• Most of us intellectually understand that the only moment we have in life is this very one. That is it.
• Being in medicine for over 40 years has shown me the incredible unpredictability of life. Life changes in second – sudden heart attack, bad car accident, diagnosis of terminal cancer, and the list is endless.
• But our minds play tricks on us by constantly worrying about the future and hanging onto regrets from the past.
• This problem arises from our unconscious mind that is protecting us. It is continually scanning the present looking for situations from the past that were perceived or were actually dangerous.
• So, your actions today are a result of your cumulative perceptions of what is safe – or not.
• You can’t control this response but by using tools to stay connected to the moment, its impact is lessened.

Commitment to change is one thing but sticking with it is challenging. One way to help yourself along is to bite off small bits at a time and proactively make the choices all day long. It will become a habit and your norm. A starting point is repeatedly asking yourself a simple question, “Who do I choose to be today?”

A tough start to my day

One morning I woke up feeling low, having just completed eight straight 15-hour workdays, including a long weekend. As I lay there exhausted on a Tuesday morning, I reviewed my choices: either 1) stay in bed feeling sorry for myself; or 2) give thanks for the opportunity to help so many patients during the week, be grateful for how well the week went, and meet my work-out group early at the gym. I chose the second alternative. I got up, worked out, went into the office, and gave 100% to each patient and my staff. I’m not saying it was easy; but it turned out to be a great day.

Proactively choosing how to experience your day is the farthest thing from “positive thinking.” No one is asking you to pretend to be happy when you are coping with a difficult situation, especially your ongoing pain. On the contrary, you must be aware of the depth of your frustration before you can choose to live a full and productive life with or without pain – or decide to enjo. Positive substitution—filling your life with positive experiences— is the essence of neurological reprogramming.

A Tough Beginning

Recently, I was talking to a friend’s teenage son. This kid was good-looking, athletic, and personable; yet he felt isolated, insecure, anxious, and emotionally unstable. He continually compared himself to others and tried to fit in. He was also justifiably upset about his family situation. His father, who was extremely critical of him, had essentially abandoned him by moving out of the country. I  understood where he was coming from, since his experience was not much different from mine at his age.

About halfway through our conversation I realized that he too, had a choice. I pointed out that, after years of stress, he had remained remarkably intact. He could choose to be proud of his resilience in the face of adversity and use this gift to take on new challenges. I could see his eyes light up.

Some suggestions

FOMO (Fear of Missing Out) seems to be rampant in this modern era. Maybe it is because we are overwhelmed with options? What we are missing out on is enjoying our day. It is a deeply embedded thinking pattern that doesn’t resolve over time. It requires specific approaches.

You can’t “solve” FOMO. By trying not to be this way, you’ll actually reinforce these circuits. The answer lies in cultivating connection, meaning, and purpose. Trying to be “happy” actually doesn’t work due to the “ironic effect.”¹

• Nurture deep gratitude for you have. It may not be as much as you want but focus on it.
• Compare your situation to those who are less well off than you. It may not seem possible in light of your pain but start somewhere.²
• Become aware of how frantic you get about your “to do” list and how endless it is. It is endless for all of us.
• Then don’t put ANYTHING on your list that you are not going to do TODAY.
• Frequently practice active meditation or breath work to calm yourself. It is one tool that connects you to the moment you are in.
• Listen to some of your favorite music – especially if it is connected to enjoyable experiences from the past.
• What is one thing you can do today that brings you pleasure? – a cup of coffee  your favorite donut; a call to a close friend; a compliment to a family member or friend; anything. There is an endless of list of small deeds that can change your day.

Recap – Your choice

What do you want out of your life? Is it more than being a sufferer enduring pain? Do you really want to live your one life this way? Of course not, you may be thinking. But trust me. It is unlikely that you will magically wake up one morning and find your troubles gone. Focusing on solutions is an ongoing conscious choice because your powerful unconscious brain automatically gravitates towards the problems. There are no shortcuts.

So, who do you want to be today? Choose carefully because you will either be reinforcing old neurological circuits or creating new ones. What is your choice this year, this month, today, the next 15 minutes, or this minute? Carve a few minutes out every morning to ask yourself that question, ponder your options, and commit to whatever choice you make.

Questions and considerations

1. The impact of chronic pain on your life has been documented to be that of having terminal cancer – except worse.³ So, first of all, honor your own suffering and give yourself a break.
2. Depending on the severity of your suffering, you may not feel like nurturing a better life, even for a few minutes. This is one point in your journey that you must begin somewhere, and the next 10 minutes is the place.
3. Then you have to keep repeating it, whether you feel like it or not.
4. Even when you are feeling better (and it will happen with practice), you’ll still gravitate towards the negative because that is what your powerful unconsciousness brain is supposed to do – protect you from danger.
5. To have a good life, you have to live a good life. It is just the way your nervous system works.

References

1. Wegner DM. The seed of our undoing. Psychological Science Agenda (1999); Jan/Feb:10-11.
2. Dalai Lama. The Art of Happiness. Penguin Random House. New York, NY, 1998.
3. Fredheim OM, Kaasa S, Fayers P, Saltnes T, Jordhøy M, Bortchgrevink PC. Chronic non-malignant pain patients report as poor health-related quality of life as palliative cancer patients. Acta Anaesthesiol Scand (2008); 52:143-148. 

The post Who Do You Choose to be Today? first appeared on Back in Control.

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So I was driven beyond words to “prove myself” and worked extremely hard to become accomplished to fill this gap. I became “successful”. But the adrenaline drive that took me up the hill took me right back down the other side, ending up with a shattered life and a suicidal depression. No one on the outside could even sense the depth of the drive or the intense angst that propelled it. So how do you define “success”? With physician burnout approaching 60% across the board, this is becoming even a bigger question.

Amongst teens, this is also a significant problem in that social media makes it seem even more that everyone has a dream life; except that there is a huge increase in adolescent chronic pain, heroin use, suicide, and generalized unrest. There is a word, “FOMO” (fear of missing out) that encapsulates the situation.

My first clue that this perspective was a problem was when I read a book, The Art of Happiness based on the teachings of the Dali Lama. He pointed out how much more productive it was to compare yourself and your circumstances to those who were less fortunate than it was to think about what you didn’t have.

“Anxiety with Success”

I became aware of another pattern of thinking in the midst of my Hoffman process. It was experiencing “anxiety with success.” The Hoffman process presented an organized format, which allowed me to become aware of my embedded reactive behavioral patterns. It turns out that the success that I was working at so diligently, was creating intense anxiety. Talk about driving down the freeway of life in the wrong direction.

Why??

I was the oldest of four children in a household with a difficult mother who suffered from chronic pain. I was the problem-solver in the family beginning around seven years-old. The baseline state of our family was chaos. The Hoffman process taught me to diagram what they term is a vicious cycle. Here’s the sequence:

• Chaos (severe and my baseline state)
• Problem-solving/conflict resolution mode (strong role, especially for a child)
• Problem solved (I felt I had some power)
• Period of calm (anxiety ensued in that we didn’t know how long it would last)
• Need for chaos (my comfort zone)
• Chaos (back in action)

Self-Sabotage

I’ve had a lot of successes and also many failures. One pattern of behavior I hadn’t seen was that I’d have some success and then somehow I rarely followed through. Or I would get into a reactive mode and walk away from potentially major successes. I then spent a lot of time wondering what happened and then beating myself up. All of this was not only a waste of time, but consumed a lot of emotional energy.

When the behavioral pattern that emerged was that I had extreme “anxiety with success”, I was shocked. I had spent the major part of my waking hours trying to be successful in whatever I attempted, yet I was creating situations that caused intense anxiety. How could this be? I’ve since learned that this is a fairly common problem.

Gratitude

Becoming aware of this sequence allowed me to use the various tools in the DOC process to work through the parts of this vicious cycle. I wasn’t as effective at dealing with the “anxiety of success” as I was with other patterns. As I continued to work with my teacher, Kani Comstock, she pointed out something that allowed me to better enjoy my life. It was gratitude.

Enduring Pain

I have endured a lot and so have most of you. Chronic pain with all of its many layers isn’t a small problem. I got lucky in coming out of this hole. Eventually, I was able to figure out many factors that contributed what I feel was almost a miracle. Amongst many things in life I am grateful for, I’m happy to be able to share these concepts with you.

It Has Been Worth It

Although I have seen hundreds of patients become pain free, this isn’t a numbers game with me. Even if my life experience allowed just one of my patients to achieve a pain free state, it has all been worthwhile. Every time a patient comes in excited about their relief of pain, I’m still fascinated and somewhat in a state of disbelief. At my core, I’m a surgeon and I don’t understand all of the variables that cause this to happen. Not only do they become pain free, but also they rapidly begin to recreate the life that they had lost and go well beyond what they ever had. I’ve seen several patients have their spouses come back to them and create a thriving relationship. Many families are able to enjoy a much happier home life.

That I have been able to contribute to their healing is a gift to me that I never would have imagined possible.

Giving Back

The post Anxiety with Success first appeared on Back in Control.

The post Anxiety with Success appeared first on Back in Control.

A functional pain system is critical to your health and even survival. He presented several stories of children born without a pain system. Their body quickly becomes deformed from over-stressing their joints and skin breakdown. The average lifespan of these children was only 15 years. I knew him when he moved to Seattle to be close to his family. He was over 90 years-old and still writing and lecturing all over the world. He was one of my true inspirations.

My Gift

I have slowly realized that I have been granted a similar gift that I did not want, nor would I accept it again if it were offered to me. It is the gift of prolonged severe suffering in the form of both physical and mental pain. I slipped into an anxiety-driven depression/ burnout in 1988, and developed symptom after symptom of the Neurophysiologic Disorder (NPD). At one point I was experiencing 16 of the over 30 symptoms outlined by Dr. Schubiner in his book, Unlearn Your Pain.

OCD

The worst part of the descent into oblivion began in 1995 when I developed a full-blown Obsessive Compulsive Disorder (OCD). I had always thought it was a loose term for some compulsive habits and felt it was some type of TV joke. It is the ultimate anxiety disorder manifested by intense, repetitive intrusive thoughts. They never stopped and became increasingly intense. By 2002 I was done and ready to check out. I will never completely understand why I survived. I have 18 medical colleagues that have committed suicide. Most recently it was one of my best friends in the spine surgery world and the other was an orthopedic surgeon acquaintance that I did some business with. Both had everything life that one could ask for.

While I was living in Sun Valley, six men between the ages of 45 – 60 committed suicide over a span of 18 months. All were extremely successful and prominent in the community. Why?

Anxiety

Raw anxiety is intolerable. It mental pain that I couldn’t escape. I cannot describe my suffering in words. My best metaphor is a “branding iron on my brain.”

I got extremely lucky in pulling out of it. In 2002 I began to heal and by 2004 began to thrive. The last five years have been the richest I could ever imagine. All of my NPD symptoms resolved, and flare only if I quit practicing the principles I have outlined in my book. So what are my gifts? This does not sound that convincing yet. They are many:

My Gifts

• Every day I am alive I can appreciate it at a depth I could not have imagined. It is a marked contrast to extreme suffering.

• I can look any patient in the eye and let them know that I understand your suffering. “You may be suffering as much as I suffered but not more.” I know where they might be going and where they are at as the come out of “The Abyss.”

• I understand the endless quest to find the one answer to the pain.
• I know loneliness.
• I did not have a shred of hope. NONE. Having the physical surroundings of success made it even worse in that I had worked so hard to attain them and I was still miserable. My efforts to find happiness had not worked. That included friends, family, and incredible experiences. I could not run from my mind. If none of that worked I developed a deep feeling of desperation of,  “What do I do next?”

• As I have learned to accept myself (the medical world is not an accepting culture), I can accept my patients wherever they are at. I know them better and it is one of the most enjoyable aspects of my practice.
• I have learned when I can help and when I cannot.

• I no longer let patients make surgical decisions when they are under extreme personal stress. In the past I never really was aware of the degree of their personal suffering in addition to the pain. The lines between mental and physical pain overlap.

• I saw patient a few months ago who came to me for a second opinion. She had seen a surgeon for correction of a spinal deformity. She did have the deformity and surgery would have been helpful. The problem was that she was scheduled for a 10-hour procedure just a week after meeting the surgeon for the first time. A month earlier her 34 year-old daughter had died of cancer.

Gratitude

The greatest gift has been gratitude. That was not a familiar word for me until a few years ago. I was charging full steam ahead just doing the best job I could. I am grateful that I am able to share the tools I learned coming out of my burnout and witnessing so many patients experiencing the same success.

I am a surgeon and do not understand all of the reasons why the dramatic turnarounds occur with such regularity. I am not a neuroscientist. But it is a completely unexpected phase of my career and is incredibly rewarding.

The post The Gift of Pain – Thanksgiving 2013 first appeared on Back in Control.

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