On 4/2/00, Kate Stevens<[log in to unmask]> wrote:

<< But I'm afraid we tend to reach straight for the drug chart in the early 
stages of recovery when pain is a

problem. What exactly did you mean by therapeutic touch?>>

***Whether we choose to accept some of the work that Dolores Krieger did with 
her "Therapeutic Touch" system, the fact that human (or animal) touch and 
closeness has been shown in some studies to facilitate or accelerate healing  
should not be ignored in therapy.  Apparently, there is a major difference in 
the rate of bodymass gain and quality of life of premature infants who are 
comforted and handled frequently, as opposed to those who are left for long 
periods in far more technological or strictly clinical care.  And most of us 
are just grown-up babies at heart!

While we accept how good physical touch and intimacy are in everyone's normal 
lives, we seem to think that such affective needs have no real place in 
therapy.  Knowing what it is like to be on the giving side of therapy and how 
unpleasant it is for medical staff to be near some patients, when I was in 
hospital I intentionally tried my best to be a pleasant patient and fairly 
normal human being so that staff would interact with me more easily and as a 
human being that they would simply enjoy visiting.  This truly worked wonders 
- even busy surgeons with the typical godlike facade and nursing matrons who 
made drill sergeants quiver in their boots would periodically sit down on my 
bed and chat, explaining everything that they would be doing with or to me.  

When I was really very ill and my survival was not at all certain, I used to 
ask nurses (usually from several different African tribes!) to just hold my 
hand a while and massage my back.  Sometimes, when time afforded it, I would 
have as many as three nurses at my bedside doing various duties for me. 
Despite strict enforcement of visiting hours, there were a few folk whom they 
allowed to spend time with me as often as I wanted it - my tough, 
larger-than-life American pastor,  a Chinese lifelong Tai Chi Master friend 
of mine, an old Weightlifting colleague/friend and a Greek student of mine 
who really bonded with me after my heart attack.  All of that made a major 
difference to my comfort levels and my state of mind.

Late after midnight when the pain was really severe and I could not sleep, my 
main Zulu nurse, Jacob, used to come and talk to me and work out solutions to 
help me without the typical hypnotics that left me groggy for days.  When he 
discovered that one of my specialisations was strength research (his hobby 
was bodybuilding), he enjoyed coming to find out about training when everyone 
else was fast asleep in the ward.  When I was discharged, he invited me to 
attend his mainly Zulu parties in city hideaways all over the place!  

When I was able to take my first few hobbling steps and was released from the 
large general ward, I regularly used to visit my former ward mates who were 
not doing very well at times and we shared some special times together, 
because I knew how much better that made me feel when I was suffering.  Some 
of them had very few visitors, so that filling of their lonely space seemed 
to bring a lot of joy into their lives and sharing our mutual problems really 
helped us all.

Later, the staff became so friendly with me that they even allowed my 
disabled wife come and sleep in my private ward - they dragged in an extra 
bed and that made a very big difference to both of us.  My wife suffered 
severe post traumatic shock from my sudden near fatal heart attack and she 
was staying in our huge house all alone, so this staff gesture was a real 
boon to us.  What's more the clinic did not even charge us extra for my 
wife's accommodation.  Needless to say, I would recommend that clinic to any 
other cardiac patients.

So, I strongly recommend touch and closeness as part of the healing process - 
in all of the forms that I have described in my own case.   For heaven's sake 
why preach and practice a policy of clinical detachment when all humans 
thrive on appropriate closeness and touch?

<<You didn't mention acupuncture as a means of relieving post-op pain. Does 
anyone on the list have experience of using this?>>

***I intentionally omitted that because I was concentrating more on therapies 
that can be self applied.  I did however, show some of my friends how to use 
acupressure or trigger point release on me and that did help to relieve some 
of the pain.  However, I found that transcranial microcurrent tended to 
reduce pain more easily (I own an ElectroAcuscope).


<<Perhaps the day will come when we will let our patients choose their 
preferred method of pain relief pre-op so that they can be made familiar with 
that technique before admission! >>

***Up to a point, a very good idea, though at times of extreme pain, one just 
wants to be "knocked out" and have some sleep, so that medically chosen 
medication might be the first choice for a while.   There is nothing as 
miserable as suffering from agonising pain and not being able to sleep - this 
is incredibly debilitating and depressing, and that is why I think that the 
conquering of pain is a far more fundamental goal than prolonging life and 
curing disease.  Of course, curing the disease may well remove the pain, but 
waiting for the healing to become significant enough can be sheer hell.  

I discovered that inhalant anaesthetics and analgesics give the most 
exquisite and rapid relief of pain - what a pity that they pose a significant 
long-term risk to liver and other organs!  I did not try nitrous oxide-air 
mixtures, but I have heard that this is one of the safer inhalant analgesics 
- has anyone had experience with it in the management of acute or chronic 
pain?

<<Has anyone done a study on the use of Walkmans during hospital admission? I 
can see it could be very useful in critical care units to block out the sound 
of all those alarms. >>

***If this study has not been done, are there some students out there who are 
looking for a suitable therapeutic topic?  This may be an interesting choice! 
When I was first admitted into high car, the sounds of cardiac monitors and 
various other emergency alarms going off was extremely unnerving, as I always 
thought that it was me who was about to go nearer to the happy hunting 
grounds.  

Then, since you cannot really lie on your side after cardiac surgery, with 
all those drain pipes shoved through the chest, abdomen, groin, neck, leg and 
arm, patients invariably have to sleep on their backs and that means some 
heavy duty snoring!  The staff had no earplugs available, so I had them 
improvise for me with Vaseline and cotton wool wads that I could insert in my 
ears.  

Wards are the worst place to sleep, yet we all know that sleep is one of the 
greatest physicians of all.  That struck me as one of the greatest paradoxes 
of medical care - you can never get a decent night's sleep, yet staff  expect 
patients to recover comfortably and not be grouchy. This problem has never 
been adequately solved in hospitals and it is was past time that the sleeping 
situation is improved.    Most hospitals wake you before dawn to suit 
hospital routines more than patients and it is sheer purgatory to be woken 
after 3 hours of painful sleep to be washed and serviced.   Even the military 
don't always mismanage recruits that callously!   Is this situation ever 
going to change? 

Something really needs to be done about noise and disturbance in hospitals.  
The use of  'Walkmans' and appropriate relaxing/soothing music (possibly even 
using embedded white or pink noise as an analgesic) is a relatively 
inexpensive step in the right direction.

Mel Siff

Dr Mel C Siff
Denver, USA
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