Hello this is James Fricton and it is a pleasure to have Janet here. I've worked with Janet as a patient over the past years, and it's a pleasure to have you here and talk about how you manage your pain. First, tell us about your pains. >> I've struggled with TMJ, it's probably been at least 20 years now, I think. So that started coming on because I just had really bad earaches. I thought I had the ear infection, and then my dentist said no you're pretty much, you're 30 years old, but you're grinding your teeth to nothing. So he sent me to the head, neck, and pain clinic. So I started working with that. But prior to that I had, you know just like lower back injury from lifting the wrong way. And ever since then I've kind of had some chronic back pain and being a teenager and wiping out on a motorbike and not letting my knee heal up. It's just kind of naggy stuff and as you get older it starts kind of to, kind of gets a little bit slower to get going. And you had to take care of yourself a little bit more. And try to just keep on moving and be healthy and have a good balance. >> So how often did the pains occur? >> My TMJ is probably always there. I think I always have a level of pain. There's always some type of a headache going on. It's kind of just in the background. It's kind of like background noise. But if I stop and think about it, it can sometimes be something that will get worse. So it flares up. I kind of have flares where, it seems like I'll go really good for like six months or even eight months and then holidays always sets it off. I always have a really hard time over holidays. And then sometimes summer months but not always, sometimes it's just not predictable. So, you just have to be aware of when, if your headaches are kind of getting worse, if your neck is getting stiff, and trying to get ahead of it. You just have to try to keep ahead of it. Get good sleep, take care of yourself. So. >> What are the things that you do do to get ahead of it, like improving your sleep? What are the other things you do? >> Well I'm probably not the most consistent, but I try to exercise at least, at least stay active. If I can't have time to exercise, I'm usually either walking, going out for walks, or I horseback ride all summer so I have six months of pretty stiff competition and my horse back rides include, I would just work my way up to 50 mile endurance rides. So when I'm on a horse, we're riding for anywhere from six to 10 hours at a time going about eight miles an hour. And so I have to be at least physically fit enough to ride him so that I'm balanced. And then in the winter as a family we ski, so we ski every Saturday. And then we go to Montana and kind of ski the mountains once a year. Just try to keep up with being active. Do some different things with the kids, just try to keep going. Lift weights, in past years I've worked with a personal trainer, who developed a core strengthening program for my back and also for riding, because when you're riding you have to have a pretty strong core. You don't want to be sitting like a, have really bad posture when you're riding a horse. So I worked with a personal trainer and she developed a couple routines for me. And I just kind of memorized them. So now I just kind of do them when I have time. So. >> So tell us how frequent the pain occurs. And how severe does it get? >> My TMJ probably, it's probably there all the time. It's kind of a chronic thing. I pretty much always have a headache going on. But it comes and goes. I have some bad flare ups sometimes during the year, like holidays can be really stressful. My other stuff like my back it's just kind of there. I just have to take care of it by sitting right and everything. It doesn't hurt all the time, but it will hurt if I'm not supporting it or sitting correctly. But as far as my TMJ, it's just, it's probably just always there. I'd try not to let it get really bad, where it's so intense. But sometimes, when it does get really bad, is when I come to see you or I make sure I see my massage therapist or something, so. >> What are the little things that you do to help self manage the pain? >> Well, I have to make sure I'm sitting correctly, that I'm sleeping right, that I'm making sure that I have a good balance in my life so that I get to do fun things for myself, in addition to my job and being a mom and being a wife. So I try to keep that in balance, and I think that if I balance that out that it just seems like it works better for keeping that pain manageable. >> Mm-hm. Now you work as a social worker. And I suppose that can be stressful at times. Tell us about how the stress and your work impact the pain. >> Well I'm a children's mental health social worker. I've been, I think it's been 17 years with the county, and 15 years doing social work for kids with mental illness. So basically the parents ask for a case manager to come on, to help them with getting services, to help them coordinate care. Sometimes kids are in the hospital because they're suicidal or they're, have some mental health symptoms or they can't be safe to themselves' or to other people. And then maybe in about 20 or 30% of the cases, the child might be to placed out of home into specially treatment center, whether that's foster care or a residential center and then you work to try to get the therapy and everything to get the child back home. But in the course of that, you're also working with families that have a lot of stress, so the families themselves, the parents might be struggling with mental illness, or unemployment, or chemical dependency issues. The child is often kind of like the steam valve to the pressure cooker, lots of times the kids, they're in this all the time but they don't always have the words or the coping skills and so then they end up kind of acting out. And so it's, as a case manager I work with the family but also with the child to hopefully to keep everybody together, because that's our goal is for kids to stay with families. >> And is that stressful for you also? >> It can be. It can be extremely busy, because I'm trying to juggle not only working with systems, but I work with school systems, we work with hospitals, psychiatrists, with all the providers that you could possibly think of that might touch a child's life, therapists and anybody that we kind of need to coordinate care with. You kind of try to help the parent coordinate this care, and sometimes if things are really stressful, you're dealing with a lot of phone calls. Besides, you have the work of being a government employee with lots of paperwork and lots of meetings. And lots of demands on your time, so I'm always behind. I've had to kind of just be okay with not being caught up. So, you come in and for me it's taking care of people first, and if my paperwork lags a little bit, well may be I'll come in on a Saturday and do a few hours but. >> It sounds like the job can develop some compassion fatigue also by helping people who are difficult problems over a period of time. How does that impact the pain? Tell us a little bit about it. >> Compassion fatigue is, it can be really hard to manage because you're taking people's kind of, their life situations, their pain, you're working with kids and it's really hard to see kids that are really struggling and that are developing mental illness because their families are so stressed. And so then you have to learn how to not take it home with you. But it's still always there and there's always some really tough cases that kind of get under your skin and it just, it gets pretty exhausting sometimes and sometimes you don't feel like you really have anybody to talk to except maybe other coworkers or other social workers. Or people that work in helping professions. I think also having some kind of a balance where you realize that even though you are hearing about their problems all the time, you can't actually go out and fix them. And that can be really difficult. >> So how does the pain affect your family? Do you bring it home? Do you talk about it? Or do you try to avoid talking about it? >> I think I'm probably not the best at, I don't talk about my pain all the time. I'm not huge at like even telling my husband if I'm having bad headaches or not. He's a military guy, so he doesn't even really get what headaches are. So I kind of get a lot of my support from other friends. I have a good friend who also has TMJ and we kind of run things by each other and then, I think when my headaches are bad or if I'm, I make sure that I try to keep ahead of them by I have a massage therapist I work with. And she's awesome. She's trained in doing trigger point releases for TMJ and usually when I call her, though, I probably should have called about maybe a month beforehand. because I'm usually probably, then it takes me three or four treatments just to kind of get all aligned. I don't see chiropractic but I really like the massage therapist and seeing you for pain management. And I just started those injections, that's new and that seems to have been really helpful for the really intense headaches. But to me I almost feel that that's kind of maybe covering up an underlying issue about how I sit or how I take care of myself or all those little things I've had to manage every day for the past 20 years so I don't make my TMJ worse. >> Well you have a complex family background also. Tell us a little bit about that background and how it impacts your pain? >> Yeah I grew up in a pretty traditional family. My dad worked, my mom stayed home, and my dad was the child of an alcoholic. He didn't drink, but he had just a lot of difficulty in parenting and was pretty controlling. So it was hard for my mom to balance things sometimes and we kind of basically had to walk on eggshells all the time around my dad. You never quite knew how he was going to react. Sometimes it would be okay, sometimes it wouldn't be. I felt like I had two different families. Like I had a family when my dad was home, and everybody had to kind of be really careful. because my dad's temper and he was really big on playing the guilt card. Everything had to be somebody's fault. And then we had the family when my dad was on trips and stuff when it was just my mom and my siblings and that was much more relaxed and we'd have a lot of fun. So it was kind of tough figuring out those families, and when I was probably about 14, it must have been a pretty rough time because my dad was pretty abusive to my mom and that was really hard, and abusive to me. And then when I left home, I found out that he was also abusive to my sister which was, again very difficult not being there to protect her or to be there. And so now, its been 30 years since I've gone. But I think that stuff just really kind of sticks with you because I wasn't the best at handling my own feelings. I wanted to be perfect, so I wanted to please him. So no matter what I did, I had to be straight A's, I had to be perfect at everything. And if I wasn't, then there was something wrong with me. So unfortunately I kind of grew up with that little voice in my ear that was always telling me I was never perfect enough. So I was my own worst enemy for a really long time. And I still battle that, it is part of who I am, but it's also not good to be so hard on yourself all the time. >> How did that affect you physically? Did it impact the pain or predispose you to pain? >> I think so, I think because even talking about it I can feel that I'm stressed. You have to be pretty sensitive to your body and I think lots of times we ignore all those little signals and we just kind of keep chugging along and then it gets to that critical point where trying to figure out why we got so bad. I think I get really tense, I used to have really bad abdominal pain because I would just kind of tense up and especially through graduate school when I was trying to balance a lot of different things. It used to be so bad, I couldn't even drive. I could literally would have to just pull over on the side of the road because it would hurt so bad. And so I had to see a gastroenterologist specialist for that. But that's resolved over time. I don't have that problem any more. But I think kind of just maybe moved on and settled in different spots. So it's kind of like you still, I think, I'm not sure how long I've been grinding my teeth, or how long I've been clenching. I think it's just kind of how my body is, maybe just works thru stress. And during times of the year when my dad comes up to visit for like, they have retired many, many states away, so when they come up they stay for a long, probably about a month. And that can be pretty stressful when you are 11 months and not really having to do with dynamics in one full month of everyday, it can be a lot. >> Well, do you have any advice for others who have pain problems and want to prevent it from becoming worse or chronic? >> I feel like I've been mostly successful living with TMJ for 20 years, I've not ever gotten to the point of having to need surgery or to the point where it's incapacitating. But I know that there are things I do that aggravate it, like talking a lot, or going to the dentist is really hard, so I have a dentist that's really good about not stressing my jaw when I open up. I've kind of created a whole lifestyle that keeps it in mind, where when I first got educated about having it, maybe I didn't think it was all that important to keep up with all of those things like what foods not to eat. I mean I haven't chewn gum for like 20 years, so [LAUGH] people ask, I'm like no, I haven't. because there's things that you just avoid. because you don't want to aggravate it, so you have to be pretty planful. And then you have to, I have to be better about breathing and relaxing, because I tend to tense up a lot. I drive a lot and I type a lot, so I'm always kind of tense, and that'll trigger my neck pain, which then if I'm grinding at night, it creates kind of a bit of a cycle. So I try to get good sleep. If I have to take medication to kind of calm some anxiety so I can get good quality sleep, I'll do that. It's was definitely kind of my last resort, but now I feel it's just another part of the puzzle. It's another part of keeping that balance. Seeing a massage therapist, going for walks, having a good friend to talk to about stress, writing. I mean it's all kind of part of the balance. >> How about the back pain? You use those same strategies to help reduce some of the back pain? >> Yeah, the back pain is just kind of more of a naggy thing. I sometimes have to use heat packs or Ibuprofen. But that's, often if I've overdone it, especially on when I travel with my horse and I'm hauling heavy things, I'm not used to doing that. That's why on the off season, I try to lift weights and try to keep in shape. So that when I am lifting 40 pound things or hauling stuff, it's not going to, not do it so bad. And then lift appropriately. And every time you try to take a shortcut, you'll always regret it. Because then you'll end up tweaking your back and then you're laid up for a day so. >> Was there anything else you wanted to tell the people listening to this interview about chronic pain and preventing it? >> I think that the balance of your life, your spiritual life, you're figuring out who you are as a person, I think for women especially, we are just so good at taking care of everybody else. We just really don't take care of ourselves and then we sometimes either feel guilty or feel are being judged, or people judge us if we try to take time for ourselves. And I think it's really important to be kind of self aware because sometimes I don't even know that I'm tense until I think about being tense and then I realize that like, there is a whole part of my face, that I'm just kind of clenching and I didn't even realize it. So that I have to be really mindful about where I'm at, and even create kind of a imagery to kind of relax. Even when I'm just sitting at my desk or when I'm driving, and I don't realize I'm tense all the time. And if I didn't think about that and just remind myself and make that a habit, I think my pain would probably be worse because I wouldn't be managing it as well or just trying to keep my stress level low. My job is going to be what it is. I'm a mom of two teenagers. I'm a wife of a teacher. And he's also been deployed to Iraq twice back in 05 and 09. So I just had to, I learned my lessons sometimes the hard way, that I can do everything myself. >> Very good, well thank you very much for your comments. It's a pleasure to have you here today. >> Thank you.
