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    RN in distress
    Healthcareworker posted:
    I am a 38 year old RN that has not been able to work for the past year and a half. My disability benefits with my former employer will end in 09/2013. I have had Type 1 diabetes for 23 years that is well controlled, panic disorder/generalized anxiety disorder/major depression for the past 5 years, Rheumatoid arthritis/fibromyalgia for three years. My current tretment for RA is Arava, arthrotec, Simponi, folic acid. I was on precription Lortab for about a year, got addicted to them which led to abuse since it was no longer working for me anymore. My Rheumatologist put me on Lyrica and it did not work. My psychiatrist has me on zoloft for depression and anxiety, xanax, and ambien cr.
    I am barely able to function at this point since the pain is daily. I tried PT and all it did was make the pain worse. Tramadol was recommended; however, it interacts with zoloft and can cause serotonin syndrome. I have been sufferring for months after my Rheumatologist stopped the Lortab due to the abuse. I can not take steroid injections or pills as they raise my blood sugar to extremely high levels (300-500), which is dangerous. Because I am already on an NSAID daily, I can not take any other meds in this class. I am also limited for Tylenol intake as many of the meds I take can cause liver toxicity on their own. At this point, I am desperate for any kind of relief so that I can function and hopefully return to work. Heat and cold compresses do work temporarily while sitting still, but once I move, that pain comes back with a vengence. Cymbalta was tried as well, which made me suicidal and was stopped immediately. I feel like my life and livelyhood I have worked so hard to get has been taken away. I barely get $1,800.00 a month, which barely covers meds and medical expenses. I have no health insurance and so can not afford to go to a pain managment doctor or physical therapy. Cognitive behavorial therapy runs about $90.00 per session and I would need to go at least 3 days a week to get any benefit and that is also out of my budget range. If anyone can help me, I am open to any new suggestions. Thanks for taking the time to read this and hopefully I can get some really good suggestions as I am at the end of my rope.
    annette030 responded:
    Get the book, "Feeling Good" by Dr. David Burns, MD. Read it and follow what it suggests. It might be nice to be able to see a therapist three times a week for CBT, I don't know because I never did it that way. My therapist suggested the book when I moved away and I bought it and did it on my own. I am also a retired RN. Still licensed in Calif.

    It is a good read anyway. I have been using the techniques it suggests for many years. It cured my depression completely. It can work for you too to some degree. But you have to be willing to really work at it every day.

    Best of luck to you. Keep in touch.

    Take care, Annette
    77grace responded:
    Hello and welcome!
    I feel bad for you ,it sounds like alot to handle
    I have'nt read the book that Annette recommended but I have ead another which is simalar!!!Our Brain can do amazing things!!
    Relaxation ,Medatation and ,everything like Cognitive Therapy does!
    I Have a for instance for you!
    My Sister in law one day said that her Dr. (Pain) told her to be mindful of your body!For instance I can sit in a chair a few minutes and then Iwill say to myself(Drop you shoulders and instantly they usually drop and release ,which helps me to relax,etc.
    Best of luck ,stay in touch! 77grace
    Nana_of_spa responded:
    I'm a CNA and have 3 things wrong with my back, spondylolisthesis, osteoarthritis and a herniated disc. These are all in the L4-S1 area. I had 1 back surgery that was going to be to put in hardware to fix the spondylolisthesis, but the Dr decided that the slip wasn't great enough for that so he was just going to do a discectomy. When he got inside, he decided not to take out the disc, because it looked to be in "good" shape, just herniated. So he carved the bone in my spine to give the nerve room to move away from the disc so it wasn't being pinched anymore. From the time of the serious pain to the heeling of the surgery, I had been out of work for 4 months. I finally go back to work, and am having pain again/still but different from the nerve pain. So the other Dr gives me these medicines. I start talking funny and walking funny. ( I didn't notice, but my family did but didn't do anything) One day on my way to work (5:30 a.m.) I fall asleep and run off the road, and go up over the curb. If that hadn't woke me up, I'd have hit the power line pole. Don't know how, but got back on the road and to work. When I got there, the nurse says I sound like I'm having a stroke and need to go to E.R. She didn't call ambulance tho. I call my husband. To shorten the story. I had to quit my job, because I could't ask for another medical leave while the Dr.s worked out the medicine issues. That was in June, this is October. I still have the pain and the medicine they gave me isn't working. The one Dr finally is sending me to a pain center. I pray they can help.
    I hope some how something helps you too. I know living with pain is miserable. If I hear of anything thing that may work for you I will come let you know.
    Good luck. And I'm sorry for my rambling. I tend to do that at times.
    Peter Abaci, MD responded:
    As an experienced nurse, you know how difficult it is to take care of others when you don't feel well yourself. I would like to offer some suggestions for you that are cost-effective but can also be meaningful.

    Learning some approaches to calm down the central nervous system can improve the management of fibromyalgia, an anxiety disorder, and generalized stress. One program that has demonstrated good success with this and also been shown to be effective in treating chronic pain is called Mindfulness-Based Stress Reduction (MBSR), This is an 8 week program that can be found in many communities now and the whole program usually runs a few hundred dollars.

    There have also been recent studies published on using tai chi and certain types of gentle yoga to improve the management of pain disorders like fibromyalgia. In my own practice, I have found tai chi to be a great activity to help patients become more active and lower their pain. You may find affordable classes at a local community center that you can take advantage of.

    As Annette has already suggested, getting the right books can also be a big help. In addition to what was recommended, I can also suggest "Full Catastrophe Living" by Jon Kabat Zin, and of course my own book "Take Charge of Your Chronic Pain." Amazon usually sells these at big price reductions.

    Medications can be very expensive, especially the newer ones, but they don't always do a great job improving the quality of our lives. Certainly, working with your doctors to just stay on the ones that are really helping can free up some money for other things when finances are tight.

    Lastly, remember that as a nurse you have a wonderful skill set, and that your talents could lead you to a modified version of the job that you loved for so many years. Health care is a growing and evolving industry with many opportunities.
    aniwangmo responded:
    I am a fellow RN who had a lifting injury in 2006, back surgery in 2008 and was then unemployed for 2 years after exhausting FMLA after the surgery and then losing job security. So I understand to some extent what you are going through.

    The pain was hard for me to deal with but I find was worsened by financial stress from unemployment and lack of medical insurance. So I would like to offer some resources on that as well.

    It sounds like you have exhausted most of the medication options for pain management. It helped me alot to have non-medication tools for pain relief.
    1. Look for massage or acupuncture schools. they usually have student clinics and offer services at low cost. they are supervised in most cases but doublecheck this.

    2. exercise/movement is helpful for your body. staying still will make pain worse in the long run. warm water aerobics/tai chi classes were really helpful for me. some clubs have discounts for pts using it for rehab. if this is prohibitively expensive even walking, tai chi or gentle yoga is a good option. it may make your pain worse initially but will likely help in the long run. Pilates was also important for core strengthening for me.

    3. Ice, heat and a TENS unit helped me a lot to relieve pain at times when I couldn't take pain medications because of work. TENS units are available online for less than $100 with a prescription although you may need a PT to show you how to use it.

    4. Mindfulness meditation helped me to decrease my emotional reactions to pain and thus decrease how bad the pain felt.

    As far as resources for financial difficulty. I received a training grant from DVR (Department of Vocational Rehabilitation) to go back to school and get my masters in nursing education to become more employable. If you are considered to have some degree of disability even if you don't have SSI then you may want to look into this. When I finally was hired again after 2 years I did telephone triage for a clinic, working PRN picking up shifts 1-2x per week. Later I picked up a part time position with medical benefits which helped alot.

    While I had no insurance and was unemployed I received assistance from Nurse's House in the form of a $1500 grant to be used for whatever I needed. It is a nonprofit organization that helps nurses in need. . Consider applying.

    I also received my pain medications through PAPs (patient assistance programs). You may be eligible for this since you are uninsured. Different programs have different financial requirements.

    I also received copay assistance for pain meds while I had insurance. You probably won't be eligible for this if you don't have prescription coverage but for others that have copays that are expensive consider applying for this.

    Hope this helps. I know what it is like to be in your situation. Several years ago I was very depressed about my situation but now my sxs have improved and while I am still on medications I am able to work part time and function as an RN again. So finally, Keep hope alive. Just because things look bad now doesn't mean they will always be like that.
    KristiLoo responded:

    I have had a lot of health problems too. One thing in your post stuck out to me- Ambien CR. My doctor had me taking it daily for over a year because of sleep problems. I had a sleep study done during that time, and I NEVER entered REM sleep?!?!

    At a certain point, I decided that my meds weren't helping, and that I wanted to start going off of some of them (with my doctor's guidance). One of the first ones I stopped was the Ambien CR. It was rough for a few days... but my pain DECREASED significantly. I was less exhausted too. I would highly suggest talking to your doctor about trying that. Taking Ambien long term can inhibit good sleep, and just knock you out... then your body doesn't get REM sleep, and the human growth hormone isn't produced enough. This causes your body not to regenerate its cells like it should.. so you end up in more pain. So, it's just a thought of something you may want to try.

    Sometimes those of us with multiple syndromes get put on a million medications... that only work for a small percentage of people. No one really knows how they interact with each other, because they are studied independently, not used together. If the meds aren't actually making you feel better, I would really stop to consider whether or not you want to take them.

    Personally, I've decreased my meds by about half. I still have a lot of problems, mind you, but at least I don't feel really overmedicated. (ever have trouble even remembering which ones to take at what times because there are so many??) I did get some relief as I went off of them. Just make sure if you decide to go down that path, to include your doctor. It can be dangerous to stop certain drugs too quickly... it's a process.

    Not that I'm good at taking this advice, but sometimes exercise, warm baths, and eating healthy can be beneficial too. Easier said that done when you are so tired and in so much pain, I know.

    I hope that you are able to find some relief.
    sharim responded:
    First of all let me say I understand your pain and I am sorry for it. I wish there was a magic bullet but there is none.
    You say that your medical benefits end next September, 2013, is that a mistake? As long as you are getting those benefits put them to work for you. Try chiropractic. Chiropractors are usually willing to help you stretch your benefits to accommodate visits and co-pays.
    You are an RN, working in a doctors office or hospital setting? Don't they usually help you out with visits and sessions within a medical group. I guess I don't fully understand your work place setting.
    For the needles, the injections for pain, not all injections have to be with cortisone. They can use just lidocaine. Chiropractors also use needling, the ancient art of acupuncture. They do acupressure and they can be very helpful and creative if you have limited medical coverage. Seek one out that has a good reputation. They are sometimes much more caring than other physicians. Just my opinion and my experience.
    First you need to calm down because in a stressful state you are doing more harm than good. Make a list of what your issues are, place them in order of importance, what you need is different than what you want. You may need to apply for SSD, do it now with a lawyer. The government pays them off the top you don't even get that bill.
    I had more than one treating physician and not one would say the words-You Cannot Work. It was a decision I had to come up with and then talk to my GP. He had all the paperwork from all the docs and he agreed and we filled out the papers in his office. Your GP won't necessarily come out and suggest it to you, it is up to you to make the decision. Once the decision is made you need to find a good lawyer (if in the US). The lawyer will take it from there and I mean it, they take charge.
    I have severe idiopathic generalized osteoarthritis, carpal tunnel (bilateral), ulnar nerve entrapment, fibromyalgia. I have had 3 back surgeries the final one a fusion, 2 x @ carpal tunnel release surgeries, ulna nerve transposition surgeries. I get absolutely everything bilaterally. Right thumb, left thumb, right knee, left knee, right ankle, left ankle. And in the beginning a neurologist tried to tell me that this was not possible. He was an ___________ (fill in the blank). I cried myself to sleep every night for months and months. It was a long time before I could even think about disability. Not me I am a baby boomer we don't get sick, we don't get old. I am not old. I was not old when this started I was still in my 40's. Well, had to adjust my standard of living and give myself a cost of living in a disabled world reduction in payroll. My "salary" was cut by two thirds. I had to adjust. We all have to adjust.
    I wish I could say things are going to get better. You will just get better at handling what comes at you. Decide what your passions are and work at those and decide what you don't need. I can only encourage you to keep going and find someone to encourage you along the way. Really, I found comfort in making lists and placing things in order of need and want and settling for what I needed first. And yes it is very, very hard and very depressing at times. I can only imagine going through all this and with a dx of depression at the outset.
    I can only offer you prayers and encouragement. I know having someone in your corner is important, I am in your corner, God bless.
    jacc0229 responded:
    First off, i totally understand. i was a research lab technologist. I have battled FM for 11 years and tried everything. I have now started myofascial release therapy. I think it may work. I have applied for long term disability and social security disability. I started having other problems and just could not work any more. It has been extremely depressing. Along with all of this comes the terrible anxiety. Fortunately, I have not lost my insurance yet, but, plan on using Cobra until I possibly get medicare. Recently my PCP added 1/2 pill of Remoron to my Lexapro. It really helps sleep and, I think, anxiety. i have just started taking this so cannot speak for long term. Maybe an idea? may God bless you and heal you.
    teatotter responded:
    I have had 9 lowback surgeries and 3 neck surgeries the most erecent one 1 month ago. Two weeks ago I was in pain from my neck down to my and down the right leg. My doctor recomended oxycodone soma and a TENS unite. I was skeptical about the TENS but I must say I don;t think I would be walking or even getting out of bed if it weren't for the tens unite it helps with the pain I don't feel it as intense as it was and I am feeling better. The pain does come back without it I have the unite for another 6 weeks ,so I don't know what will happen when I don't have it anymore. I am hypothyroid, fibromyalgia, and have had a total of 27 surgeries total. I don't know if this will help you but anything is possible to help.
    sharim replied to teatotter's response:
    Do not over indulge in your TENS, you will become immune to it believe me it has happened to me. I am happy it has helped you gain some relief. I used to attach my TENS and then tuck my heating pad into my sweat pants, tighten it up with the draw string, on a long extension cord, long enough to let me get up to get drinks, do a dish or two and so on. Eventually I needed to turn the TENS up higher and higher, a game I began to play with myself. How much can I do today?
    Like everything else it's best in moderation.
    I am surprised that it took that long for someone at PT to introduce you to TENS. It was at one of my first ever visits to PT that I was attached to it and my insurance paid for it.
    I know about the surgeries, I have a long list too. You sound like a candidate for something implanted, gets the treatment, drug or stimulation directly at the source and works much better. You have no control over the pain meds administered but I don't know about the electrical stim.
    You will plateau on the TENS. You don't mention PT. That is where I was first "fitted". The combination of TENS, exercise, heat and or ice, massage might be beneficial but after 16 weeks, 3 times a week I did hit the wall. I was getting worse, it was my first experience with all this and somethings really hurt to manipulate. They did not always listen to me and I don't recall them telling me that I have the right to refuse exercises or any treatment at any time without repercussions.
    In other words the right to complain, skip things, and actually leave sessions early. Also the right to talk things over with a nurse practitioner, on site. They did things in those 16 weeks that were not in the book, scared me and sent me home in tears when they increased my pain level. It was a tough go round. Probably the only person who left the place in more pain than when I started.
    Bless you and my prayers go out to you.
    ctbeth replied to aniwangmo's response:
    Thank you so much for sharing Nurses House.

    I am an RN, disabled, but hold a current license.

    Nana_of_spa is a CNA, though.

    Nursing House offers assistance ONLY to RNs.

    I had never heard of this organisation before.

    There was a time that I could have used the help.

    What a fine resource!
    annette030 replied to ctbeth's response:
    I have never heard of Nurses House before either. I will check out their website later today. I am still a licensed RN also.

    I did use the state Dept. of Disability and Voc. Rehab. in Nevada. They were great.

    Take care, Annette

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