Tag: medical

Harm mitigation vs. cure

Scott Alexander has a very good post up about semantics and gender, which you should read in its entirety even though it is very long.  I have nothing to add to his main thesis, but there is a cute little anecdote about a woman with OCD whose life was nearly ruined by her fear she’d left the hair dryer plugged in, no matter how many times she checked it or how far she was from her house.  She was on the verge of living on SSDI for life despite trying every therapy and medication in the book.

Finally, a psychiatrist suggested she keep the hair dryer with her.  This transformed “checking if the hair dryer is unplugged” from a 40 minute task (to drive home and back) to a 2 second one.   The psychiatrists at the hospital were divided on this.  Scott doesn’t specify, but I assume the argument against was that you have to rip the problem out by its roots.  OCD is anxiety in search of a cause and if you assuage this one she’ll just find something new to worry about, and if you keep treating the symptoms she’ll end up loading her car with every appliance she owns every day.

This strain of thought is not baseless, and I think it’s important to keep in mind when developing population-level guidelines for treatment.  I also think that any doctor that argues that hairdryer therapy for this particular woman should be sent to a reeducation camp, because

  1. it worked, so shut up
  2. root-cause psychiatry and psychology had their shot.  They had in fact emptied an entire clip into the problem and had no more bullets.  At that point, unless something is actively and immediately harmful, they need to gracefully exit the field.

There’s also the matter that the problem was not just “she felt bad”, but also “she’s about to lose her job.”  Jobs are important.  They provide the money and health insurance that let you go to fancy psychiatrists that don’t believe in hair dryers.  Even if you’re independently wealthy, jobs are important psychologically and socially.  SSDI is oriented around the problems of factory workers who lost limbs, and really does not work well with people with high-variance mental disabilities, who can do some work some of the time but cannot function at the level society demands.   If hair dryer therapy does nothing more than buy you six more months before she experiences a negative shock from which it is very difficult to recover, that’s actually pretty good.

Even more than that, I think the psychiatrists are underestimating palliative care.  I absolutely do not think overcoming mental disorders is a matter of will power or wanting it enough, but I do believe that human brain and body are very good at repairing themselves, and that this implies that any non-traumatic disorder that persists must be in a self-reinforcing loop.  Chronic pain lowers your pain tolerance, worry that something will trigger a panic attack makes you anxious.  Pain and depression are mutually reinforcing.  Mental Illness saps your energy and cope and time, which makes it difficult to seek and follow through on treatment.  “Palliative” care like pain killers and anti-depressants give people energy they can use to heal, which is why oncologists sometimes prescribe them. For big scary things we don’t know how to cure, freeing up the patient’s own resources may be the most helpful thing we can do.

Meanwhile, my EA group is debating this article on charitable giving, which articulates something I’ve been trying to say for a long time, and not just about charities.  American capitalism is set up to encourage shooting the moon.  We’ve carried that over to charity, trying to find The One Simple Trick To End Poverty.  That is toxic on many levels: it doesn’t exist, we can’t measure finely enough to detect it, the most effective thing now is not going to be most effective thing after we’ve done it to death, finding things that work is a massive expense in its own right, and oh, poverty is a system of many millions of moving parts.  Waiting for the silver bullet is doomed and immoral, and perhaps a bit like refusing to let this patient adopt a hair dryer as her constant companion.  Yes, treating the root cause would be better, but it’s not on the table.

But that doesn’t mean we can stop doing RCTs and start firehosing money again.  It is tragically easy for aid to make things worse.  This is what the anti-hair dryerists were afraid of: that putting a salve on the symptoms will make the root problem, and thus eventually the symptoms, worse.  Possibly much worse.  Most people who gave food aid did it with the best of intentions: even the American agricorp executives who benefited probably convinced themselves this was a way of giving back .

So: you can’t tell people it’s cure or nothing, but you also have to be really careful with palliative care.  It’s even harder for charity, because you have to consider the externalities, not just the affect on the recipients.  This is one good argument for donating local, even if distant recipients are dramatically worse off: you will naturally get and give more feedback on a local charity’s effectiveness.  It’s also a very good argument for restricting yourself to charities that measure their effectiveness, almost independent of what the measurement says.  When we don’t know what to do, gathering new data is a good in and of itself.  And small pareto improvements may eventually free up the resources for societies to heal themselves.

HAES pre-check

I’ve been meaning to do a “science of fat and health and food” series for a while now, but have never quite gotten it together. There’s too much stuff I remember reading in some blog years ago but can no longer find.  The library has finally delivered Health at Every Size to me (just in time for Thanksgiving), and I’m hoping to use that as both a serious source and a jumping off point for other research I want to do.  In the spirit of inquiry, here are my basic beliefs, as cobbled together from an undergrad biology degree, personal experience, things people said on the internet, and scientific studies I read the abstracts of.  When possible I’ve included a citation but mostly this is just stuff from my brain.

  1. Some diets are lead to a better functioning body than others.
    1. The healthiest diets supply all necessary trace nutrients, including ones we haven’t identified as necessary yet.
    2. Protein, fat (of multiple kinds) and carbohydrates are all necessary for proper functioning.  Right now a lot of people are pretty sure that you should minimize carbs and especially sugars, but 20 years ago they were equally sure fat was evil, so I’m unconvinced even though their numbers look very shiny.
  2. Exercise is super good for you right up until the point it is super damaging.
  3. Despite our astonishing lack of genetic diversity, humans have a pretty wide range of how they react to identical food and exercise inputs.  Additionally, the same person can react differently to things over time.
    1. For example, people’s beliefs about the deliciousness of the milkshake they are about to receive affects ghrelin production, which definitely affects satiety and probably affects nutrient and calorie absorption.
    2. Medication can do the same.  Cortisol makes you gain weight. Several psychiatric medications lead to severe weight gain.  Hormonal birth control definitely used to make you gain weight. Many scientists claim the newer drugs haven’t been shown to do so, but my feeling is that “baby chemicals lead to weight gain” is the default assumption and the burden on them is to prove it doesn’t.
    3. Past deprivation, including in utero, can decrease basal metabolic level, or make it more likely to decrease in the face of further calorie deficits.
  4. At the same time, people are remarkably resilient to environmental changes.  A given person can eat a wide range of calories and stay at the same weight.  No one understands why.
  5. So while calories in/calories out is literally true, in the sense that everyone is taking in and using calories, it’s not useful, because so many things affect intake and output.
  6. It is possible to have an excellent diet and exercise routine and still be fat.
  7. But any given person will probably be fatter the worse their diet and exercise.
  8. When you tease these out, fat is mostly a symptom of things that lead to bad health, not a cause of bad health.  Extreme amounts of fat are hard on the joints and heart.  But all evidence says (good diet, good exercise, 40% body fat) > (bad diet, no exercise, 20% body fat)
  9. Nonetheless, the general and medical public alike seem extremely fixated on fat, and this is hurting fat people.
  10. Shame around fat seems to contribute to both fat and the negative health outcomes associated with being fat.  Shaming fat people for the health is right up there with rescuing prostitutes by arresting them.
  11. To the extent fat itself affects health, the ideal body fat % from a health perspective is much higher than the ideal body fat % from an American aesthetic perspective.
  12. Lab animals are fatter than they were a generation ago despite provably identical conditions.  This has got to mean something about our food, and it’s probably not good.
  13. It is possible to be both fat and undernourished.  Most poor Americans are.
  14. Your body needs calories to run.  Faced with a calorie deficit, your body may choose to cut programs (like the immune system, or thinking) rather than dip into savings (stored fat).  This means that maintaining even an “unhealthy” weight may be the healthiest choice a person can make.

Antibiotics: is there anything they can’t do?

Until fairly recently, gastric ulcers were a disease of stress and spicy food.  Those things probably did make it worse, but it turned out ulcers were almost always caused by overuse of NSAIDS or an H. pylori infection.

Back pain is the prototypical malingerer’s disease.  The medical establishment isn’t saying you’re faking it, but given that back pain is positively correlated with low job satisfaction, to the point that job tenure and unemployment are considered when predicting someone’s recovery time.  The most charitable explanation is that the pain is real, but working through it is ultimately more beneficial than rest, so people who love their job or hobby enough push themselves through it, and people who hate their job don’t have the incentive.  The uncharitable explanation is that they’re faking it because they are lazy.

Or maybe they have a severe bacterial infection.  There’s new evidence that people who fail to recover after a herniated disk are suffering from a bacterial infection that can be treated with prolonged antibiotics.  Patients treated with antibiotics continued to improve after the antibiotics were discontinued, suggesting they got to the root of the problem.

And then there’s a bunch of non-specific symptoms that may or may not be associated with chronic Lyme disease, which may or may not be cured by antitbiotics.  And even though Toxoplasmosis is not a bacteria, the treatments are commonly used antibiotics.  Part of me wants to recommend everyone take a broad spectrum antibiotic holiday every few years, just to sweep up all the low level things that must exist but we don’t know to look for.

But you still can’t have them for the flu.  That’s just stupid.

…and the Wisdom to Tell the Difference

I haven’t gotten too much into my own dental stuff because I spend enough time thinking about it as is, but the current count is:

  • 3 completed surgeries
  • 2-5 more planned, depending on what you count as a surgery
  • painful nerve damage on the lower right
  • a hole in my lower left gum.  You can see a good chunk of bone if you look in my mouth.

After the last surgery (wow, two months ago now), my pain level actually dropped significantly.  We took out a major part of the problem, which not only helped on its own merits, but meant I stopped clenching/grinding, which made the nerve damage on the other side stop hurting continuously.  It was still touch sensitive, but I can handle that.  My ability to focus skyrocketed, limited only by my exhaustion.  I dropped CBD in favor of naproxen, and then didn’t need anything at all. I read a book a day for a month.  You can roughly see this increase in focus in my blogging, although the signal on your end is a little messy because publish can come long after writing, unless wordpress screws up, which it usually does.  I went on forays to the library to practice thinking around other people.  I even started to program a little bit.*

Then the surgery site started to hurt.  And my upper right (which needs surgery but hasn’t had it yet) began to ache from the sudden chewing burden.  I saw myself faced with two possible paths: a life where the pain just kept increasing and no amount of treatment could keep up with it, and I was never able to accomplish anything because it rendered me stupid, or a life where I was never in pain and I went on to be Brene Brown’s more medical second coming.   Obviously future #2 is better than future #1, and in future #2 I don’t take pain medicine, so I needed to just keep not taking pain medication and everything would be fine.

Causality does not work that way

If you’d tracked self reported pain it probably wouldn’t have gone up that much, because I have a lot of practice pushing dental pain out of conscious awareness.  But my reading rate plummeted, and I stopped going to the library.  Blogging which had felt like a thing I needed to do to clear my head a week before now felt like a chore.

I had just started to give in and take more CBD when I had a follow up appointment with my dentist, who explained that there was a hole in my gum where the jaw was growing in order to push out an infection.  I started crying the minute he said it.  I went home and took real pain meds.  A few days later, when I didn’t have to drive anywhere, I took twrugs o days and took way more pain medication than I consciously thought I needed.  Since then I’ve continued taking more-than-forebrain-thinks-is-necessary at night, but NSAIDs only during the day.  My reading and writing productivity has picked up significantly, talking barely hurts anymore, and I feel safe being in touch with my pain level again.

This is what I call the “nuke if from orbit” pain medication option, and it really seems to work.  Catching the pain before it “settles in”, or sending a surge against it, moves the baseline pain level back significantly, and lets you use less drugs over all.  The reluctance or inability to do this is another casualty of our awful attitude towards pain, where medication is essentially viewed as a failure of the individual to tough it out.

But nuke it from orbit doesn’t always work either.  Right now I’m in a tiny bit of pain.  It would take a lot of drugs to get that to zero, possibly an infinite number.  I faced a stronger version of this problem right before the last surgery, where the nerve damage side just kept upping the pain level to keep up with whatever amount of drugs I took.  In that case, I was better off simply accepting that pain was the state of being I was in right now.  The most helpful thing to do was meditate, except that while meditation often helps by relaxing the jaw, meditation for the goal of pain relief doesn’t.  Since most of the emotional impact of the pain was frustration and fear over my ability to think (read/write/plan) while in pain, practicing thinking while hurting would definitely lead me to look back more fondly on the experience, although it probably would have led to more distress at the time.

The first lesson here is to treat for the pain level you have, not the pain level you wish you had.  The second is to aggressively counteract pain at the first peep of its head.  The third is to learn to live with pain instead of fighting it.  I guess this is one of those “wisdom to tell the difference” situations.

*Fine, I started to set up a dev environment and that took two weeks because I was still very sleepy and android development studio is stupid.

Any straw that doesn’t break your back must be weightless.

Toxoplasma gondii is a single-cell parasite usually associated with cat feces, although undercooked meat is the more common form of infection.  For years, everyone knew that T. gondii was totally harmless unless a pregnant woman caught it at a very particular stage in the pregnancy, at which point it caused miscarriage or devastating birth defects.  I probably learned about this younger than most because this was my parents official reason for not letting me have a cat while they were trying to conceive.  But eventually I got my cat and never thought about it again*, because I was not a pregnant woman.  While the concept was gross, 20% of the US and 30-60% of the world has it, so clearly it’s harmless.

Then science began to poke around a bit more.  Toxoplasmosis causes pretty drastic behavior changes in rat, as demonstrated by this adorable video of rats attempting to cuddle a cat…

…which is actually a video of a paramecium attempting to get this cat to eat the rats so it can sexually reproduce in the stomach.  Enjoy that mental image.  If it can have such a strong effect in rats, might it have some measurable effect in humans as well?

Yup.

First, T. gondii was always considered dangerous in immunocompromised individuals (e.g. AIDS patients). But it gets worse. Research revealed associations between T. gondii and lower IQ in children (which may reverse with treatment), suicide attempts, decreased novelty seeking, car accidents,  lower IQ  in men, greater friendliness and sexuality in women , and perhaps 20% of all schizophrenia.**

Here is what I think is going on.  The human body is incredibly robust.  It can take a number of hits and show only a very minor decrease in function.  But if you already have enough hits against you (HIV, age, genetic predisposition to schizophrenia), it can have a big effect.  Or maybe it will do nothing, but it uses up one of your hits, so when the next blow comes, you don’t have the energy to fight it.    This is why the phrase “only dangerous in immunocompromised individuals” bugs me so much.  First, everyone who doesn’t die of trauma lives at the mercy of their immune system.  Second, immune function is not bimodal.  There’s lots of people that don’t have AIDS, but do have, I don’t know, multiple chronic complex infections in their jaw requiring extensive surgery to remove.  Or they’re poor and have substandard housing and nutrition.  Or they pick up a second parasite while camping.

Telling these people- who don’t have AIDS or leukemia, but aren’t functioning at optimal either- that T. gondii, or any other aggravator, can’t affect them is like telling a working-poor person that ATM fees can’t hurt her because she’s not homeless.  It’s great that the fees are a rounding error to you, but don’t discount the cost they impose on others

*Which turned out to be totally justified.  Owning a cat is not a risk factor for toxoplasmosis, and I happen to have been tested as part of a larger parasite screen last year and am certifiably toxoplasmosis free.

**A lot of these studies are associational, which I usually frown upon.  I find it more valid in this case because causational studies in animals show similar effects.

…wait a second

We all know most genetics v. environment* research is done using a mix of monozygotic (identical twins), dizygotic (fraternal) twins , and non-twin siblings, reared apart or together.   The idea was that monozygotic twins share 100% of their DNA, and dizygotic and non-twins shared 50%, so you could tease out the difference between environment and genetics that way.

The first problem was that identical vs. not identicalness was originally assessed based entirely on looks.  But not all genetically identical twins look alike, and not all twins that look alike are genetically identical.  Mislabeling this makes genetics look less influential than they are.

The second problem is that this discounts nine months in utero as an environment, when it is probably the most influential environment you will ever be in.  Some (though not all) studies use dizygotic twins. vs non-twin siblings to measure the affect of a shared uterus, but there’s a lot of confounding variables there.  Worse, 75% of monozygotic twins are monochronic (sharing a placenta), and an exceptional few are monoamniotic (share an amniotic sac) (dizygotic twins never share a placenta or amniotic sac).  Monoamniotic pregnancies are rare and dangerous so we don’t know much about the twins, but monochronic twins are more alike than dichronic-monozygotic twins, despite the fact that sharing a placenta is more like to result in unequal distributions of blood, which can have huge effects.

The third problem is that not-identical -> 50% shared genetics was a reasonable assumption to make in the 1950s, or even the 1980s, but it’s not true. You have a 50% chance of sharing any given chromosome with a full sibling, which means your average relatedness is indeed 50%, but the total percent in common could be anything between 0 and 100**.  With genetic testing as cheap as it is, there’s no excuse not to test study subjects for exact relatedness.

*A stupid framing to begin with

**With complications from crossing over between chromosomes.  The probability math on this is straightforward but the actual calculations are so ugly because it depends on which chromosome crosses over and where.

The Real Reason Ebola Should Scare You

Ebola is not that contagious.  It’s easier to catch than HIV*, but way less than the flu, or norovirus**, aka stomach flu.  One of the Ebola nurses flew on two planes before she was quarantined, and so far no one has reported catching it.  Do you know how good planes are at transmitting illnesses?  Extremely.  So for me, the scary part of learning that two nurses caught Ebola while tending to a patient is that if their/the hospital’s hygiene was so lax as to allow transmission of Ebola (even after they elevated the hygiene procedures), what the hell else are the transmitting?

Greg Mitchell doesn’t give an exact answer, but he does have a body count: 2000 people died from hospital acquired infections last week.  So if everyone could redirect their panic from the scary African disease to the nice WASPy ones and start designing emergency rooms that aren’t festering petri dishes, that would be great.

*Although because HIV has a long dormant period, a person with HIV will on average infect more people than a person with Ebola.

**I am still mad at norovirus almost killing me in 2006.

Cochrane review

This was going to be a post about zinc for colds.  I read many journal articles (fine, abstracts) and wrote many witty analogies.  Than my friend pointed me to Cochrane review, which did the same thing much more rigorously.   Some day I will be grateful for this wonderful resource but right now I am just mad my thunder was stolen

Edited to add: the friend was John Salvatier.

Pain, part 2: Options for Treating Pain

Anesthetic (e.g. Novocain):  This is a very good option for when you need to block an extraordinary amount of pain in a very specific area for a short period of time (e.g. dental work).  However, as someone who received nerve damage from surgery that exactly mimics the effects of local anesthetic, I can tell you that it is not a long term solution.  Feeling nothing is actually very weird, and makes it easy to injure yourself.

Non-steroidal anti-inflammatories (e.g. ibuprofen):  These are great for occasional use, and have their place for long term pain caused by inflammation (e.g. arthritis).  But they carry some heavy risks for long term use.  One, inflammation is often a helpful reaction.  Topical NSAIDs helped my cat’s pain but retarded the growth of blood vessels in the eye which ultimately made the problem worse*.  Suppressing a fever can prolong illnesses.

NSAIDS are also hard on the stomach, which is bad for everyone, but especially bad for someone like me, who has long running stomach problems that interfere with my ability to absorb nutrition.  I completely wrecked my stomach with naproxen the week before surgery.

COX-2 inhibitors are a subclass of NSAIDs that target pain pathways more specifically, while sparing the gastic pathways that cause so many problems.  The problem is they also increase the risk of coronary events, to the point many were taken off the market and others restricted to single use post-surgery.  They’re so out of favor for pain relief that the three different medical professionals I begged for dental pain relief didn’t think to suggest them, even though I have many gastric risk factors and essentially no coronary risk factors.

Even before realizing COX-2 inhibitors might be perfect for me, I was very angry that they had been taken off the market.  The coronary risk was limited to a small subset of patients, of even of those, some might very well choose to live a shorter life in less pain, because pain is depressing.

Non-NSAID analgesics (e.g. tylenol and asprin): You know how new drugs like to advertise themselves as “safer than asprin?”  That’s because asprin is actually pretty dangerous.  Not super dangerous, but dangerous enough it might well be denied FDA approval today.  Asprin is also a blood thinner, which is great for coronary patients but terrible for dental patients because it can melt the blood clot protecting the surgical site, leading to dry socket.  Some descriptions down play dry socket, but it is in fact both extremely painful (because it exposes a nerve to open air), and dangerous (because it leaves the wound open to infection).   Tylenol is the world’s worst way to commit suicide, because there are several days between the point of no return and actual death, and they are extremely painful.

Opioids (e.g. heroin): I’m told these are super fun for some people, but I have had many different kinds over the years (as one dentist after another fucked up trying to fix my mouth), and I hate them.  The milder ones (everything short of percoset) do nothing for me, and the stronger ones (percoset) are so supremely unpleasant I would rather be in pain.  The only exceptions were when I was literally dying of norovirus, and whatever opioid they gave me was apparently integral to me not dying, and when I got dry socket.  And even with dry socket, I only took them to sleep, because they were just so awful. I refused to even get a prescription this time, because they just don’t work for me.

But even for people who find opioids tolerable, they have serious risks.  They depress respiratory function, cause constipation, and reduce mental function.  They’re insanely addictive on a chemical level- which doesn’t mean everyone who takes them once is hooked forever, but does mean that most people who take them will go through an unpleasant withdrawal period, no matter how “legitimate” their reason for use.  People develop tolerance to the pain relief faster than to the negative side effects, and quitting them may leave them in more pain than they were when they started.  For all these reasons, opioids are pretty much exclusively used for acute pain management and terminal patients.  Doctors who stray outside this risk serious sanctions from the DEA and FDA.  Even if I found opioids tolerable, there is absolutely no way I could have safely used them for the months of surgery + recovery I am going through.

And because I’m working my cat into everything: he doesn’t like opioids either.  Even after having four teeth pulled he fought me on taking his medicine, and then he just stood around in a stupor and drooled.

Tricyclic antidepressants: This is a cutting edge use of a very old drug.  I was prescribed topical doxepin by the doctor who did the research proving it was useful for oral pain- and even then, he was researching a different kind of oral pain.  It had some ugly side effects: I fell asleep immediately upon taking it, and couldn’t stand being touched (anywhere) the next day.  It left some numbness that lasted indefinitely- when I ate spicy food I could feel in my throat where the liquid had trickled down.  On the plus side- it left some numbness that lasted indefinitely.  That was a huge improvement over the shooting pain I’d had before.  I eventually stopped because the permanent effects had boosted me to the point it didn’t hurt that much, and the side effects were getting worse, but it was overall a great experience.  If I hadn’t found something better it’s what I’d ask my doctors for now.

Capsacin (aka spicy food): This really only works for dental pain.  When you eat capsacin it activates all your pain receptors at once.  Which hurts a lot, but then you’re good for a couple of hours.

Cannibidiol (i.e. marijuana): This one isn’t as well researched as the others because it’s illegal at the federal level (although, I must stress, legal in my state for both medical and recreational use).  But everything we know about it is awesome.  People tend to use THC and marijuana interchangeably, but that’s not true at all.  Any given strain can very in the amount of THC and CBD, and some strains may not have any THC at all, or the treatment may not activate it.  THC causes a lot of the symptoms traditionally associated with marijuana use, like munchies everything being funny.  CBD causes nerves to stop hurting for no reason, and may do a bunch of other awesome things like reduce inflammation, encourage bone growth, decrease anxiety, fight cancer, and (I can only assume) whiten your teeth while you sleep.  There is essentially no way to kill yourself with it** and there’s no physical dependency.  I used this off and on after all three surgeries, and my use naturally trailed off after each one.  It either doesn’t have any effect on me mentally, or the effect was less than the pain it was stopping.

THC may work synergisticly with CBD.  In my case it makes me sleepy, which is a terrible trait for a recreational drug but an amazing one for convalescent therapy.

A note for dental use in particular:  you are not even allowed to use a straw, so you definitely cannot smoke anything.  The nice people at the medical dispensaries have precisely dosed pills, and if you are lucky, CBD tinctures.  These are meant to be taken sublingually, but if your pain is in your mouth you can apply them to the area and everything stops hurting really really rapidly.  It gave me an amazing sense of control over my pain and enabled me to take more risks, in terms of eating and talking to people, which really sped up my recovery.

I don’t want to get too much on the “yay marijuana” bandwagon, because it’s entirely possible that as its usage becomes more widespread we’ll find out it has some rare but nasty side effects too.  But I do think it’s a travesty it is treated as worse than ibuprofen or alcohol, when it is clearly better.

*I think his infection was also resistant to the first antibiotics they gave him.

**Weirdly, this may be true for humans but not pets.  When I investigated using CBD to treat pain from my cat’s corneal ulcer, I discovered that we are pretty sure there is no amount so high it can kill your pet in one sitting, but chronic use may lead to something resembling serotonin syndrome (aka the reason you have to be so careful when taking MAOI inhibitors).

Pain, part 1: Pain is bad.

This seems obvious, and yet we as a society seem to have chosen to ignore it.  The problem is not just that pain is painful, although that is a terrible start.  It’s how pain effects you.

Humans on the whole are remarkably adaptive.   Parapelegics can emotionally bounce back from spinal cord injuries in two months.  One of the very few things human beings never, ever adapt to, meaning they produce a permanent lessening of happiness, is pain.  Pain (and long commutes) will continue to depress your happiness forever.  If you lose a limb, phantom limb syndrome is actually a vastly bigger threat to your happiness than the physical disability.

Pain also effects what you are capable of doing.   In the months leading up to dental surgery, I felt like Harrison Bergeron; I had to race to finish my thoughts before shocks of pain broke up the chain entirely, and I couldn’t have a thought that took longer than the space between shocks.  I couldn’t really enjoy books anymore.  I clung desperately to the feeling of accomplishment I got from “finishing a seven season TV series”, because I really couldn’t do anything else. * This is depressing in general, and endangered my ability to keep the job that gave me the money to fix the problem.

Then there’s what fear of pain does to you.  Imagine if every time you socialized, there was a 10% chance you received massive convulsing shocks that took days or weeks to recover from.  That would probably depress your socializing a lot more than 10%.  Now imagine that applied to everything you ever do.  And that fear made the effect worse.  It would take series efforts of will to even hold a job, much less a full and satisfying life.  And while any given bout of socializing could be dismissed as a luxury, human beings inevitably get depressed when deprived of social contact entirely.

Pain makes it harder to treat the root cause of problems.  Exercise helps back pain, but back pain makes it hard to exercise.  I couldn’t get my cat to accept eye drops for his extremely painful corneal ulcer until I started giving him pain medication.  It only took two days for the eye drops to help enough that he no longer needed pain medication, but without those two days he might very well have lost the eye.

So I’m going to proceed from here in the understanding that pain is not only very bad, but often a bigger threat to people’s total well being than physical limitations or even fear of death.

*In fact, you can track my discovery of useful pain relief and when the root problem was fixed via my blogs and my goodreads queue.  I cannot tell you what a relief it is to be able to enjoy reading again.