Entering Pain Management in a Post Opioid-Epidemic World

I’ve been injured since December 2011; I long stopped keeping track of how long that is. Throughout this time I’ve largely declined pain medication because pain was a good indication of whether healing was taking place, and whether I was causing more damage to myself. I dealt with the pain in order to give conservative treatments a chance, and to prevent from developing an addiction to narcotics.
Around September 2015, four years after my initial injury and one month prior to my first surgery, I broke down literally and figuratively. I could no longer navigate my life around the constant pain. Through tears I explained the injury and how it had been managed to my primary care physician:

That I was initially told to have surgery but had been giving conservative treatments a chance instead. I’d completed physical therapy and two epidural injections. That I managed the past several years with frequent chiropractic treatments and continued physical therapy. Physical therapy was the reason I could still walk but I hadn’t improved so surgery was in my future. I was interviewing surgeons.

Instead of compassion and understanding I was treated with disdain. My request for pain medication from my primary care physician was denied because I “lack[ed] a history of needing pain meds.” Amongst other things I was told that “if it were really that bad [I] would have gotten them sooner,” and that I should have asked for pain medication from the surgeon. Nevermind the fact that I hadn’t yet chosen a surgeon. I was informed that new procedures had been implemented to keep narcotics ‘off the streets’ and I should see a Pain Management specialist.

I have never felt so horrified and alone. I had done everything right. Everything.

I tried conservative treatment.

I tried to live stronger than my pain.

I consulted several surgeons and never asked them for medication.

I did finally find a specialist and obtained a prescription but encountered even more frustration at the pharmacy. They didn’t have any of that particular medication in stock and couldn’t tell me when to come back because “procedures are in place to keep narcotics off the street.” They couldn’t accept the prescription for me come back another day; I was told to try another pharmacy or come back everyday to see if stock was replenished. I called other pharmacies but soon realized that staff can not discuss controlled substances over the phone. I was supposed to visit each store.

At the time I thought these were fairly isolated incidences; they really aren’t. Since entering our health-care system as a pain patient I’ve since discovered that primary care is routinely overshadowed by medication, and we’re are openly mocked by pharmacy professionals.

Like most people, I visit my Primary Care Physician for a variety of reasons; most visits are outside the scope of my injury and pain management. Still, my obvious awkward gait usually attracts the attention of staff. While they frequently ask whether my pain management provider gives me random drug tests; I’m rarely asked how I’m doing. Such interactions make me feel ignored as a patient because the actual reason for my visit gets pushed aside. There seems to be little concern for the actual cause of the pain, or mental and physical implications of it.

My experience at the pharmacy is still no better. I recently had to change pharmacies for insurance reasons. When I noticed my controlled substance was taking significantly longer to fill than the other medications I asked if there was a problem. I was informed that “sometimes this kind of medication takes awhile;” “no, they couldn’t give me an approximate time it’d be ready.”

Five hours, a phone call to them and another to my doctor later, someone finally told me the pharmacy was having trouble finding me in the state’s database. To me it’s absurd that a patient wouldn’t be called when there’s a problem with their prescription. But the common response is “well pain medication is highly abused so providers have to take precautions. Maybe they thought you were doctor shopping.” So it’s worth noting that this new pharmacy couldn’t find me in the database despite me having previously used the same pharmacy and doctor for several years.

What’s worse is walking into the pharmacy and knowing how pain patients are mocked, as shown in the two screenshots below:

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No other type of patient is so openly ridiculed.

As an athlete I never thought I’d become a chronic pain patient. Negotiating chronic pain is no fun; and it’s made more difficult by being trapped in an uncaring system.

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Historic Badwater Double an individual and team accomplishment

 

BWD map

The course for Badwater Double extends from North America’s lowest point at Badwater Basin to North America’s highest peak at the summit of Mt. Whitney. The 146-mile route between them is completed as out-and-back for a round trip of 292 miles. Tom Crawford and Rich Benyo were the first to attempt The Double in 1989. 

Florida resident Bob Becker made running history with his 2015 completion of the Badwater Double. Less than 40 people have accomplished this feat but Becker ensured his was an extra-special finish by coinciding it with his 70th birthday; enabling him to best the existing age record for completing the Badwater Double…by nearly twenty years.

The idea began shortly after finishing the 2014 Badwater 135. He thought to himself “what could I do that would be a personal celebration of my 70th, but also be ‘out there’ a bit.”

The Badwater Double is definitely ‘out there.’ Runners not only cross some of America’s harshest landscape, but they do so for little more than personal recognition.

Don bob kevin at summitt

The Badwater Double consists, in part, of summiting 14,505-foot Mt. Whitney. (left to right) Don, a fellow runner, Bob Becker, and crew member Kevin Grabowski celebrate reaching the top.

The 292-mile journey begins and ends at Badwater Basin, California, the lowest point in North America. From there the runner traverses 146 miles through Death Valley and up Mt. Whitney, then turns around and retraces the route back to Badwater Basin.

It would be a bit of a misnomer to call it a race, though, since there are no officials, central organization, or swag. Instead, each participant agrees to follow an unofficial set of guidelines. Those interested in completing the trek publicly post their intention including start date and time, then use some sort of GPS to record and verify their progress. There’s very little fanfare upon completion; just the satisfaction of having completed a physical feat very few others have attempted.

For most people, the idea of truly making history is just a wild dream. And if television is any indication, people thrust themselves into the limelight to extend any 15 minutes of fame. Bob is not one of those people. When you talk to Bob you very quickly learn that this was no publicity stunt. “It was,” he says simply “for personal satisfaction. I did not expect [an] outpouring from so many people.”

Testing physical and mental boundaries through extensive miles is just a way of life for him, and runners like him – ultra runners. What draws people like Becker to such long distances may surprise you.

Becker told me: The entire notion of camaraderie at these races, and actually supporting each other out there when someone is in trouble, is the first thing I observed at my first ultra. More than any other factor, that is what created the “love at first sight” [that] has kept me coming back and [drove me to become] immersed full time in the sport as a race director.

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A member of Becker’s team assists him while a television crew watches. Bob Becker’s journey will be included in a BBC documentary slated to air sometime in 2016.

Indeed, Race Director of the Brazil 135, Mario Lacerda, echoes the sentiment noting that camaraderie is necessary for most ultra-runners. He explained that most people in ultra-running aren’t runners; they’re people looking for something different in their life, an experience to be had for the duration of all those miles. “We really understand that we need help. We understand that we need a support team because we are all facing something bigger and harder than we can do by ourselves.”

Because of ultra’s anchor of teamwork it comes as no surprise that Becker had a team helping him behind the scenes to complete his spectacular Badwater Double. Such support teams, called a crew, are common within the ultra-running circuit; they’re like the NASCAR Pit Team, except for a runner instead of a racecar. Crews provide a variety of functions including first-aid, logistics, and moral support.

Using crew is largely an individual choice; few races actually require them. Some runners, like Byron Roca also from south Florida, only use them in specific circumstances. He says he’ll use crew as a safety net if he plans to try a crazy pacing strategy. Other runners don’t use a support crew at all – runners Dusty Hardman and James Schroeder have both finished uncrewed hundred-mile runs.

Bob likes to have a crew accompany him on his long races, he says, to support and maintain the race plan that he has for that event. “When changes to that plan have to be made along the way, they help determine and support the best alternative to help get you to the finish line.”

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Bob Becker, pictured center, completes the first leg of the 292 mile out-and-back journey called the Badwater Double. At 70 years young he became the oldest to complete the feat. With him are crew members (left to right) Kevin Grabowski, Beth Stone, and Roger Burrus.

Two teams accompanied Bob; one for each leg of the trip. Roger Burruss was part of both teams who handled logistics, pacing, and making sure Bob had the fuel he needed throughout.

Roger agrees with Mario’s assessment on the nature of ultra-running and noted that the crew’s experience mirrors that of the runner. “We experience ups and downs,” he says, “and tend to share our thoughts not only on the race but life; and that brings a closeness to one another.”

Bob’s noticed something the longer he races: There is, for me, an increasing dependence and closeness to each crew, no matter the role they are playing on the team. It is true that it is on the runner to get the job done, to tough it out and finish. But it is that crew support that makes it possible to retain the focus in “down” moments when all you want is for it to be over.

 

 

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What ultra-marathons have to do with life

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Runners participating in ultra-marathon races have a reputation for being a bit eccentric, weird, and generally overboard. That reputation is partially derived from the colorful personalities and tattoos that adorn most of these runners. Anecdotes about finishing races in spite of extreme fatigue, blisters, boredom, and irritability help bolster that perception. And it also doesn’t hurt that the only prizes for completing such extreme endeavors are bragging rights and a very large belt buckle.

It’s easy to see why these runners earned that reputation because on its surface ultra-running is nothing more than the illogical act of traversing an insane number of miles on foot in pursuit of a gaudy fashion accessory. At its core, though, the ultra-running experience is a lot like life. Ultra-running shows its participants that long-term goals are best accomplished through patience and forethought, that progress is not deterred by obstacles, and that individual pursuits usually involve outside assistance. These ideals are not only applicable to endurance races but also to attaining personal and professional goals.

It’s near impossible to reach any long-term goal on a whim. The process is calculated and deliberate no matter what that goal might be. You must research the best possible tools and route, practice the applicable skills, and eventually follow through on the necessary action despite the possibility of failure.

It goes without saying that you’ll encounter many emotional and physical barriers along the way. Finding a way to work around those obstacles is an important attribute during endurance events, and in life. Not letting them deter progress is how it’s possible to reach that proverbial finish-line.

Generally, at the end of any pursuit, only a singular recipient is recognized: the runner completes the race; only one name is written on a degree. But achieving these goals usually involves receiving help from others. It wouldn’t be possible to reach these seemingly individual achievements without the guidance, support, and push from those around you.

The attitude and thinking needed to successfully complete an ultra-marathon echo those encountered in real life. Fulfilling any long-term goal requires planning and follow-through. Its participants have to persevere despite challenges, and usually accept help along the way.

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The Face of Commitment

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In December 2011 I suffered an injury that has since proven to be my toughest opponent; requiring physical and mental strength I had no idea I could muster. And like any journey, it’s had its share of successes, and setbacks… And the corresponding moodiness.

Not long ago one of those moody setbacks came in the form of a particularly rough couple of days. The hows and whys I no longer recall. Sitting in my car before yet another workout that I really hated, I asked friends for some encouragement. Many responded with e-hugs and exclamation points. I also looked online for some sort imagery to remind me that I was committed to progress. What I discovered is that the motivational posters looked nothing like I was feeling.

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Google Images and I agreed to disagree about what ‘commitment’ looked like. Holding hands is not what I had in mind.

I was in tears throwing stuff across the car. My friend’s well-intended remarks and the posters’ sanitized images just made me more upset because, well, I felt stabby.

They make being committed to something sound so easy, noble, pretty; like you just grin and bear whatever it is you’re experiencing.

“No Whining, No Excuses!”

“Suck it Up”

“Soldier On”

In that moment I was absolutely failing at any of those. My tears, frustration, and irritation surely meant that I had lost my commitment to getting better.

Have you ever seen a motivational poster for being committed that didn’t involve perfectly orchestrated serenity, power, or some combination of both?

I rest my case.

Commitment in practice though, when it’s really needed, is absolutely not pretty. Sure, the result of commitment looks strong and magnificent, but the actual doing part, the actions that grow that strength, is very very ugly.

Commitment happens at your weakest, most painful, and completely obliterated. Reaching it involves crying, fighting, feeling helpless and pointless. There’s nothing beautiful about finding your mental and physical gutter of despair. There’s nothing poetic in believing you’re incapable of going any further, any harder, or any longer than you already have.

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Just put your big girl panties on, right? Shit gets real ugly once the mood changes.

Commitment is having all the excuses, the whining, and the reason to quit but doing the exact opposite, albeit kicking and screaming the entire time. It’s dragging that broken carcass of a spirit towards a goal it can no longer fathom. You’re not sure how or why you continue forward. You just do.

Commitment is not “No excuses;” it’s what you do when you can do nothing else. It’s there when all you have is excuses.

Commitment is carrying out what is necessary. And sometimes what’s necessary ain’t pretty.

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Book Review – Idle Feet Do the Devil’s Work

 Disclosure: I didn’t receive a free copy but I did snag a cool discount by pre-ordering the e-book.

Idle Feet Do the Devil’s Work is Ray Charbonneau’s fifth book, though the first that I’ve read. The title struck me on a deeply personal level since my own feet are currently very idle. You see, I’m on the Injured Reserves list and have found that all this new-found free time gets me in trouble. I thought Idle Feet would be a story about all the crazy hijinks he created when left to his own devices instead of training. It wasn’t. But that doesn’t mean I was disappointed.

What I learned is that for Idle Feet Do the Devil’s Work Ray compiled his favorite published short stories and articles from the last four years into one collection. What you’ll find is a mostly light-hearted look at runners, races, and advice. All that humor doesn’t mean Ray neglected serious topics such as the increasing cost of race fees, or the Boston Marathon bombing. Comical advice interspersed with heart-warming anecdotes makes Idle Feet an easy fulfilling read.

Visit his website to order your copy of one of the few running books that doesn’t try to sell you the secret to shaving 5 seconds off your next marathon, talk about barefoot running, or even have a blank training plan.

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Inaugural multi-day ultra in Florida invites international elites, novices

Icarus LogoThis November Ft. Lauderdale, Florida will become home to the first 6-day foot race in the southeast region of the continental United States. Aptly named for the Greek mythological character symbolizing ambition, Icarus Florida Ultrafest wants its participants to push themselves further than they ever believed possible.

Though the idea of a 6-day foot race may sound like a new extreme twist to the already formidable sport of ultra-running, in actuality quite the opposite is true. People have been traveling hundreds of miles over the course of several successive days since the early 1800s. Robert Barclay Allardyce set one of the first known record in 1809 by run/walking one mile each hour of each of 1000 consecutive hours.** During the “golden era” of multiday races, roughly the 1870s and 1880s, thousands of spectators, several hundred vendors, and even musicians crowded around a small indoor track to be part of the excitement. The

The starting line of ultramarathons in the 1800s (left) seem to be filled with more people who happen to be wearing more clothing than in the 2000s (right).

atmosphere more resembled the spectacle currently reserved for large popular marathons such as Disney than the low-key un-commercialized ultras that runners are now accustomed to.

Director Andrei Nana hopes that Icarus Florida Ultrafest attracts both new and veteran ultra-runners. He also wants to raise American ultrarunning to an international level. So far it appears he has succeeded in developing an event that satisfies both goals.

The course consists of a one kilometer loop through beautiful Snyder Park that is completely flat and shaded. Its main aid station area will be located near the start/finish and “serve three hot meals per day along with ample gels, sports drinks, electrolytes, granola bars, cookies, cakes, and snacks.” Each runner will always be within one kilometer of all their supplies and personnel.

Elite runners will appreciate that Icarus Florida Ultrafest is a USATF– and IAAF-sanctioned event on a USATF- and IAAF-certified course, marking it as truly a professionally competitive event. USATF designation means that athletes can submit performances as an official record or national ranking; IAAF designation describes an international elite field adhering to anti-doping and timekeeping standards. Additionally, Icarus will offer qualifying options for the World 24 Hour Championship and the Spartathlon. The course’s small flat loop combined with cool weather should yield some pretty spectacular records.

Snyder Park in Ft. Lauderdale, FL (USA) offers the perfect combination of shade and flatness for runners going the distance.

Snyder Park in Ft. Lauderdale, FL (USA) offers the perfect combination of shade and flatness for runners going the distance.

Andrei Nana made sure novice ultra-runners would feel welcome by creating shorter races run concurrently to the six day event. Each day runners will be able to participate in a three, six, 12 or 24 hour race. Marathons and half-marathoners interested in getting a feel for the atmosphere and challenge of an ultra could comfortably participate in those events; and as Nana explained “those races are held alongside the six day competitors so it’s very possible to have a world record holder running with someone who has only run a few races.”

With less than twenty six day events in existence, only four within The States, that’s a very real possibility.

What: Icarus Florida Ultrafest
Where: Snyder Park – 3299 SW 4th Ave, Fort Lauderdale, Florida 33315, USA
When: November 10th – November 16th, 2014

 

** 9/4/14 Correction – An earlier version of this piece incorrectly stated that Robert Barclay Allardyce traveled 1000 consecutive days. The mistake has been corrected to 1000 consecutive hours.

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Athletic Shorts: Jim ‘Animal’ Schroeder

In just a few weeks I get the honor of being part of the crew that will support Jim Schroeder, or Animal as he’s often referred, as he completes his first Badwater 135. Badwater is one of ultra-running’s most difficult courses, pitting the participants against

Lynsey and Jim post-coffee and pre-100 for the Keys100 in May 2014.

Lynsey and Jim post-coffee and pre-100 for the Keys100 in May 2014.

California’s extreme terrain and weather as well as themselves. The 2014 course contains a grueling 19,000 feet of elevation gain, and two ascents into the Sierra Nevada.

I’ve had the pleasure of watching him perform at just about every formal and informal trail and road running event in Florida. I thought you guys might like to learn a little about this spectacular runner and the journey that brought him to Badwater.

To hear him tell it, earning the moniker ‘Animal’ was mere happenstance; the nickname simply stuck after a running buddy created a giant birthday card wherein a picture of his face was transposed onto the body of Animal the Muppet. But to most of his running associates Jim’s moniker is a reminder of his persistence and unwavering spirit on and off of the road. No exaggeration.

Animal is the primitive man and crazed drummer of Dr. Teeth and The Electric Mayhem, the fictional band from The Muppet Show.  Jim is the extraordinary man and crazed runner of FUR, the nonficitional online running community Florida Ultra Runners. The resemblance is uncanny.

Animal is the primitive man and crazed drummer of Dr. Teeth and The Electric Mayhem, the fictional band from The Muppet Show.
Jim is the extraordinary man and crazed runner of FUR, the non-fictional online running community Florida Ultra Runners.
The resemblance is uncanny.

Off the road, Jim completed three deployments to the Vietnam War zone while serving within the US Navy then went on to earn a PhD in Electrical Engineering. He’s successfully held positions within several large defense contractors and currently works as a Research Professor at Florida Institute of Technology in Melbourne, FL.

Jim says that running has always played a big part in his life. “I grew up running: Running to the sand box; running to the back yard; running to the pine grove; running to the neighbors; running to pick wild raspberries; running after my siblings; running from angry buzzing wasps; running for cover from severe electrical storms; running in heat, humidity and frosty cold and snow; running for pure simple joy; running everywhere and anywhere.”

On the road, Jim enjoyed success in shorter distances and could boast a 20 minute 5k. But a sudden injury in June 2000 sidelined him. He chronicled the agony and ecstasy he

pictured left to right: Jim, Kayte, Luis, Lynsey Group crew photo at mile 90 of the 2014 Keys100.  Jim achieved a personal best of 28:39:03 earning him an age-group award.

pictured left to right: Jim, Kayte, Luis, Lynsey
Group crew photo at mile 90 of the 2014 Keys100. Jim achieved a personal best of 28:39:03 earning him an age-group award.

experienced that accompanied that experience in Zen Track Rambling. During his return to the road he found that although he could no longer run competitively he could maintain a slow pace infinitely.

An ultra-marathoner was born.

Having since completed over 110 cumulative marathons and ultra-marathons it becomes easy to see that there is no stopping him.

Jim Schroeder is definitely an animal: focused, determined, smart. I look forward to unleashing him upon Badwater in a month.

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