Social Security Increase in Benefits

Medicare costs to offset Social Security hike
(CBS News, Oct 19, 2011)

Social Security payments will be increased next year! There hasn't been an increase in benefits since 2009. 2010 and 2011 have been the first two years without a cost of living adjustment (COLA) since automatic increases were enacted in 1975.

Medicare is expected to announce the 2012 Part B premiums early next week. The expected premium will be $106.60 per month; which will lower the paid premiums for about a quarter of those enrolled in Medicare Part B, but increase the premiums for many others.

According to the article I read (here), the amount of wages that will be subject to Social Security payroll taxes will increase from the first $106,800 in wages to the first $110,000. (I think that all of one's income should be subject to taxes, but whatever). Currently, workers pay 6.2% Social Security tax on wages (which is matched by employers), but the tax rate was reduced to 4.2% for 2011.

3-Year Anniversary of Car Accident

Today marks the 3-year anniversary of the car accident that has changed my life forever.

Back before my car accident in October 2008, I worked full-time. A friend had given me this little perpetual calendar with a Scripture verse for each day, and I kept it on my work desk. Luckily, my previous boss is a dear friend of mine, and I was able to get my personal things back from work.

My accident was on October 10. The Scripture for that day is:

"Now faith is being sure of what we hope for and certain of what we do not see... By faith Abel offered God a better sacrifice than Cain did. By faith he was commended as a righteous man, when God spoke well of his offerings. And by faith he still speaks, even though he is dead." ~ Hebrews 11:1,4 NIV

The chronic, debilitating pain that was caused by the accident has been a time of great trial for me, affecting every aspect of my life. My faith has been / is being tested.

I try to keep in mind something a close friend of mine told me (on the one year anniversary of my car accident): "Think of today as the anniversary of the day God entrusted a season of spiritual growth, understanding and total dependence upon Him that you would not have acquired any other way."

In the midst of pain that never ceases, it can be extremely difficult to remember that our God still loves and cares for us. But, the lessons that I'm learning during this time are important...

• Trust
• Faith
• Humility
• Dependance / Surrender
• Adaptability / Flexibility
• True Love / Intimacy
• Communication (at least with my husband)

I'm not yet at a point where I can be thankful for these trials and suffering; but I'm doing my best to accept the way things are now, to learn the lessons that come my way, and to build / deepen my relationship with my Lord (and with my husband).

National Pain Awareness Month

This year's National Pain Awareness Month is coming to an end, and yet I'm continually reminded that my pain is not.

It pains me to know that there are so many people in chronic pain; and that they, too, often feel misunderstood. It can be difficult for others to comprehend / believe that anyone could really hurt so much all the time, which is the reality for those that live with a chronic illness. Regardless of the intensity of the pain, when it's unrelenting, it reduces a person's ability to function (concentrate, perform day-to-day tasks, work, socialize, exercise, sleep); and it can lead to depression, isolation, and loss of self-esteem.

While it can be very difficult for others to imagine what it must be like to live with constant pain, it's important for friends and family members of someone in chronic pain to be understanding, and to show support and encouragement. Listen without judgment, and let them know you care. Just because someone with a chronic illness is doing something that seems "normal" doesn't mean that they are suddenly better / cured... it's not all or nothing. It's extremely painful to have loved ones question the validity of your pain or accuse you of being lazy or just wanting drugs / pain meds... sometimes more painful than the physical pain itself.

The caregivers of those in chronic pain also face misunderstanding, isolation, and frustration. I'm so grateful that my husband has taken such a difficult situation and helped make it something to bring us closer together. He takes care of me, cheers me on, etc... all without making me feel guilty for my illness changing the trajectory of his life. He is such a blessing!

My hope is that EVERYONE will try to be more compassionate and understanding with each other. One of the groups of people that desperately needs this is the chronic pain community.

NHF Regional Conference - Part IV

Dr. Tim Clark

Dr. Tim Clark is the program director for interdisciplinary services for the Baylor Center for Pain Management in Dallas.


Migraine is a Chronic Disease

• Examples of other chronic diseases: diabetes, high blood pressure, high cholesterol, fibromyalgia, arthritis, asthma
• It's there even when you're not having a headache

Knowledge is power

• What you think (your perception) matters
• Identify, manage, avoid triggers
• Take medications as directed
• Talk with your doctor (it's important to establish empathy and trust between patient and healthcare provider)

Triggers - Being exposed to more at one time makes you more vulnerable for a "perfect storm" / migraine attack


Pain is the 5th vital sign

• There's no way to objectively measure pain
• You have to record it and communicate it with your doctor

Ways to Improve Chances for Successful Headache Management:

• Diaries
• Managing pain is the primary goal
• Discuss goals/expectations with doctor
• Find support
• Doing several positive things at a time often leads to greater effects
• 3 P's of long-term success -

• Persistence
• Patience
• Positive attitude

Physical Therapies

• Acupuncture
• Have to give it a fair chance - 2 x's per week for 10 sessions, 1 week off, then 10 more sessions (sessions ~30 minutes each)
• Exercise
• Massage
• Chiropractic

Cognitive-Behavioral Therapies

• Biofeedback
• Training body in relaxation techniques (must practice regularly)

Relaxation Therapies

• Progressive muscle relaxation
• Autogenics
• Meditation or passive relaxation
• Hypnosis
• Abdominal breathing
• Mindfulness meditation

Treat Comorbidities

• Anxiety
• Depression
• Sleep disorders
• Chronic dysfunctional coping skills
• etc...

NHF Regional Conference - Part III

Dr. Steven Linder

Dr. Linder has a private practice in Dallas, TX, where he treats children and adolescents with migraine. He discussed neurostimulators (occipital and supra-orbital nerves) in adolescents. He was very knowledgeable, and answered audience questions.

Dr. John Claude Krusz

Dr. Krusz has a private practice in North Texas (Anodyne Headache and PainCare), where he treats pain, headache disorders, sleep, mood and neuropsychiatry/neurobehavioral disorders. He spoke primarily about treatment options for migraine.

* The goal of medication is to improve function *


Acute Medication Treatment:

• Not more than 2 days per week
• Treat early (don't wait until severe)
• Use adequate dose, combine meds
• Keep headache diary
• Goal is to get you back to 'normal' within 2-4 hours
• Can repeat meds, if not getting relief
• Go to sleep (sometimes, no matter what you do, some headaches get out of control)
• Some examples:
• NSAIDs - Aspirin, Ibuprofin, Naproxen, Diclofenac, Indocin
• Anti-Nausea - Reglan, Compazine, Zofran, Phenergan
• Others - Excedrin, Tramadol
• Triptans - Amerge, Axert, Frova, Imitrex, Maxalt, Relpax, Zomig
• Ergots - DHE, Migranal, Ergotamine

Rescue Medication Treatment (when acute treatments don't work):

• Sedatives - get to sleep
• IV or IM injections (often requires office or ER visit)
• Avoid narcotic pain meds
• Examples: Corticosteroids, Depacon, Magnesium, Toradol

Medication Overuse Headache:

• Rebound (use acute/rescue meds too often)
• Acute meds become less effective
• Headache frequency increases, eventually becoming daily
• Narcotics (opioids)/barbituates - high rebound
• No preventative works well

Preventive Therapy:

• Control other medical problems
• Diet
• Exercise
• Sleep
• Medication
• Anti-depressants (SNRIs)
• Anti-hypertensives
• Anti-epilepsy (neurostabilizers)
• Anti-inflammatory
• Muscle relaxants
• Sleep aids

Supplements:

• 5-HTP
• Magnesium
• Riboflavin (Vitamin B-2)
• CoQ-10
• Butterbur
• Feverfew

NHF Regional Conference - Part II

Migraine Triggers

Dr. Frederick Freitag

Dr. Freitag recently stepped down as co-director of the Diamond Headache Clinic in Chicago, IL. His new position is at Baylor University Medical Center in Dallas, TX. He is very active in headache initiatives (including clinical research, lecturing, etc...).

Migraine Facts:

• 1 in 4 households has a migraine sufferer
• Migraine affects women more than men (3:1)
• ~30 million people in the U.S. have migraine
• 12-18% of the population have migraine (more than asthma and diabetes combined)
• If one parent has migraine, his/her child has ~50% chance of also having migraine
• 75% of migraine sufferers have neck pain/tenderness

Migraine is...

• Genetic - brain programmed to be sensitive
• Hyperexcitability / hypersensitivity of the brain
• Neurologic process
• Whole-body disorder
• Chronic systemic disease
• Attacks vary (between migraineurs and migraine attacks)
• May be progressive
• SULTANS --
  
  • (moderate to) Severe pain
  • Uni-Lateral
  • Throbbing
  • Aggravated by activity
  • Nausea or vomiting
  • Sensitivity to light and sound (environmental)

Premonitory Phase (can include any combination of the following symptoms):

• Fatigue
• Thirst
• Yawning
• Dizziness
• Increased energy
• Food cravings
• Frequent urination
• Poor concentration
• Hypersensitivity to sound
• Neck pain/tightness
• Blurred vision
• Irritability/emotional

Aura - builds gradually 5-60 minutes (usually visual)

Prodrome Phase ("Migraine Hangover") can include any combination of the symptoms from the Premonitory Phase

Comorbidities (more prevalent in people with migraines than the normal population):

• Depression
• Anxiety
• Bipolar
• Obsessive-compulsive disorder (OCD)
• Panic
• Sleep disorders
• Heart disease
• Irritable bowel syndrome (IBS)
• Fibromyalgia
• Stroke
• Obesity
• Migral valve prolapse
• Back/neck pain
• Patent foramen ovale (PFO)

Risk Factors (Triggers):

• Stress (or let down)
• Hormonal changes
• Diet (skipping meals; specific foods)
• Sleep disruptions
• Weather
• Head trauma

Food Triggers (not an exhaustive list):

• Additives - aspartame, MSG
• Vasoactive amines - aged cheddar, fava beans, soy products, left overs, lunch meats
• Other foods - long list of possible food triggers
• Alcohol - red wine, other wines/beers
• Caffeine

Protective Factors:

• Eat regular meals
• Standardized sleep pattern
• Exercise
• Stress management (biofeedback, recreation/have fun, massage)
• Post-menopause