Sold

It's all over. Almost. Will be, once all the subject-to's are gone, by May 29th. Then I will be officially in transition, not just preparing to be in transition.

I'm pretty satisfied with the sale. I got nearly as much as I was asking, and the buyers were people who knew what they liked and moved decisively, didn't burn a lot of fuel dithering around wasting everybody's time and patience. They came/ they saw/they bought, all in the space of a single day.

Hurray.

It looks like I'll be able to go where photons shine all year round, about mid-July. If I'm careful with money, I'll be able to afford a longed-for, self-assembled "sabbatical," during which I can rest one part of my brain (the treating part, which is so automatic it will never forget how) while I work on developing the conceptualizing, writing part. I plan to write furiously while I have the opportunity. Maybe less blogging, more actual book-writing.

Might have an offer

I just heard from my real estate agent - he says a realtor called him, wants to set up a meeting tomorrow afternoon to present an offer. How exciting!

A Friday work afternoon in May

This afternoon I had three new patients in a row, all very senior, a rare event - usually I treat people 20-ish to 60-ish..

Lady number one, age 85, recently hospitalized for food poisoning, a week ago. Had a cataract removed just on Tuesday. Said that she developed sharp pain in her neck and shoulders while being hospitalized for the food poisoning, that it was better but not gone, and didn't want to delay the cataract surgery because she didn't want to have to wait for the next available slot. So she toughed through it and turned up in my clinic, brought in by her daughter who I treated a decade ago. She definitely couldn't move her head on her neck much. She had never had any treatment ever before from anyone. Her husband had died 4 years prior, and she had moved overseas to Canada to move in with her daughter. Tough lady.

So, I worked carefully with her, and in the end she could move quite a lot better on one side but still had pain on the other, so I added a few pieces of stretchy tape, made sure the tape was holding her skin comfortably so she could move less painfully, showed her daughter how to remove them after a few days.

Lady number two was about the same age and had stumbled - although she had not fallen, she had sprained her ankle. She was wearing a brace on it, and limping. She had been to the PT her doctor had sent her to, but found she didn't like electrodes or ultrasound or the heat pack. She said her ankle had felt worse after. We had a provincial election here on Tuesday, and where she had gone to vote, a scrutineer had given her one of my business cards. She made an appointment and here she was.

She had lost her husband less than a year ago - they had been married nearly 60 years. She still could hardly believe he was gone. She was a treat to treat. Her nervous system responded extremely well to hands-on work, and by the end of the hour the swelling was way down and she had full range. When she got up she could walk normally. I asked her to leave the brace off. She hugged me. Twice. Might be back to have her fingers worked on.

The third new patient was an elderly man with pancreatic cancer, which had been diagnosed a year ago and treated with chemo. He looked really good. Thin but good color. He had pain in his belly. His son, who had been in for treatment for a few different problems, had made the appointment. I had been really clear on the phone that there were certain sorts of pain, like cancer pain, that my attempts wouldn't be able to help, but that if there were other kinds of pain as well, perhaps what I am able to offer could help with that. When he came in, I had the same conversation with the dad. As it turned out he had old shoulder injuries from sports, and very restricted shoulder range on both sides, so I took that on. I worked on skin (dorsal cutaneous nerve roots) along both sides of his spine, the sides of the trunk (lateral cutaneous nerves of the torso), the shoulder blades (many different nerves at different levels), and the front fold of the armpits (intercostobrachial nerves and supraclavicular branches of the superficial cervical plexus). Both arms were able to raise up all the way after. He still had the belly pain, of course. I reiterated that I didn't think what I did could help that, that the patches were his best bet. He said he was thinking of having acupuncture, that they offered it at the cancer clinic. I said I thought whatever they offered at the cancer clinic, under supervision, should be OK. We all shook hands and he and his wife left.

Quite the day, with three brand new elderlies all in a row. Elderly people make me go all soft and tender. They always have. Not sure why. They are living heroes to me.

I treated an old woman once shortly after I graduated. She was in her nineties, was being hospitalized for something I can't recall. Her hands bothered her a great deal. They were gnarled and thick-knuckled. She said, "Look at these hands. They are ruined. Whatever you do, don't use cold water to wash your vegetables. I used cold water all my life, and look what happened to my hands! Use warm water. It doesn't matter - you're just going to cook the vegetables anyway!"

I took her advice. I've never done anything under cold water that couldn't be done in warm.

Another 95 year old I worked with scoffed at herself one day about being a "dried-up old prune." I objected immediately. I pointed out that prunes were nothing but plums which had grown more condensed and had concentrated their sweetness. She was a poet. She got that in a deep place. I think she thought better of herself after that.

Once when I was in my mid-twenties, I was in a medical building for one reason or another, and caught one of those glimpses that lands like a snapshot, glued in the brain forever. An elderly man came off the elevator. He was short, but pulled himself up to his full height, as fully as he could. He was dressed impeccably, hat, jacket, tie. Shined shoes. For whatever reason, I suddenly saw him as living poetry, and my throat caught in that moment with the poignancy and beauty of it all. A life nearly all lived out. Fully. Upright. Dignified.

Still waiting

Still nothing. Still no offers on my condo..

I'm still in the transition zone therefore, feeling a bit bored, a bit restless. I decided to go where I had never gone before and put a few ideas out onto a taxonomy thread at IASP.

In a recent conversation about possibly renaming the syndrome currently known as fibromyalgia, a poster (MD) wrote:

">"Whatever we call tenderness in 11 of 18 spots with associated cognitive dysfunction is bound to be confusing unless there is an examination based on an agreed methodology (which currently doesn't exist) to identify specific muscles (40 % of tender points are thought to be TrPs in some studies and treatable with injections) that are the source of some or all of the patient's pain in distinction to CNS dysregulation."

I replied:

"Here is a thought (harboured for a long time) about the tenderness detection method used to arrive at a diagnosis of fibromyalgia: Please bear with me while I explain:

With all due respect, it seems to me, that unless the clinicians who originated this way of determining 'muscle' tenderness first physically removed the skin and its attached subcutis, then tested for tenderness, then placed the skin back on again, the idea that they actually found tender points in 'muscles' might be (dare I say) erroneous.

Cutis/subcutis is very thick, in case anyone doesn't remember. It contains a great deal of physiological tubing (nerves and vasculature and smooth muscle), sensitive structure and function, most or all of which is regulated by the sympathetic NS and efferent function of sensory nerves. Skin is closely read by the brain, and by the S1 sensory cortex, in full awareness by the non-anesthetized, non-hypnotized patients being tested for point tenderness.

I would like to propose, therefore, that tenderness in skin itself and its attached layers will always be a confounding variable to finding and being able to assert that point tenderness is from something wrong in muscle tissue. I'd say chances are rather high that some structure located within cutis/subcutis itself is what feels "tender" - a cutaneous nerve perhaps.

I'm speculating - however, I think my speculation is likely more accurate than the supposition that somehow one can locate tender points in muscles, by:
1. conceptually subtracting skin as though it did not exist, or was not sensitive, or didn't count;
2. forgetting that cutis/subcutis can be a good inch thick and is full of sensory neural structure, or that palpable hardness can't develop and then disappear within C/subC itself;
3. forgetting that a dense tough layer of fascia (hard to palpate through) surrounds and contains and separates 'muscles' from one another;
4. assuming the patient's brain/nervous system (already stressed and producing pain output) wouldn't read skin input first and regard exteroceptive pressure as something it needed to defend its organism from by making the patient flinch;

... all of which I think should be factored in long before the clinician/examiner assumes he or she has found a TrP in somatic 'muscle' tissue.

I respectfully submit that one should not rule out anything one has not already considered.

Diane Jacobs PT"

Maybe I am getting a bit ornery these days, or as a result of aging, or as I prefer to think about it, ripening while still on the vine, but I'm not going to sit back and stay quiet anymore about anything, anywhere.

As talk-show host Ellen is fond of saying, "ANY-way..."