which path will you choose?
 

Now i am generalized CRPS in all 4 limbs and left side of face and am SIP. 2nd opinion Dr. gave treatment as ketamine coma in Mexico for $50, up front (Germany not doing them anymore) Thats not going to happen, then said i could try 3 day high dose ketamine. I was taking methadone to cover the pain. I tried all narcotics and methadone was the only one working. Dr. didnt agree with narcotics b/c he said if come off them i would go thru withdrawl and flare CRPS or skin becoming more sensative. I had recently read an article about how Methadone is a good choice for tx! My original Dr. said dont worry you are not going to be able to come off them b/c you have a chronic condition. I have read: tx is topicals, lyrica/neurontin, antidepressant-cymbalta, MAO inhib. and opoids! Is this just a ploy for me to come off narcotic and have a coma? Is anyone else on narcotics and how do you feel about it? I do fear my body becoming addicted and getting older being on narcotics but i dont get it. I still feel i missed my opportiunity to get the SCS, but i guess i have to move on. I dont know who to believe anymore. I came out of that Drs office thinking-you know what no one knows. I feel I listened to Drs and now i am general CRPS. I feel like now its my decision to choose my path and i dont know which to take. momof4

Not really sure I understand your question completely - the part about the Methadone is a little confusing to me but I might just be missing something...

So many people have had awful outcomes with the SCS that I don't think you missed anything at all there.

You didn't mention the Pain Pump as an option. Why not? Your doctor doesn't do them? Maybe you need to find one that does. Then you could come off the opiates without having withdrawals, and still be painfree. See Lostmary's posts and the new forum. The pain pump sounds like a viable option for many of us that have been sick for a while and have exhausted many of our other options.

Will your insurance company cover the cost of the 3 day ketamine infusions? It's worth a shot before you try the pain pump.

The RSDSA.org website has a wonderful database of articles on these issues.

Like I said above, I wouldn't waste too much time worrying about a missed opportunity with the SCS. After what I have read about them, I wouldn't ever want one - not only because I would be dealing with a rep from the company that sells them after the surgery, instead of a medical professional; when the medical professional that installed likely pocketed a huge kickback from the transaction (remember - I live in RI where this kind of stuff is routine). But also because the SCS can cause infections, leads move and need to be fixed over and over, movement is restricted for the rest of your life, RSD usually spreads from the surgery, etc. They are just very problematic.

Good luck to you.

XOXOX Sandy

ketamine, ketamine, ketamine!!!! :) It is worrrth it!!!!! It gave me my life back, I still have a little pain here and there, and am still taking 2 meds (cymbalta, and remeron to sleep, but then again I have had sleep problems for years prior to rsd)... My answer to everyone is ketamine :) You pee the ketamine out the next day, so it isnt like putting medicine in you where your body is dependent upon it. It resets your pain transmitters (never did I think I would know this much about ketamine :D) It is worth it, for all the side effects we have going through medicine to medicine, why not take a chance on something for 3 days where you dont have to take pills daily!!!!!!!!!!!!! If you have questions feel free to pm me :)

Hannah, Im glad to hear the ketamine worked for you. Please tell me was your pain well localized or was it spread to other areas? Did you do 3, 5 or 10 day ketamine? How long ago did you have it and have you had boosters? thanks. Heard the Magnesium infusion helps the same but not as dangerous-anyone have that? momof4

Please know... Because no two of us with RSD are the same, that no medicines will treat us all the same.

Ketamine is not for everyone and will not work for everyone.

I was offered this but after much research with my doctor... including him talking repeatedly with Dr. Schwartzman and Dr. Kirkpatrick it was discovered that since I have severe allergic reactions to narcotic and synthetic pain medicines and my body metabolizes anesthetic medicines at a rapid pace that Ketamine was NOT an option.

Please research as much as you can with your doctor before you rule out or accept this treatment.

:hug:
Abbie

I've been on methadone for almost 20 years. I'm fine with it.
There is the constipation, if I don't get enough exercise, it's easily dealt with.
Also, if my dose wears off, I DO get pain, and probably some sort of reaction that's over and above the normal CRPS pain. I was told to think of it like Blood Pressure medicine, I'll take it forever, or until something better comes along. It's remarkably inexpensive too.

I do take Cymbalta and diazepam, along with migraine meds.

My pain is more than crps.

Wish you luck with your decision!

Pete

Pete, Thanks so much for replying because that is similar to what my regular pmDr. said about methadone- that its like a diabetic needing to take insulin. It's also good to hear that you have been on it for that long and it still works. Out of all the narcotics that is the only one that didnt mess with my head and all of them cause constipation. My sister feels if I finally found something that stops the pain why would i stop taking it and with the medical advances I might not have to be on it forever. Like Abbie said, different things work for different people. Thanks. momof4

RNcrps2 -

There is a variation/combination of ketamine (or other NDMA-receptor antagonists and some other drugs as well) along with the pump that should be considered as well. But some background is in order. For a long time, we've known obout "opioid-induced hyperalgesia," defined in open-source (and freely useable, thank you) Wikipedia as follows:

Opioid-induced hyperalgesia[1] or opioid-induced abnormal pain sensitivity[2] is a phenomenon associated with the long term use of opioids such as morphine, hydrocodone, oxycodone, and methadone. Over time, individuals taking opioids can develop an increasing sensitivity to noxious stimuli, even evolving a painful response to previously non-noxious stimuli (allodynia). Some studies on animals have also demonstrated this effect occurring after only a single high dose of opioids.[3]

Although tolerance and opioid-induced hyperalgesia both result in a similar need for dose escalation, they are nevertheless caused by two distinct mechanisms.[4] The similar net effect makes the two phenomena difficult to distinguish in a clinical setting. Under chronic opioid treatment, a particular individual's requirement for dose escalation may be due to tolerance (desensitization of antinociceptive mechanisms), opioid-induced hyperalgesia (sensitization of pronociceptive mechanisms), or a combination of both. Identifying the development of hyperalgesia is of great clinical importance since patients receiving opioids to relieve pain may paradoxically experience more pain as a result of treatment. Whereas increasing the dose of opioid can be an effective way to overcome tolerance, doing so to compensate for opioid-induced hyperalgesia may worsen the patient's condition by increasing sensitivity to pain while escalating physical dependence.

Notes
1. Angst, MS & Clark, DJ: Opioid-induced hyperalgesia: A qualitative systematic review. Anesthesiology 2006; 104:570–87
2. Mao J: Opioid-induced abnormal pain sensitivity: Implications in clinical opioid therapy. Pain 2002; 100:213–7
3. Celerier E, Laulin J-P, Corcuff J-B, Le Moal M, Simonnet G: Progressive enhancement of delayed hyperalgesia induced by repeated heroin administration: A sensitization process. J Neurosci 2001; 21:4074–80
4. Chu LF, Angst MS, Clark D. Opioid-induced hyperalgesia in humans: molecular mechanisms and clinical considerations. Clin J Pain. 2008 Jul-Aug;24(6):479-96. PMID 18574358

Opioid-induced hyperalgesia, Wikipedia, the free encyclopedia, http://en.wikipedia.org/wiki/Opioid-...d_hyperalgesia (last accessed February 10, 2010)

And in that regard, we have numerous peer-reviewed articles, such as the following by Sanford M. Silverman, M.D., Opioid Induced Hyperalgesia: Clinical Implications for the Pain Practitioner, Pain Physician 2009; 12:679-684 FREE FULL TEXT AT http://www.painphysicianjournal.com/...12;679-684.pdf:

Abstract
Opioids have been and continue to be used for the treatment of chronic pain. Evidence supports the notion that opioids can be safely administered in patients with chronic pain without the development of addiction or chemical dependency. However, over the past several years, concerns have arisen with respect to administration of opioids for the treatment of chronic pain, particularly non-cancer pain. Many of these involve legal issues with respect to diversion and prescription opioid abuse. Amongst these, opioid induced hyperalgesia (OIH) is becoming more prevalent as the population receiving opioids for chronic pain increases. OIH is a recognized complication of opioid therapy. It is a pro-nocioceptive process which is related to, but different from, tolerance. This focused review will elaborate on the neurobiological mechanisms of OIH as well as summarize the pre-clinical and clinical studies supporting the existence of OIH. In particular, the role of the excitatory neurotransmitter, N-methyl-D-aspartate appears to play a central, but not the only, role in OIH. Other mechanisms of OIH include the role of spinal dynorphins and descending facilitation from the rostral ventromedial medulla. The links between pain, tolerance, and OIH will be discussed with respect to their common neurobiology. Practical considerations for diagnosis and treatment for OIH will be discussed. It is crucial for the pain specialist to differentiate amongst clinically worsening pain, tolerance, and OIH since the treatment of these conditions differ. Tolerance is a necessary condition for OIH but the converse is not necessarily true. Office-based detoxification, reduction of opioid dose, opioid rotation, and the use of specific NMDA receptor antagonists are all viable treatment options for OIH. The role of sublingual buprenorphine appears to be an attractive, simple option for the treatment of OIH and is particularly advantageous for a busy interventional pain practice.

PMID: 19461836 [PubMed - indexed for MEDLINE]

Thus, much can be gained by just tinkering with the medications, including opioid rotation and using the opioid with drugs that strengthen the opioid analgesic effects (a “potentiater”) to the point that you are actually taking lesser amounts of the narcotic – with all of its side effects – or by otherwise using an opioid or “partial opioid” that also interferes with pain signaling between the brain and the spinal column. From what I understand, the principal drugs that are either “full” or “partial” opioids, while at the same time interfering with pain path signaling are Methadone and Buprenorphine (Subutex).

And interestingly, Buprenorphine has been combined with trace amounts (millionths of a gram) of a powerful anti-opioid drug developed to treat overdoses, Nalaxone HCL (Narcan), which can act as a powerful potentiater. For a good recent article in the area - and one of hundreds - check out, Abul-Husn NS, et al., Augmentation of spinal morphine analgesia and inhibition of tolerance by low doses of mu- and delta-opioid receptor antagonists, Br J Pharmacol. 2007 Jul;151(6):877-87, FREE FULL TEXT AT http://www.ncbi.nlm.nih.gov/pmc/arti...3/?tool=pubmed

Abstract
BACKGROUND AND PURPOSE:
Ultralow doses of naltrexone, a non-selective opioid antagonist, have previously been found to augment acute morphine analgesia and block the development of tolerance to this effect. Since morphine tolerance is dependent on the activity of micro and delta receptors, the present study investigated the effects of ultralow doses of antagonists selective for these receptor types on morphine analgesia and tolerance in tests of thermal and mechanical nociception.

EXPERIMENTAL APPROACH: Effects of intrathecal administration of mu-receptor antagonists, CTOP (0.01 ng) or CTAP (0.001 ng), or a delta-receptor antagonist, naltrindole (0.01 ng), on spinal morphine analgesia and tolerance were evaluated using the tail-flick and paw-pressure tests in rats.

KEY RESULTS: Both micro and delta antagonists augmented analgesia produced by a sub-maximal (5 microg) or maximal (15 microg) dose of morphine. Administration of the antagonists with morphine (15 microg) for 5 days inhibited the progressive decline of analgesia and prevented the loss of morphine potency. In animals exhibiting tolerance to morphine, administration of the antagonists with morphine produced a recovery of the analgesic response and restored morphine potency.

CONCLUSIONS AND IMPLICATIONS: Combining ultralow doses of micro- or delta-receptor antagonists with spinal morphine augmented the acute analgesic effects, inhibited the induction of chronic tolerance and reversed established tolerance. The remarkably similar effects of micro- and delta-opioid receptor antagonists on morphine analgesia and tolerance are interpreted in terms of blockade of the latent excitatory effects of the agonist that limit expression of its full activity.

http://www.ncbi.nlm.nih.gov/pubmed/17502848

The one drug on the market that actually combines the two is called Suboxone and is marketed to treat drug dependence. I’m not sure if the proportions of the two drugs in Suboxone are perfect for its use as a potentiated analgesic, but if you do a term-search for “Suboxone” in this forum, you will find some people who swear by it.

But the problem is that Suboxone (for FDA approved prescribing information, see http://www.suboxone.com/pdfs/SuboxonePI.pdf ) is that it's titrated to assis in the weaning off of narcotic dependency, not necessarily for maximum analgesis effect, which could in theory vary slightly from person to person.

The pump could moot the questiion, putting a good pain specialist in the driver's seat, lawfully administering a combination of FDA approved drugs in a pain pump, and notwithstanding which recipe is chosen (full/partial opiod plus either a potentiated such as micro-doses of nalaxone or an NDMA-receptor antagonist, ranging conceivably from low, low dose ketamine to the over-the-counter cough suppressant dextromethorphan) all in what may be the very near future.

And the best part is, not only is the "augmented" opioid a much better analgesic, but the patient gets far less of it, ergo fewer complications. Potentially a whole new world, right around the corner. (Seroiusly, if you search "Augmentation of spinal morphine analgesia and inhibition of tolerance by low doses of mu- and delta-opioid receptor antagonists" on PubMed, you'll pull up the abstract I've quoted above, then go to the right hand side of the page a click "See all" under related articles, and you will get 2.603 hits, of which 548 will be freely avaiable in full text!)

For those whose pain is at the point where it boils down to the choice between a ketamine coma or a dilaudid pump, it's worth a conversation with your pain dr. in any event.

Mike

thanks Mike for this post...when I took my daughter to Dr. Kirkpatrick, After she had the Ketamine treatments, he took her off of all opiads for this reason. Thank you for posting this, because I really could not quite understand why he would take her off of these pain meds. Now I truly get what he meant. Thanks again Mike! :)

??????? Have you thought about MED School???? :wink:

:hug:Sandy

Hi Momof4, I totally agree with Sandy on the SCS. I also have generalized RSD full body SIP. My Dr. is a neurologist, psychiatrist, and pharmacologist. He is very conservative and I have been seeing him 6th year. He is against Methadone. I have been taking vicodin for years. About 6 months ago I was able to go down from 6 a day to 4 . My Dr. believes in muli meds to minimize the opiads. I also take Lorazepam also reduced from 6 to 4. I take 2 blood pressure meds. Cymbalta 120 mg. and a sleeping pill. I used to take 3200 mg neurotin but was able to slowly go off and the electric jerk and jolts did not come thru. I hated that med-weight gain. I have a window of time to drive. I am totally mobile with the exception of one hand 50% range of motion. It was 4 years before I was diagnosed and had delay of treatment of the hand.
I did go thru 150 physical therapy treatments for both frozen shoulders, but got full range of motion back- that was before diagnosis of RSD. I had a year remission after each shoulder
My third round with RSD came while water skiing. I pulled a nerve in one hand getting up out of the water. Misdianosed as RA- Changed Drs. and diagnosed with RSD in one min. confirmed with nuclear med. equipment.
My Dr. just built two clinics with HBOT and I'm going to try the HBOT. I also have trigeminal nerve disorder-feels like an ice pick in temple. loss of feeling down left side of face. I also have internal pelvic RSD If the HBOT doesn't work, I'll consider Ketamine.
How are you doing? I was devasted when a new neuro said I had generalized. He suggested seeing a psychiatrist. I didn't like his two suggestions, in fact I didn't like him. So I found one on my own. The first visit I knew he could help me. He is a gem. I had already had over 2 years of counseling with a psychologist when my parents died. and that helped. but as we both know, this is a different animal.
Are you mobile? have you had pt. I found massage therapy very good. I started right away. and had it each time just before the pt. This is all before I was diagnosed with RSD. Now, I find swimming pool 86 degrees, very helpful in keep mobile and even reversing my toes that were curling. They went back to touching the floor in 4 months in the pool.
Really hope the best for you. please let us know how you are doing? Your friend, loretta with soft hugs:grouphug:

Okay..let me say.....
 

As we are all aware... not one treatment or medicine works the same for any of us..so who is to know what affect we'll all get..there now with that said...

We go thru the high and lows of treatment and interventions...SCS, blocks..Ketamine...on and on... I am beginning to feel a bit like the fury fella running on the wheel..anyone else???? I am starting to side with one of our friends who once said..I am done..DONE.. done..with it all..I am an RSD mess and that is the way I will live... one good thing..we won't die from it...thats what they say right???

Guess I am sounding tired..but what I really want to say is..I wish I had a magic wand..cuz if I did ..I would love to make you all here feel better and rid of your RSD....

Momf4... I am so sorry on what you should really do...as it seems we are all hitting the part in the road in which way to turn.. Our Dr.'s still go home at night ... painfree themselves..leaving us lie awake at night wondering what tomorrow has in store for us.. Please let us know how you are doing.. We are your friends....

You, and all of my friends here are in my prayers....

Kathy:grouphug::grouphug::grouphug::grouphug:

Kathy--

Don't EVER GIVE UP!! That's what WC wants me to do - that's why they have tormented me, harassed me, harassed my treating physicians and other providers...Mike's answer was AWESOME - there is an answer for us - in the long run. It just takes time, which is so darned frustrating. We wait FOREVER for phone calls, and approvals, and appts, and treatments, etc. And for me, I am not made of money, so we need the cooperation of the insurance company, which is NOT going to happen easily. EVERYTHING is a battle, nothing falls in our lap, we have to work hard for it. BUT WE CAN'T GIVE UP. If ketamine is not the answer for us, then a pain pump likely may be. We need to ensure that we always have a Plan A and a Plan B. And maybe even a Plan C. You are going to see Dr. S soon - he knows so much, and can guide you to the best of the best. You hang in there...It's almost here.

FMichael - I have said it before, you are awesome!!!... as your were composing your posting I was in the process of trying to wean down off of some of my opiods. The brain fog and depression and crying spells are creating quality of life issues, and I think cutting down on some of my meds will make me better off - your posting was so timely. I just have trouble with the head and neck pain...they tend to get worse on lower levels of meds...but I want to give it at least several days.


Love and Peace, Sandy

Hi I am also thinking of ketamine. A few thoughts I agree that it is so hard to make treatment choices. We all differ so much. I think what I like about my last pain doc out of many is that he started at the least invasive and worked up. Now i have seen a couple pain docs who feel narcotics in the long term were not for me either. Like you said because it is chronic and actually your brain begins to process pain more. Again though I don't judge anyone for being on them here if it helps them. I was also suggested a scs but after 2 procedures that were less invasive that increased my pain level this was ruled out for the time being. I am not seeing are you on any meds like neurotnin etc? Also I had been suggested anti inflammatory meds. For me in a flare up this does not cut it but for some it may. I wish I had an answer for you and unfortunatly docs do take guesses at us. For me it is weighing the pros and cons and feeling comfortable with the doc. Hang in there and hold to hope. I always say it just takes 1 doc to look out of the box to make such a difference

Sandy...

You are awesome..can you tell I go high and low with my strength and energy to fight.. RSD is not our friend..but it has met its match..I know that if I am not a candidate with dr. S... (I have cardiac problem also).. i will be okay as I knew it was not in the cards for me.. but as you say..I will move forward.. how ?? Cuz of you and my friends here..feuling my tank... I so need your support and help..ANd you always have mine... I wish I could say something to help ease you back off of your meds and help you with not crying..Please.. don't cry... you are loved..

Hugz, Kathy:grouphug:

Dear Kathy -

I keep feeling the need to try and connect with you. I guess I was again struck in your last post when you noted that "RSD is not our friend..but it has met its match.."

Please be careful. It's been my experience after living with this for nine years now that the more we struggle "against" RSD, the greater our sense is that life has become unsatisfactory. Which may be the case, seems to be especially so if we express our satisfaction relative to meeting certain pre-set goals and expectations. I know some wonderful women who have withstood the greatest possible challenges of motherhood while fully afflicted with CRPS. It's my sense they have done so by modifying in some subtle sense the definition of what it meant to be a success as a parent, while not losing touch with its essence: maintaining a compassionate relationshio with one's child, through which the child will grow and mature. (Never easy for me in the case of my youngest son, now 12, who has no memory of me being healthy and doing a lot of the expected things with him, and which will bring him to tears in a second if focussed upon.)

But the key IMHO is not to wear ourselves out swimming against the tide. You let the rip tide take you where it's going, and swim into shore where you have the chance, not necessarily where you planned.

I was reminded of this over the last week in two related contexts. Firsts I was discouraged when a doctor changed my psychiatric diagnosis to "personality change secondary to general medical condition" (DSM IV 310.10) until a very wise psychologist who's currently repeating some neuro-psych testing on me in response to increasing complaints of loss of attentional skillls - which were never good - pointed out that I wasn't being told that I had acquired a personality disorder, only that my deep patterns of dealing with the world had changed. Then, case in point, I got my revised WISC III scores back (using the older test for better comparison with old data) and while the spread between my verbal and non-verbal IQ has increased to an almost unheard of 45 points (6 points is considered by some to be probative of ADHD, and 12 points typically conclusive, but 45???)* the thing was, although my non-verbal scores had decreased - as expected - my total verbal score was the highest it had ever been, with the most substantial increase in my ability to spot abstract similarities.

The point being, if we are determined that we are going to beat this thing, then we might as well stop trying to learn anything from it. In the words of Ram Dass, we "take the curriculum."

Of course, that doesn't mean that we shouldn't take advantage of opportunities when they come along, such as the chance that we may soon bave access to potentiated analgesics, with more effectiveness in controlling pain and less opportunity for developing either tollerences or GI/respiratory side effects. Which would be - in my own book of prejudged outcomes - not a bad thing at that.

Peace.

Mike

*This, by the way, is the reason I could never be a doctor.

Thanks Mike..
 

Hello Mike...

I so appreciate your note and insights... no doubt through your 9 years in having RSD..you must have much education and become quite versed on best we need to view and approach our daily struggles with our RSD.. You are right in that it is an education that we learn over time which must couplink with the process of acceptance.. which is the very first step of this process... I probably should clearify myself when saying "RSD is not our friend and that it has met it's match".. I guess best said.. it was my way of not givng in.. and faking it out... in that it does not have total control...although I have altered and learn to live with my condition..simplified and educated my family and friends on how best to live with it and me but also..accepting it as this is me now (not going against the tide).. but also still keeping the gentler, kind, simple parts of my life matter as much as they did before.. Yes, things have changed in that physically and mentally my life is different but it has met it's match due to not surrending and now living with it.. I guess you and I are saying the same thing... except my approach is different...I insist I need to blend in the soft parts of life ... like laughs.. love..and giving out to others which over shadow my sadness and bring me warmth and pleasure to my heart..that gives me strength... that is something RSD can not get it's hands around and spoil..that is where I say... it has met it's match and it is not my friend.. but I can still enjoy my life inspite of it...again it has mets its match...as we all need to have an out which does not depend on RSD.. RSD is such a big part of us now..but we can't let it consume us... we need to draw strength from it to swim toward the tide and nicer parts of our lives.. gives us the re-newed strength.. to keep swimming... I am not able to support this with numbers or data..just talk that comes from my heart....

Painfree day, my friend...Kathy:)

Dear Kathy -

Thank you so much for that. I know all too often it doesn't sound like I'm coming from the heart, but I am in my way. I just don't do so much of the hearts and flowers sort of stuff - although I have in fact embarrassed myself in that area in one member's blog of late.

What made your response so wonderful is that it was spoken from a point of true authenticity. Which is great.

And while it may come across that way, my more technical postings, at least these days, are meant to be a genuine response to something someone has said. As a result, I'm not starting a lot of threads anymore. Whereas, years back, I started threads often, frequently on what appeared to be the latest medical advance, until it came to the point that I had to admit that every time I reread one key article I was totally revising my understanding of it, to the point that it took me weeks to figure out that the key concept that was eluding me was the same one that caused me to double-incomplete a 5-level linear algebra class in college, c. 1978. That said, one of my early "best selling" threads (maybe 2,000 hits either here or more likely on the old BT) began with a holds no barred post under "RSD and marriage." So at least lately I really try to make a point of staying with what I believe I really understand, whether in the head or the heart. But when I do, I have no hesitation in trying to drive home hard truths, even to the viscera, with the understanding that we speak from the heart only when we speak from truth, however uncomfortable that may be. But that's just my style.

It's funny, before I turned on the computer this afternoon, I had been out with one of my sons, and while I was waiting for him I was thinking of what might be your take on my note. Then it hit me. There was something else that I could have included in the post, part of an email I got the other day from my MBSR teacher, to whom I was introduced a year into this sleigh ride, in response to a recent cry out on my part. Having now read your response, it feels perfect:

It seems that we are getting to an age where people around us (including ourselves) are getting sick and some are dying. It's a tuff one. We all know it happens and get it on many levels.... but still it is a sad loss.


These things bring up lots of emotion and for most it is pretty difficult to talk about it, no less understand oneself. After reading what you wrote to me, this is what came to mind...


I think because death, sickness, our mortality is all so confusing to most (including me... who actually has some understanding.) Maybe one way to deal with this is to really pay close attention to our own reactions. Doing this by paying attention to our body sensations, thoughts and moods(emotions/feelings.) But doing this, not just in formal meditation, but more frequently during our daily living... Paying attention to our speech, (content and quality of voice) listening to our attachment to our ideas and witness how they color how we experience ourselves and others. And doing this as much as we can in the here and now. Remember to check in with the body, notice our clenching (the grasping and pushing away) Asking how are we deluding ourselves? Ultimately... Pausing and asking what is true here and doing this in a very kind way. What I mean by this is not to analyze but to just notice what is arising, no matter pleasant or unpleasant, like or dislike. Just noticing and experience, how it is in the moment, as conditions arise and pass away. This journey we are on is really simple... waking up and seeing what is true. Experiencing what it is to be human. So really experiencing life moment by moment (obviously easier said than done.) I think this is the best thing any of us can do for ourselves and for our children. This journey is an inside job. And the more we continue persevering on this path, true wisdom and compassion shows itself to ourselves and others. So, each time we open to this moment, freedom is possible. Side note... if this is too much for Sunday morning... please forgive me. (loving smile . . . .

Mike

I think..
 

that is so nicely said..and I believe..looking in at ourselves is probably the hardest thing to do..at the good and bad.. especially since we all have a less than favorable illness..an illness that will take more patience and understanding of the normal... So allow me to add...that we all have a path..a life long path to follow.. their are many bends and swift turns in our path... it's not the unstable...path that is the trouble..it is how we chose to travel the path that makes us stumble... Allowing ourselves to enjoy our life no matter what challenge lies ahead.. love our life for what we are presented as we get only one shot at this journey and no practice runs..take each minute, each day and rest assured...Even now with RSD, I would not trade one step of my path for anything... I am still the luckiest lady out there.. I am very sure of that...

Great post and thank you Mike, and others for your honesty and input!

Rest peacefully tonight my friends...

Kathy:grouphug::grouphug::grouphug: