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Archive for the ‘Health’ Category

I’ve been experiencing the truth of impermanence recently.

We’re leaving on a driving trip in two weeks, and the head gasket has chosen this time to start leaking.  We’re having friends stay at our house while we are gone, and the front door lockset has chosen to fail.

We were spreading a new layer of gravel on our paths and realized that one of the trees have grown so much that they intrude on the path.  It was either cut the tree or move the path; we moved the path.  Meanwhile, other hedges were intruding on other paths; those we trimmed back severely.

As I think about our house, yard and gardening, our efforts seem to be all about either coping with change or creating change.  Nothing ever stays the same.  Plants grow, bloom, and are harvested.  Others bloom, fruit, and die back or break from excess fruit or snow on the branches.  Soil wears out and needs to be enhanced.

Even the gravel disappears over time, and rocks are overgrown and broken up.

Part of our bluff sluffed off in the last year with a slide towards the beach that almost overtops the bulkhead.

On our trip, we’ll be going to Utah and visiting Arches National Park.  One of the arches I want to see has fallen and is no longer.  The trail to another arch has been rerouted because parts of that arch have flaked off in recent years.  In Canyonlands, what I once knew as rough, four-wheel drive roads are now paved and usable by any vehicle. In Yosemite, part of a campground has been closed because rock slides have been falling on it.

My weight goes up and goes down.  Health changes, sometimes for the worse and sometimes for the better.  Emotional states are transient; none are permanent.  Relationships change—some relationships last a long time, others a shorter time, but they all change constantly.  Some changes happen slowly (rocks erode), others occur very quickly (emotional states). Even changes to rock are visible in a single lifetime.

Nothing stays the same.  I literally cannot think of anything unchanging in my experience.

Some changes we respond to—the car and front door will get fixed this week.  Some we note but there’s no action to take—an arch falling or the bluff slipping.

But whether we react or not, nothing stays the same.

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I Get My Wish!

We woke up this morning to find snow!  We see snow in Port Townsend perhaps once or twice a year.  Mostly it seems to have snowed while we were out of town.  This time we were here to see it!

Snowy day in Port Townsend

Snowy day in Port Townsend

True, there’s not a lot of snow.  The accumulation was  between one and two inches, drifting to four to six inches on our deck.  It’s been more than forty years since I’ve lived where I could expect significant snowfall, so any snow gives me a feeling of freshness and peace.

I got to take a walk in the snow—a childhood experience in Illinois that I’ve missed for a long time.  I see a totally different world when walking in the fresh snow.  There are tracks everywhere, each telling a different story.

When I first left the house, the only tracks in the road were footprints.  As I walked further, I saw more.

Here I see where a couple has walked to the mailbox to pick up their newspaper.  There I see where someone has walked their dog, with side trips to the edge of the road for doggy business.  Another person had taken their trash out for collection the next day.  Three kids build a snowman in their yard.

Some tracks were more difficult to interpret.  One set to the bluff and back looked like a tricycle.  I saw the same tracks later and now suspect it was a tricycle baby carriage.

I got a good look at my own footprints.  That was interesting because this was also my first walk with the new orthotics that I received yesterday.  Teresa tells me it has improved the way I walk.  They sure feel bumpy when I put my shoes on.  I get used to them quickly and find them comfortable enough to walk in.  It will take a while to see whether they make a difference to ankle and back pain problems.

The last set of tracks was a real puzzlement.  At first I could not figure out what made two narrow, parallel tracks.  As I walked up the hill I finally realized they were cross-country ski tracks.  Seeing where the wearer had sidestepped up the top of the hill confirmed that.  I have never seen cross-country skies in use in this area—we just don’t get that much snow.

For more photos I took on my walk, click here.

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It would be nice to learn from experience!

As I wrote on Tuesday, I applied mindfulness very successfully for reducing pain to simple sensation while having laser pulses to my retina.  This morning, I did something that resulted in low back pain.  Did I explore treating that just as sensation?  No, I forgot completely about that possibility and worried about what might be happening.  I went directly to using ice and resting to resolve the pain.  After I woke up from a nap, I realized what I had forgotten to do.

For better or worse, by that time, the pain was gone.

Well, maybe next time—and there will be a next time—I’ll remember to practice being mindful! “Practice” is certainly the correct word to use. It takes practice, practice, and more practice at being mindful.

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This Monday was a lot easier than last Monday!

As I wrote last week, I have proliferative diabetic retinopathy.  This is being treated by pan retinal photocoagulation (PRP), or lots of laser pulses to the retina. On my treatment last week, I was able to tolerate only 200 laser pulses.  I slept like I was drugged for the rest of the day and did not feel well the next day.

This week, I had 700 laser pulses.  My discomfort level after 700 was less than my discomfort level last week after the first 100!  After the treatment, I was full of energy, active through the remainder of the day, and felt fine the next day.

What has made the experience so difference this time?

There are three major changes between last week and this: physiology, medication, and preparation and mindfulness.

Physiologically, sensitivity of the retina is not uniform.  Some areas are nearer to nerves and some farther away.  It’s possible that the first treatment hit the most sensitive areas and the second treatment hit less sensitive areas.  While that’s possible, the doctor gave me no reason to believe that was a factor.

Last week, I took a Vicodin after the treatment to alleviate pain.  I don’t know that it did much.  This week, I tried one before going in for treatment.   Comparing the most intense pains from both weeks, I would say that the Vicodin may have dulled the pain slightly but that it was not a significant factor.  This agreed with the doctor’s observation that she had  not found Vicodin to be helpful.

I see preparation and mindfulness as the key changes.  Last week, I drove an hour to the appointment, so my mind was very busy before the procedure.  I was also complacent about the pain, having been through the experience twice before—forgetting that the first time was four years ago and I was sedated and numbed the second time. Last week, I paid no particular attention to my posture, breathing, or to the sensations.  Every laser pulse felt like pain—some of it very intense.

This time I did it very differently!  Teresa drove to the appointment while I listened first to a guided meditation on healing and then to an excellent talk by Gil Fronsdal on Pain.  When I sat in front of the machine, I arranged some back support and made my posture as erect as possible.

During the procedure itself, I had to stay very still and keep my eyes focused straight ahead.  I paid regular attention to my breath to be sure I was breathing regularly and deeply.  I watched my posture to be sure I didn’t curve my back and shoulders to slouch—postures that would reinforce feelings of pain and fear.

Most importantly, I watched carefully the sensations accompany each laser pulse.  I watched with a sense of curiosity, asking myself “what, exactly, is this sensation, and this one, and this one, and this one….” If you’ve ever had an eye exam with a slit viewer, you know how bright and uncomfortable a light can be.  Every laser pulse was a flash of ultra-bright light.  Most of the pulses were accompanied by a sensation I can best describe as the back of the eyeball being pricked with a needle; the experience was sometimes more intense than others.  Some of those pinpricks were accompanied by a strong shooting pain, like a lightning strike from the eye to the left forehead.  (I speculate that the shooting pain was the result of a pulse hitting on or very near a nerve.)

I had nowhere near the pain as I did a week ago.  We were able to do 700 laser pulses before the discomfort level made it seem advisable to stop.

Now that we have a cumulative total of 900 laser pulses, it’s time to wait and see how my eye responds.  My next appointment is in early January.  After an exam, we’ll decide whether more laser pulses or whether another shot of Avastin might be the better treatment.

What is pain, anyway?

This experience has led me to a new understanding of pain.

In the Bahiya Sutta, the Buddha says “let sensation simply be sensation….”  In other words, don’t add anything to the sensation.  It seems to me that what when we say pain, we always include an element of aversion.

Dharma talks typically distinguish between pain and suffering.  To me, it seems that the important distinction is between sensation and pain, with suffering just more mind accumulation around pain.  I now see pain as sensation plus the emotional experience that the sensation is unpleasant.

If you “let sensation simply be sensation,” then anything added is just mental proliferation.  Add unpleasant, and the sensation becomes pain.  Add pleasant and the sensation becomes pleasure.

Now that’s a thought with unexpected ramifications!  Is pleasure a mental proliferation just as pain is?

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I used to get massages regularly, but have been dissuaded partly by my current insurance not covering it and partly by my focus on recovering from cardiac bypass surgery in April. I finally feel completely healed from the surgery and scheduled a massage last week.

When I get a massage, I focus my attention on sensation while keeping my breathing deep and regular. I view the sensation as a way to bring my attention to exactly what is happening in my body—in essence a mindfulness exercise. I follow the the moving hands, noticing which muscles are tight, which are relaxed, and how everything feels. It’s as if the moving fingers were continually saying: “Notice this. Notice this. Notice this.”

I track and notice sensation for about half of the massage. About half way through, I seem to tire of noticing and fall half asleep. But then it’s time to turn over and do the other side, so that wakes me back up—for a while anyway.

After a massage, I am much more aware of body sensations and posture. I find that I sit differently and hold myself differently. These changes last for several days, until habitual patterns reassert themselves.

I’ll get another massage in two weeks or so to refresh my body awareness.  I’ve found that as I get beyond the second massage, the benefits seem to be less.  It’s as if I were getting used to the massage and no longer receiving the same benefits.  I think that the massage penetrates the defenses until the defenses learn how to keep themselves intact.

The bottom line is that I’ll get a couple of massages then wait for perhaps six months before getting another one.  Changing masseuses “restarts the clock” as each masseuse has her own style and that reaches through defenses in different ways.

Anyway, I feel physically more relaxed.  That’s good, because tomorrow will be my next laser eye treatment!

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Teresa and I drove to Sequim this morning.  Near Blyn we saw fields of grass glinting with a white covering of frost.  The frost reminded me of the crisp fall and winter mornings when I was growing up in Illinois.  I always loved walking in the snow in the woods—everything was so quiet and peaceful.  I felt my worries drop away from me.

Not much snow here!  It probably snows enough for a few inches of accumulation less than once a year here.  Each time it’s happened, we’ve been out of town on a winter vacation.  Maybe this year will be different?

We went to Sequim so that Teresa could be fitted for a new set of orthotics.  I have had intermittent problems with shooting pains in my ankles for several years.  Inserts customized by my now-retired podiatrist solved that.  This year I’ve also experienced some low back pain and minor knee problems.  On a day to day basis, I hardly notice it, but every few months it’s enough that I see the chiropractor.  Since these problems may all be related, I decided to be fitted for orthotics too, replacing my worn inserts.  I’ll get them in two weeks but it may be several months before I know for sure whether they alleviate these pains.

With respect to pain, mindfulness means an objective awareness of sensation and not getting caught up in it.  It means not letting the mind run amok with fear of all the possible consequences of the pain—from “I’ll never walk again” to “I’ll die tomorrow.”  Neither does it mean denying or ignoring the pain.  Both getting caught up in and denying the pain results in suffering needlessly.  The Middle Road would be to take action when appropriate.

The trick is to find that middle road!

Namasté.

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The Buddha said: “Let hearing simply be hearing, let seeing simply be seeing, let sensation simply be sensation….”  I find it more difficult to be equanamous about sensation when I consider it to be pain, especially when unexpected.

All the teachers say that the body deteriorates with age, and I know that to be true in my case.  I have proliferative diabetic retinopathy (PDR).  While there are some experimental medications to treat PDR, the “gold standard” of treatment is pan-retinal photocoagulation (PRP).  Or, in simpler words, blasting the retina with a laser.  Since my body was not responding adequately to the medication, PRP seemed the appropriate treatment to prevent vision loss.

I’ve had PRP twice before, in my right eye.  The first time was several years ago, and I remember some pain.  This  summer, I had further treatment but I was sedated and did not feel any pain.  Today, it was time to treat the left eye.  I think I had grown complacent—I had been through the treatment twice before with only minor discomfort, so I was prepared “to do it again.”  I wasn’t expecting or prepared for the pain.  I noticed that I was strongly resisting the sensation and could tolerate only 200 flashes of the laser (between 1,000 and 1,500 are planned).  Each flash felt like a pinprick on the back of the eye.  I wasn’t centered at the beginning and didn’t even think to try to regain my balance to experience the sensation differently.

When I am prepared for an uncomfortable situation, I at least have a chance to handle it well.  If not prepared, I am more likely just to react.  And reaction usually means suffering.

Further treatment is scheduled for next Monday.  My goal is to be calmer and more centered when the treatment begins, and to let the sensation simply be sensation and not something to recoil from.

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