Tag Archives: chronic pain

Spoonie for Life

The Spoon Theory was written by Christine Miserandino, while explaining to a not-chronically ill friend how her chronic illness, lupus, effected every part of her life.

It goes like this: Christine picked some spoons off a table and told her friend that everything she does—from getting out of bed, to shaving your legs, to preparing a meal, to making a phone call—costs a spoon. When she is out of spoons, she cannot do anything else. The spoon theory exists to point out the limits the chronically ill face, limits that not-sick people might not think of on a daily basis. Those are the basics—but I really, really recommend reading the whole, original article.

I don’t remember when I first read the spoon theory—I don’t remember it being a part of a whole website-network-forum like it is now, nor do I recall being able to buy mounted posters with its details. I just remember how it began to be passed around in a whisper, devoured by others like Christine and myself, to people who had no way to conceptualize the reality of our lives. I don’t remember when I began to call myself a “spoonie,” only that it sure sounds nicer than “chronically/invisibly ill.” And now spoons are kind of our thing. (I’m dying for this pendant in particular.) From the spoon theory sprung many social groups, an aesthetic to rally around, and (I believe) helped mobilize us sickies—along with social media—to create networks through which we can support and care for one another.

When I first read about the spoon theory, I had been diagnosed with rheumatoid arthritis and fibromyalgia for a couple of years. I’d endured strange looks when taking the elevator from the first to second floors, supposedly light-hearted teasing from friends, and of course, the inevitable cajoling and pleading: “Just one drink!” “Stay out with us until 10!” “It’s not that far of a walk, right?” Even after talking to friends, loved ones, and professors, over and over, I still found my illnesses—this new way I had to live my life—so hard to explain.

There’s the fact that I am alright one day and barely able to get out of bed the next—some days you have a lot of spoons and some you don’t. I took on successive, strange diets to try to curb my body’s inflammation. If I didn’t get ten hours of sleep, I felt like death; the same went for getting out of bed before 9 am, when my arthritis is the worst (damn you, 8:30 am college algebra!). I had been sick for four years before getting a diagnosis, but it took another four to find a “medical cocktail”—less fun than it sounds!—that my body responded to without unbearable side effects. Even now, I struggle with managing my illnesses, symptoms, lifestyle, pain levels, and medication/therapy schedule in order to maintain what looks like a normal life.

But thankfully, I have the spoon theory. A very dear friend, who’s known me from my first days of college as a perpetually-grumpy-and-pained frosh, recently told me that reading the spoon theory really helped her understand what I was going through. My boyfriend understands when I groggily wake up in the morning and groan “not enough spooooons.” They help represent the reality of my life, where I only have limited, constantly changing amounts of physical, and thus emotional, energy. That sometimes putting on make-up gives me an extra emotional boost, or that I can walk through a grocery store but need a wheelchair at Disneyland. I’m thankful for the idea of spoons—that they represent concepts so intangible, like chronic fatigue, pain, discomfort, and the fatigue that comes from being in pain all the time, in a way that I myself can easily communicate to others.

Like Christine says in the article, no matter how much someone watches you from the outside, it’s really hard to conceptualize what their life might be like. We live in an ableist society that subtly insists that our value as people and the amount of things we can do are intrinsically tied—and that getting out of bed, going to work, and seeing friends is simply a matter of willpower. In this way, I’ve also found a lot of strength and hope in identifying as disabled, because a) I am, b) I have a community with a history of anti-ableist activism, and c) people sometimes believe you if you say you have a disability! If someone can’t understand the basis of the spoon theory, that my energy is limited, and that it’s a thing they should respect—my objections to being called an “old lady” or being told to go out dancing when I physically can’t—then I probably can’t be friends with them. Realizing this saved me a lot of heartache. Spoonies ourselves are an exercise in cognitive dissonance—we may not look sick, but that sure as hell doesn’t mean we’re healthy.

I’m not sure if Christine had anything to do with online support groups now available for young adults with chronic illnesses, but it least allowed me to have that keyword so I could look for “spoonies” on every social media site ever created. After meeting offline maybe three other young adults in my whole life who are also chronically ill, joining a group with twenty to three hundred members made my eyes do the heart thing as I sighed in relief at not being alone. These support groups have done just as much for me as any doctor or medication—the unwavering support and love of people I’ve never met, who nonetheless, get it in a way non-sickies can’t is abso-fucking-lutely mind-blowing. I’ve met thoughtful, struggling, lovely people and finally have been able to think Yes, this is me! Me too! And, just as importantly, I am able to give that love and support that I wish I had received early on, and that all people should receive from every person they encounter.

Photo by Gali Levi-McClure

Photo by Gali Levi-McClure

23andme, Myself and I

I’m a really information-driven person. I commonly get lost on Wikipedia rabbit-holes, feel unhappy if I’m not learning something new every day, and was one of those kids that sometimes enjoyed school. So, of course, when I heard about a way to learn more about your own genes from the comfort of your laptop, I was so there.

In late November, I signed up for 23andme, a service that analyzes your DNA and gives you shiny, color-coded information on your ancestry and health.  But if you were paying attention to the news last fall, you already know where this is going—the Food and Drug Administration (FDA) asked that 23andme “stop returning health results to new customers until [they] completed the agency’s regulatory review process.” So, that spring, when I got an email from 23andme saying my results were ready, I had already come to terms with the fact that I wouldn’t be getting everything I supposedly paid for.

Side note: Yes, it took over 6 months for me to get my results. There was a huge influx of participants right as I signed up, so I’m hoping that’s what took so long. I signed up for 23andme a few days after they made their decision to comply with the FDA’s request but, obviously, before I had heard about the change. This problem might have been avoided if I had read through the website before handing them my money. Sad trombone.

I imagine the ancestry results—I am “18% United Kingdom” and “78% other European”—could be really useful. And getting to know how much Neanderthal genes you have in you might make for good conversation…? I guess…? But, as a chronically ill person, I was 99.99% interested in the health results 23andme supposedly offered. Ever since being diagnosed with rheumatoid arthritis in 2007, I’ve read and re-read Wikipedia’s article and every news release I see. I should probably just set up a Google Alert for every diagnosis I have to automate the process. One thing I learned is that the highest risk factor for autoimmune disorders is, unfortunately, already having an autoimmune disorder. So I was hoping, among other things, that my 23andme results might shed light on what other disorders I might be at risk for, as well as cancers and medications to which I might be sensitive, etc. I was really open to whatever information they might offer!

If you order 23andme now, your health information will be delivered in the form of SNPs. These basically don’t mean anything unless you’re a certified genetic counselor. I discovered that I could import my 23andme results to a third party, Promethease, who then (for the low price of $5) gave me the information I thought I’d get through 23andme—and then some. What is really cool about Promethease is that, while your and everyone else’s information is up in their cloud, their SNPedia (a kind of Wikipedia for those SNPs) is constantly being updated, so your results should reflect whatever latest information is up on the SNPedia.

I say “should” because, as my genetic counselor was nice enough to point out, SNPedia is editable by anyone with a computer. Yes, after giving my 23andme results to Promethease, I then sent those results to someone else—a genetic counselor! My genetic counselor showed my Promethease interpretation of my 23andme results to someone with an M.D. in Genes (I don’t know, y’all, I haven’t taken a science class in like seven years). Because I looked at the Promethease results and realized I have no idea what I am doing. These genes literally just say the results of the one study to which they’re referring.

So, for example, I had one SNP that said, “Most people with this SNP have blue eyes” and one that said, “Most people with this SNP have brown eyes.” Well, both my eyes are the same color, and they’re not blue—but my mother’s are. So, this indicates (if my seventh grade biology is correct) that I have both genes, and that any children (LOL NOPE) I have might have blue eyes! And according to the genetic counselor I spoke with, it’s even more complicated than Punnett squares taught us: there are thousands of eye colors, because there are more than just two genes associated with eye color. So if you wanted to use genetic therapy to make sure your kids have a certain eye color, well, a) what science fiction novel are you in, and b) it may not work that well!

And that’s just eye color. I had four SNPs—that I saw—that related to rheumatoid arthritis. Two said I was less likely to get it, two said I was more likely to get it. Ha! I also had an SNP that said I may be less susceptible to caffeine, an SNP that said that alcohol is three times more toxic to my liver (but that something like 40% of the population may have this gene?), and another that said I’m sensitive to a blood-pressure medication my grandmother used to take. I always thought I had a low caffeine and alcohol tolerance, and I hopefully won’t have a chance to test my sensitivity to Wayferin anytime soon.

I think synthetic biologist Terry Johnson (quoted by Newitz at io9) encapsulated this problem well:

I worry most about the popularization of the idea that when a genetic variation is correlated with something, it is the “gene for” that something. The language suggests that “this gene causes heart disease”, when the reality is usually, “people that have this allele seem to have a slightly higher incidence of heart disease, but we don’t know why, and maybe there are compensating advantages to this allele that we didn’t notice because we weren’t looking for them”.

So basically: there are a lot of different genes doing a lot of different things, and so far we haven’t, mostly, isolated what does what enough for it to be terribly useful.

“BUT WHAT ABOUT THAT BREAST CANCER GENE,” I perhaps shouted into the phone while speaking with my genetics counselor. Well, she said that, a) I don’t have the BRCA genes, and b) most of these SNPS involve increased risk. Increased from what? Well, you would have to figure out a couple major things to figure out your baseline risk: detailed family history and environmental factors.  So, for example, I had a 30% increased risk of multiple sclerosis. If my baseline risk with no family history or environmental factors was 1, my new risk would be 1.3. Not that much of a difference in the grand scheme of things, especially considering that we now that some lifestyle factors that decrease the risks of certain diseases. If anything, detailed family history—including what kind of medication family members used, the type of heart attack, when a disease originated, etc.—is just as, if not more, useful to your general practitioner when talking about your risk for health problems.

It was also pointed out to me that a) doctors can do these tests too, when you’re trying out new medications! and b) doctors can do these tests too, when you’re thinking of having a baby! It makes sense to me, logically, that family history would be super important—I saw a lot of health issues in my Promethease report that don’t appear in my family history, so I should probably be more worried about the things that do run in my family, like heart disease, strokes, and skin cancer.

In the end, I didn’t really get the answers I wanted—and according to every doctor I talked to, there aren’t really any answers to be had. I was hoping for a print-out of my genetic destiny, but instead a digital run-around and a barrage of uninformative scientific information happened instead. I did learn about the importance of family medical history, some stuff about genetics I’ll probably forget sooner or later, and that if I ever need blood thinners I should mention this to my doctor. For someone incredibly data driven, learning the real reason I began to love Brussels sprouts and that I might be genetically predisposed to be less  socially empathetic than others (…okay, then), I still had a really good time.

So tell me, curious readers: Have you patronized something like 23andme? What did you learn about yourself? And how did you feel about the results?

Photo by Andy Sutterfield

Photo by Andy Sutterfield

Let’s Ask: Managing Chronic Pain

Hey there, we’re Mackenzie and Theresa, health-conscious sister-friends who were probably separated at birth. Mackenzie is a newly minted Occupational Therapist, and Theresa is a person living with multiple chronic illnesses: rhuematoid arthritis (RA), fibromyalgia, irritable bowel syndrome (IBS), and migraines. We thought we could offer a dual perspective on pain, so we sat down at one of our favorite coffee shops with some delicious tea and cake and, as per usual, the conversation turned towards health.

ML: You told me long ago and far away that you were misdiagnosed at first, and your pain was kind of brushed aside by your pediatrician. What was that like?

TD: Yeah, when I first developed RA, I was 14, and my pediatrician told me it was just growing pains. My mom had had similar pain when she was younger, so I just thought it would go away with age. I was also sleeping like 18 hours a day, and people kept telling me that’s just how teenagers are. But I was always tired. My joints were tender, and I was super sensitive to cold, but I was under the assumption that this was kind of normal. So I questioned it a little but I didn’t really pursue it. Honestly, I was too tired to pursue it.

ML: That’s a really common question: how much of what you’re experiencing is normal, especially when it comes to pain? One thing that will help you identify “good pain” from “bad pain” is how chronic it is.

TD: Yeah, chronic pain is usually a sign that there’s a problem. For the record, “chronic” means the pain happens more days than not. Which is a definition I wish I had 11 years ago!

ML: Pain is, at a fundamental level, your body trying to tell you that something’s wrong, so it’s important to know what kinds of sensations are linked with what structures in your body.

Pain Sensation Body Part Involved
Cramps, dull ache Muscle
Sharp, shooting Nerve root
Sharp, bright, lightning-like Nerve
Burning, pressure-like, stinging, aching Sympathetic nerve
Deep, nagging, dull Bone
Sharp, severe, intolerable Fracture
Throbbing, diffuse Vasculature (blood vessels)

Even in this table, you can see that sensations for different body parts can be very similar, like a “dull ache” can be either muscle or bone pain. But it’s really a matter of your intuitive sense of your body when trying to figure out what body part is involved.

TD: Plus, it’s really important to take your symptoms as a collection, not just as separate occurrences. Separately, flu-like symptoms, joint pain and fatigue can be any number of things, but put together they make up a pretty standard definition of RA, or similar autoimmune disorders. Unfortunately my pediatrician didn’t put the pieces together. What are some questions she should have asked, though?

ML: Some questions might include, where is the pain focused? Is it radiating? When does it happen: during a particular time of day, or during a specific activity?

TD: Right, like my RA pain is worst in the morning and improves throughout the day. My life made so much more sense once I read that “morning stiffness” is an RA symptom. IBS, on the other hand, seems irrelevant to when or what I eat and strikes randomly, like a Jackson Pollock painting.

ML: Those are some other good points to consider: Are there triggers, like something you’ve eaten or something you’ve done? Is it constant or intermittent? Having these answers before calling an MD might’ve smoothed out those appointments, Theresa.

TD: Yes, and even with these answers I still was misdiagnosed. I always encourage people to advocate for themselves if they need more testing. For me, the severity of the pain was also very telling, once I saw a more open-minded doctor.

ML: The medical world often rates pain on a 0 to 10 scale, with 0 being no pain and 10 being the most pain you’ve ever felt in your life.

TD: And that’s a very subjective scale, because what constitutes one person’s 10 may barely register on another person’s scale. I’ve met other people with the same inflammatory markers (i.e. blood test results) as me who have more and less pain based on this scale. Pain really obscures your perspective, so your own scale may change—mine definitely has. It wasn’t until my treatments started working that I realized how much pain I was actually in, and how much pain I had accepted as “normal”.

ML: And that probably affected how you were misdiagnosed.

TD:  I really, really wish I had gotten a second opinion or had the Internet to do my own research (thanks, dial-up!). And I didn’t have any ER-worthy stuff—like bleeding, fever, or fainting. So, in some ways, my diagnosis was slow because I was managing my pain relatively well.

ML: You’ve had a lot of diagnoses now. What’s your first reaction when you get a new diagnosis?

TD: Well, first I add it to my Pokedex of sickness! [Laughter] Then I research the hell out of treatments, fill prescriptions, etc. I’m always most interested in how to manage the pain on the daily, though.

ML: I think that’s a pretty common reaction­—wanting to make the pain go away.

TD: I think so, and it’s very pragmatic, because chronic pain can change your whole perception of life.

ML: That goes back to the idea that pain is your body’s way of telling you that something’s wrong. The problem with chronic pain, especially after diagnosis, is that your body keeps telling you something’s wrong, but you already know that and you’re trying to make it stop.

TD:  Your body is that ex that keeps leaving you voicemails and won’t stop calling.

ML: Exactly!

TD: I know what’s comforting about my RA’s medical treatment is that I’m able to treat the root cause of the pain, which is my overactive immune system.

ML: But is that always possible? Especially with chronic conditions? I know that doctors are only now beginning to understand what causes Fibromyalgia and IBS. So a lot of treatment still focuses on coping with pain, not necessarily eliminating it.

TD: For me, I’m on a lot of medications to knock out the disease processes that are causing my pain, but I still find that the pain, managing meds, and therapies impact my everyday life. I think my biggest coping mechanism besides the medications is accepting what I can and can’t do. There are a lot of things that people expect that I can do, but they’re very painful. It’s hard for me to accept that I deserve to not feel pain when it means not being involved in certain parts of the world. I’m naturally very outgoing but I tend to be more of a homebody to prevent pain-hangovers. For example, walking around the mall won’t be painful while I’m doing it, but later tonight and tomorrow, I’m definitely going to feel some pain. I have to take into consideration what I need to do the next day and make sure I can rest or medicate before deciding to embark on a pain-inducing activity.

ML: What are some other activities like that?

TD: Well, sometimes it’s the little things you don’t think about—I always make sure to carry bags on my shoulders instead of my hands, when possible. Smaller joints are more delicate and deteriorate faster, and I’m trying to keep my hands working for as long as possible! Or, for example, I like to cook, but can only stand for about 15 minutes before my lower body starts to ache, so I try to sit on a stool while I do meal prep. I also use really sharp knives so I can put less pressure on my joints when chopping things—otherwise my hands will ache the next day. Knowing how often I’d like to eat (you know, daily) that can add up to a lot of pain if I’m not careful.

ML: That’s where my field really shines in treating folks with chronic pain, I think. Occupational therapy looks at “occupation” as anything people do to occupy their time, which means pretty much anything you do throughout the day is fair game. With chronic pain, OT looks at how to restructure activities so they’re less painful and less effortful, and teaches energy conservation techniques to combat the fatigue that often comes with chronic pain. People without chronic pain don’t usually think about how exhausting pain is, but spending the day in even a little bit of pain will wear thin on most people’s patience. It affects motivation, mood, and especially the ability to interact with other people.

TD:  So basically everything. I know one thing we bonded over at first was being migraine-buddies….

ML: Yep! My migraines are chronic and they come with a lot of what I like to call accessory pains (in my knees, hips, back). They’re not the focus of the migraine, but they’re still caused by it. I notice for me that the mindfulness practice of non-judging is really helpful with these accessory pains.

TD: Non-judging?

ML: I just think of the pain not as “bad” but rather as a part of me that’s just there, and I find I can get through more of my day than if I don’t. It doesn’t make the pain go away, but it helps me work with it better. Non-judging means taking away that little voice that evaluates everything as “good” or “bad.”

TD: So, basically, making a conscious choice not to give into the “I’m in pain, and it sucks that I’m in pain” mentality. I think that falls under the umbrella of accepting your own condition. I know for me, I started being able to do a lot more and be a lot happier once I started understanding my limits and figuring out how to work within them, rather than fight against them.

We’d like to invite readers to share their stories about how they’ve coped with pain, chronic or not, in the comments below! Who or what has supported you and made your life better?

MacKenzie Lorenzato is a contributing writer, newly minted occupational therapist, baker, Joss Whedon fan, Disney guru, musical theatre lover, dog person, and tree climber extraordinaire. 

Theresa Dee is a contributing writer, Bay Area native, and a big ol’ geek about thrifting, tea roses, fantasy-sci fi, and intersectional politics. Reach her at: theresa.dee.writes (AT) gmail (DOT) com

Photo by Andy Sutterfield

Photo by Rob Adams