it was to escape by falling asleep, and I did not want to have that possibility whispering to me from the medicine cabinet. It wouldn’t be a relapse or anything….Tricky thinking. Nope, get rid of it. I took them back to the pharmacy and asked my pharmacist to safely dispose of the remaining pills. He was somewhat taken aback, so I explained the situation and we had an interesting discussion about this very topic.

Although I am glad that I was granted what is considered a safer option than opiates, I see some flaws in the system. I wish I had been given more education on how to use and then discontinue use of pain meds when I was discharged from hospital. I wish I was given further information when the prescription was picked up. I wish someone touched base to follow up. I understand that there is no provision for these things in our current system, but imagine the lives that could be saved if those steps were taken.

The bottom line is, my sobriety is my priority and my responsibility. I guard it with the same passion and ferocity as I do my own children. Getting sober gave me whole new view on life, and I won’t let anything take that away from me!

 

 

 

 

 

Emergency Surgery

I cheerfully signed off my last post with a mention of my New Year’s plans for hosting family at the ski hill. A raclette dinner was in the works, lots of extended family arrived, and the snow was deep and powdery. All of the right conditions for a perfect New Year, except for one small problem: I was sick.

I’ve written about my ulcer before, and since Christmas Dinner it was back with a vengeance. I was enjoying the cabin – skiing daily, cooking for a steady stream of family and guests, being the hostess-with-the-mostest – but feeling bloody awful. The day before New Year’s Eve, it got so bad that I decided to leave my husband in charge of the guests so I could return home to rest in quiet.

My doctor squeezed me in for a quick appointment before closing for the long weekend, promising bloodwork results on Monday. I went home to spend New Year’s Eve alone under a blanket on the couch, terribly uncomfortable and suspicious that this was no ulcer. By Saturday night I was planning my own funeral.

Fast forward a few days and I was in the local emergency room, getting lots of attention for what turned out to be acute gallbladder problems. The surgeon was called in and I was admitted. First thing the next morning I had a procedure to clear out the gallstones that were lodged in my main bile duct, followed by surgery to remover the gallbladder itself.

I’d gone from a wonderful, fun family vacation to a lonely, uncomfortable sick bed for days and then finally three nights in hospital. Things can turn on a dime!

The hospital was noisy and chaotic. I was in pain and alone. It could have been terrible, but I was too grateful to wallow. As I lay there, I realized that many things I’ve learned in recovery were getting me through this ordeal:

  1. Ask for Help:  When I was sick at home and certain I was dying, I should have called an ambulance or a neighbour for a ride to the hospital, but I didn’t. I wanted to be helped but I didn’t want to ask for help. I was afraid they would say I wasn’t sick enough to be in hospital and send me back home. This was reminiscent of when I knew I needed to quit drinking but was scared to go to a meeting for fear they’d say I wasn’t addicted enough. Don’t be silly – help is there and the people who provide it are caring.
  2. Be Grateful: If you’re new to sobriety, you might not yet be aware how important a role gratitude can play in your journey. Sober or not, everyone can benefit from taking time every day to list three or four things for which to give thanks. Stop right now and look around you – what are you thankful for? This simple act is a life-changing habit. As I laid awake through the night in my hospital bed, wishing for sleep but surrounded by noises and activity, I reflected on all the positive things deserving thanks: the iv that was replenishing my hydration, the kindness of the nurses and doctors, the ultrasound tech who quickly confirmed the problem, the warm blankets an orderly brought when I shivered on a gurney. I was sick, uncomfortable and a little scared of the surgeries ahead, but reflecting on the situation with gratitude kept me smiling.
  3. Give Service: Service is another concept that helps sober people stay the course. Helping others get and/or stay sober strengthens our own recovery efforts, and having a helping attitude spills over into the rest of our lives as well. How could I help anyone while I was sick in bed? I spoke kind words to each nurse, attendant, and worker who came through my room, thanking them for their work (see also: gratitude). I sent kind thoughts and prayers for the well-being of the doctors and nurses who were working all around me. I looked over at the sweet 92-year-old in the next bed, and sent prayers for her comfort and healing, for her family and caregivers. Thinking about others took my mind off of my own pain and fear, and allowed me to reciprocate some of the kindness I was receiving so thankfully.
  4. Be Present: Hours passed by slowly in the hospital, and at times my mind would bounce between two unhappy places: the pain of the previous days and fear that the next day’s surgery would have complications. Bouncing between past pain and future fear is a rollercoaster ride of depression and anxiety; I’ve learned this lesson well in recovery. So if I caught myself slipping in either direction, I coaxed myself back into the present by deep breathing exercises. Staying in the present is enormously helpful in sobriety when we are likely to ask ourselves, “Is this forever?” “Can I make it through the weekend?” “Am I a horrible person for all the bad things in my past?” Stop. Breathe. Stay in the moment, just do the next right thing. Moment by moment, we can get through anything.

So although I was sidelined for a few days, I am feeling much better already and should be back to normal in no time. Having an alcohol-free lifestyle (as well as smoke-free and drug-free) lends itself to a strong, healthy body that bounces back quickly from these things.

The new year always brings lots of new readers who are looking for help and insights as they consider sobriety as a resolution. I am sorry that I was not able to respond quickly to those of you who have written this past week – please know you are very much on my mind and I am cheering for you.

If you are in the early days of recovery or experiencing a post-holiday wobble, I hope this post shows you how the principles of recovery can serve you well in all areas of your life. Stay well. Seriously.

 

Hurrah for coffee!

My new sober adventure!

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