Book Review on All Our Waves Are Water: Stumbling Toward Enlightenment and the Perfect Ride

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My high school graduation gift – the original Walden Wahine Blue Funboard. Photo by Undiagnosed Warrior (2002).

As any avid reader will tell you, it’s really quite rare for a book to find you rather than the other way around. But that is exactly what happened with Jaimal Yogis’ third book entitled All Our Waves Are Water: Stumbling Toward Enlightenment and the Perfect Ride. More times than not, the reader selects their next material based on their individual interests or as a way to fulfill an empty segment of the self in some manner. For some people, books bring with them all the adventure that may be missing from one’s life; other stories may appeal to more intrinsic motivations of the reader, perhaps offering the integral preservation of the self as if the words and the wisdom divulged in the ink shares the hidden secret of the world, the true meaning of life, or what you need to do to be happy. My go-to reading material, on the other hand, would put most people to sleep: college textbooks, medical journals, research studies, psychological theories, and self-help books about coping with chronic illness. Although my personal interests were much more diverse before I became really ill, both science and research were pretty much the only running theme for which I came to understand the social environment. I am far too analytical to find truth any other way. I should also preface that I’ve never made a commitment to one religion or belief system over another yet have always considered myself highly spiritual according to my own definition of the word. This was the only way that I could reasonably explain my natural attraction to the ocean or the way that large open bodies of water always made me feel at home, particularly in providing much-needed peace within the surrounding chaos of the outside world. All I’ve wished for lately, though, is some semblance of calm within this storm so that I could securely ground myself once again.

“Psychologists say blending into our surroundings is a feature of having thin boundaries versus thick ones. In decades of studies, thick-boundaried people see themselves as part of firm groups (“we do this; they do that”). They see the world as separated into good and evil. They don’t recall dreams well or feel unified with the diversity of the world. Thin-boundaried people remember many, often wild dreams. The border between self and other fall away from time to time. It’s easier for them to feel empathy, but the thin-boundaried sometimes struggle to say focused” (Yogis, 2017, p. XVII-XVIII).

This book review is long overdue as a result of the endless disarray that has taken over my life as of late. In addition to my health declining and my symptoms worsening, my ability to read and write is becoming progressively compromised as I can’t seem to concentrate long enough to put words together that make sense without significant effort and medication anymore. It’s also been challenging to manage my symptoms after recently losing multiple doctors and, therefore, having to find new providers willing to take over where the other doctors left off. Not to mention the fact that I’ve been trying to get through the final semesters of college by taking courses that unnecessarily require at least three or more different writing assignments per week. Thankfully, I only have 2 more classes left until graduation. It’s just been extremely hard to manage anything more beyond medical appointments and academics, so I apologize for the long pause in between updates. Perhaps this is one of the many reasons reading All Our Waves Are Water happened at just the right moment because, if we’re being honest here, it’s been getting harder and harder to stay positive about the future when you’re constantly dealing with one setback after the next. I mean, how are you supposed to maintain hopeful about the future when all you have to compare to is the mundane life you’ve felt stuck in for years? It doesn’t help any that I’ve been overly consumed with thoughts of permanent and total disability with the latest developments in my quest for a diagnosis – the final answers still remaining. Regardless, questions arising about the future continue to be difficult to answer with any definitely, but isn’t that case for all of life’s greatest questions regarding one’s spiritual path and purpose? At least that’s what the author of this book set out to answer in sharing his anecdotes about adversity, whether in love, in travel, in surfing, and eventually in reaching spiritual enlightenment – but perhaps not in the way that you’d expect from a spiritual novel on surfing.

“…the tube was the perfect metaphor…The definition of a wave is a “disturbance moving through a medium,” and the memory of wind is spiraling through the medium of ocean. Atoms, molecules, cells, are bouncing air’s message in an endless domino effect – a game of telephone. Each swell is a sort of ghost, an illusion that only looks like a firm set of matter in motion. And people are too. We look firm with our cookie-cutter parameters: head, shoulders, knees and toes. But the bits of matter that compose our bodies are constantly getting traded out by new water, new food, new air, new chemicals. There is no static amount of stuff that stays with us from birth to death…” (Yogis, 2017, p. 76-77).

The first thing you’ll notice when initially thumbing through the pages of All Our Waves Are Water is the fact that some chapters of the book are cut perfectly straight and narrow, while the edges found in other chapters are clearly jagged and mismatched by comparison.

This distinction in the boundaries physically represents one of many stunning metaphors found within the broader context of the book, whereas the true meaning and eloquence of these metaphors are better illustrated in the author’s tales of surf trips in exotic locations, recollection of events while in the pursuit of a graduate degree in journalism, struggling with the acceptance of adulthood at the start of a professional career, and stories of lost relationships that led to newly found friendships that ultimately composites Yogis’ mystical journey towards spiritual enlightenment. However, a lot of what is written in All Our Waves Are Water is not what you would normally expect from a traditional surfing book, though the ocean and surfing act as the underlying metaphor equating to spiritual and emotional transcendence into adulthood. Surfing and spirituality also participate in the author’s memoirs as both the antecedents and moderating variables that distinguishes life’s successes from perceived failures, acceptance from frustration, or happiness from sadness if you will. Nevertheless, Yogis does a great job at blending spirituality and surfing into the storyline as his inner voice speaks to readers using the same dialogue that we all use to converse with our friends about our experiences, while combining the positive and negative self-talk into the dialogue as either a question or guide for achieving one’s greatest path in the journey.

“This time around, for whatever reason, I had to keep close to the sharp earth and human chaos. This wasn’t the happy path or the sad path, the perfect path or the imperfect path, the caged path or the free path. It was just my path. I had to look into my heart and trust it because nobody knew it, and nobody could walk it, but me” (Yogis, 2017, p. 186).

Aside from the apparent wisdom that comes along with any spiritual growth and development, the author’s internal conflict over settling into adulthood or fleeing from the modern world also brings with it an experience that nearly all readers can relate to in learning how to adjust one’s expectations for the future to fit within the reality of personal circumstances. This, more than anything, resonated with me on a deeper level than any of the lessons found amid the author’s chronicle of events because I honestly have no idea what I am going to do with my life after I graduate from school, especially as I watch every opportunity for recovery slipping away as one treatment fails me after the next. I know we all question the future to a degree, but it’s even more so when you have a chronic illness because it’s next to impossible to plan a future when you can barely commit to plans you made for later that same day. I’d take physical pain over the unknown time and time again; life’s a lot less stressful that way.

“We all know that we could go any day: a car accident, a brain aneurysm, a heart attack, a bullet. Rich and poor, black and white, gay and straight, nothing protects us. We know this, and yet we don’t know it. We move through life as if we have forever, as if we can take a stroll around the block, the cappuccino made unusually well, the Tuesday fusilli, for granted. We live as if there will always be a million more like this. So we filter out the details. We go on stressing about accumulating achievements the big impressive things. But the big impressive things we hold up as the meaning of it all – success, the house on the hill, the shiny car, the World Series title – the things we decide are worth filtering out the little things for – are they so great?” (Yogis, 2017, p. 228).

One of the main things I loved about All Our Waves Are Water is that it provides a myriad of metaphors to help readers examine the overall quality of their lives. It was also a pleasant, but unexpected, surprise to find that a lot of the symbolism in the book seamlessly applies to the expressive nature of both physical and mental illness.

“You couldn’t run away from sadness any more than a river can run uphill… Life was sad. Really sad. Loss. Sickness. Cruelty. Death. There was no way around it. But sadness, when it was always allowed to be itself, was strangely not sad. Sadness was just sadness. Tears just salt water” (Yogis, 2017, p. 41).

Yogis’ accounts also offer readers critical lessons in coping with the pain and disappointment that’s inherent to the inherent obstacles to health and well-being when you’ve been diagnosed with a physical or mental disease as well.

“…the ‘run-of-the-mill person,’ when shot with an arrow, ‘sorrows, grieves, and laments, beats his breast, becomes distraught. So he feels two pains, physical and mental… the pains of two arrows.’ The person trained in mindfulness, however, when shot with an arrow, feels only the physical pain and ‘does not sorrow, grieve, or lament, does not beat his breast or become distraught. So he feels one pain: physical, but not mental” (Yogis, 2017, p. 190).

Could something so minimal and nearly effortless such as mindfulness be the hidden secret to having a happy life? Maybe, maybe not. But isn’t it worth trying to find out? Plus, it’s hard to argue against all the scientific research that suggests that practicing positive psychology can teach chronic illness patients how to effectively cope with pain and symptoms, thereby improving therapeutic outcomes and minimizing the need for pharmaceutical interventions in treating physiological and psychological disorders (Ghosh & Deb, 2017).

“In other words, you witness what’s in front of you – breath, sensation, thoughts, feelings – without trying to change what’s in front of you… scientists now know that doing this simple act every day increases immune function, decreases pain and inflammation, increases positive emotions, decreases depression, and on and on. Doctors are now prescribing mindfulness for everything from back pain to postpartum depression. But for early Buddhists the point was not only getting better grades, fewer colds, and feeling a little happier. It was to actually end suffering – like, for good. Thoughts create reality, when the thinking, and suffering is an experience in the mind. Master your thoughts – or simply let them be without constant reactions and identification – and you master reality. You master being” (Yogis, 2017, p. 37).

Whether you have a chronic condition or not, there’s still quite a lot to learn from this book since it’s full of the raw emotions that consistently thwart and frustrate personal growth. Part of the trouble with trying to gauge personal happiness and success accurately is that the only thing we have to compare these variables to is the modern standards that American’s use to measure and define levels of success, such as beauty, productivity, and income – none of which come even close to resembling any aspect of spirituality and enlightenment. Still, perhaps the most important lesson found in the entire book is learning how to adapt to the ebb and flow of the waves of life by approaching conflict in a similar manner as waiting for the perfect set of waves to come. While wading in the water, you can either become restless and angry or you can accept the fact that the ocean is out of your control. In other words, there will always be difficulties in life – it’s simply unavoidable – but it’s how you choose to handle or perceive each individual setback that will ultimately regulate the amount of pain or suffering you experience as a response. Personally, I’d rather bask in the sunshine than not feel the water at all.

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Waiting for that perfect wave while surfing Sebastian Inlet. Photo by Undiagnosed Warrior (2002).

“There are cycles. Some patterns repeat. Some are shocking flash floods. But here is the thing about storms. I don’t wish them on you, but they are coming and would you want it differently? What would we talk about? How would we become strong? How would we get off our lazy asses and look into what is actually going on here? What would we celebrate? Storms, after all, have that rare power to bring us – yes, we humans who love to devour each other and put it on TV to watch again – together” (Yogis, 2017, p. 230).

The hardest decision in life essentially lays in the choice to either run from the storm or ride it out. The only person with enough power to settle on the best course of action, in this case, is you – no one else can choose a path for you. It helps when friends and other loved ones support your journey by offering enough encouragement and motivation to push you forward in attaining your hopes and dreams for the future, even if there may be many obstacles left to overcome. In all reality, that’s truly what life’s journey and spiritual enlightenment are ultimately all about – it’s the endless pursuit of goals and self-actualization in hopes of achieving one’s highest potential so as to gain access to the ever-elusive experience of spiritual awakening (Maslow, 1943). The rest of the time is merely paddling through the choppy water until you reach the eye of the storm so that you can breathe for a moment before starting the process over once again.


All Our Waves Are Water

Image by Jaimal Yogis [http://www.jaimalyogis.com/]

If you’d like to purchase your own copy of All Our Waves Are Water: Stumbling Toward Enlightenment and the Perfect Ride, please visit one of the following online retailers:

https://www.amazon.com/All-Our-Waves-Water-Enlightenment/dp/0062405179

https://www.harpercollins.com/9780062405173/all-our-waves-are-water/

https://www.barnesandnoble.com/w/all-our-waves-are-water-jaimal-yogis/1125172299


References:

Ghosh, A., & Deb, A. (2017). Positive Psychology Interventions for Chronic Physical Illnesses: A Systematic Review. Retrieved from https://link.springer.com/article/10.1007/s12646-017-0421-y.

Maslow, A. H. (1943). A theory of human motivation. Psychological Review, 50(4), 370-396. doi: 10.1037/h0054346.

Yogis, J. (2017) All Our Waves Are Water: Stumbling Toward Enlightenment and the Perfect Ride. New York, NY: Harper Collins Publishing.

Sinus Surgery and Recovery 

I wish someone would have told me of all the horrors I’d find in the aftermath of my sinus surgery. I really feel like I wasn’t prepared for this at all and I did my due diligence in researching this procedure before even committing to it – or so I thought:

  • I read everything I could find  online
  • I talked about it in-depth with my surgeon
  • I even talked to friends and family who have had sinus surgery themselves (and not that long ago I might add)

But nothing – NOTHING – could have prepared me for the reality of this surgery. It’s like they knew nobody in their right mind would go through with it if they had told the truth. So, in the spirit of patient education and the level of honesty I put forward on this blog [even if it is highly embarrassing at times],  I figured I’d provide the truth – the REAL truth.

I am  giving you fair warning now – the following will not be pleasant

and I have the pictures to prove it!

If you’re really squeamish or easily grossed out, please do yourself  a favor and skip over this post.

If you do decide to proceed, however, you do so at your own risk.

Please don’t say I didn’t warn you.


Background:

As I had mentioned in a previous update, my new neurologist had finally ordered an MRI of the Head/Brain after years and years of me begging every other doctor I saw to have one done. Really, I just wanted to see if my symptom were really inside of my head this whole time like everyone kept telling me it was.

In case you were wondering, here’s what my brain actually looks like:

mri-of-the-head-and-brain-1mri-of-the-head-and-brain-2

Here’s what the MRI report said:

mri-report-1

Well, at least my brain is functioning appropriately. 

My sinuses, however, not so much…

The neurologist decided to refer me to an ENT to see what needed to be done. After the reading the reports and looking over my long case history, the ENT didn’t originally believe that my sinuses were that bad. However, he did say that the sinus cavity is better viewed using a CT rather than MRI, so he ordered a CT scan without contrast to rule out the possibility that I might need surgery to fix my sinuses.

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This is a copy of my CT report:

ct-sinus-report

I guess I was going to need surgery after all.

Bummer.

icd-code


Surgery Prep:

The night before surgery, my occipital and posterior auricular lymph nodes suddenly began to swell and were extremely painful. I started to become really worried I wouldn’t be able to do the surgery, so I called the doctor on-call and he didn’t seem too concerned about it. He just told me to wait and see how I felt in the morning.

Luckily, the only surgical prep I had to do the night before was to stop food and water 8 hours before. However, I was allowed to take all my medications on the morning of the procedure and was allowed a few sips of water to get them down.

I still felt super sick that morning, although I decided to go through with the surgery anyway. Fortunately, my lymph node swelling had gone done for the most part. My stomach pain and nausea were so bad, though, that I had to take meds just to get myself into the car for the 15-minute drive to the hospital. Really, the last thing I wanted to do that morning was to have surgery but I also didn’t want to have to prep again either. However, while laying in the hospital bed waiting for the nurse to take me back for the procedure, I honestly began to regret this decision.

The Procedures:

Functional Endoscopic Sinus Surgery (FESS):

sinus_diagram

Given the extent of the opacification and the number of procedures I was having,  my surgery needed to be done endoscopically in the hospital, instead of outpatient in office as some of these procedures are.

Taken from the American Academy of Otolaryngology website (2015 ):

Developed in the 1950s, the nasal endoscope has revolutionized sinusitis surgery. In the past, the surgical strategy was to remove all sinus mucosa from the major sinuses. The use of an endoscope is linked to the theory that the best way to obtain normal healthy sinuses is to open the natural pathways to the sinuses. Once an improved drainage system is achieved, the diseased sinus mucosa has an opportunity to return to normal.

FESS involves the insertion of the endoscope, a very thin fiber-optic tube, into the nose for a direct visual examination of the openings into the sinuses. With state of the art micro-telescopes and instruments, abnormal and obstructive tissues are then removed. In the majority of cases, the surgical procedure is performed entirely through the nostrils, leaving no external scars. There is little swelling and only mild discomfort.

The advantage of the procedure is that the surgery is less extensive, there is often less removal of normal tissues, and can frequently be performed on an outpatient basis. After the operation, the patient will sometimes have nasal packing. Ten days after the procedure, nasal irrigation may be recommended to prevent crusting.

Septoplasty:

septoplasty

Taken from the American Academy of Otolaryngology website (2016 ):

The shape of your nasal cavity could be the cause of chronic sinusitis. The nasal septum is the wall dividing the nasal cavity into halves; it is composed of a central supporting skeleton covered on each side by mucous membrane. The front portion of this natural partition is a firm but bendable structure made mostly of cartilage and is covered by skin that has a substantial supply of blood vessels. The ideal nasal septum is exactly midline, separating the left and right sides of the nose into passageways of equal size.

Estimates are that 80 percent of all nasal septums are off-center, a condition that is generally not noticed. A “deviated septum” occurs when the septum is severely shifted away from the midline. The most common symptom from a badly deviated or crooked septum is difficulty breathing through the nose. The symptoms are usually worse on one side, and sometimes actually occur on the side opposite the bend. In some cases the crooked septum can interfere with the drainage of the sinuses, resulting in repeated sinus infections.

Septoplasty is the preferred surgical treatment to correct a deviated septum. This procedure is not generally performed on minors, because the cartilaginous septum grows until around age 18. Septal deviations commonly occur due to nasal trauma.

A deviated septum may cause one or more of the following:

  • Blockage of one or both nostrils
  • Nasal congestion, sometimes one-sided
  • Frequent nosebleeds
  • Frequent sinus infections
  • At times, facial pain, headaches, postnasal drip
  • Noisy breathing during sleep (in infants and young children)

In some cases, a person with a mildly deviated septum has symptoms only when he or she also has a “cold” (an upper respiratory tract infection). In these individuals, the respiratory infection triggers nasal inflammation that temporarily amplifies any mild airflow problems related to the deviated septum. Once the “cold” resolves, and the nasal inflammation subsides, symptoms of a deviated septum often resolve, too.

Septoplasty is a surgical procedure performed entirely through the nostrils, accordingly, no bruising or external signs occur. The surgery might be combined with a rhinoplasty, in which case the external appearance of the nose is altered and swelling/bruising of the face is evident. Septoplasty may also be combined with sinus surgery.

The time required for the operation averages about one to one and a half hours, depending on the deviation. It can be done with a local or a general anesthetic, and is usually done on an outpatient basis. After the surgery, nasal packing is inserted to prevent excessive postoperative bleeding. During the surgery, badly deviated portions of the septum may be removed entirely, or they may be readjusted and reinserted into the nose.

If a deviated nasal septum is the sole cause for your chronic sinusitis, relief from this severe disorder will be achieved.

SMR Turbinate Reduction:

inferior-turbinate-reduction

turbinate_reduction_2

Taken from the American Rhinologic Society website (2015):

There are many ways to shrink the size of the turbinates. Surgery is typically called turbinate reduction or turbinate resection. Surgery can be performed either in the office or in the operating room. In many instances, turbinate surgery and septoplasty are performed at the same time.
It is important that the turbinate not be removed completely because that can affect the function of the turbinates. Complete turbinate removal can result in a very dry and crusty nose. Occasionally, turbinate tissue will re-grow after turbinate surgery and the procedure may need to be repeated. This is preferable to the situation of totally removing the turbinate.

You may hear of many different terms being used when it comes to surgery for the turbinates. Examples of these terms are cauterization, coblation, radiofrequency reduction, microdebrider resection, and partial resection. These all refer to different methods of reducing the size of the turbinates.

Some of these methods shrink the turbinates without removing the turbinate bone or tissue. These methods include cauterization, coblation, and radiofrequency reduction. In each of these methods, a portion of the turbinate is heated up with a special device. Over time, scar tissue forms in the heated portion of turbinate, causing the turbinate to shrink in size.

With some of the other procedures, a portion of the turbinate is removed. It is important that enough of the turbinate be left intact so that the turbinate can warm and humidify the air that is flowing through the nose. A procedure called submucosal resection is a common technique used to treat enlarged turbinates. With this procedure, the lining of the turbinate is left intact, but the “stuffing” from the inside of the turbinate is removed. As the turbinate heals, it will be much smaller than before surgery. Sometimes, this resection can be performed with a device called a microdebrider. This device allows the surgeon to remove the “stuffing” through a small opening in the turbinate. In some instances, more of the turbinate is removed.

In some instances, packing may be placed in your nose during the healing process.

I was lucky enough to receive absorbable packing and sutures for my surgery – I heard the removal of the other kind of nasal packing and stenting is awful, though.

Maxillary Antrostomy w/ Removal of Maxillary Tissue:

Endoscopic anatomy of the pterygopalatine fossa

Endonasal endoscopic approach to the pterygopalatine fossa. (A) Maxillary antrostomy made in the medial wall of the maxillary sinus. A mucoperiosteal flap is reflected posteriorly to the crista ethmoidalis (CE) to expose the sphenopalatine artery (SPA) and posterior nasal artery (PNA) emerging from the sphenopalatine foramen. (B) Crista ethmoidalis and sphenopalatine foramen are enlarged with a drill. The posterior wall of the maxillary sinus is removed in a medial-to-lateral manner to the edge of the infraorbital nerve (IN). Elevation of the large fat pad, occupying the pterygopalatine fossa, exposes the internal maxillary artery (IMA) and its branches, the sphenopalatine and posterior nasal arteries, which are clipped and ligated. (C) With the use of a drill or Kerrison rongeur, the greater palatine nerve (GPN) is safely mobilized from its bony canal inferiorly. Gentle lateral retraction of the ganglion and GPN reveals the vidian nerve (VN) emerging from the vidian canal (VC) and exposes the pterygoid plate. (Reprinted with permission the Mayfield Clinic.)

Taken from the New York Head and Neck Institute website (2016):

Surgery begins with careful inspection of the nose. Key landmarks are the three turbinate bones or conchae (conchae = shell) arising from the lateral nasal wall and the ostiomeatal complex (a complex where the maxillary, ethmoid and frontal sinuses drain into the side wall of the nose). The most anterior, or nearest to the front structure within the ostiomeatal complex, is the uncinate process. This semilunar (half moon shaped) ridge of bone projects in front of the ostium of the maxillary sinus. Behind or posterior to the uncinate process, is a group of ethmoid cells known as the bulla ethmoidalis. The first step in ethmoidectomy is the careful and atraumatic removal of the uncinate process to visualize the ethmoid sinus and maxillary ostium. In our experience, incomplete removal of the uncinate process is a significant factor in leading to revision surgery. We believe that the uncinate should be removed at its attachment to the lateral nasal wall.

Endoscopic view of right nose showing uncinate process (up) and middle turbinate (mt). Ethmoidectomy begins with probing the space between the uncinate process and bulla ethmoidalis known as the ethmoid infundibulum (infundibulum = funnel-like). Endoscopic view of right nose showing uncinate process (up) and middle turbinate (mt). Ethmoidectomy begins with probing the space between the uncinate process and bulla ethmoidalis known as the ethmoid infundibulum (infundibulum = funnel-like).

 

Often complete removal of the uncinate process reveals the natural ostium or drainage pathway of the maxillary sinus into the nose. Various instruments have been designed to enlarge the maxillary ostium and remove the uncinate process. How much to enlarge the natural ostium of the maxillary sinus, also known as an antrostomy (antrostomy = to drain or make a permanent opening in the maxillary sinus to the nose), remains the subject of debate. Some surgeons prefer to only expose the natural ostium, while others routinely remove much of the maxillary sinus wall as part of this step of the procedure. All agree that the antrostomy must include the natural ostium of the sinus because mucocilliary flow is directed to the ostium and mucous may re-enter the sinus through the antrostomy. This so-called “circus effect”, which leads to reinfection of this sinus, is avoided by incorporating the natural ostium in the antrostomy.

Confining maxillary sinus surgery to primarily restoring the drainage pathway of the sinus into the nose is a significant departure from the pre-minimally invasive or functional sinus surgery era. Traditionally, theCaldwell Luc procedure was an integral part of maxillary and ethmoid sinus surgery. However, the American anatomist J. Parsons Schaefer recognized that the “maxillary sinuses are often the cesspool for infectious material from the frontal sinus (sinus frontalis) and certain anterior group of cellulae ethmoidalis” (ethmoid sinus air cells). That is, Schaeffer was implying that the maxillary sinusitis was often the result of infected drainage from the ethmoid and frontal sinuses, and not the cause of infection in these sinuses. In the modern era of sinus surgery, Caldwell Luc is reserved for disease processes such as fracturs or tumors which cannot be treated through an endoscopic transnasal approach.

Endoscopic image of the right nose showing completion of removal of the uncinate process by a debrider exposing the natural ostium of the maxillary sinus (mt = middle turbinate). Following the antrostomy, the maxillary sinus is inspected and polyps, fungus or infected secretion are removed. An uncommon complication of antrostomy is to injure the nasolacrimal duct (arrows) which drains tears into the nose. When such injuries do occur, the patient may have no problems because the tears drain directly into the nose at the site of injury. Less often the patient experience epiphoria or tears flowing onto the cheek. In such individuals, a dacryocystorhinotomy (DCR) reestablishes the normal drainage into the nose. Axial cadaver section through the ethmoid sinus. Enlargement outlines the infundibulum (infundibulum = funnel-like) drainage pathway of the ethmoid (yellow) which is bounded anteriorly by the uncinate process (yellow arrow) and posteriorly by the cells of the bulla ethmoidalis. After the uncinate process is removed, ethmoidectomy consist of exenteration of the ethmoid cells. From Schaefer SD et al. The combined anterior-to-posterior and posterior-to-anterior approach to ethmoidectomy: An update. Laryngoscope 116:509-513, 2006.
Endoscopic image of the right nose showing completion of removal of the uncinate process by a debrider exposing the natural ostium of the maxillary sinus (mt= middle turbinate). Following the antrostomy, the maxillary sinus is inspected and polyps, fungus or infected
secretion are removed.
An uncommon complication of antrostomy is to injure the nasolacrimal duct (arrows) which drains tears into the nose. When such injuries do occur, the patient may have no problems because the tears drain directly into the nose at the site of injury. Less often the patient experience epiphoria or tears flowing onto the cheek. In such individuals, a dacryocystorhinotomy (DCR) reestablishes the normal drainage into the nose. Axial cadaver section through the ethmoid sinus. Enlargement outlines the infundibulum (infundibulum = funnel-like) drainage pathway of the ethmoid (yellow) which is bounded anteriorly by the uncinate process (yellow arrow) and posteriorly by the cells of the bulla ethmoidalis. After the uncinate process is removed, ethmoidectomy consist of exenteration of the ethmoid cells. From Schaefer SD et al. The combined anterior-to-posterior and posterior-to-anterior approach to ethmoidectomy: An update. Laryngoscope116:509-513, 2006.

 My list of medications while in the hospital:

medications


Discharge Instructions:

GENERAL DISCHARGE INSTRUCTIONS:

For the next 24 hours or while taking narcotics:

  • Do NOT drive or operate any motorized equipment
  • Do NOT drink alcohol
  • Do NOT use marijuana products
  • Do NOT make any important decisions

CALL 911 OR REPORT TO THE ER IF YOU HAVE…Chest pain

  • Difficulty breathing
  • Sharp cramping calf pain
  • Sudden weakness to any part of your body
  • Sudden uncontrolled bleeding
  • Just don’t “feel” right or you’re suddenly nervous

CALL YOUR MD’S OFFICE FOR…

  • New, uncontrolled, or worsening pain
  • Unable to void after 8 hours
  • 101-degree temperature
  • Questions concerning any surgical dressings
  • Redness, swelling or foul-smelling drainage

ACTIVITY

The first 24 hours after your procedure, you must have a responsible adult available to assist you.

If you use oxygen at home continue to do so.

It can be normal to have dizziness, drowsiness, a sore throat, headache, or muscle aches. Call your MD if it becomes persistent.

Just take it easy for the rest of the day and gradually increase your activity level.

You may resume showering tomorrow unless your MD tells you otherwise.

DIET

Some nausea or vomiting is expected after anesthesia, call your MD if it becomes persistent.

Start with clear liquids (any liquid you can see through).

If no nausea, slowly return to eating your normal diet.

If you are nauseated, remain on clear liquids until it passes.

If your MD ordered a medicine to help with nausea, take this as directed.

If you have any questions or concerns, call your MD.

Sleep Apnea or Suspected Obstructive Sleep Apnea

You have received this handout because either you have sleep apnea or your health care provider suspects you may have Obstructive Sleep Apnea (OSA).

Obstructive sleep apnea (OSA) is also called sleep apnea. During normal sleep, muscles keep your throat open. This lets the air pass through easily. With OSA, the muscles and tissues around your throat relax and block or partially block air from passing through your windpipe. You may stop breathing for ten or more seconds, many times during your sleep. This causes your blood oxygen level to drop, which can strain the heart and blood vessels. This can also lead to high blood pressure, heart disease, and even death.

You may wake up during the night to catch your breath. You may feel tired and sleepy the next day. You may also have a hard time doing your usual activities.

It is important to know for sure if you have OSA. Follow up with your primary healthcare provider.

A sleep disorders center diagnoses sleep apnea. Treatments may include wearing a constant positive airway pressure mask (CPAP) while you sleep. Other options may also be considered. The results of the sleep study will guide the right treatment.

When you are at home and you have OSA or are suspected of having OSA:

  • Do not have alcohol or use sedative medicine before you sleep. These allow the muscles and tissues around your throat to relax and block the airflow to your lungs.
  • Sleep on your side or use pillows designed to prevent OSA. This keeps your tongue or other tissues from blocking your throat. You can also try raising the head of your bed or try sleeping on several pillows. Sewing a sock that holds a tennis ball to the back of your pajama top may stop you from sleeping on your back.
  • If you have OSA, follow your treatment plan. Special devices that you put in your mouth, called dental appliances, may help. If you have sleep apnea, you may have a CPAP machine to help you breathe while sleeping. Use this during your recovery unless specifically asked not to use by your surgeon.
  • Do not take sleep aids while taking pain medicine.
  •  If you have chest pain or trouble breathing, get help right away or call 911.

MEDICATIONS TO TAKE HOME:

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POST-OP INSTRUCTIONS:

Although the following set of  instructions were taken directly from the John Hopkins  (2016) website, they are quite similar to the directions I was provided by my own surgeon.

What to Expect After Endoscopic Sinus Surgery:

  • Bleeding:  It is normal to have some bloody discharge for the first 3-5 days after sinus surgery, especially after you irrigate your sinuses.  If steady bleeding occurs after surgery, tilt your head back slightly and breathe through your nose gently.  You may dab your nose with tissue but avoid any nose blowing.  If this does not stop the bleeding you may use Afrin spray.  Several sprays will usually stop any bleeding.  If Afrin fails to stop steady nasal bleeding then you should call our office or the on call doctor (see contact below).
  • Pain:  You should expect some nasal and sinus pressure and pain for the first several days after surgery.  This may feel like a sinus infection or a dull ache in your sinuses.  Extra-strength Tylenol is often all that is needed for mild post-operative discomfort. You should avoid aspirin and NSAIDs such as Motrin, Advil, and Aleve (see below). If Tylenol is not sufficient to control the pain, you should use the post-operative pain medication prescribed by your doctor. 
  • Fatigue:  You can expect to feel very tired for the first week after surgery.  This is normal and most patients plan on taking at least 1 week off of work to recover.  Every patient is different and some return to work sooner.
  • Nasal congestion and discharge:  You will have nasal congestion and discharge for the first few weeks after surgery.  Your nasal passage and breathing should return to normal 2-3 weeks after surgery.
  • Postoperative visits:  You will have a certain number of postoperative visits depending on what surgery you have.  During these visits we will clean your nose and sinuses of fluid and blood left behind after surgery.  These visits are very important to aid the healing process so it is essential that you attend all those scheduled for you.  There is some discomfort involved with the cleaning so it is best to take a pain medication (described above) 45 minutes before your visit.

What to Avoid After Endoscopic Sinus Surgery:

  • Nose Blowing and Straining:  You should avoid straining, heavy lifting (> 20 lbs) and nose blowing for at least 10 days after surgery.  Straining or nose blowing soon after surgery may cause bleeding.  You can resume 50% of your regular exercise regimen at 1 week after surgery and your normal routine 2 weeks after surgery.
  • Aspirin or Non-steroidal Anti-inflammatory (NSAIDs) medications:  Aspirin and NSAIDs such as Motrin, Advil, and Aleve should be stopped 2 weeks prior to surgery.  Aspirin and NSAIDs such may cause bleeding and should be avoided for 2 weeks after surgery.
  • Steroid Nasal Sprays:  If you were taking nasal steroid sprays prior to surgery you should avoid using these for at least 2 weeks after sinus surgery to allow the lining of the nose and sinuses to heal.  Your doctor will tell you when it is safe to restart this medicine.

Postoperative Care Instructions:

  • Nasal Saline Spray: Nasal saline mist spray can be used every 2-3 hours after surgery and can make your nose more comfortable after surgery.  These sprays (Ayr, Ocean, Simple Saline) are over-the-counter medications and can be purchased in any pharmacy
  • Sinus Irrigations:  You will start the sinus irrigations with the sinus rinse kits (NeilMed Sinus Rinse Kit) the day after surgery.  This must be performed at least twice daily.  Your doctor or nurse will show you how to perform the irrigations.  At first they will feel strange if you haven’t done them before.  Soon, however, they will become quite soothing as they clean out the debris left behind in your sinuses after surgery.  You can expect some bloody discharge with the irrigations for the first few days after surgery.  These irrigations are critical for success after sinus surgery!


Recovery Log:

Day 0:

Just got home from surgery a few hours ago. Sadly, I look better than I feel. Although you can’t really see it in this picture, I definitely vomited in my hair a little bit – good times. It can only go up from here my friends.

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And, in case you’re wondering, that thing under my nose is to catch all the blood coming out from my nose. Luckily I’m not bleeding that bad – at least yet. We’ll see how the day goes.

Day 4:

It’s true what they say about recovering from this surgery – it really does feel like you have the worst sinus infection ever. Like ever, ever. I feel like I’ve been hit in the face with a shovel and no, I’m not joking. My face is super swollen and painful today. However, I also fell behind on taking my painkillers because I slept nearly all day.

My face is super swollen and painful today. However, I also fell behind on taking my painkillers because I slept nearly all day. Remind me never to do that again.

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Day 7:

Had my first follow up with the surgeon today. He said that I’m healing well and that the pathology report on all the “gunk” he pulled out of my face came back as normal. However,  he also said he’s never had a patient with that much opacification have a normal report without something causing it. I’m just one of the lucky ones, I guess. Nothing odd about the way my body reacts really surprises me anymore. But I am just glad it wasn’t the result of any type of disease or a fungal infection.

Pathology Report

I still look and feel terrible, though. The doctor also did some debriding while I was at the office, so I can at least breathe a little better. My next follow-up is in three weeks from today.

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Day 10: 

Left a message for the ENT nurse to call me back regarding the odd smell in my nose. Do I need another appointment? Antibiotics? Please make this smell go away!

Really, the only way I can describe it is rotting flesh… or maybe meat… rotting something. There’s no way to hide from it – it’s in my nose. And every time I breathe in – I gag. God help me.

Day 11:

THIS just came out of my nose. It looks and feels like cartilage. I know it’s not but that doesn’t make it any better. At least it’s not the blood clots I was blowing out earlier in the week. Please don’t judge me by what comes out of my face.

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Day 12:

Went back to the surgeon to make sure I didn’t have an infection, despite the fact that I just saw him a few days ago and he said everything was fine. After what came out of my face yesterday,  I just wanted some reassurance. I’m happy to report that everything seems to be looking good.

The doctor did say that there were some debris and crusting in the right middle meatus, which he got out using the endoscopic suction and forceps. There was also a moderate amount of mucus, so he performed some more debridement as well.  Unfortunately, the grossness  I was seeing [and SMELLING] is a “normal” part of the healing process. Normal… yeah, okay.

Day 17

There are simply no words to accurately describe the true horror of watching this come out of your own face…. I’m honestly disgusted with myself.

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Day 21:

Today was my 3-week check up since surgery.

A friend of mine  drove me to the appointment and had the pleasure of watching the doctor pull some of the remaining scabs out and the look on her face was priceless. She said one of the scabs he pulled out was about a half of an inch to an inch long. Lovely, isn’t it? Hopefully, I haven’t scared her away.

Day 30:

I’m slowly starting to feel better thankfully. I still have occasional scabs coming out but they are few and far between. The scabs are also a lot less gross than they were before, although they do still smell of something terrible. I think the shape of my nose is finally looking more normal as well. Even though it has taken much longer to recover than expected, I am still hopeful that this surgery will be worth it in the long-run.

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Day 60:

I am two months post-op and, finally, I  think I am almost to the point of being completely healed. I can actually breathe better and I haven’t had anything else horrific come out of my face in a while. I’ve been keeping up with the sinus rinses every day, mostly because it seems to be helping my normal seasonal allergies as well. My oxygen saturation has also been at 99% and 10o% at my last few doctors appointments, which is a huge improvement. I really hope this means that the upcoming allergy and flu seasons will be much easier than the last few years in which I had a sinus infection almost every month or two. I guess only time will tell.

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References:

American Academy of Otolaryngology (2015). Sinus Surgery. Retrieved from http://www.entnet.org/?q=node/1429

American Academy of Otolaryngology (2016). Deviated Septum. Retrieved from http://www.entnet.org/content/deviated-septum

American Rhinologic Society (2015). Septoplasty & Turbinate Surgery. Retrieved from http://care.american-rhinologic.org/septoplasty_turbinates

John Hopkins Medicine (2016). Otolaryngology-Head and Neck Surgery. Retrieved from http://www.hopkinsmedicine.org/otolaryngology/specialty_areas/sinus_center/procedures/post_operative_instructions.html

 New York Head and Neck Institute (2016). Endoscopic Ethmoidectomy & Antrostomy: Operative Technique. Retrieved from http://www.nyhni.org/Centers-and-Services/Sinus-and-Allergy/What-are-the-surgical-treatments-of-sinusitis-and-/Endoscopic-Ethmoidectomy—Antrostomy–Operative-T

What Is The Best Way To Cope With Pain?

Pain is defined as being an experience of both physiological and psychological discomforts marked by unpleasant or uncomfortable sensory symptoms resulting from some sort of damage or injury (Gurung, 2014). The origin of pain can come from a variety of sources and there are numerous ways that individuals can cope with pain, consisting of either psychological or biological interventions. Certain pain management therapies may work better than others depending on the source and duration of pain, as well as an individual’s tolerance or threshold for the pain. According to Gurung (2014), there are three primary classifications of effectively managing pain: physiological treatment, psychological treatment, and self-management techniques.

Physiological techniques for managing pain, for instance, often involve the use of pharmacological or chemical management methods, traditional or holistic treatments (e.g. acupuncture), and surgical interventions. Medicinal therapies are generally one of the first approaches used for pain management, particularly if the ailment is caused by acute pain triggers (e.g. broken bones, sprains, illnesses, etc.), and generally comprise of pharmaceuticals called nonopioid, opioids, and adjuvants. Adjuvants are medications that are prescribed to manage pain but are not solely listed for that purpose. These medications are used primarily because they have shown some effect in helping to manage pain, although they may elicit different physiological responses. Some common example of adjuvants includes benzodiazepines, corticosteroids, antidepressants, and local anesthetics (Gurung, 2014). Nonopioids, on the other hand, include many of the over-the-counter pain relievers, such as ibuprofen, aspirin, or acetaminophen. According to Gurung (2014), “these medications act locally, often at the site of pain” (p. 291) and provide quick-acting, short-term relief in milder forms of acute pain. However, nonopioid drugs are generally not recommended for continued use due to the many long-term side effects associated with these drugs and their inability to maintain pain relief over time.

A stronger category of medication, known as opioids or narcotics, are much better suited for more severe pain management, particularly for those undergoing a surgical procedure, have suffered a severe illness or injury, or are living with a chronic or debilitating illness. Some well-known examples of opioids include oxycodone, codeine, morphine, and methadone. Opioids are the drug of choice for moderate to severe pain, given their level of effectiveness. Morphine, for example, works by binding to the “receptors in the periaqueductal gray area of the midbrain and produces pronounced analgesia and pleasant moods” and mimics the body’s natural response to coping with pain (Gurung, 2014, p. 291). However, opioids come with their own set of side-effects that are often much more severe than nonopioid medications. For instance, there is a much higher risk factor for overdose or addiction, and individuals who take opioids for chronic pain management often build up a large tolerance to these types of medications. Therefore, in order to gain the same benefit, patients also need to increase the dosage of the drug which places them even further at risk for the potential of overdose or addiction. Nonetheless, the controversy over the effects of long-term opioid use is a hot topic of debate in both the medical and chronic illness communities.

Still, there are a number of physiological techniques, outside of medications, that also assist with pain management strategies. Some examples include acupuncture, surgical interventions, and the use of either hot and cold compresses (and even alternating the two). Acupuncture, for example, works to manage pain by releasing blocked energy associated with pain and has been used in Traditional Chinse Medicine for years (Gurung, 2014). Alternately, surgical treatments can also help in decreasing levels of pain by removing the conduction of many of nerve fibers throughout the body that directly or indirectly transmit pain signals to the brain. However, while surgical approaches typically provide relief of pain for a period of time, improvement does not seem to provide a long-term cure since nerve fibers’ have the ability to regenerate. Still, while the majority physiological techniques offer relatively good methods in managing acute forms of pain, psychological strategies for the management of pain are likely to be more effective for handling chronic forms of pain.

Research into various psychological techniques shows that many of the pain pathways found within the human body are directly linked to the brain, ensuring that pain is very much a psychological process in addition to being a physiological one as well. A person’s mood can greatly impact how individual’s cope with or experience pain and altering one’s cognitions about chronic pain is, therefore, detrimental to obtaining control of individual levels of pain. For instance, when a person is undergoing chronic stress or is depressed, they are likely to feel more pain. According to Gurung (2014), “negative mood states can lead to biased forms of thinking. These cognitive biases can accentuate the feelings of pain and need to be modified” (p. 294).  Often, these behavioral modifications come from the use of psychological techniques (e.g. hypnosis, distraction methods, and relaxation techniques) in a similar manner to the practices associated with coping skills for dealing with stress. Distraction techniques, for example, are helpful in handling pain because it diverts attention away from the problem, similar to stress management techniques, and includes the use of some common practices like guided imagery, meditation, or watching television, reading a book, or talking with a friend over the phone. Likewise, biofeedback is also helpful in identifying pain triggers through observing physiological responses to pain through the use of machines or computers and then teaching relaxation techniques in order to assist individuals in gaining control of their physiological reactions to pain.

Although both psychological and physiological approaches to pain management procedures are helpful in their own ways, neither necessarily define the “best method” for handling pain—at least, not alone. Essentially, the primary problem in defining a standard method of pain management is the fact that the experience of pain is mostly subject. Although tests are available to measure specific fragments of pain, currently there is no exam available that can objectively measure pain with any amount of accuracy. Also, since both physiological and psychological factors influence the involvement of pain, it’s hard to distinguish which variables are positively or negatively altering elements of pain and individual levels of pain can change day-by-day. Given the number of factors involved, perhaps a better method for managing pain is to utilize a dual approach by combining both psychological and physiological techniques.

One way to combine both pain management strategies is through a technique known as self-management, which has been particularly supportive of individual’s living with chronic episodes of pain. Self-management programs are defined as “treatments for pain relief that make the patient with chronic pain the one with the most responsibility for making the change rather than the doctor or the health professional staff” (Gurung, 2014, p. 452). Self-management programs for chronic pain are effective because they focus on the emotional aspects of pain, outside of the physiological response, by teaching patients to change their thoughts or behaviors to better cope with their pain – mainly by focusing on various strategies to improve one’s overall quality of life. According to Gurung (2014), the main goals of self-management programs are to:

  1. Provide skill training to divert attention away from pain;
  2. Improve physical condition (via physical reconditioning);
  3. Increase daily physical activity;
  4. Provide ways to cope more effectively with episodes of intense pain (without medication);
  5. Provide skills to manage depression, anger, and aggression; and
  6. Decrease tension, anxiety, stressful life demands, and interpersonal conflict. (p. 297).

Gender Bias of Pain:

It’s important to point out a very significant problem currently plaguing patients across the country — the gender bias in medicine. Although this problem is not exclusive to pain management, the gender bias in medicine is alarming because many women are often left without the proper care essential to maintaining a good quality of life.

It’s become far too common that women’s complaints of pain or illness are minimalized by the medical professionals they turn to for help, often implying that women are overly dramatic in their interpretations of pain. Doctors often label many of the pain symptoms found in women as being psychosomatic or “all in their head” when a diagnosis is not easily obtained. This bias becomes even more evident in women who have chronic pain, who continue being called a “drug-seeker” when asking for pain relief. “Women are more likely to have chronic pain conditions that are more difficult to diagnose and treat (TMJ Disorder, fibromyalgia), and in many cases, these are treated as mental or hormonal rather than as a disease or disorder” (Stacey, 2012). Likewise, many doctors still foster the ideology of the gender bias by suggesting that women are affected by pain harder than men.

According to Gurung (2014), “women reported significantly higher pain in most categories with the most significant differences in patients of the musculoskeletal, circulatory, respiratory and digestive systems, followed by infectious diseases, and injury and poisoning” and “men report less pain, cope better with pain, and respond to treatment for pain differently than women” (p. 274) However, at least in their initial presentation, these statements are somewhat misleading. At best, research is relatively and widely varied. Recently, an article I came across by Dusenbery (2015) called Is Medicine’s Gender Bias Killing Young Women? described this phenomenon in detail:

This pervasive bias may simply be easier to see in the especially high-stakes context of a heart attack, in which the true cause usually becomes crystal clear—too often tragically—in a matter of hours or days. When it comes to less acute problems, the effect of such medical gaslighting is harder to quantify, as many women either accept misdiagnoses or persist until they find a health care provider who believes their symptoms aren’t just in their head. But it can be observed indirectly: In the ever-increasing numbers of women prescribed anti-anxiety meds and anti-depressants. In the fact that women make up the majority of the 100 million Americans suffering from (often under-treated) chronic pain. In the fact that it takes nearly five years and five doctors, on average, for patients with autoimmune diseases, more than 75 percent of whom are women, to receive a proper diagnosis, and that half report being labeled “chronic complainers” in the early stages of their illness. Then there are the diseases, like chronic fatigue syndrome and fibromyalgia, that exist so squarely at the overlap of the Venn diagrams of “affects mostly women” and “unknown etiology” that they’ve only recently begun to be recognized as “real” diseases at all.  (para. 20)

There are some valid explanations for why pain across gender is inconsistent. In a study by Hamberg, Risberg, Johansson, & Westman (2004), for instance, it was found that “proposals of nonspecific somatic diagnoses, psychosocial questions, drug prescriptions, and the expressed need of diagnostic support from a physiotherapist and an orthopedist were more common with females” (para. 3). However, laboratory tests, physical examinations, diagnostic testing, and pain management were offered to men more often than it was for women patients. Additionally, the differences offered in treatment could result in the many inconsistencies demonstrated throughout the literature as to how men and women are different when it comes to pain. Furthermore, the gender difference may be the direct result of our modern culture expect men and women to experience pain. We often encourage women to express their feelings about pain, yet make them feel like they are crazy or are behaving like a hypochondriac in following the expectation. Alternately, society tells men to hide their emotions. So of course, it’s easy for “science” to say that women have more reported pain than men because females are more likely to confess about their experiences of pain, skewing the results and furthering the gender bias. At the end of the day, I do believe that Dusenbery (2015) stated it best by saying, “call me crazy—hysterical, even—but I don’t think you should have to feel that empowered just to receive proper medical treatment” (para. 20).

References

Dusenbery, M. (2015). Is Medicine’s Gender Bias Killing Young Women? Retrieved on Feb 16, 2016, from http://www.psmag.com/health-and-behavior/is-medicines-gender-bias-killing-young-women.

Gurung, R. A. (2014). Health Psychology: A Cultural Approach (3rd ed.). Belmont, CA: Wadsworth.

Hamberg, K., Risberg, G., Johansson, E.E., & Westman, G. (2004).  Gender bias in physician’s management of neck pain. Journal of Women’s Health & Gender-Based Medicine, 11(7): 653-666. doi: 10.1089/152460902760360595.

Stacey (2012). Is There Gender Bias in Pain Management? Retrieved on February 16, 2016, from http://www.tmjhope.org/gender-bias-pain-management/


To find out how you can receive FREE online therapy to manage chronic pain, please visit the following article on the Better Health website:

https://www.betterhelp.com/advice/therapy/get-free-online-therapy-should-you-use-free-counseling/

‘Cause we’re the afterlife….

I know a lot of you are struggling tonight.

I’m struggling tonight too.

I wish I could take all of our pains away, but I can’t.

Instead, what I CAN do is

let you know you’re not alone

in your suffering.

And that somehow, someway…

we will make it through this,

just as we always have.

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AfterLife

“When the world is breaking down around you
Taking everything that you know
What you didn’t know
Is that we can go forever if we want to
We can live inside of a moment
The one that we own
You and me we got this
You and me we’re beautiful, beautiful
We all, we all, we’re gonna be alright
We got, we got, we always got the fight in us
We all, we all, we’re gonna live tonight
Like there’s no tomorrow ‘cause we’re the afterlife
Living like you’re dying isn’t living at all
Give me your cold hands put them on my heart
Raise a glass to everyone who thinks
They’ll never make it through this life
To live a brand-new start
You and me we got this
You and me we’re beautiful, beautiful
We all, we all, we’re gonna be alright
We got, we got, we always got the fight in us
We all, we all, we’re gonna live tonight
Like there’s no tomorrow ’cause we’re the afterlife
‘Cause we’re the afterlife
‘Cause we’re the afterlife
Every time I close my eyes I hear your favorite song
Telling me not to run, not to worry anymore
I can hold on tight to nothing better than the rest
So it’s now or never more
We all, we all, we’re gonna be alright
We got the fight in us
We all, we all, we’re gonna live tonight
Like there’s no tomorrow ’cause we’re the afterlife
We all, we all, we’re gonna be alright
We got, we got, we always got the fight in us
We all, we all, we’re gonna live tonight
Like there’s no tomorrow ’cause we’re the afterlife
‘Cause we’re the afterlife
‘Cause we’re the afterlife
We all, we all, we’re gonna be alright
We got, we got, we always got the fight in us
We all, we all, we’re gonna live tonight
Like there’s no tomorrow ’cause we’re the afterlife”
(“Afterlife” by Ingrid Michaelson)

Ultimate Survival Guide For When Everything You Eat Makes You Sick: Trigger Foods

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Eating for me is a complicated process. I have to think in-depth about the effects of what I’m about to put in my body and weigh the pros and cons about how it’s going to make me feel. I also need to know what’s in it to see if it will call any type of allergic reaction. In the last twenty-four hours alone, I had mild anaphylaxis twice. Not sure if this was from my swollen lymph nodes that have now moved farther south into my neck or if it was caused by the food. Seeing as I don’t eat a whole lot or a whole variety, I could have easily developed an allergy or reaction to food that I used to always eat with no problem, but suddenly can’t have due to the lack of exposure I’ve had to it in recent times. Add on top of all of this almost never experiencing the act of “feeling hungry” -and only know it’s time to eat when I’m weak and about to fall to the ground.

Considering my list of trigger foods is way longer than what I can currently consume, without becoming ill, it’s easiest to have a list of the things I can eat. I will say, though, it’s an ever-changing data base and is adjusted to how I feel that day. For example, I used to live primarily on vegetables and fruit since almost all meats hurt my stomach. Then this past January, suddenly, I stopped digesting any part of my vegetables. It would go in and come out the same. So off the list it goes and time to readjust. So what is one to do?

Step 1: Keep in stock the basics.
Mint-For-Stomach-Ache

Mint is great at helping all kinds of ailing stomach pains. I always make sure I have some on me, as well as next to my bed for when I wake up with severe nausea and can’t move without wanting to throw up.

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Ginger Ale is a staple that I keep in my house for the occasions when I really need it. I’m personally not a fan of “real” ginger and “ginger mints”, as I think the taste is too strong. I’m more nauseated by the strength before it has time to help, but I know it works for a lot of people. Personally, I like the store brand soda’s like Canada Dry and Seagrams, although they do have sugar and can upset your stomach even more. You just have to see what works for you.

saltines

Oh saltine crackers. You have been my hero on so many occasions when I’m unable to digest anything. Salty, bland, and simple.

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Also, salty, bland, and simple. Plus they’re not as “dry” in your mouth as saltines and you can easily break of tiny pieces without making a mess like you would with crackers.

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I know this seems like an odd choice for when your nauseated, as it’s greasy and not very healthy. But when I’m having problems with acid in my stomach, have had diarrhea, or  am feel dizzy and dehydrated, these chips are plain but loaded with salt. Lots of salt. If you can follow it with fluids, then I notice improvement with retaining fluids in my body. 

alkaline-water_benefits

Since we’re talking about water and water retention, we all know that water is essential in life. Being chronically ill, water is also important in keeping healthy, hydrated, and balanced. I try to drink alkaline water when possible because of all of its health benefits, but any water will do. 

g2-gatorade

Obviously, for hydration and electrolyte balance. Often when you lose fluids quickly when you’re sick, the first thing you want to do is drink water to stay hydrated. I used to only drink water (and coffee) but my eyes would constantly twitch and I’d still feel awful. My doctor told me it was from the effects of not replenishing my electrolytes. I was out of balance and water only continued to flush my system. I prefer the G2’s, as they are lower calorie, less sugars, and are not as strong as regular Gatorades.

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For days when I can handle more substantial food, I like mashed potatoes. Actually, I love ALL potatoes, but the instant potatoes are easy to keep in the cabinet. I find if I buy mostly fresh foods, then they expire or go bad before I feel good enough again to eat. 

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I also keep these handy for the “good” days. They don’t hurt me too bad, most days. And they last on the shelf a long time. They fast and easy too.

keurig-coffee-maker

Last but definitely not least. Now I know caffeine can cause different reactions for everybody, but I need my coffee. It helps keep me going on those days I didn’t sleep because of pain or have to fight throughout the day to make it through all I have going on. Luckily, this is the one thing that doesn’t bother my stomach. Sadly, it’s a large part of my daily calories, but it helps keep up my current weight.

Step 2: Try an elimination diet and keep a food diary.

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If you are not sure what is causing the pain and discomfort after eating, try eliminating pieces of your normal diet to see if you can pinpoint the problem. Keep a food diary like the one above. Track everything and read the nutritional facts of what you are eating. You may not know that something in it can be a trigger for your symptoms. Share it with your doctor, maybe they can notice a pattern that you may not have even thought of.

When I started having abdominal pain again, six years ago, I tried multiple elimination diets: Gluten Free (even though I tested negative for Celiac’s Disease), Lactose/Dairy Free, Low Sugar, High Protein, etc. There’s so many allergies out there that can be the cause of excruciating symptoms. “The eight foods included in food allergy labeling account for an estimated 90 percent of allergic reactions. These eight foods are:

  • Milk
  • Eggs
  • Peanuts
  • Tree nuts (such as almonds, cashews, walnuts)
  • Fish (such as bass, cod, flounder)
  • Shellfish (such as crab, lobster, shrimp)
  • Soy
  • Wheat

Most food allergies start in childhood, but they can develop at any time of life. It isn’t clear why, but some adults develop an allergy to a food they used to eat with no problem. Sometimes a child outgrows a food allergy only to have it reappear in adulthood.

If you have a food allergy, you’ll need to avoid the offending food. An allergic reaction can quickly put your immune system into a state of emergency, affecting many organs in your body. For certain people, even a tiny amount of the food may cause symptoms such as digestive problems, hives, facial swelling or trouble breathing.

Some people with a food allergy are at risk for a life-threatening reaction (anaphylaxis) that requires emergency treatment.

Don’t ignore a reaction that occurs shortly after eating a particular food. See your doctor to find what’s causing it. Even if you’ve had a relatively mild reaction in the past, subsequent allergic reactions may be more serious. Get emergency treatment for any severe food reaction.”

Reference: The Mayo Clinic

Step 3: If nothing else works.

Or if you having a really bad flare up, try a low residue and low fiber diet.

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This a great list to get started with. It’s not meant to be a long-term solution, but eating something is better than nothing, and following for a few days gives your digestive system time to relax and reset itself.

Step 4: Look into other options.


Try Juicing.
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Or the FODMAP diet.

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It has been gaining a lot of attention recently for being one of the best diets for functional disorders.

Also, when all else fails and you can’t find relief, meal replacement shakes will at least get some essential nutrients to keep your body going. 

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There’s so many on the market now. Some are better than others, but find the best one that fits your budget and you can stomach on the bad days when you need emergency nutrition.

But when push comes to shove, and nothing works

and you truly can’t maintain a normal weight or nutritional balance

without becoming violently ill,

then there are more extreme options available, but only by your doctor:

Feeding tubes (with difference placement depending on need/situation)

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Note: Not all of the things I listed will work for everybody, but these work for me. But no matter what that is, keep it in the house at all times if possible so that if you’re having a bad day, it’ll be there waiting for you and you won’t have to fight the pain to get what you need.


Also Note: I am also not a doctor or a dietitian, so please consult a professional to discuss if any of these suggestions are right for you and your condition.