How I find a Word in my head? Oops! Pam fell down!

Thought I’d try to catch up a little bit today.

Overall, Pam has been doing a little bit better. The pain specialist has been working for over a year to find the right combination of meds for her. Finally, I think we have something. He’s managed to narrow it down to two meds. She has several conditions which we’ve managed to get a grip on over the last 4-6 months of evaluation. Each condition seems to have its own type of pain. Some of the types of pain she suffers from is neuropathic pain, radiculopathy and fibromyalgia all of which are relieved with Topiramate (brand name Topamax). He also needs to use a narcotic agent (unfortunately) to manage some of the other types of pain.

So, overall, we see some mild improvement. But, low and behold! After much protesting from me, last week she decided to go outside to get the mail. Yep, she slipped on the snow and ice in the driveway and fell on her knee! Gosh! How could I turn around and say, "I told you so." Well, I did, but only several days later when the time was right. Smile, smile.

Because of her osteoporosis, she has a 5-6X risk of bone fractures. I saw her go down and immediately pictured in my head of having to call an ambulance. Fortunately, she was able to get up. Needless to say, she is sore and bruised all over with a big ‘egg’ on her knee! I did take her for evaluation and no fractures!! But it sure doesn’t help deal with Mr. Arthur in her knee which many of us also have.

Some of my latest thoughts and insights have to do with language difficulty — expression and word finding.

• difficulty finding the right words. I can remember a long medical terminology word but can’t always retrieve a simple word such as sofa, fork, etc.
• I tend to use descriptions in place of words “that thing behind the house you sit on" instead of “patio or back porch”). Recently I couldn’t remember the word "fork" so I resorted to saying, "You know, that thing you stab into food."
• occasionally have difficulty with some pronunciation; familiar words don’t sound right
• sentences don’t sound right or are phrased incorrectly (don’t make sense)
• have difficulty explaining a thought or idea
• I rely on Pam and Chad to guess at the meaning of what I am trying to say
• very frustrating when I have trouble say what I mean
• Now I have a lot of trouble talking on the telephone unless it’s someone I know very well or from many years ago. I think part of it is that there are visual cues over the telephone.

One of the descriptions I was able to use with Pam recently was this. At times, whenever a word won’t come, it’s as though I can picture a long tunnel starting at the front of my head progressing to the back of my head. The tunnel gets more narrow and blacker as it goes to the back. At the back, sometimes there is nothing there, thus no word.

At other times, there is a vague dot or small object or small word which is incomprehensible. Sometimes I can visualize it slowly coming to the front of the tunnel. How far it comes up seems to determine whether I get the ‘word.’ Sometimes, I literally pause and wait for "it" to come forth. Sometimes, it will only come half way and then stops. This is actually more frustrating than if it is just totally blocked. Other times, it all comes forward with the right word but in "slow motion." That’s when I find myself talking and literally saying, "wait a minute." I just need some time for it to crawl up.

It seems very hard to describe all this. If someone can’t follow what I just said, I totally understand.

Enough for today. Just thought I’d share my perspective on word finding.

Warmly………..David

I wonder if this is related to Pam

This article intrigued me. Pam has chronic pain and needs to take a lot of meds for it. Some months ago I blogged about her having to be placed on vitamin D supplements due to low levels in her blood. Now that her vitamin D levels are normal, her pain has mildly lessened. I never would have made the connection. I’d post the link to the article but it is for physician members only. Don’t worry about the technical jargon.   Medscape Medical News 2009. © 2009 Medscape Chronic Pain Linked to Low Vitamin D by Allison Gandey   March 25, 2009 — Inadequate vitamin D may represent an under recognized source of nociperception and impaired neuromuscular functioning, say researchers. "Physicians who care for patients with chronic, diffuse pain that seems musculoskeletal — and involves many areas of tenderness to palpation — should strongly consider checking vitamin-D level," Michael Turner, MD, from the Mayo Clinic in Rochester, Minnesota, said in a news release issued Friday. "For example," he added, "many patients who have been labeled with fibromyalgia are, in fact, suffering from symptomatic vitamin-D inadequacy. Vigilance is especially required when risk factors are present, such as obesity, darker pigmented skin, or limited exposure to sunlight." Dr. Turner was lead investigator of a study published in the journal Pain Medicine in November 2008. The work suggests a correlation between inadequate vitamin-D levels and the amount of narcotic medication taken by chronic pain patients. Required Nearly Twice As Much Pain Medication The researchers found that patients who had inadequate vitamin-D levels and required narcotic pain medication were taking much higher doses — nearly twice as much — as those with adequate levels. These patients also reported worse physical function and worse overall health perception. Dr. Turner told Medscape Neurology & Neurosurgery his group was surprised by the finding. "We didn’t anticipate that the difference would be so high." The investigators retrospectively studied 267 patients admitted to the Mayo Comprehensive Pain Rehabilitation Center. They compared serum 25-hydroxyvitamin-D levels at the time of admission with other parameters such as the amount and duration of narcotic pain medication used, self-reported levels of pain, emotional distress, physical functioning, health perception, and demographic information such as sex, age, diagnosis, and body-mass index. Patients with vitamin-D levels below 20 ng/mL were considered to have inadequate amounts. The prevalence of low vitamin D was 26% (95% CI, 20.6% – 31.1%). Among patients using opioids, the mean morphine-equivalent dose for the inadequate vitamin-D group was 133.5 mg/day compared with 70.0 mg/day for the adequate group (P = .001). The mean duration of opioid use for the inadequate and adequate groups was 71.1 months and 43.8 months, respectively (P = .023). The researchers also observed a link between increasing body-mass index and decreasing levels of vitamin D. Inadequate Vitamin D May Create or Sustain Pain The preliminary results suggest that inadequate vitamin D may play a role in creating or sustaining chronic pain. During an interview, Dr. Turner suggested that patients with inadequate vitamin D may benefit from cholecalciferol 50,000 international units dosed according to the level of deficiency. But he urged caution for patients with calcium- or phosphate-processing disorders. "Increasing vitamin-D levels could be problematic in patients with kidney failure or stones or primary hyperparathyroidism or sarcoidosis. This doesn’t preclude increasing levels, but it might warrant discussion with an endocrinologist," he said. For patients with adequate vitamin D looking to maintain levels, he recommends10 to 15 minutes of sun exposure with no sunscreen on the trunk and arms and legs 3 times a week. Sun Exposure or Diet and Supplements? It is a recommendation often made by proponents of vitamin D but hotly contested by the American Academy of Dermatology. The academy recommends that vitamin D be obtained from a healthy diet and supplements and not from unprotected exposure to ultraviolet (UV) radiation. "Unprotected UV exposure to the sun or indoor tanning devices is a known risk factor for the development of skin cancer," dermatologists write in the academy’s position statement. Dr. Turner and his team conclude: "Prospective trials utilizing a repeated-measures design are warranted to assess the effects of vitamin-D repletion on pain outcomes and physiological measures of neuromuscular functioning among patients with chronic pain and comorbid vitamin-D inadequacy." The researchers have disclosed no relevant financial relationships. Pain Med. 2008;9:979-984. Abstract

Warmly………David

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