Mind over matter – the power of the depressive voice

painyinyan I no longer believe that I will ever get better. The possibility of this becoming my reality entered my mind a couple of years ago, but this the first time I’ve written it down and I guess that in doing so, it entails an ‘official acceptance’ of it in some way. I’m very aware of how potentially damaging this mindset can be, and am also conscious that this is the product of my ‘depressive voice’.

So what does this apparently simple statement actually mean, to me? It means that I fully expect to be in pain for the rest of my life; it means that no matter what procedures the surgeons perform, the arthritis will always be one step ahead of them and continue to spread to other parts of my body; it means that my mobility will continue to deteriorate and I will become increasingly dependent on other people; it means that I will continue to be potentially unemployable; it means that I will be increasingly marginalised and disenfranchised; it means that I will continue to withdraw from life and isolate myself. It means that despite all of the above being wholly unacceptable to me, the depressive voice has won.

There is general medical consensus that there is a link between chronic pain and depression. It’s hardly rocket science – my body hurts so I feel depressed. But this is depression we’re talking about here, a nasty bastard of a disease, an entire entity in itself, and managing it is a whole different ball game to feeling a bit fed up because part of your body is a little sore. Some medical opinions go further: individuals who experience chronic pain commonly experience anxiety and depression; anxiety and depression disorders in themselves can cause chronic pain; anti-inflammatory medications and opioid analgesics can cause additional pain; as the pain worsens, so does the depressive condition; and orthopaedic trauma, either through injury or surgery, triggers PTSD in 20%-51% of patients. A Canadian study from 2017 recognises this and is calling for a more holistic approach for orthopaedic patients by supporting their mental health both during and post-treatment, not only for the purposes of monitoring their well-being during a period of psychological distress, but also to facilitate a better recovery and improved outcome. In the UK however, the focus remains on degenerative bones and crumbling joints. Despite being asked to complete orthopaedic questionnaires which include a couple of ticky box questions about mental health and depression, no additional support or guidance on managing depression was forthcoming, so I can only assume this information was collected purely for statistical purposes. It remains abundantly clear that a more holistic approach is needed here, a human perspective if you like; I am more than my crumbly crappy skeleton, and my psychological issues over the past couple of years have impacted massively on my ability to manage both my physical condition and life in general. Below is an image depicting areas where I experienced pain yesterday, and rather interestingly, my arthritic problems are only present in my lower body; this is a fairly typical day, so I think it is only to be expected that my mood is currently very low.

It remains disturbing to me that the psychological impact of orthopaedic conditions is briefly acknowledged then so readily dismissed. I firmly believe that the power of the mind far exceeds that of the body, so it is both logical and absolutely vital that psychological issues be dealt with alongside the management of chronic pain. Recently I experienced several ‘meltdown days’, days when I could barely function due to the level of my depression. I found it curious that on one particular day, as the depression deepened, my levels of pain were reduced. I have no idea what other people experience when they have a depressive episode, but in my case it is a complete absence of thought – my head seems empty, it is a numb, dark, empty void, and I stare at blank walls for hours without any awareness of time or whether a single thought might have been created or processed. I see it as my brain going into emergency shutdown, a filtering mode in an attempt to protect me from myself, sifting out anything which might rattle me or upset me, leaving only what is necessary for my physiological survival. Perhaps on this particular day, my brain decided that the endless pain needed to be filtered out, even just for a short time?

As for the depressive voice, I need to find a way of getting it to work for me in a positive way, to help rather than hinder me, and to convince me that some level of recovery is possible, I want my mind to actually support me and be on my side for once. What I need from it are constructive thoughts and patterns of behaviour, some positive input to change my way of thinking and rid myself of the defeatism which consistently takes over my mind. As time goes on, more physical problems continue to emerge; the depressive voice needs to go, or I fear that I will never achieve anything more than a temporary superficial recovery and an increasingly self-imposed isolated existence.

“Why me?!” Chapter 4: A brick wall and a shiny new knee

cropped-bone-on-bone Fast forward through the first decade of the new millennium and it was a brave new world of possibility and optimism in the world of orthopaedics. Since stomping off (or rather, slowly limping) from my previous consultant appointment a decade earlier, I had made a conscious decision to avoid such things in the future, go into complete denial if necessary, and had taken his parting words quite literally: “Come back when you can no longer walk…”

I was now in my early 40’s, and I hit a brick wall. I’m not especially comfortable with using the word ‘crisis’, but I haven’t yet come up with an alternative which suitably describes the situation of when your life grinds to a halt, and you have no choice but to take action unless, of course, you want to stay there forever. This was my first ‘arthritic crisis’, and rather alarmingly, has not been my last. I was working full-time, did an arduous commute each day, and my limp and lumbering gait were now very pronounced; as the pain increased my mobility decreased, and my mental health deteriorated rapidly. I found it difficult to walk, drive, work, stand, sit, sleep… Myself and Bastard Knee were referred to yet another orthopaedic consultant.

It was immediately apparent that progress and improved technologies had brought about massive change in what was previously a rather dark and dusty world. The consulting room was gleaming, bright and equipped with all sorts of flashy screens and technologies, and the consultant was a rather cool and groovy guy with excellent people skills, who apparently had a particular penchant for playing Pink Floyd very loud whilst performing surgery. This was all a very welcome change from the rather dusty world and balding consultants of the past who muttered to themselves as they scribbled away with their scratchy fountain pens and endlessly rummaged through piles of folders containing yellowing paperwork from decades earlier. I now had an electronic file, and the consultant viewed my x-rays with a strange combination of curiosity and excitement, almost gushing about me being “an unusual case”. He immediately offered to perform an arthroscopy, the purpose being to take pictures inside my knee and check the condition and location of any cartilage within the joint, just to confirm that the best outcome would be a unicompartmental knee replacement on the lateral side of my knee where the cartilage had been removed. I did ask about how long I would have to wait until this could be performed, but he reassured me that the new joint replacements were quite different from those available in the past and that surgery could be performed when it was needed, regardless of patient age. He added that I would be one of the youngest people to have this procedure, which perhaps went some way to explain his evident enthusiasm, but I didn’t feel that this situation was something to be especially proud of; in my head, I was still angry that I had developed an old people’s disease, and only old people got joint replacements. Nonetheless, I was really pleased that I could now go ahead with the much-needed surgery, and fully believed that it would resolve my various pain and mobility issues. The surgery went ahead as planned, but sadly it didn’t turn out to be the miracle that I needed or had hoped for, and the reasons for this will be covered in another later post.

Because the previous age restrictions for joint replacements were no longer an issue, the new surgical procedures and replacements had a huge impact on the number of surgeries performed. Even though I was an NHS patient, both my arthroscopy and replacement surgery were performed in a private hospital, and this practice has continued to the present day. It is possible that the demand for joint replacements is now so high, that the NHS simply doesn’t have the capacity to deal with it so patients are ‘diverted’ to other health providers for their surgery. This continues to be the case now, and the idea of joint replacement surgery, certainly within the UK, has morphed into an efficient and lucrative business.

“Tell me, where does it hurt?”

“Where does it hurt?” and “Can you describe the pain?” seem simple enough questions, but to provide a succinct and objective response consistently evades me. The quiet, pensive, patient expressions on the faces of orthopaedic consultants makes me feel that maybe I haven’t said it right, perhaps have been misunderstood, probably that I haven’t described it sufficiently clearly, and I start to feel nervous, slightly desperate, and persevere by rambling on in an unhelpful or confusing manner.

Describing osteoarthritic symptoms and pain accurately is possibly as challenging as managing the condition itself, and trying to describe both the location and type of pain is quite tricky. The easiest type of pain to describe are the ‘full-blown arthritic burns’, as I will call them in this post (I do have another name for them, which is unsuitable for the public domain). These are nasty beasts which often come suddenly without warning, a tear-jerkingly awful but brief sharp burning sensation in a small and specific area, in my case, usually inside my knee cap or hip; the burning is often a response to specific weight-bearing actions, for example, a sudden high impact movement or using steps or stairs. On days when I’m especially unlucky, they come in clusters. Other types of pain include aches in varying degrees of intensity, but their location is always vague; the aches I experience are usually in the lower part of my legs and ankles, but they feel very deep inside my body far away from the skin, perhaps on the surface or even inside the bone. I find these aches the most psychologically disturbing of my symptoms, they usually last for hours and there is something very dark and creepy about them; they bring with them a real coldness which feels as if the life is very slowly draining out of that particular part of my body. Other common symptoms include an intense soreness or tenderness in specific areas of the body and problems with stiffness; the most difficult time for managing these is usually immediately on waking up, the physical difficulties of actually getting out of bed is often the most challenging and painful part of the day for many people with arthritic conditions.

So, here I am, back in Human Guinea Pig mode and ready to launch into my next ‘investigation’ on myself. Previously, I used a word-cloud programme to take a look at issues relating to osteoarthritis and mental health. Today, I am in the early stages of Investigation 2, testing out a possible way to explain my pain and where it occurs, so that I am fully armed with the necessary information for when I next attend my consultant appointment.

I’m a simple soul who likes pictures to convey potentially complex information. The intention here is to use a visual to record where pain occurs, with additional notes where necessary; I intend to record this for at least a week. My decision to do this is for my own clarity as much as that of my consultant because, rather embarrassingly, since our last meeting, the pain I am experiencing has actually moved, and continues to move to other parts of my body on a regular basis. The ‘plan of action’ discussed some months ago was to investigate further degenerative change and the possibility of nerve damage or trapped nerves, so the fact that the pain is moving about will either support this investigative route, or alternatively could blow it to smithereens and we’ll have to look at other possibilities.

I really like beautiful images, so although drawing a stick-man would suffice for this task, I opted for something far better. The Vitruvian Man. If there is one image in the history of art which really celebrates the perfection of the human form, this is it: the incredible mathematical and relative proportions brilliantly observed and recorded, the geometry, the symmetry, the perfection of design, the beautiful drawing quality itself, the inherent strength and power of the figure, it is gobsmacking stuff! Unfortunately, I will be defacing this image to record the location of my pain – something which I am a bit uncomfortable with (no pun intended) – but am hoping that perhaps the markings will reveal patterns of pain: perhaps some consistencies in the pain, repeated locations of certain types of pain, or maybe patterns relating to a nerve path?

Regardless of the outcome, Da Vinci’s contribution to this is very much appreciated and actually provided me with enough motivation to get this moving, as did Botticelli’s Venus. My consultant appointment is a couple of weeks away, and I am looking forward to presenting him with these and several other pages of legendary art figures – but I suspect that the irony may be lost on him…

Update:

I’ve been recording pain experienced in this way for 6 days now, and the visual below is the result. Hardly what could be described as empirical evidence, but I think it’s an interesting and worthwhile task. What strikes me most is the actual amount of pain I am experiencing at the moment, and by recording it using a static image has surprised me at how much of my body is affected by it. Having said that, what these images don’t record is the intensity or duration of the pain; the lower back pain recorded in every picture is extremely uncomfortable and is my constant companion – it never stops. However, the pain in my legs are cold aches which fade after several hours, and the burning pains are unpleasant but of short duration. I also experienced the excruciating pain of a trapped nerve twice during this period, and some of these images would suggest that at least some of the pain could be following a ‘nerve pathway’. The images are misleading in their implication that I experience all this pain at all times, and that is certainly not the case – the images record what I experienced within a 24 hour period, with some pain being less acute or more fleeting than others. My consultant appointment is fast-approaching and, based on these visuals, I am fully expecting the result of my recent MRI scan to reveal continuing arthritic degeneration alongside nerve damage.

pain-pics

“The feral pile”

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Dogs. I’ve owned them all my life and can’t even begin to imagine how desolate I would feel without one. Owning dogs, or spending time with them, has been scientifically proven time and again to have huge benefits for your physical well-being and an even greater impact on your mental health. So how and why does spending time with dogs (or other furry companions) improve your overall health?

Companionship

Dogs are especially loyal and loving creatures, so offer their owners comfort, reassurance, companionship, emotional and physical security, and unconditional love.

Responsibility and Motivation

Owning a dog brings with it responsibility and motivation – the responsibility for feeding and caring for your pet, and the motivation to exercise it regularly and sufficiently. In fulfilling these responsibilities, you should notice some improvements in your physical and mental health, even if the changes are small at first.

Depression

Walking a dog can increase your physical level of fitness, but also give your mood a boost. Here’s why:

walking releases endorphins, which reduce physical pain and improve your mood.
walking has a calming effect – it can reduce adrenaline levels which, in turn, lessen levels of anxiety and stress.
walking increases levels of seratonin, the ‘happy chemical’ or mood elevator.
walking enables more efficient use of dopamine, a neurotransmitter which signals responses of pleasure and motivational reward.
walking increases your levels of Vitamin D3, which is absorbed directly from the sun; this enables increased seratonin and dopamine release to the brain, and subsequently can elevate a low mood.
walking increases oxygen levels in the body and brain, enabling dopamine receptors to function more efficiently and lift a low mood.

Click here for an article about the benefits of walking and mental health.

Socialising

Walking dogs inevitably leads to meeting other dog owners, and sometimes chatting – usually about dogs! – and occasionally these chance encounters can lead to lasting friendships. Social isolation can be a key ingredient of depression, and it is believed that people who are socially connected are more likely to be mentally healthy. Socialising with other dogs is also good for your canine companion – dogs need doggie friends too!

Click here for a wonderful article, How getting a dog saved my life

“The Feral Pile”

The Feral Pile is not a phrase that you will find in any study about human and canine relationships or behaviour, but it is the way which I describe the most important behavioural aspect to my relationships with my dogs, and why they are so important to me. I think the simplest way to describe it is ‘mutual bonding’ and the behaviours which bring that about. The picture at the top of this post is of my current dog, a golden labrador, who was 5 months old at the time. She had had an unpromising start to her life, and this picture was taken the day I brought her home; she was clearly needy, anxious, in desperate need of reassurance, and we spent our first week together snuggled up in a feral pile on the sofa. She is now a strapping 3-year-old who weighs in at 30 kilos, but we have continued our tradition of spending several hours each day in the feral pile together; she loves the reassurance and attention, and I love everything about it: her scent, her soft velvet fur, her warmth, her rhythmic breathing, even her snoring in my ear, her reassurance, her devotion, and her beautifully gentle personality. Being in the feral pile immediately reduces my levels of stress and I feel much more relaxed, the warmth and softness of snuggling up to her relaxes my muscles and my physical pain seems less, and her gentle breathing has a soporific effect usually resulting in the best quality sleep I’m likely to have that day. Every day, I smile at her behaviour or her expressions and she lifts my mood considerably, which is hugely important since my mental health has been poor for a while now. Yet, despite the obvious mismatch of having a large energetic dog alongside my current mobility problems, she brings with her enormous reassurance, affection and a whole host of other intangible, wonderful things which far outweigh the challenges. If we can’t manage to do something or if it all gets too messy, we stay calm and simply revert to the feral pile until all is well again, and then we try again another day.

The miraculous properties of cod liver oil

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The health benefits of adding cod liver oil to your diet for the purposes of improved physical well-being have been well-documented, but did you know that cod liver oil could also be beneficial to your mental health and well-being?

Cod liver oil is massively nutritious, containing omega-3 fatty acids, Vitamin A and Vitamin D. It is generally recognised as having the potential to provide a variety of health benefits, the best-known being stronger bones, reduced inflammation and less joint pain, but there are also arguments claiming that cod liver oil also improves brain function, can reduce symptoms of depression and anxiety, improves cognitive function and impacts on mood. The arguments for the miraculous properties of cod liver oil are as follows:

Inflammation

Cod liver oil contains omega-3 fatty acids which could suppress the production of bodily proteins which create chronic inflammation. Vitamins A and D possess high antioxidant properties, which can reduce inflammation by impacting on harmful free radicals.

Bone Health

Bone mass begins to decrease at around the age of 30; this can become problematic in later life and the possibility of bone fractures can increase, especially in post-menopausal women. It has been argued that Vitamin D can decrease the likelihood of age-related bone loss because it facilitates the absorption of calcium into the body.

Joint Pain

A variety of studies into Rheumatoid Arthritis and joint pain have revealed that patients who regularly take cod liver oil supplements reported a reduced level of joint pain and were subsequently able to reduce their intake of prescription anti-inflammatory medication.

Symptoms of Anxiety and Depression

Research into the impact of cod liver oil on mental state is on-going and inconclusive; however, what the research does suggest is that there is ‘something’ in cod liver oil which can alleviate symptoms to some extent. It seems more plausible that this is due to the Vitamin D content which, it has been argued, can stimulate the production of hormones such as seratonin, and it is generally accepted that higher levels of Vitamin D in the blood can reduce minor symptoms of depression. Click here for an article on the impact of fish oil and Vitamin D on brain function and mood. It has also been argued that there is a link between chronic inflammation and anxiety or depression, and although some studies claim that cod liver oil could reduce symptoms of low mood, more research is needed before a reasonable conclusion can be reached; although inflammation can decrease and some improvement in mood has been acknowledged, the level of improvement is very small.

Other health benefits

Eye Health: The omega-3 fatty acids and Vitamin A present in cod liver oil have been shown to offer some level of protection against, for example, glaucoma and age-related macular degeneration, by reducing inflammation in the body.

Heart Disease: incorporating omega-3 fatty acids into the diet can reduce the risk factors of heart disease, although it is important to note that it cannot prevent heart disease developing. The presence of omega-3 fatty acids can lower blood pressure, increase HDL cholesterol (the ‘goodie’), prevent plaques forming in the arteries, and reduce the production of triglycerides.

Stomach and Gut Ulcers: results of animal studies are suggesting that cod liver oil could enable the healing of stomach ulcers by reducing inflammation in the gut, and it has also been argued that cod liver oil can suppress genes which create inflammation of the gut. Users of prescription anti-inflammatory medication can be at risk of developing stomach ulcers, as can smokers and individuals who experience acid reflux.

Ok, so how much should I take?

One teaspoon of cod liver oil contains 90% of the RDI for vitamin A, and 113% of the RDA for Vitamin D. Taking 1000mg capsule has long been the advisable daily dose for individuals with arthritic conditions, however, research from 2005 has concluded that higher doses appear to be extremely beneficial to individuals awaiting joint replacement surgery. In this study, the higher dose resulted in two specific changes in the body: firstly, a huge reduction in the production of an enzyme which can cause damage to the cartilage, and secondly, a reduction in certain enzymes which cause joint pain. Click here for this research article.

NSAIDs

Personally, I’m a big fan of anti-inflammatories, and have used them long-term with no problems so far. What I really like about them is that they actually DO something! NSAIDs reduce inflammation in the body, thus reducing the level of arthritic pain, and for me this is extremely important – OK, so the level of pain isn’t massively reduced, but it’s something, it’s physical, it’s real, and it’s progress of sorts. The main reason for this little outburst is that there are so many drugs which DON’T actually do anything for your body – for example, painkillers. Painkillers lie. They lie to your brain, telling you that you have no pain which, to a point, is good because it takes the pain away if only temporarily, but only (and this is important) because you believe it to be so. In the meantime, there is absolutely no progress or healing going on, and in some cases further physical damage is taking place but is unrecognised.

Anti-inflammatories are not a perfect drug, and there are certain issues with their use, especially if it is long-term, as in the case of arthritis. NSAIDs can impact detrimentally on your stomach, causing damage to the stomach lining and are thought to be responsible for the development of stomach ulcers. Therefore, monitoring their use is important and I now am required by my GP to have regular blood tests to check that all is well. However, there are now NSAIDs being manufactured which have a type of ‘coating’ which is said to protect the stomach lining from damage.

Something else worth noting is the impact of NSAIDs on your blood’s consistency and ability to clot. Last year I was taking anti-coagulents after surgery and was not allowed to take NSAIDs alongside these because, as I understood it, my blood would become too thin. Here is an article which reiterates this, arguing that anti-inflammatories should not be taken alongside blood-thinners, and how NSAIDs appear to impact on blood platelets.

I see NSAIDs as the unsung heroes of arthritic pain. They tick over quietly in the background and most of the time you could be forgiven for thinking that they’re not doing anything, but believe me, they are. They certainly don’t wallop the pain in the heroic manner that painkillers do, but I think it is only when you stop taking anti-inflammatories that you realise how much they actually do for you. Following an enforced break from them for 8 weeks last year, I really noticed an immediate difference when I was finally allowed to use them again, and if I ever had to make a choice over using NSAIDs or painkillers, NSAIDs would win every time.

“Why me?!” Chapter 3: But arthritis is something old people get, isn’t it?

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Well, yes and no… Osteoarthritis is generally believed to be a degenerative condition which affects older people, an undesirable but natural part of the aging process; it is often described as ‘wear and tear’ on the joints, the direct result of a thinning of the articular cartilage layer. However, it has also been argued that osteoarthritis develops because the aging of the musculoskeletal system increases susceptibility to osteoarthritic conditions. Click here for more information about osteoarthritis and age. Risk of developing the condition certainly increases with age, and most people over the age of 50 will have developed some minor symptoms, which are generally the inconvenience of a few minor aches and stiffness rather than full-blown arthritic pain. Gender is also a determining factor, with the number of women aged 50+ far outweighing the number of men in the same age group who have the condition. Click here for an article about women and osteoarthritis.

So, it seems fair to say that the majority of people with an osteoarthritic condition are middle-aged or older, but there are also many others who develop it at a younger age and for a variety of different reasons – in my case, I believe that the surgical removal of articular cartilage from my knee when I was a child is the most obvious reason for me developing the condition. Being ‘an unusual case’, such as I was, brings with it a number of difficulties which are additional to the condition itself; during the 1990’s, my relatively young age actually prohibited me from obtaining the treatment I needed at that time.

My life as a Juvenile Degenerate continued much as expected. In my twenties, I walked with a slight limp, I could no longer run but could manage a rather slow and lumbering jog if absolutely necessary, and I experienced manageable pain on a daily basis. I had finished college, had a couple of jobs, had worked abroad, and become a mother By the time I was 30, I began to experience much higher levels of pain, my mobility had deteriorated, I now limped badly, I couldn’t move quickly even if my life had depended on it, and I was finding it extremely difficult to fulfill my role as the mother of a busy and energetic pre-school daughter. I was referred once again to an orthopaedic consultant.

This particular consultant had a reputation which preceded him, not only was he a brilliant surgeon, but was equally well-known for his brusque, if not downright rude, manner. He was internationally revered and spent much of his time performing orthopaedic miracles around the globe. I considered myself very lucky to have been referred to him, and was extremely impressed that humble NHS patients such as myself could receive care from such esteemed professionals. During our first consultation, he announced that I urgently needed a knee replacement. In those days, ye olde joint replacement surgery was somewhat different to the relatively recent carbon-fibre replacement surgeries of today; outcomes were inconsistent and erred more on the side of ‘unsatisfactory’, some patients experienced more pain and less mobility as a result, and some designs were at best inadequate, or at worst flawed. It was a challenging surgical procedure, knees being an especially complex joint, the success rate was poor, and they were expensive; most crucially, you could only have one replacement per joint, which was intended to last for the remainder of your life. For ‘younger’ arthritis sufferers such as myself, this was bad news – I was informed that the procedure would go ahead when I reached the age of 55. Under normal circumstances, this was the minimum patient age that the surgery could be performed, so I was looking at a further 25 years of waiting until the procedure could go ahead.

The consultant did offer a couple of alternatives to tide me over until I was old enough for the surgery. Firstly, because my x-rays revealed significant quantities of attached and loose osteophytes which were rattling around, he suggested keyhole surgery to try to clear the joint of bone spurs using a suction tube; this is probably similar to today’s lavage and debridement procedure. Secondly, he offered to undertake an osteotomy, a procedure where the tibia or femur have a wedge shape removed enabling the leg to be realigned, the purpose of which is to relieve pressure on the affected joint and thus reduce overall pain. I accepted the hoovering-out option, and several of the offending escapee bone spurs were successfully removed, the biggest offender being 8mm in length which had taken up residence next to a nerve; however, I declined the offer of an osteotomy because I found the prospect quite terrifying.

For about 6 months after the hoovering-out procedure, the pain was reduced and my mobility improved, but it was only a temporary fix and not intended to resolve more serious problems within a joint. About a year later, the consultant conceded that it would be necessary for me to have a knee replacement before the magical age of 55, and to return to him again to get things started when I could no longer walk or drive or get on with my life. At the time, I was absolutely appalled at his attitude, but in retrospect I think this was entirely the right thing to do. As mentioned above, the old type of knee replacements were notoriously unsuccessful, and as an eminent orthopaedic consultant he would have been very aware of the state of progress in the design, materials, and improved surgical procedures for the flashy new carbon-fibre replacements which emerged less than a decade later. These new replacements had a relatively short lifespan of around 10-15 years in comparison to their rather ineffective predecessors, but the newly emerging replacements had a significant advantage for younger arthritis sufferers – they could be replaced, and you could have as many ‘replacement-replacements’ as was deemed necessary. I genuinely believe that this consultant’s plan all along was to make me wait as long as possible so that I would, eventually, get a much-improved type of replacement and a far better surgical outcome than if we had rushed into surgery at an earlier stage. It’s just a pity that he didn’t share this with me at the time, since I was in a state of absolute despair that day when I left his clinic.

Osteoarthritis and Mental Health

This post is a continuation of the static post which can be found on the Mental Health page where I was undertaking an experiment to examine the potential relationship between arthritis and psychological well-being, using a word cloud programme to create an image using text. A week has now gone by, I have recorded 12 words or phrases each day relating to the question ‘How do I feel today?’, and this is the resulting image:

wordle-wk1-generic

This image is what I would describe as a ‘generic’ image to reveal the symptoms and emotions I have experienced over the past week. Word cloud programmes, by default, recognise text as individual words rather than as a complete phrase, and the larger the text, the more frequently a specific word appeared in my lists – for example, the largest words, such as ‘pain’, ‘back’, ‘stiff’, ‘sore’, etc appeared in my list several times, and in various combinations or phrases. Conversely, the smallest words appeared once only. This is all well and good, and provides an overall generic view of what I was trying to capture by doing this experiment. Evidently, the physical symptoms of my arthritic condition dominate in this image, but it is also interesting that several words relating to mood appear in moderately-sized text.

In this second image, I have tweaked the word cloud programme so that phrases are ‘read’ by the programme as complete words – in other words, ‘lower back pain’ will be read as one complete word. This provides a much more specific image:

wordle-wk1-specific

Interestingly, the words ‘low mood’, ‘sore back’ and ‘cold’ are now the most frequently occurring words and therefore appear in the largest text. Although the word ‘pain’ no longer dominates the image, it occurs several times in medium and smaller text, but this time specifically relating to the type of pain I experienced: ‘back pain’, burning pain’, ‘hip pain’, ‘sharp pain’, etc. What this image also reveals is the extent to which symptoms of low mood and depression appear and how they seem to be as prevalent an issue as the physical symptoms themselves. Additionally, I believe that these images provide a valuable insight into how exhausting it is, both physically and mentally, to experience an arthritic condition.

A couple of additional thoughts relating to this experiment and the resulting images.

Firstly, at the time of writing, it is a typically cold and damp January, and as arthritis sufferers are well aware, this is the absolutely worst time of year for us regarding our experiences of pain and is also the most problematic with regard to managing our pain and symptoms adequately.

Secondly, although I am firmly of the belief that osteoarthritis and reduced levels of mental well-being are intrinsically connected, I would also argue that low mood and symptoms of depression cannot be solely attributed to arthritic conditions, and that there are many other factors at play in our lives which influence our moods and well-being. Having said that, however, I have been extremely pleased to discover that during my medical appointments over the past couple of years, arthritis sufferers are now routinely asked to complete mental health questionnaires. I am assuming that this is an extremely positive step forward in better managing arthritic diseases – after all, how can individuals experience chronic pain on a regular basis, without also experiencing low mood and symptoms of depression?

“Why me?!” Chapter 2: A Juvenile Degenerate

In 1977, I underwent my first orthopaedic surgery, fully believing that it would also be my last. Keyhole surgery was in its infancy, so I emerged after a traditional surgical procedure sporting a 10cm scar across my knee which looked strikingly similar to a question mark. The cartilage in its entirety had been removed from the outer side of the knee joint, and the answer to the “Why me?!” question was self-evident – I had damaged my knee, most likely due to an overzealous approach to athletics, and had earned myself a scar. In those days, scars were not considered to be cool or something to be proud of with a heroic or amusing tale attached to them, and my reaction to it was one of deep shame and embarrassment. I covered it up whenever possible, and have continued to do so ever since.

Following the recuperation period, I was told that all had apparently been successful, or at least as successful as could be expected. After a few weeks of using a walking stick, I learned to walk independently and finally learned to run again, but now it was purely for fun rather than speed, and the exhilaration I had felt before no longer existed. I was noticeably slower than before, but still participated in PE lessons and played in school teams, although I was no longer considered physically well enough for anything too strenuous or demanding. Occasionally, however, the leg would ‘collapse’, but these incidents were rare, and almost always when I was doing something physically strenuous. I also noticed that ‘high impact’ or sudden movements highlighted the fact that it was now significantly weaker than my other leg, so after a few years, I became less interested in sports and running, possibly because I’d morphed into a sullen teenager, or perhaps because I was experiencing increased pain within the knee and left leg and had developed a slight limp so was no longer an enjoyable experience.

By my mid-teens, the knee had earned itself its first name: Knaughty Knee, the first of several names I have had for it over the years. Psychologically, I had begun to disassociate with and even disown it – I now referred to it either with a derogatory name, or it was spoken of passively, using ‘the’ rather than the usual possessive adjective, ‘my’. Following more pain and consistent problems with it, I was eventually referred to another orthopaedic consultant who informed me that I had developed mild osteoarthritis in my left knee cap.

It was official, I was now a Juvenile Degenerate, my new name for myself. My knee had also earned itself a new name, Bastard Knee, and I now referred to my left leg as Stupid Leg, as I slowly disassociated myself from both whenever possible. The “Why Me?!” question had also acquired several somewhat different answers: because the surgery didn’t work? because that particular surgery was the wrong thing to do?, or because by removing the cartilage, my knee was left wide open to the development of osteoarthritis? My conscious attitude to this new situation was one of disdain, regarding it all as a rather bad joke; I continued to sneer at my body and regularly made deprecating remarks about it – after all, who needs a leg that works properly anyway, and hey, I’ve got another one and it’s much more co-operative than that stupid left one! Subconsciously, I was furious. I had always held consultants and surgeons in high regard, and continue to do so; after all, they possess reams of knowledge I couldn’t even begin to comprehend and skills which I could never acquire. I wasn’t looking to apportion blame, however, something had gone badly wrong here; rather than resolving the specific issue of dealing with a raggedy cartilage, I appeared to have gained a medical condition which had the potential to be far more damaging and enduring.

I was an unlikely ‘candidate’ for osteoarthritis. The contributory factors for developing the condition are as follows: genetic predisposition, age and gender, obesity, physical activity levels, joint injury, joint alignment, and abnormal joint shape. As stated previously, I appeared to have no genetic disposition towards it, and as a woman, my likelihood of developing it before the age of 50 was significantly lower than if I had been male. The only contributory factor which I appear to have met at this point, was that of joint injury, and the inevitable answer to the “Why me?!” question was now “because I had a surgical procedure which creates more problems than it resolves”.

It is reassuring to know that this particular surgery is no longer practised; interestingly, I can’t even find the correct name for it or details of it online, so presumably medical professionals have realised that it is not simply an inappropriate course of action to take, but it has the potential for creating further, more extensive damage to an individual’s joints. However, a modified version does still exist; surgery is still undertaken to deal with rogue bits of knee cartilage, but it is restricted to simply trimming away any torn areas and no attempt is made to remove the cartilage in its entirety.

For more information about cartilage damage and NHS care and procedures, click here

Cabbage compress, anyone?

hhl-reframes_nov-29_14_wrap-your-leg-with-cabbage-728x381 According to this article, red cabbage possesses Anthocyanins which, it is claimed, reduces joint pain and inflammation. If you fancy testing this theory, follow the link below for information and details of how to make and administer a cabbage compress.

Obviously, this is more suitable for some areas of the body rather than others – for example, if your arthritis is in your legs or arms, this seems a promising thing to try out; if however, you have pain in your hips, you could be looking at making a pair of very big cabbage pants…

Click here for the article and instructions.