Heather Finlay-Morreale, MD

@neuralgia_sfn | contributor
multiple neuralgia, small fiber neuropathy, POTS / dysautonomia

How COVID-19 Is Limiting Health Care Access for Disabled People

The COVID-19 pandemic has focused attention on those on the frontlines and COVID-19 patients. However, this focus ignores those with chronic health needs and disabilities. People with these conditions are left unable to continue their care or to seek care for new exacerbations. People are avoiding the ER and dying at home. Needed surgeries are postponed leaving patients with continuing pain and disability. And for many, a fear exists of not only acquiring COVID-19, but of being denied a ventilator due to prejudicial views about the value of disabled lives. People with chronic health conditions are frequently at a higher risk of severe illness from COVID-19. Some are able to isolate at home, but many are not able to avoid exposure to others. Some have workers coming into their homes to assist with care or to deliver groceries. For example, I have had four different infusion nurses in my home this month, some of whom also work in emergency rooms with COVID-19 patients. In an online IVIG forum I participate in, some patients have discontinued their therapies due to not wanting to be exposed to this risk. Others, like myself, are both persons with disabilities as well as essential workers. I work as a pediatrician and since children often carry the virus asymptomatically, every child I treat is a potential danger. The result is fear of contagion when out in the world or even at home. A special kind of vulnerable fear that is new since the start of the pandemic. I wash my hands like my life depends on it — and it does. I have autoimmune neuropathy and multiple forms of neuralgia — a severely painful nerve condition. In order to keep working, I rely on regular pain clinic interventions including Botox injections, nerve blocks and epidurals. Those have been put on hold since the Massachusetts Department of Public Health shut down elective surgeries and procedures. Other patients needing elective procedures are similarly abandoned. For example, those needing hip and knee replacements are left waiting. They face more time waiting in pain and with limited ability to move without pain. But what is meant by elective? Without “elective” pain procedures I am limited in my function at work and home. These interventions don’t seem elective to me. There already was a pain crisis and an opioid crisis before the pandemic and I fear this reduced access to pain procedures is only exacerbating both. Even at a basic level, entry to medical facilities has become challenging for those with disabilities. I at times use a wheelchair, especially for trips to hospitals which involve a lot of walking. The state department of public health has ruled there are no visitors allowed in hospitals except for pediatrics and maternity. I approached the screeners at the hospital being pushed in a wheelchair by my husband. They gave us new masks and took our temperatures and then we were informed that my husband was not allowed in. They did not offer to have a staff member push the wheelchair — I am not sure what their solution was. I had to repeatedly insist that people in wheelchairs are allowed an exception for someone to push them. Then the screener began quizzing me on if my husband was my PCA. Finally, we were allowed in, but the whole experience was ableist and aggravating. The new rules and regulations made to react to the pandemic have often been hastily made and not considerate of those with disabilities. Not only are those with chronic illness afraid, but many people are afraid of any contact with the medical system. The few parents that call my office do not want to bring their children in to be seen. They do not want to go to the ER. I had to strongly urge one reluctant parent whose child had numerous signs of a severe condition to go to the ER. In addition to working in a pediatric office, I also work in the urgent care part of the ER. In the winter pre-COVID-19, all 13 beds in the pediatric ER are usually full, plus at times there are 15 in the waiting room. Yesterday there were three pediatric patients in the ER, in total. One of the pediatric ER attendings noted to me that children with chronic conditions usually present to the ER for several predictable reasons — g-tube issues and patients with sickle cell and cancer who develop a fever. These chronically ill children are absent from the ER. Did they stop having complications or are they simply staying home? While working in the ER, I sit across the table from the adult physician. It has been quiet for the adult providers as well. The people with back pain, tooth pain, and abdominal pain are simply not presenting to the ER in the same numbers. There is a 40 percent reduction in people getting care for heart attacks. People are having symptoms and deciding to ignore them. Perhaps some of these issues can be ignored, but patients are not always the best judge of the acuity of their complaints. Abdominal pain can be an appendix about to burst and back pain can turn out to be a life-threatening aortic aneurysm. Have people simply stopped having non-COVID-19 medical issues? I doubt that is the case. Rather, people are choosing to stay home and endure symptoms at great personal risk. In part due to decreased use of medical services, there have been an increase in deaths at home. ProPublica reported this month this is occurring in several parts of the country. Some may be COVID-19 deaths where people were overcome before seeking medical care. I suspect others are people with exacerbations of chronic illness or new acute issues that simply did not get medical care. I argue that these deaths should also be counted when accounting for  COVID-19 fatalities. How people access healthcare has changed due to the pandemic, and in a way not equally accessible to all. Telehealth was quickly launched by many organizations, and people are seeing their doctor by video screen. For some with disabilities, this is a benefit. I was recently able to telehealth a specialist I usually have to drive over an hour to see via telephone. I appreciated the easier access, especially since long car rides are challenging for me. However, video telehealth leaves behind those with no access to smartphones or those who have difficulty using new technology. An elderly patient with vision issues is unlikely to be able to set up an app for video visits. Although telehealth has some advantages as far as convenience, the lack of a physical exam is a significant limitation. For example, I have been having chronic ear fluid and an infection that ruptured my eardrum. I was able to telehealth with an ENT, however, an ear exam cannot occur for weeks. Telehealth has some benefits, but also clear drawbacks. Finally, I believe the biggest fear for many with chronic illness and disability is the predicted ventilator shortage. States’ guidelines on who gets a ventilator have led to a lawsuit being filed with the federal government arguing against discrimination against disabled people in the allocation of COVID-19-related resources. My state’s guidelines were just revised after uproar from the disabled community. Numerous people in wheelchairs or with blindness or other disabilities have fulfilling and active work and home lives. I still fear eugenics in the decision about who gets a limited resource based on judgments about the value of a disabled person’s life. If it comes down to a competition for a vent, where would I end up? Overall, life as a person with chronic illness or disability has only gotten harder with this pandemic. Fear and lack of medical care and resources are the new status quo. The inequality gap between the disabled and abled has only widened. For more on the coronavirus, check out the following stories from our community: If I Get COVID-19 It Might Be Ableism – Not the Virus – That Kills Me How America’s COVID-19 Response Is Exposing Systemic Ableism Why I’m Worried About Rationing If My Child With Down Syndrome Gets COVID-19 I’m Autistic and This CDC Equation Says My Life Is Less Valuable If I Get COVID-19

Finding Relief from Chronic Pain — Lessons From an Expert

I have lived with chronic pain for decades. First, my episodic migraine evolved to chronic intractable migraine, then I developed shingles and post-herpetic neuralgia as well as small fiber polyneuropathy. Along this journey, I have learned lessons as a pain patient that are informed by my training as a physician. 1. Decide that you want to do something about your pain and seek the best care possible. For years I suffered with near-daily headaches, tinkering with over-the-counter regimens and dietary changes before deciding to seek professional help. I had to decide that the current situation was unacceptable. I called around to headache specialists at top institutions and asked for recommendations on where to seek care, eventually finding care at a specialty headache clinic. This specialty clinic offered interventions not available at my local primary care office. 2.  Be organized. Come to all appointments with a list of all your medications and dosages. Bring a list of all the treatments you have tried and their effect. Often the newer and pricier treatments have insurance requirements, and if the doctors know what you’ve tried and failed in the past, they can pursue the next steps you qualify for. 3. Consider a pain specialist who does interventions and not just prescriptions. Some pain specialists only do interventions and others only prescribe. Some do both. I have found interventions such as field blocks, nerve blocks, epidurals and radio-frequency ablations helpful. They have allowed me to rely less on medication and live a better life. 4. Consider alternative medicine approaches. As long as they don’t break the bank and don’t interfere with traditional approaches, alternative medicine approaches can be helpful. I tried acupuncture and take supplements, for example. 5. Consider allied health approaches. Physical therapy and osteopathic approaches have been helpful for me. While physical therapy doesn’t help the nerve pain, it helps with the muscle pain resulting from unbalanced movement and spasms from the nerve pain. Even if not in a formal physical therapy program, some form of gentle movement such as yoga, walking or exercise biking is beneficial. 6. Consider mental approaches. Cognitive-behavioral therapy or acceptance-commitment therapy has proven effective. The assistance of a health psychologist specializing in pain was hugely helpful for me. Learning to live your life with the involvement of pain that may not go away is tough to navigate on your own. 7. Consider mindfulness. A tool that is free and always with you, mindfulness can greatly lessen pain. MBSR (Mindfulness-based stress reduction) programs exist at many medical centers and online and online apps such as Calm, Headspace and Insight Timer make it easy. Once you decide to do something about your pain, become an active, organized advocate for yourself. Work in collaboration with your health care team to come up with a pain management plan that works.

Ruth Barber

How Yoga Helps My Chronic Pain

I don’t do yoga. Yoga happened to me because pain happened to me. I have no choice but to strive for some sort of state of bliss. My bliss is craving comfort and silence. Comfort and silence from the pain; comfort and silence in a world not welcoming of the weakness that pain brings. Because the alternative is unthinkable. Pain takes minds and lives, but it was not going to take mine. I was brought to tears in yoga class because I had found a place in my painful life that made sense. Yoga made my painful body meaningful. And it was attending pain management that brought me to yoga. Asana: To sit. Sukhasana easy pose is interpreted as to sit with ease. Yoga practice is a preparation to sit and to sit with ease. Why does this matter so much to me? Why does this definition ring so true and at the heart of any yoga I practice? I live with chronic pain. And most people interpret that as “an old injury,” a “bad back.” It’s not that. I do not and never have had back pain. I am strong, physically strong. I have never been unable to do a physical task. I danced several times a week, I taught many styles of exercise and fitness classes. My pain never stopped me from doing anything physically demanding. But my pain stopped my sitting down. For two years (before attending pain management) I could not sit down. I stood on the train and tube for my 1.5 hour commute twice a day. I stood in work meetings, I couldn’t go out to a restaurant as I needed to stand, I couldn’t sit at the table with my family for Christmas dinner. So Sukhasana, to sit with ease, is a major achievement in a painful body. And it is yoga in it’s fullest sense that enables this. I have no injury, I have nothing wrong but my brain and nervous system are working like a faulty alarm. I have the sensation of hot, burning barbed wire wrapped around the top of my thigh. And it is there all the time. It never leaves, it is a loud sensation, blaring at me 24/7. And it has done for the last 13 years. I am physically in pain but I am not physically damaged. Pain management is about self-compassion, living honestly within your limitations, not desiring a life without pain, pacing – with moderation of everything, appreciating what you have. My asana practice definitely does not have a physical goal. There is no end point to a particular asana. I am not achieving trikonasana, I am not mastering shoulder stand. I am using the shapes with my body to enable my faulty alarm to shush, to turn off. I feel everything, my body is alight all the time. I am keeping this system dampened down by working towards sitting, working towards sitting and breathing. I’m working towards detaching from the pain, detaching from the senses attached to being in pain, allowing contemplation and thoughts away from pain (break the circuit, cancel the faulty alarm) and yearn for a state of removing myself from the pain. A state of bliss. Samyama. And I have achieved this in small degrees. Tearful moments of realization that I can sit without wanting to pull my leg off, without feeling the heavy hard steel of the metal cilice that has imprinted itself on my thigh and my brain. That I can sit and know my breath, that I can sit and not focus on the clock and when can I stand up. No, just sit. Simply sit. Sit. We want to hear your story. Become a Mighty contributor here . Getty image by fizkes

Seeking Pain Relief as a Patient Gave Me New Perspective as a Doctor

As a physician I’ve taken numerous CME (continuing medical education) modules about pain and the opioid crisis. I’ve even had training in suboxone prescribing and obtained my DEA X number. But it was a recent journey on the other side of the exam table that opened my eyes to what it’s like to be a patient with severe pain during the opioid crisis. How My Own Crisis Began At the start of November, I had severe right CVA tenderness on my back and flank pain. Trying to avoid the ER, I went to an urgent care clinic. The kind nurse practitioner, suspecting a kidney stone, referred me to the ER for an ultrasound. At the ER, I had a bedside ultrasound which showed possible hydronephrosis (kidney swelling), and the attending agreed it was likely a stone. I deferred a radiation-heavy CT scan and went home with some tamsulosin, NSAIDs (nonsteroidal anti-inflammatory drugs) and oxycodone. I had a complaint that fit a known clinical scenario, I had a finding on my imaging and I was given a treatment plan and discharged. I was advised to return for a CT if the pain worsened or failed to resolve. I never took the opioids, but I took the tamsulosin and the NSAIDs. I got better for a few days, but then the pain came back much worse. About 10 days later, I returned to the ER as instructed and saw a different ER attending. I was given a stronger NSAID and this time had my CT, which was negative. No stone. The ER attending returned, told me I had no stone and advised me to go home and take ibuprofen. At that point my pain was eight out of 10, and I was having significant trouble moving despite the NSAID. I felt like my physician saw me as a drug seeker, rather than a fellow attending. I had already tried ibuprofen and diclofenac at home and the stronger NSAID in the ER, and I remained in unrelenting pain. But my pain didn’t fit a clinical picture; I had no abnormal result to hang a hat on, so I was discharged with no diagnosis and no treatment plan. Once a stone was ruled out, the attending didn’t widen his differential and obtain additional history and exam findings. He never did more than a cursory 30 second exam. Clearly, I knew something was wrong; I just didn’t know what. ERs, I’ve concluded, are places to rule out or treat life-threatening issues. I was in severe pain, but I wasn’t dying. So, I was sent home. As a clinician, it was a good lesson in how not to work up an undifferentiated problem. Little Help in Mindfulness Over the next week or so I tried different things: ice, heat, ibuprofen, moving more, moving less. Nothing worked. I attended my community’s interfaith Thanksgiving service. There were several readings and prayers on gratitude and acceptance. The Shaker song “Simple Gifts” was sung. As I sat in the service, I tried to reframe my pain. There is a saying in the mindfulness community attributed to Haruki Murakami. It states that “Pain is inevitable. Suffering is optional.” I tried to have gratitude for my pain. I reflected on what gifts it brought me. My experience that month accepting care from others was making me a better caregiver. I certainly had more sympathy for patients with complaints that don’t fit clear patterns and don’t have easy answers. I was more aware of the challenges patients face when they deal with biases in our medical system. My times of pain made me better appreciate times when I was able to more fully participate in activities. But no amount of mindfulness was going to make this pain livable. I was beginning to get hopeless. I had to keep looking for treatment. Finally, a Diagnosis After the service, a nurse friend advised an osteopathic adjustment, so I made an appointment for OMT. I was describing my pain and moving gingerly around the room when the physician asked, “Do you have a rash? Because this really sounds like shingles.” He checked, and I had no rash. After the treatment, my constant level of pain decreased. But I was still having episodes of agony, albeit less frequently. I was on call the long Thanksgiving holiday. Like most providers, despite my own significant discomfort, I kept working. Thinking about the osteopathic doctor’s comment, I turned to a doctor’s last resort: Google. A search for “shingles without a rash” brought up descriptions of zoster sine herpete. Shortly thereafter, I went to an appointment at a pain clinic for an evaluation. The pain physician sat down near me and respectfully listened to my story. He did an exam — something that hadn’t happened in the ER the second time. He concurred that I had severe, unilateral, dermatomal pain with cutaneous allodynia with some myofascial pain as a result. I had zoster sine herpete (shingles without the rash). His treatment plan included valacyclovir, a nerve block, and other non-opioid modalities. I sat up after the nerve block and could finally take a deep breath. Three weeks of excruciating pain had passed, but finally, it was gone. After five doctors (including myself), two ER visits, and one CT scan, I had a diagnosis and a treatment. I got perhaps as much relief from having a reason for my problem and knowing the pain would not last forever as I did from the therapies. Over/Undertreatment I wonder how long I would have suffered had I not been a physician and been able to seek out care from two specialists: an osteopathic physician and a pain physician. I had the time and motivation and persistence to seek out additional opinions after being dismissed. I certainly learned that the ER is no place for a pain patient. My second trip in which I was discharged despite incapacitating pain was a medical failure. I can see how people get desperate and turn to unhealthy coping methods or addictive medications when medical providers offer no help. The opioid epidemic has resulted in both an overtreatment and undertreatment of pain. At times large supplies of opioids are given too freely. For example, after dental procedures or some orthopedic procedures. I’ve had pediatric patients of mine go to the ER and be doled out opioids for painful menses and headaches. At other times, even if people have severe pain but it’s not classifiable into a packaged diagnosis, like my presentation, they aren’t treated at all or they’re treated with minimal and ineffective strategies. There are reports that women, children and infants, minorities and those with mental illness have their pain undertreated. I live in an urban medical mecca where well-regarded, evidence-based pain clinics are an option. Of note, the pain clinic where I sought care doesn’t take Medicaid, so it’s out of reach for 25% of the population and an even higher percentage of the disabled population. I’m fortunate to have medical insurance that covers multiple modalities of therapies. Many insurances are more than happy to cover oxycodone but don’t cover strategies that avoid opioids, such as OMT, massage, cold compression machines or even the nerve blocks and lidocaine patches I found to be a lifesaver. In many regions, comprehensive pain centers are either nonexistent or disreputable pill mills. I have friends in other states with legitimate pain issues and an indisputable diagnosis who struggle to find pain management providers. People in pain are left see-sawing between over and undertreatment. There is as much a pain crisis in America as an opioid crisis; the pain crisis is the one we don’t talk about. Chronic pain is perhaps the most common chronic illness in America, and the medical establishment simply doesn’t have a handle on it. There needs to be more calibration in treating pain and the right medications and other modalities, titrated for the individual patient, in a respectful environment where people’s needs are understood.

Why Childhood Abuse and Stress Causes Health Problems

As a pediatrician, some children present to me with complex problems or multiple problems that fail to resolve after the typical interventions. I recall a child with severe abdominal pain. He had tried numerous medicines and had scopes and studies galore. It had reached the point where he was being scheduled for exploratory surgery to try and see the cause of his pain. I lost track of his case when I rotated elsewhere for a month but upon my return, I learned that all of his symptoms resolved when his home environment changed. Sometimes, changing the environment makes all the difference. This has been recognized for years — I recall, in training, supervisors mentioning what would really help a certain child would be a “parent-ectomy.” More recently, another child was on a laundry list of medications and had a long list of active medical problems. Once her living situation stabilized, her health issues resolved. Problems that didn’t even seem to be stress-related or psychosomatic but seemed more physiological resolved. Childhood stress is now described as adverse childhood experiences (ACEs). Another term is toxic stress. ACEs and toxic stress include parental substance abuse , homelessness, physical or se xual abuse or other negative experiences. (Visit here to calculate your own ACE number.) When a child is in an environment with toxic stress, their body is always in fight-or-flight mode, which takes a mental, physical and emotional toll. When you are gearing up to fight a bear, you need this adrenaline response on a temporary basis. But when the bear lives with you (for example, an abusive parent) and you are always ramped up, it is harmful. I have met children who faced abuses as infants and were removed early from a harmful environment, yet still have several behaviors linked to early stress. There are studies on the effects of toxic stress . The more toxic stress in a person’s childhood, the more likely they are to struggle with a host of ailments as they age. Some are easy to link to childhood ACEs, such as mental health issues , obesity or substan ce abuse, but e ven ailments that are viewed as more “physical” such as asthma are increased. It has been shown that stress in childhood changes a person’s body, mind and even their DNA in harmful ways. Click here for an infographic on ACEs and toxic stress from Harvard’s Center for the Developing Mind. I have seen that, in the same family where children are facing similar stresses, that some children struggle with medical and psychological issues whereas siblings have resilience. One family had one sibling who would hop into my office smiling and laughing and friendly. In contrast, her sibling required significant mental health interventions to function even at a basic level. The author and lawyer J.D. Vance in “Hillbilly Elegy” details a childhood full of ACEs but became an Ivy League-trained lawyer. Clearly, some succumb to these stresses and others thrive despite them. What is behind resilience ? Access to a supportive and caring adult makes a huge difference. This may be a teacher, coach, therapist or another rela tive. Programs that teach coping and mindfulness most likely help. Exercise helps. Sleeping well helps. Strengthening executive function and coping skill s helps. Nadine Burke Harris, who spoke in a TED talk about ACEs and wrote a book called “The Deepest Well” on the same topic, has established a pediatric practice designed to screen for ACEs and implement and study interventions. Sometimes children do need a “parent-ectomy” and need to be removed from an abusive parent or a harmful environment. But today’s foster care system is straining. In some cases, I feel children’s lives do not significantly improve once in the system. At times, I wonder if one set of stressors are just replaced with a different set. Moving from one setting to another with no consistent caregiver is a toxic stress just like living with an impaired parent is a toxic stress. A black bear has been substituted with a brown bear. Perhaps one is larger than the other but you are still living with a bear. ACEs are common. A great number of children face them. Institutions that serve children such as schools, daycares, foster care programs , and juvenile justice programs are at tim es using trauma -informed care which considers ACEs/toxic stress and works to promote healing and resilience. Without treatment of the harms caused by ACEs health problems, physical and mental, unhealthy behaviors such as overeating, substance abuse and other societal problems develop. Focusing on childhood may help ameliorate some of the challenges facing our communities. Anecdotes and details changed and anonymized to provide privacy.

Lessons in Mindfulness From This Cute Animal

Meet Kiwi. She is a Lutino cockatiel, she is 9 months old and was hand-raised before being adopted by my husband and me. She is a cheerful, playful and energetic presence in our home. Before she arrived I had no idea about the life lessons she would demonstrate to us. Kiwi wakes up each day under the sheet covering her cage and eagerly rings her toy bell to be let out. She likes to spend mornings with us repeatedly trying to sample our coffee. She certainly doesn’t need the caffeine. She never wakes up grumpy or moaning about her to-do list. Each day is a new gift in her eyes. Recently Kiwi’s nails got too long and talon-like. My husband gently restrained her in a towel and I clipped them. I got a little too close to the quick and she started bleeding. She flapped around and blood got all over her feathers. I was very alarmed—– a little blood is a big deal in a tiny bird. She was alarmed too, but not as much as I was. My husband ran for some styptic and we stopped the bleeding, finished the trim and released her from her towel burrito. Was she fearful? Mad at us? Wanting to retreat? Nope. She hopped to my husband’s arm, perched and wanted to hang out with us. Whatever happens to her, even negative things, is gone as she faces the new and present moment. If the present moment is happy, she is happy, even if the preceding one was traumatic. What resiliency. Kiwi has no anxiety whatsoever. She is curious about every living creature and wants to befriend everyone. Houseguests, if willing, will be perched on by Kiwi as she grooms their beards and glasses. We also have a pet hedgehog, Apache, and Kiwi has tried to groom his quills and has licked him on his nose. (He is antisocial and could do without this attention.) To Kiwi, everyone or everything is an equal opportunity to make fast friends. She will explore new environments, new objects, new people and new foods. Everything is a new adventure and a possible toy. She delights in a variety of objects — twist ties, cotton swabs, velcro strips and earrings. The mundane to us becomes a feature of delight for her, sometimes with humorous results. Last weekend, I was painting and took her out after. Although I had put away the canvas, I had forgotten that the palette still held drying paint. Well, Kiwi hopped into it and dabbed her beak in. The next 30 minutes was me and my husband frantically trying to catch her, which she thought was a great game. She bravely let me wash her down and swab out her beak. Even after all this, she wanted more playtime and jumped onto my arm to spend more time with me. Perhaps we could all stand to be a little more like Kiwi. Greeting each morning with delight. Eager. Friendly. Having no preconceived notions that get in the way of making friends. Appreciating every moment as it comes. Bravely meeting new challenges and adventures. Finding delight in the everyday.

Managing the Holiday Season With Chronic Illness

I live with chronic pain and chronic illnesses. These are my tips for managing the holidays. 1. Communicate with your family and friends about your limits. You don’t need to give health specifics, but relay that you have an illness and x, y and z are difficult. If you can’t stand and help do dishes, let people know. If you’d prefer to skip hugging and kissing everyone as your immune system is low, let people know ahead of time. People like knowing clearly what you can and cannot do. Ask for understanding. 2. Plan for travel and arrange as best you can for comfort. I have found it helpful to request a wheelchair for airports even if you don’t regularly use one. Airports are typically large, so if walking the airport will exhaust you, ruining the following day, get a wheelchair. The attendants are professional and should not ask for proof of disability. Bring empty bottles to fill with water in the airport to keep hydrated. If flying, consider nasal saline gel to keep your nose hydrated to potentially avoid getting sick later. Bring favorite snacks. Consider leaving a buffer day at the start and end of your trip with a cleared schedule for recuperating. Arrange for grocery delivery the night of your return home so you have essentials fresh and ready for you. 3. Adjust your expectations. Holidays will be different after chronic illness, as your limits have changed. You can still have fun. Different doesn’t mean worse. Consider making new traditions. Perhaps rather than a hike through the woods to cut down a tree, you can sit inside a warm home and craft homemade ornaments. Maybe you can’t visit multiple homes on Christmas Day, but perhaps you can visit other family members a different day that week or when the season is less busy. 4. Keep gift giving simple. If you can, avoid malls and busy stores. Mall shopping is exhausting to even think about. Do as much of your shopping online as you can. Buy gift bags in assorted sizes at the dollar store to make wrapping easier. People appreciate the thought and effort of gift exchange. If your financial resources are less this year, consider giving ornaments and a heartfelt note of gratitude or appreciation for those in your life. 5. Consider scaling back holiday cooking. Maybe go to a community or temple based latke making party rather than cooking at home. Swap out laborious dessert recipes for simpler recipes or consider store-bought items. Explain to family and friends that you just can’t handle the cooking as you did before. 6. Get enough sleep. Sleep can be disrupted with the holidays, and even more so if you are traveling. Try to stick to the same sleep schedule if you can. If traveling, consider earplugs or a white noise machine.

Community Voices

The healing ability of music

I have had a complex relationship with music. As a child, I had several instances of feedback that I was “bad at music”. When my class would sing at assemblies I would get side glances and subtle and not so subtle clues that I should be at the edges and sing quietly. I played the viola from 2nd grade to 9th grade. I had fun in orchestra class. For the rehearsals, I was placed sharing a music stand with a strong player in the front so she could help me. But for concerts, I was placed at the back. By myself. By the time I reached 10th grade, I had dropped all involvement with music. After all – I was “bad at music” so even though it gave me joy I dropped it. As an adult, I listened to music and sang along quietly if alone in the car. When I joined a church and there was singing – I barely whispered to the songs.

As a resident, I had some exposure to music therapists in the hospitals. I saw how happy the kids and families were when spending time with the music therapists. I love seeing the therapist enter the floor – arms loaded with instruments. One day a teen was admitted to the medical floor in florid psychosis. She was for days now non-verbal. Further, she knew no English and was totally cut off from communication with most hospital staff. I asked the music therapist to spend some time with her – not sure what would happen. I later found the child tapping a drum in time to the singing of the therapist – a bridge had been built. It was the only instance of reciprocal exchange and connection the child had experienced in days. Music broke through the psychosis and healed. A friend shared another example of music healing mental illness. He was a psychiatric nurse in a state institution. A patient had been a resident for years and had always been mute. One day during a music session he played a 70s hit and she jumped on the table singing and dancing. From that point on she talked up a storm. Later in my life I met a friend who was a professor of music therapy and a musician and often played in church. Her website introduced to more stories of music therapy’s healing.

This year I faced the tremendous pain of post-herpetic neuralgia and I turned to music as a source of healing for myself. As a method of coping I have been practicing short daily sessions of restorative yoga and loving kindness meditation or metta. I found the Pandora channel Classical Meditation. I found the music soothing although I hadn’t listened to classical in ages. First I began listening just for these meditative sessions but then my listening expanded. I now often keep the channel on as I work and I find it lowers my heart rate and soothes me. I listening while driving. I found a series of meditative classical CDs at the library that I downloaded so I have hours of music for when offline. I have rediscovered the joy of music and its healing effect. Song was truly transformative. In the car on the way to undergo painful procedures, I had a relaxing music playlist and once in the pre-op area I would listen on headphones to meditative classical as I got my IV and was positioned on the procedure table.

Then suddenly this month I was healed of a great deal of my pain and my energy and vitality returned. I found myself playing cheerful music in the car turned up loud and loudly singing along. I didn’t want to listen to the melancholy indie rock anymore and created a cheerful playlist on my phone. Before I was stuck in a monotone low whisper singing in the car but now I was able to sing along and change my notes. In church, I was singing along audibly and with a stronger, more musical, sound. As my body healed – song returned. Music was with me all along this journey and once my spirit was restored my singing spirit returned as well.

Music has the power to transform. Lift the spirit. Build connections. Heal. I hope that more people can have access to music therapists. Music can be a greater anxiety-reducer and help people cope with pain more than medication in some cases.

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Community Voices