My Story

I just finished my last final of physical therapy school and now only have my last rotation in pelvic floor and the PT boards exam left before I can practice. With school coming to a close, I've thought a lot about how I got here. I've blogged about my medical journey for seven years now, but I've never put my entire story together. A few months ago I was asked to write my story for Pelvic Pain Explained, a book written by two physical therapists that is due out in January 2016. I am thrilled to share my essay with you now and hope you look for it when it hits shelves in a few months!

Part I:

"Birds make great sky-circles

of their freedom.

How do they learn it?

They fall, and falling,

they are given wings."

-Rumi (translated by Coleman Barks)

            I was a busy college freshman only concerned with three things: my studies, tennis practice, and going out swing dancing with my boyfriend. I was young and eager to figure out my place in the world. Every day I would wake up early for tennis practice and hit for a few hours. Then I would quickly wolf down breakfast at the cafeteria and go to my classes before returning in the afternoon for weightlifting, conditioning, and more drills. I was known on the team for my mental toughness and my ability to do whatever it took to win.

       That strength would disappear when I first had sharp pain with intercourse the summer after my freshman year. My boyfriend and I had been together for eight months, and up until that point, sex had been pain-free. Obviously concerned, I began seeing several gynecologists. The first told me I had a yeast infection, gave me some medication, and sent me on my way. The pain continued, so I saw another gynecologist on campus who told me I had a UTI, gave me some medication, and sent me on my way. The pain only worsened, and one night during my sophomore year, I felt such a stabbing pain that I found myself in an ambulance on my way to the emergency room. The doctor on call disregarded everything I told him and told me I must have an STD and tried to treat me for it. When I explained this was impossible as I was in a committed relationship that practiced safe sex, and besides hadn’t had intercourse in months, he shook his head, said I must be lying and there was nothing more he could do. I left the ER that night feeling ashamed and misunderstood.

I felt so alone in my pain - no one could see or understand I was hurt. I closed up for months, unable to tell anyone what I was going through. The pain continued to break me down, and I found it more and more difficult to make it through my school work and daily tennis practices. I began skipping classes because I had difficulty sitting through lectures and placing pressure on my pelvis. If I had to attend class, I brought ice pack pads to put in my underwear and wore bulky sweatpants so no one would know. After continued frustration, I went to a fourth gynecologist who mentioned vulvar vestibulitis for the first time to me. She explained this was a new diagnosis for women who felt sharp pain around their vulva and referred me to a specialist in Philadelphia for further treatment.

            During my first visit to the specialist, I was prescribed an estrogen-based cream to build up the tissue around my vulva. I was also placed on an increasing dosage of an antidepressant as part of a pain control intervention. It had disastrous effects on me. Over the course of the next few months, I experienced extreme emotional swings. I would cry in the shower and found myself yelling at those closest to me. The medication also made me extremely groggy and made it even more difficult to focus on my school work. My dad drove to my school several times a week to type my papers while I would dictate from bed. I no longer felt in control of my body or my mind. It was the furthest from myself that I have ever felt.

Not able to handle the side effects any longer, I returned to my specialist and I remember sitting across from her in a small, cold room. I was frustrated that my treatments weren’t working and wanted answers. She looked into my eyes and told me that vulvar vestibulitis is a chronic condition and that there would always be flare-ups, so I had better start preparing to live with this for the rest of my life. I felt the last bit of hope in me was shattered. I would never get better? How could I continue to live my life like this? The word chronic felt like a prison sentence. It meant both the certainty that I would have pain and the uncertainty of how it would affect me. I was trapped. I sat motionless on the train back home that day, watching the world whirl by me. I felt as if my life was rushing past me and I was missing it. To make matters worse, this visit coincided with a bad break-up only weeks later. We had been together for two years, but the weight of my illness became too much for him to handle. I believed no one would ever love me again, that I was cursed to go through this life alone. There was no sense in looking ahead to the future. I was now living day to day.

Since conservative treatment had failed, my specialist signed me up for a vestibulectomy. If the vulva were a clock, this surgery would essentially cut out 4:00-8:00, the portions that were causing me the most pain, and would replace them with internal vaginal tissue. In my case, the issue with this last resort surgery was its narrowed focus. It would cut out the place I first felt pain, but what if there were more to the story? What if my pain came from elsewhere? These were questions I did not have enough knowledge to ask.

It was at this point that I turned to writing and started a health blog called “Sky-Circles.” The title was based on a poem by Rumi about having hope in the face of struggle. I had always been an avid reader, but I turned to poetry when I was sick - not as a hobby, but as a necessity. I sought solace in the words of Mary Oliver and Rumi. And eventually, they inspired me to write. It had been seven long months of misdiagnosis, failed treatments, and continued pain that I had kept hidden from everyone but my immediate family. Writing was cathartic and allowed me to share my story. I found a nurturing online community where women could share their experiences and seek guidance. Only weeks before my vestibulectomy, a reader of my blog wrote to me and suggested that I see a women’s health physical therapist because something else could be referring pain to my pelvis. She gave me the name of Liz and Stephanie’s practice in San Francisco and after researching what pelvic floor physical therapy entailed, I decided it was time to become proactive about my health. This whole time I blindly let my doctors dictate my plan of care. It was time for me to become educated before making any more medical decisions. I booked an appointment and my flight, and two weeks later, my mom and I found ourselves driving up and down the hills of San Francisco. We would soon learn that up until this point, doctors had been looking at my pain through a narrowed lens. We were about to step back and see the bigger picture.

Part 2:

“But who

can understand what life is like

when it begins to crumble?”

-Mary Oliver

            It wasn’t my first time seeing a women’s health physical therapist. I had previously seen two in New Jersey who claimed expertise in the field, but in hindsight, had no idea what they were doing when it came to my case. The first only prescribed Kegel exercises and said I needed to strengthen my pelvic floor. The second used a biofeedback machine to show me I needed to relax my pelvic floor. Going to San Francisco was a completely different experience. Liz performed a comprehensive evaluation that included an internal pelvic and external orthopedic exam. She paid close attention to my hips, testing my flexibility and strength. She also asked extensive questions about my medical and athletic history. At the end of the visit she told me her findings, which included limited range of motion at the hip, indicative of labral tears. She explained the asymmetrical rotation of tennis led to repetitive motion at the hips, causing stress to the musculature and joint. Liz also explained that hip trauma can refer pain to the pelvis. She recommended seeing a sports physician and having imaging done immediately. I flew back to the East Coast feeling more educated and more in control of my future. I was in the middle of my junior year and felt hopeful for the first time that I would make it to graduation pain-free.

            Sure enough, I had tears in both my left and right labrum, and spent the next two summers getting them repaired. They ended up being two of the biggest tears my surgeon had ever seen and required extensive rehabilitation. I found a new pelvic floor physical therapist in NYC, who did extensive internal and external manual physical therapy work, as well as strengthen and stretch my hips. We discovered my pelvic floor was extremely tight, as well as my obturator internus and piriformis muscles. This was an explanation for why sitting had been so painful. Slowly, I started improving and feeling more like myself. My hips became stronger and I felt ready to get back to my life. When I became a senior, I was named captain of my university’s tennis team, an accomplishment I thought I would have to give up for good. I put my patient identity to the side and became an athlete again. I played my heart out, but as the matches continued, the pain in my hips returned. I had to leave halfway through the year to focus more on recovery.

            Although my hip surgeries were successful, I was still having setbacks in my treatment. I continued to have pain throughout my body. I found a new pelvic health specialist and went through two years of traumeel injections, a natural anti-inflammatory to help reduce pain. She would give them to me at certain trigger points around my vulva, vaginal opening, gluteal muscles, and hips. The injections only lasted a few minutes, but needles going into your vagina and deep into your muscles is not an easy procedure to sit through. I would have to bring a pad for the walk home to prevent the blood from staining my underwear.  

Around this time I finished my degree and accepted an exciting opportunity to work in environmental advocacy in Denver. I wasn’t healthy yet, but I was tired of waiting to start my life. In many ways, I needed an escape. Unfortunately, after less than two months of working, I called home crying and explained I couldn’t do it anymore. My parents, steadfast in their love and support, picked me up from the airport that weekend.

Back home, I went through yet another surgery, repairing tears along my pubic bone and surgically releasing my tight adductor muscles. I was infuriated and upset that yet again, my life was back on hold. I still had difficulty sitting for longer than 15 minutes and dealt with constant, unshakeable pain. But giving up wasn’t an option for me. I went to physical therapy after my third surgery and was referred to a pain doctor for prolotherapy injections. These differed from my previous injections because they were more aggressive and required longer sessions.

Every month for the next year I went through trigger point injections in my hip, pelvic, and gluteal regions; the idea being the irritant glucose solution would trigger the body’s natural healing process and repair damaged areas. Each treatment was over an hour of repetitive injections with long needles. Out of all the things I went through, these treatments were undoubtedly the worst. During the first one, I was unprepared, but managed to stay silent until I curled up in the back of the car while my mom drove me home. I cried and cried and cried. I cried out in pain, for going through something so awful, for not knowing when it would end. I cried because I wanted to be braver, stronger, better. I cried because it felt right and because I needed it and because I wanted to feel something other than pain.

            And so, having been there myself, I want to tell you that it is okay to be at your worst. To cry your heart out because you feel defeated and alone and scared. It’s okay to feel pain, to lose control and run away for awhile. It’s okay to lean on your friends and family, even though you have been for weeks or months or years. It's okay to be vulnerable and ask for help and see a therapist. It's okay to shut yourself down and lock yourself in your room. Just do whatever you can to make it through the day. Know that change is the only constant in life, and tomorrow always brings new possibilities. After six months of enduring the difficult prolotherapy treatments, I finally started to notice a decrease in my pain.

Part 3:

“One day you finally knew

what you had to do, and began...”

-Mary Oliver: The Journey

I continued to document my medical and emotional struggles online since writing was so therapeutic. My blog began to grow in readership as more women searched for answers. It soon reached tens of thousands of readers from across the world. What began as a personal release became an avenue to spread awareness about an unknown and too-often misunderstood topic. I unexpectedly became a confidant and mentor to others struggling with pelvic pain. I even appeared on an MTV True Life episode to further advocate women’s health, especially the intimate connection between the hips and pelvis. I received hundreds of emails from readers expressing their gratitude for my openness and asking for help in their own medical struggles. As I read more of these emails, I realized I could offer more than just an encouraging response or a referral. I realized over these past few years, my path continued to lead me back to women’s health.

One day, I was sitting in the exam chair at my specialist and suddenly knew that I should become a women’s health physical therapist. Despite the barriers of going back to school and my continuing health problems, I wanted to help others find answers sooner than I found mine. I wanted to offer comprehensive medical care that looked at the whole body, the whole person. I wanted to help others overcome struggle and hardships and help them persevere and make a meaningful life for themselves. And so, I set off to give my own life more meaning.

In August 2012, I started at Thomas Jefferson University in Philadelphia, PA. For the past three years, I have worked towards my doctorate degree in physical therapy and my dream of becoming a pelvic floor therapist. As I find myself mere months from graduation, I am excited and eager to begin and help my patients heal. My dream is to develop a practice that focuses on holistic pelvic health, especially female athletes. I want to develop protocols for these women, to prevent injuries like mine from occurring to others in the future.

I have been able to focus on my health, as well as my schoolwork. During the first year of school I worked with a new pelvic floor therapist in Philadelphia to manage my residual pain through aggressive manual work, strengthening exercises, and stretching. I am happy to report that after that first year I have not been back to physical therapy and have stopped all injection treatments. I have also been able to fall in love and have pain-free sex for the first time in five years I am beginning to love my body instead of seeing it as a battleground. I continue to live pain-free through preventative care, such as maintaining a healthy, balanced diet, stretching tight musculature, training with functional movement, strengthening my core and pelvis, and utilizing good body mechanics. I also focus more on emotional health, reducing stressors in my life, by meditation, reading, and yoga.

People often ask what helped me the most during my recovery. With such a complicated medical history and trying so many interventions simultaneously, it is difficult to pinpoint the exact medical impetus for my healing. After going through physical therapy school, I firmly believe in the strong connection of the pelvic floor and the hips. The surgeries I went through fixed my body’s mechanical problems, while the proceeding physical therapy strengthened muscles that were weak and stretched muscles that were overcompensating.

The most useful thing for me during this entire process has been the obtainment of knowledge. Self-education allowed me to take control over my own health care once I started researching which competent specialists to see. As a physical therapist, it’s a requirement to be a lifelong learner, but I urge other patients to actively seek information so they can be proactive about their health.

Part 4

“As for myself, I swung the door open. And there was

the wordless, singing world. And I ran for my life.”

-Mary Oliver: Work, Sometimes

My story is about broadening perspective. What began as a sharp, localized pain in June 2007, grew to encompass a journey throughout my body and mind for the next seven years. When I was in the midst of my pain, I would have done anything for someone to take it away from me. When I felt the most broken, a dear friend gave me a small Japanese pot with several gold lines. I thought it was an unusual gift until I read the card, which said it was a piece of Kintsugi pottery. It is a Japanese method of fixing cracked pottery with gold or silver. It is more than an art form, it is a philosophy. The Japanese believe there is beauty in being broken, that cracks should be celebrated and not concealed. They also believe the gold fillings reinforce the pottery, making it stronger than it was before.

Now, looking back at the person I have become, I would not change my journey. I am surrounded by family and friends, who have gone through the fires with me and continue to support me. My experiences have forged my life into something more worthwhile. Not only have I discovered a new career, but I have also found love. I have been with my boyfriend for more than three years and he respects the struggles I have been through, while holding deep affection for the woman I have become. I used to associate sex with suffering, but now we can explore passion and intimacy in a safe and affectionate space. Better yet, as the sun enters our room in the mornings, I wake up in his arms, no longer feeling broken or alone. He puts a smile on my face every day and has taught me to be less angry and more carefree. We frequently go to our local park and throw around an old football, running and jumping for passes like two young kids who never want to come back inside.

It’s such an incredible feeling to sprint down that football field with no fears or limitations. I am currently in the best physical shape of my life, even better than my years as a collegiate athlete. I go to the gym daily and especially love serious weight lifting. I have climbed Kilimanjaro, the tallest mountain in Africa, along with several other high mountain peaks in the United States.

Last year, I ran my first marathon for my 26^th birthday. I remember my first long training run and how difficult it was to drag myself out of bed and out the door. Once I hit the trail, the road seemed endless out in front of me. As my feet hit the pavement, images flashed through my mind of the past four years. I especially remembered the difficult rehabilitation after my last surgery. With the support of my crutches and parents, I repeatedly hobbled around the living room table until I fulfilled the mile-a-day recovery requirements stipulated by my surgeon. During that time, the road seemed endless too. As hard as I tried, as strong as I was, I felt like I could never reach the end of it. All I could do was keep my head down and power through each step, willing myself to move forward.

The memories soon faded during that training run in late September. The sun was out, the leaves were turning, and I lifted my head up to absorb everything around me. The river ran along next to me as I traveled further and further. The road used to be so frightening to me because it was boundless and I never knew when or if I could get off it. Now I’m realizing that’s the beauty of it. Health is not something we obtain, it is a state of being. And it requires work every single day. That autumn day, the road stretched out in front of me, and I let go of it all and just ran. For the first time, I enjoyed how limitless it was. Because this time I could keep running.

The Man Behind the Curtain

Pain does not equal damage.

You are more than your pain.

These ideas are easy to understand, yet difficult to adopt. Imagine if we (patients and practitioners) could embrace these attitudes. Imagine if we cohesively united to change how we think about and treat chronic pain. Imagine pain no longer as a nebulous force in our lives, but a defined and logical biopsychosocial process.

I am currently attending the Combined Sections Meeting for the American Physical Therapy Association (APTA) and listened this morning to Dr. David Butler and Dr. Lorimer Moseley's "Explaining Pain" lecture. What an experience! It took them less than four hours to shake my fundamental understanding of chronic pain. One of the topics they broached was utilizing and choosing the right metaphors when explaining pain. Looking back over my writings, I am slowly realizing I took the wrong approach when discussing my pain. Remember this poem I wrote? It was one of my favorites because I thought it perfectly represented my inner battle:

In the Ring

My life is a constant battle
of bruises and bullies.
Are you fighting too?

Remember, dear friend.
Our scars do not deform us,
they define us.

Go another round.
----------------------

At the time, this poem made perfect sense to me. I was a fighter, I was strong. My body was a battlefield and I would fight pain to the end. Herein lies the problem. How can you win a battle against yourself? This warrior metaphor is detrimental to our healing process. If we expend all our energy fighting ourselves, how can we begin to heal ourselves? It reminds me of The Wizard of Oz. We need to look at pain less as the booming and flashy "Great and All-Powerful Oz," and more as the man behind the curtain. We need to get close and see pain for what it really is, instead of standing back and marveling at its power. We need to stop giving strong metaphors to pain and building it up to be some large force we are waging war upon. It's time for the lights and smoke to dissipate and time to become better acquainted with our pain.

It's a scary thought- to become better acquainted with your pain. You make it out as some great enemy, yet the only way to defeat it is to befriend it. After listening to the Explaining Pain lecture, I reflected on my fight with pain and realized it should be my pain journey. I started feeling better a year ago when I was a semester into my physical therapy program. Yes I had several surgeries, PT, prolotherapy leading up to that point that contributed to my relief, but I also had the power of knowledge that school provided. I was forced to look at my pain systematically, to understand what was hurting where and how I could strengthen or stretch the affected muscles or quiet the spasms. I learned to reduce my stresses outside of school, to work on my relationships with family and friends, to attend yoga classes regularly... to start loving my body and stop seeing it as a battleground.

There is still much to be learned about pain and its process. But it is time to stop fighting our own bodies, and start fostering understanding of why we experience pain and what we can do to lower our contributing factors. Wizard of Oz writer L. Frank Baum told us, "Pay no attention to that man behind the curtain," but that's exactly what we need to do.

Birthday Wishes

For the past 5 years I have stared at the candles in front of me and wished for the pain to go away. There were even a few birthdays I refused to leave bed because I was so defeated. Last year my pain levels drastically improved, but I still felt unsure about the future and scared of flare-ups. I was also still going prolotherapy and wasn't sure how many more treatments I'd have to endure.

I used to be frightened that I was in control of my health decisions- what doctors to see, what treatments to try, what medication to take. I wanted a magical fix, someone to take control for me and make it all go away. I didn't realize that I was the one who needed to be in control, needed to be proactive, needed to make lifestyle changes to maintain my health. I have finally accepted there is no singular solution. My body necessitates daily stretching, vigorous exercise, proper nutrition, mental strengthening, and commitment. I am completely in control, which no longer frightens me but empowers me. Not only has this experience shaped my professional life, but it's given me a greater quality of life. I am currently in the best shape of my life, and getting stronger every day. When I do have flare-ups, I know exactly what muscles are tight and what combination of modalities and stretching I can do to abolish the symptoms. Pain is no longer this nebulous and exhausting cloud weighing me down, but an identifiable problem I can fix.

I have been so focused on my health and school that I forgot to make a 5 year anniversary post. As I scroll back to my earlier posts, I cannot believe how much I have been molded and reshaped. It has and continues to be a transformative process. I have met some incredible people along the way and continue to be inspired.

What's even more incredulous to me then turning 25 tomorrow is that when I stare down at those candles, for the first time in five years, I won't know what wish to make.

Truth's Illumination

  

One glowing flame can

light a hundred candles,

and then a hundred times

a hundred more. I pray to

be such a flame, my illusions

giving fuel to what is real.

Light recognizes light,

and leaps to meet it.

May this sweet contagion

increase until light prevails,

and we all live in the

glow of truth’s illumination.

         Danna Faulds

Pain's grasp

I promised more updates and exciting news over this winter break which has come and gone. However, circumstances arose and people very close to me needed my attention and care. Now I am back in school, starting my second semester and don't have the free time I need to begin my project. What I hope to put together my next break is a small collection of poetry, entries, and thoughts I have developed over the years living with pain. It's not to be simply a motivational book, but the journey one goes through when suffering. I have found my best companion during the worst times to be quotes and poems and books and hope to generate a similar companion for others to have. Anyway, that's a small glimpse of what's to come.

Like always, a lot has happened since I last wrote. I did in fact run that half marathon I was training for and I treasured every mile. After all the surgeries and invasive treatments, I was elated to see my body perform and enjoy itself. I remember the days I hobbled around the kitchen table, where each step seemed to be a mile.

Last semester I continued to see a pelvic floor specialist at UPenn and was very impressed with my results. It is amazing how much physical therapy has lowered my pain levels. Unfortunately the therapist I was seeing moved to a different practice recently. I am currently looking for someone new, but it is difficult to balance with my most challenging semester ahead of me. I have been focusing more on maintaining pain levels myself. There are numerous stretches I do for my hip flexors and piriformis. I'm avoiding sitting for long periods of time, especially on uncomfortable surfaces. I am also spending more time doing yoga and utilizing my stim pack on my piriformis to get me through lectures. It's also a big help to have my boyfriend or good friends use their elbows to work on my trigger points.

Things have been going very well, but this past week was a bit of a setback. I think it was a mixture of starting a new semester, dealing with different stresses, and even the weather outside. I had more pain than normal and I was a bit depressed (mostly from feeling the pain in higher intensity.) I found myself retreating to my room and lying on bed, submitting to pain's grasp. Sometimes I don't feel strong enough to fight it off. Mostly I am tired that I need to actively fight it off every day. Don't get me wrong- I have been so happy the past year and things have changed significantly. It's just difficult when pain slowly creeps back in and takes hold of you. I know there's many people out there who know the feeling for many different reasons. I think it is important to know that you don't have to be strong all the time. It is okay to be upset and think it's unfair. All of us have moments we break down. What makes us strong is getting back up in the morning and tackling a new day. Sometimes we need help. But ultimately we lift our own heads back up and keep going.

"...Yet if I could instruct
myself, if we could learn to learn from pain
even as it grasps us    if the mind, the mind that lives
in this body could refuse    to let itself be crushed
in that grasp    it would loosen    Pain would have to stand
off from me and listen    its dark breath still on me
but the mind could begin to speak to pain
and pain would have to answer:

                                                 We are older now
we have met before    these are my hands before your eyes
my figure blotting out    all that is not mine
I am the pain of division    creator of divisions...
                                               And remember
I have no existence    apart from you"

from Splittings by Adrienne Rich in A Dream of a Common Language

The Road

I'm training for the Philly half-marathon and had to do my eight mile run today. It's beautiful out, but it still took effort to drag myself out the door and off to the Schuylkill River. I've never run eight miles before, and it can be difficult to get motivated if you're running alone. I got on the trail and the road seemed endless out in front of me. As my feet hit the pavement, images flashed through my head of the past four years. Recovering from each new surgery, re-learning how to walk three separate times. Each time I would drag myself out the door and hit the trail on crutches, a cane, and finally my own two feet. During those times, the road seemed endless too. I felt as hard as I tried, as strong as I was, I could never reach the end of that road. All I could do was keep my head down and power through each step.

Today the sun was out and the leaves were turning, and I kept my head up to absorb everything around me. The river ran along next to me as I traveled further and further. And would you believe somewhere around mile 4 a monarch butterfly flew along with me for a few seconds? If you recall this post from almost exactly a year ago, you'll understand my life continuing to come full circle.

The road used to be so frightening to me because it was boundless and I never knew when or if I could get off it. Now I'm realizing that's the beauty of it. The road stretched out in front of me and I released my feet and just ran. For the first time, I enjoyed how limitless it was. Because this time I could keep running.

Transitions

My life is currently in a series of transitions. I'm transitioning from suburban life to city life, from a familiar home to a new apartment. I'm transitioning from an employee to a student. Most importantly, I'm transitioning from a patient to a practitioner. Granted this transition will take me three long years, but the process is beginning. The problem with transitions is you cannot simply forget the past.

I'm having some difficulties moving from the patient mindset. This is because I still have pain and frustrations about what exactly is occurring with my body. Sitting through classes is quite difficult at times. It seems like my piriformis muscle refuses to relax, no matter how much I stretch it, stim it, or ice it when I get home from school. I'm looking into pelvic floor therapists in Philadelphia and will hopefully find some time to make improvements.

Don't get me wrong, my pain levels have tremendously decreased from a year ago. The combination of hip and pelvic surgeries, as well as the proceeding physical therapy and the intense prolotherapy injections into trigger points have made the pain much more liveable.

I think today was an especially emotional one because we covered the pelvis and pelvic floor muscles in Anatomy class. On the one hand, I was ecstatic because it's structures and muscles I'm so familiar with, which will give me time to catch up on previous lectures. On the other hand, it was difficult to sit through- mentally and literally. When we talked about the ischial tuberosities, I was more aware of the pressure and pain emanating from my own sit bones. When we talked about the pubic symphysis, I was more aware of the scars covering that area on my body, and the erosion of the bone I'm dealing with. We talked about the obturator internus, which I know too well how that feels to be internally palpated and worked on by a therapist. Finally we spent a great deal in the powerpoint talking about the piriformis and how it is the reference point of the pelvic region. Slide after slide, I stared it down, almost challenging it. This is my great enemy, who I will do everything in my power to finally defeat. I'm determined to learn everything I can so that I am no longer at its mercy. And so that I can effectively treat my own patients one day.

Just a side-note: now that I'm in school, I have less time to answer the personal emails I receive. Please know that I read each and every one, as well as all the comments you leave. You are not alone. And if you ever find yourself in Philadelphia, drop me an email and we can get coffee.

Power
 
Living     in the earth-deposits     of our history

Today a backhoe divulged    out of a crumbling flank of earth
one bottle     amber   perfect   a hundred-year-old
cure for fever     or melancholy     a tonic
for living on this earth    in the winters of this climate

Today I was reading about Marie Curie:
she must have known she suffered     from radiation sickness
her body bombarded for years     by the element
she had purified
It seems she denied to the end
the source of the cataracts on her eyes
the cracked and suppurating skin     of her finger-ends
till she could no longer hold     a test-tube or a pencil

She died    a famous woman    denying
her wounds
denying
her wounds    came    from the same source as her power

                    -Adrienne Rich


I came across this poem today because I am reading Wild by Cheryl Strayed, a grief-stricken and lost woman who decides to hike the Pacific Crest Trail to find catharsis. She is completely unprepared and ends up carrying a ridiculously heavy pack. Later on in her journey she is given some help on what items she can get rid of to lighten her load. She relented on most things except her copy of The Dream of a Common Language by Adrienne Rich. She brought other books as well, but was able to burn chapters as she read them. But there was something in this book that she safeguarded and there was some reason she carried it thousands of miles. I wanted to know why. I felt connected to Cheryl a few pages in because she was a female backpacker, choosing a poetry book as her lone companion. It had to be pretty special.

After no luck in a used bookstore, I decided to cross the street and search in Barnes and Noble. Lo and behold, there was one copy left. Too curious to find a table, I plopped myself down on the carpet. Tall bookshelves rose above me as I turned to the first poem. It was the same poem Cheryl turned to her first night on the trail. It was perfect.

digging through notebooks

I found this entry in one of my notebooks, dated 2/25/12 and wanted to share it.

I have been gone a long time. Updating is getting difficult for me because I find I'm distancing myself from past horrors. And even though there are still health obstacles to overcome, I find it easier not to write about it. I want to enjoy life and relish in this happiness. For months now, I wake up in the morning feeling happy. Truly happy. For a period of time, the joyous emotions were so overwhelming that I would cry. Not just a few tears either. I opened my eyes each morning, and felt such a dramatic reduction in pain that I bawled. It was a right I thought I'd never get back.

The crying did not stop there. Life became dramatic- the sunlight caressing a tree a certain way would move me to tears. One day I was walking down the streets of Philadelphia with my sister and started crying without any sort of trigger. Luckily my sister was used to these reactions and told me to pull it together because we were about to walk into a pizza parlor to meet all her teammates. And it's best not to meet twenty girls on your sister's crew team when you're bawling your eyes out. Because then they'll want to know what's wrong and you'll have to tell them that nothing is wrong. In fact, things are wonderful. And they won't believe you and then you'll become that weird older dramatic sister that they try to avoid.

Luckily I pulled it together and no one was the wiser.

The frequency of these episodes has greatly been reduced over the past months. But they'll still happen if the trigger is good enough.

Many people have been writing to me asking me if my pain is gone. I'm still undergoing intense prolotherapy treatments, but I feel they are helping. I am being patient and putting faith in my doctor and my body to heal itself. But I don't want to talk about that today.

I remember years ago being so frustrated by all the depressing stories of women I found online. I realize now that writing is very therapeutic when you are struggling. People tend to stop when they are doing well. I think we just want to forget this ever happened to us and are anxious to go back to the way things used to be. This is of course impossible because we have been forever changed.

I wanted to write this post to give strength to anyone fighting a difficult battle right now. I remember how hard it used to be. I remember hitting my arms, bruising them repeatedly to try and distract myself from the pain. I remember driving in the car and thinking how easy it would be to turn the wheel slightly and escape from the pain.

I remember specific nights, crying on the floor, wondering how I was going to get through another day. If I only knew the happiness, the elation that I would feel just a year later. I couldn't whisper in my ear back then, so I'm whispering in your ear now.

Whoever you are, wherever you are, whatever your battle, however long it's been happening, keep going. Keep going. You can't give up when you don't know what tomorrow will bring.

To strive, to seek, to find, and not to yield.

I dreamed about writing a post like this for many years. Years, can you believe it? Whenever I have a moment to myself, old scenes flash before my eyes. They no longer haunt me, but I am still amazed they were lived through.

I'm trying to explain how I feel right now, but words are failing me. Imagine being weighed down by a huge pack while climbing a mountain. (Did you expect anything else?) The pack is so heavy, you cannot even lift your head up. Bending forward, teeth clenched, you spend all your energy taking one step at a time, being careful not to trip over anything in your path. Sometimes you stop and think about how far you have to go and life seems hopeless. You wonder if it's even worth it anymore to continue to take it, to continue stepping forward. If you could just take your pack off, if you could just lighten the load, if you could just feel a release for a little while...

Think about that burn in your legs, the ache in your back, the shortness of breath, and then imagine what it would be like to have your pack removed. Immediately, your back straightens and you realize how far from normal it was. With the weight now gone, you slowly regain your breath. Walking tall, you now lift your head and your eyes are just flooded with vistas of light. It is like you are seeing for the first time. You see everything around you and it all looks different. It does look like you are seeing it for the first time.

You cannot help but reach out in front of you, just to make sure this is all really happening. As you continue to walk upward, you pause several times, checking to see if you are still carrying the weight, but you realize you just feel the ache of carrying it for so long. It's at that moment you understand how much weight you had been carrying this whole time, and what a toll it took on you. Life is now a second chance. It's a gift.

My prolotherapy treatments are working. They really are. The release I feel is unbelievable. We still have a lot of work left, but every time I go my pain decreases less and less. I'm beginning to go every two weeks now in order to treat the front of my hips as well.

I've been an emotional wreck recently because I am just so happy. I cannot contain it, I cannot hide it. It spills out of me in long waves. After my treatment last week, I cried for almost an hour in the recovery room with my dad and sister. I just could not stop and kept apologizing to them and the nurses who came in. It was like every bad thing that has happened to me needed to be released from my body. There's a lot that needs to leave. If you see me, don't be surprised if I start to tear up. In fact it's already happened in this coffee shop. Never did I understand what tears of happiness were until now. Every moment feels a bit dramatic. I just did not think I would ever feel this way again. It's as if life has said to me, "Welcome back."