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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