Yesterday, an hour after my physical therapy session, I had a follow-up appointment with my Stanford Pain Management Center doctor. We discussed how the low-dose naltrexone is going, and we decided to change the dosing schedule from nighttime to daytime, since I've been having trouble getting to sleep ever since starting it. I don't recall having that trouble with it last summer when I was in the treatment study, but I do remember being told that some people did better taking it in the daytime instead of before bedtime. Naltrexone interferes with the natural opioids in my central nervous system, so it makes sense that I would experience a few hours of wakefulness after taking it since I would not be able to feel any sedating effects of my natural opioids.
I also discussed the problems I've been having with physical therapy -- not only the difficulty of the exercises themselves, but the grueling twice-a-week schedule. My doc said, "Gee, I didn't know it was too fast-paced for you. It's good to know about that." That was a headdesk moment for me, now that I have only one session left!! Gee, doc, ya think maybe ya coulda talked it over with me ahead of time, before setting up this schedule for me?? What good does your lightbulb moment do me now??
She decided that more physical therapy would be good for me (yikes!), but only once a week, for 4 to 6 weeks, getting aquatic therapy in a heated pool. Stanford does not offer aquatic therapy, so I have to find someplace else to go for that (at an additional cost). She also said that most of the patients in the physical therapy department are younger people with sports-related injuries, and they're not used to patients like me with chronic health issues who need a different, slower approach. Another headdesk moment for me; if you knew this, doc, why did you set up the schedule the way you did? It's like I started physical therapy with two strikes against me.
The doc also thought relaxation biofeedback would help reduce stress and tension, both mental and physical, and she offered a referral to a psychologist at Stanford for that.
I mentioned the problems I've had with stiffness and tight muscles, and how I do the stretches but I tighten up again overnight anyway. "But not if you stretch every day!" she butted in. For crying out loud, yes I do stretch every day and I still . . . oh, fuck it, forget it, never mind. If she's got her mind made up I'm being dishonest or exaggerating, then I'm not going to bother wasting my breath, especially when I'm in pain and tired.
Then I was left alone in the exam room for two geological ages while she put together these 2 referrals. She was running late to begin with, and my stiff neck began hurting worse and worse sitting around waiting for her to return. The physical therapy session earlier that day had already ratcheted up the pain in my neck, plus sitting for a long time in those awful non-ergonomic chairs in the exam room, all added up to considerable pain. You'd think a pain management clinic would have decent chairs to sit in, but for some reason the chairs there were the pits. Not even the extra-strength Tylenol I took 15 minutes before the appointment seemed to help. My neck was screaming louder and louder in pain as each minute crawled by, made worse by the fact that I had no idea what was going on or how much longer I had to wait around. Even though I distinctly heard her say that she'd be right back, my doc was gone so long I thought she'd forgotten about me and moved on to her next patient or three.
Once I finished doing all 3 crossword puzzles from the Sunday paper, I used the rest of the time to practice some of the pain-decreasing strategies from the chronic pain treatment study I've been in lately. It was hard to concentrate, but I think it worked a little bit. Or maybe it was just wishful thinking. I was so glad when the doc finally came back to finish the appointment and I was able to get out of there and get home. I am so not looking forward to my next follow-up appointment.