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Ups and Downs - The Rollercoaster Ride we call Emotions

                I’ve been having a couple of down days, not for any reason in particular. I’m not experiencing any extra pain, or even any severe pain. Yet, I’ve been feeling sad.

                Every individual person has a lot of things to complain about life, even me (and believe me, I complain a lot). Whether it’s about a job, a person, an event….

                But you know what, for everything we complain about, we could think of something we’re thankful for too!

                It can be hard to see when you’re feeling low, but it only takes one good moment or good deed to show me the amazing things in life.

                I know Thanksgiving has long since passed (in Canada it has anyways) but here’s a list of things I sometimes take for granted, but absolutely love and am thankful for every day, even if I don’t show it all the time!

                My boyfriend, my job (I know I’ve never spoken of my job before, but trust me, it’s amazing… maybe I’ll talk about it in a future post), the various other people in my life that support me like friends, coworkers, family, etc., I’m thankful my dad lets me live in his house rent free while I go to school, my car (I do love my car Goldilocks), annnnd tea (which I’m drinking again by the way if you haven’t read my low oxalate diet post yet)!

                I know there are more things than just that, but this is just a quick post to get it all off my chest. I was in a quick session at work, and it just went so well, and one of the women I work with/for said some very supportive and great things that pulled me out of my nasty blues. I’m ready to conquer the rest of my day and hopefully week too!

                Brighten someone’s day today!

Enoxaparin Research Study - Summary and Review

Hey girls! As a psychology student, and consumed by the idea of vulvodynia, I do a lot of research in the subject! I haven’t posted any of the research I’ve found as of yet, but would like to start. Today I found a study on this drug called Enoxaparin. The study is called Enoxaparin Treatment for Vulvodynia A Randomized Controlled Trial by Yaniv Farajun, Doron Zarfati, Liora Abramov, Alejandro Livoff, and Jacob Bornstein. I’ll post the real citation underneath my summary of the article.

                The study recruited 40 women with severe localized provoked vulvodynia. They were randomly assigned to a placebo group or the Enoxaparin group. The women had to self-administer an injection every day (either 40mg of the Enoxaparin or a saline solution for placebo group) in the abdominal region, for 90 days. Women ALSO had to follow a low oxalate diet and take calcium citrate supplements (to give all clients a similar nutritional background – controls the variable of nutritional background).

The researchers hypothesized that Heparanase is a cause for an increase in neuron growth and neuron penetration in the vestibule which would vulvar sensitivity and pain. Enoxaparin may block the enzyme activity and inhibit the effects of the heparanase and so this study tests to see if Enoxaparin relieves any vulvodynia pain symptoms.

The Q-tip test was administered before treatment, with pain measures, and re-administered after the 90 days of treatment and then three months after completing the treatment. Participants kept a log book of side effects such as easy bruising, abnormal bleeding.

So what did they find? The Q-tip pain scores (scale 0-10), in the Enoxaparin group, reduced on average from 8.2/10 to 6.25/10 after treatment and 5.8/10 three months following treatment (a nice graph showing this on pg. 568 - figure two). Also, the women in the Enoxaparin group reported feeling less pain during intercourse by the end of treatment.

At the beginning of the study, women in the Enoxaparin group, had 15 women who could not have intercourse because it was too painful but by the end of the study, 20 women could not have intercourse because it was too painful (that doesn’t sound to promising!).

At the beginning of the study for the Enoxaparin group, 45 women had such intense pain they always had to stop mid intercourse and 40 women had intense pain but were able to complete intercourse with full penetration; by the end, these two categories decreased to 15 and 25 women (that’s a bit better).

And at the beginning of the study, zero women were under any of these three categories: almost painless intercourse, painless intercourse and not sexually active lately; by the end, these categories were filled with 35 women, no women and one woman.

But, the women in the placebo group showed a decrease in as well (although not as much)! There’s a detailed table showing everyone’s pain increases and decreases on pg. 570 in table five.

So there you go! Maybe Enoxaparin could be used as a treatment for women with localized provoked vulvodynia. It WILL NOT work for women with generalized and/or unprovoked vulvodynia treatment. The downfall to thus treatment: you have to inject yourself every day! And if you look the drug up, it’s got some not so nice side effects because its main use is to prevent Venous Thromboembolism type diseases.

There were a couple other things I didn’t like about this study, starting with the use of a low oxalate diet. I understand they wanted everyone to follow a similar diet to cancel out any external variables that could influence the treatment, but a low oxalate diet COULD affect treatment, because it is a treatment for some women! So it’s possible that some of the women (in either the control or the Enoxaparin groups) could have had symptom/pain relief not from the placebo or the Enoxaparin but from the low oxalate diet!

The other thing I didn’t like was that there was no mention of how many side effects were logged or called in.

Either way, I personally think, that this isn’t enough evidence (yet) to go out and ask for an Enoxaparin prescription. I’m sure further research will be done on the subject, and I would wait to see what those studies come up with for results first.

The proper citation for this article is:  Farajun, Y., Zarfati, D., Abramov, L., Livoff, A., & Bornstein, J. (2012). Enoxaparin treatment for vulvodynia: a randomized controlled trial. Obstetrics And Gynecology, 120(3), 565-572. doi:10.1097/AOG.0b013e3182657de6

And the article can be found for PDF download at: Link to site with PDF

If you guys have any questions about the study, about my summary, about any confusing terminology, etc. Leave a comment and I'll answer as best I can, ask someone who can or refer you to other resources.

I'm in my fourth year of a psychology program, so there are even some things in this study that I didn't quite understand, but what I've written for you guys above is the nitty gritty (the main important portions of the study that are important to an every day consumer). 

vaginismus.com

Just found this great website! It's got products available for purchase (dilating sets, self help books, videos, kits, etc.) and great information on different treatments, diagnoses (primary vs. secondary, etc),  just a whole bunch of great stuff that I just had to share!

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Low Oxalate Diet

 

            I haven’t made a post about this yet, but for about a month and a week I’ve been trying the Low Oxalate Diet. I tried it a couple months ago, and after two weeks had a session of relatively successful sexual intercourse. It was still painful, but not so painful that I couldn’t get past it and make it through a whole session of intercourse. I stopped the diet afterwards, as it’s not a fun one in my opinion, and haven’t had intercourse since. I have no idea whether it was a factor or not in the less painful intercourse, but I thought I’d try it up again, and this time for a bit longer as they recommend individuals do the diet for three months!

            The Low Oxalate Diet is the diet they put people on when they commonly get kidney stones and such. When I first came across the diet, I was like “What the heck is oxalate?” not easy to find info on, but from what I’ve read, it seems to be in EVERYTHING (i.e. all plants and all animals). The body uses it as a way to get calcium out of our bodies, it bonds to the calcium and crystallizes to make it easier to excrete it from the body. When we have high levels of calcium AND high levels of oxalate that’s when kidney stones can form (the crystallized calcium) or smaller portions of this crystallized calcium can cause pain when being excreted in our urine (thus the pain some women may have following intercourse as they urinate). I personally do not get these forms of pain, but I came up with a theory on my own! Can’t remember if I read it somewhere or not, so don’t take this as a fact (I’ve mentioned it to my doctor and he didn’t tell me it wasn’t impossible…) but calcium is typically near bones, like pit spinal cord segments, if the oxalate bonds to the calcium near a spinal segment where my neural pathways to my pelvis are, perhaps the crystallized calcium pushes up against and pinches the nerves/neural pathways. Seems logical, right? So I decided to give the diet another shot!

            Here’s the grid I follow for what I can eat every day, what I can have every once in awhile and what I should not ever eat.

 

            The only problem I found while being in the diet: the psychologist told me not to do anything that causes higher than 3/10 on the pain scale, so how do I test whether it’s working or not??

            Well! Today is the day I’m hoping to find out, it’s been almost a month and a half, and I’ve decided that today is going to be my cheat day! I’ve already had a big cup of black tea, a grainy bagel with peanut butter on it and some chocolate! Oh how I’ve missed all of these things, and berries too (but I haven’t had the chance to have any today … yet)! If this diet works, I’d expect that after this cheat day of high levels of oxalate, I’d experience a significant amount of increase uncomfortableness over the next couple of days. If I do experience an increase in pain or general discomfort, then I’ll continue the diet, if I don’t feel any difference in my comfort or pain level, I’m going to go back to eating my normal foods (and tea!).

            I’ll keep you guys posted J

Biofeedback with Physiotherapist!

                It’s been a crazy week! Monday was Remembrance Day, my partner is the bugler for the ceremonies in our city so we were running around all morning for that, it was also my dad’s birthday so there was a big dinner that night! Then Tuesday I had a midterm, Wednesday I wasn’t too busy but was freaking out about a presentation I had to do today that I hadn’t finished, so I was up until midnight, didn’t finish and had to wake up at 6am to finish up and still make it to my 8am physiotherapist appointment! Phew.

                I was nervous about this appointment because today was the day we tried biofeedback. I had no idea what to expect. I was worried about where the electrodes would be placed, because they’re quite sticky and I was advised not to shave (not that I needed an excuse anyways!); it turns out physio’s usually place them near the anus, as I learnt firsthand this morning; apparently it’s because there is typically less pubic hair there, fair enough!

                I’m not sure if any of you have seen how biofeedback works, if not here’s a quick video: Biofeedback with Dr. Oz

                Basically, an electrode (or multiple electrodes) is attached to the muscle area you’re trying to learn about, in my/our case: the pelvic floor (and apparently anus). Then it’s plugged into a computer and a program is started that shows a graph/chart of the electrical activity going on in that muscle area. The line on the chart is in continuous waves, when you’re relaxed they are quite small, and low on the graph, when you tense the muscles the line spikes to the top of the chart and the waves increase in size and frequency. You’re asked to tense your muscles for so many seconds followed by relaxing your muscles for so many seconds, and you repeat it between 5 and 10 times. After that, you get to look at the screen and see what it looks like when you’re tense versus when you’re relaxed.

                It was very interesting for me, especially for the first couple of trials when I couldn’t see the screen. The physio would say “tense up,” I’d squeeze my pelvic floor, wait for her to say “and relax” and then I’d “relax” my pelvic floor… or what I thought was relaxing! I must not have been re, axing very well, because she would repeat that a couple of times: “okay, relax… relax… push it out… deep breaths, relax…” I understood why after she showed me my activity on the screen, I was not relaxing! Even though it felt like I was? It was strange. So we tried some more myofascial tissue massage, re-hooked up the electrodes and tried again.

                It seemed to have gone better on the screen, but when I got to watch my activity, I could see myself relaxed, I could tense my muscles, but when I’d try to relax (or what I thought was relaxed and felt relaxed) the computer and chart still showed I was tense. If I focused really hard, eventually the line on the chart dropped down to what was considered “relaxed” but I physically could not feel that relaxation. I could feel my muscles going from relaxed to tense, but not tensed to relaxed. So I believe that might be our next goal! Trying to get me to recognize when my pelvic floor is tense or relaxed and how to get it from one stage to the next.

Today’s total: $40.00

                Grand Physiotherapy total: $210.00

Second visit with Psychologist - Sensate Focus and Thought Recording

Another long day, about six hours of travel time for a two hour psychologist appointment. A very productive appointment though! Learnt some new techniques that I’d like to share with you guys, mainly to do with the homework I was assigned.

The first thing I’d like to mention, is last time I was assigned homework for this appointment that I forgot to write about: A Cognitive Hierarchy of Fears.

I’m no psychologist, and so I’ll do my best to describe it, but do some research of your own and if you think it may be a beneficial tool I would recommend consulting a psychologist to help you build one or look over yours and help you with the steps after the hierarchy being written.

When I was building my hierarchy, I thought of all the situations that scare me to do with my pain (self stimulation, foreplay, sexual intercourse with penetration, kissing, cuddling, etc.). Once I thought of all the situations that cause me anxiety (any level anxiety/fear from a little bit to a lot), I put them in order of least fearful to most fearful and finally give them a fear score out of 100 (ex. Sexual Intercourse - 85/100). When working with a psychologist after making your hierarchy, he/she will help to decrease the anxiety associated with those situations, and each psychologist will have his/her own methods of going about this. What I have heard of some psychologists doing is teaching their client relaxation techniques (deep breathing, muscle relaxation, changing thought processes, etc.) and once the client is comfortable with the technique(s), the psychologist will describe a lower anxiety situation from the hierarchy to the client, the client is to imagine this situation as it’s being described, and use the relaxation skills to decrease the body’s natural reactions to anxious situations. You might be thinking “but how is that going to help my real life pain?” Surprisingly, research has shown that once you can remained relaxed while imagining all these situations, and your anxiety level in these situations has decreased to a low score (out of 100), that the skills will transfer to the real life situations as will your anxiety levels to the situations. The brain is powerful, but easily tricked! When you imagine a stressful situation (or any situation really), your body will act as if you are truly, physically in the situation, and so practicing while imagining can be equally as effective as practicing in as real life situation!

My psychologist and I did not work on this today, but she noticed in my previous homework that I have a bit of fear to any physical touch that may or may not lead to any sexual activities, so she suggested an interesting exercise for my partner and I to try: Sensate Focus.

Apparently there are five stages to sensate focus, she only described to me the first stage. The first stage involves taking a half hour with your partner, and exploring with touch anywhere except the genitalia and the breasts. For fifteen minutes each, one partner will touch the other all over his/her body – light touch, deep touch, one finger tracing, full hand massage, etc. As the partner is touching different parts of the body (for 30-60 seconds each body part touched), the receiving partner is to “go inside his/her own body” and practice deep breathing and thinking about how the touch feels (where do I feel this? It is tingling. It is ticklish. It is soft. Etc.). There is no talking between partners during the process, except that the partner receiving the touches should say ratings out loud as to how the touches feel (example: 2/10; 9/10; 5/10, etc.). Any rating above zero is a good rating, if there in any touch that is painful or too unenjoyable, “stop” must be said, and the partner just moves on to another area of the body. 1’s, 2’s and 3’s should not discourage the partner touching from the area he/she is touching, in fact he/she should continue touching that area for the thirty to sixty seconds, because as the partner receiving touch relaxes and is deep breathing, the feeling of the touch may change. After fifteen minutes lf touching one partner, the two should switch roles (no feedback or discussion while switching). After both individuals have had fifteen minutes of touch, then you can offer each other feedback. This is a beneficial exercise for many reasons: couples get to learn where their partners enjoy being touch and what kind of touch is pleasurable; if either partner had a fear of touch, he/she will begin to habituated and maybe start to uncover some non-sexual pleasurable touches; it allows each partner to practice relaxation techniques and a new way of thinking about touch, a more curious thought process about how the touch feels, where it affects your body, etc. The last important thing to remember is that this is not meant to be sexual, and that the couple should refrain from any sexual interaction during the exercise and for at least an hour afterwards.

Some resources to learn more on senate focus:

-          Short but Sweet Description on Website

-          Link to Great PDF

My second homework assignment was to start a thought record.  In this thought record, I’m to write down any thoughts I have about my diagnosis or pain, the date I have this thought, if I experience pain during the thought or prior to the thought I need to rate the pain out of 10, the situation that provoked the pain and/or the thought and if my thoughts follow any thinking errors.

Thinking errors are different ways of thinking that have been identified of thought processes that people experience when they experience chronic pain, depression, anxiety and other disorders that affect the way we think. Here are some examples:

-          All or none thinking: you see only two categories in a situation, everything is black or white, no grey areas. You might use language like “always, every or never” and something feels like it is either completely good or completely bad.

-          Fortune telling: predicting that negative things are going to occur. An example might be “I’ll never get better.”

-          Catastrophizing: thinking that the worst is going to happen (kind of like fortune telling, but to the extreme).

-          Discounting the Positive: ignoring positive aspects or somehow altering them to seem negative.

-          Emotional Reasoning: because you feel emotionally something is true, you ignore any evidence discounting it and follow your emotions. Example: “I wouldn’t feel so hopeless if it wasn’t so.”

-          Labeling: labeling yourself or others. Example: “I’m a (sexual) failure.”

-          Mental Filter: paying attention to negative details instead of the whole situation.

-          Mind Reading: believing you know what others are thinking and not thinking of alternative possibilities. OR you assume that others should know what you’re thinking.

-          Overgeneralization: making the assumption that a negative situation will occur forever and repeatedly. Example: “I will never have pain free sex.”

-          “Should” and “Must” Statements: you know how you want yourself and others to act and are upset when the expectations are not met. Example: “I should be able to enjoy sex.”

-          Maladaptive Thoughts: thoughts that may be true, but do not help to dwell on. Example: “I’m feeling a lot of pain” or “It’s not fair.”

-          Minimizing: refusing to five yourself credit for any positive feedback received.

Nobody will experience all of these thought errors, but maybe a few of them. There are ways of rethinking these, and writing them down makes it that much easier to see them and say, “That definitely is fortune telling, I could think this instead.”

Here are some good resources to learn more about thinking errors and thought recording:

-          Cognitive Thinking Errors

-          PDF of Thinking Errors

-         PDF of Version of Thought Recording Sheet

-         More Thought Recording Sheets

My last homework assignment was to start tracking my pain and interventions. At the end of every day I need to write down if I had physiotherapy that day, if I experienced pain that day, what my stress level was that day and if I used any interventions that day. Hopefully this will help us to start pin pointing aspects that might affect my pain!

This was a long trip, but it was productive, I’ll be returning in three and a half weeks to the psychologist. Here’s money spent:

Money spent today on psychologist: $300.00

Travel Expenses today: $165.00

Total expenses today: $465.00

Total Psychologist fees up until today (not including travel expenses): $450.00