|Transformation and Hope—The Means to Recovery
By Kathleen Campbell, M. Div
The Onset and Diagnosis
and Hope—The Means to Recovery
- Quota-Based Physical Therapy Exercises
- Setting Goals
- Texts and Tales of Transformation and Hope
- Keeping a Log and Journal
- Humor and Healing
- Spiritual Practices
- Psychological Support
- Keeping My Foot Warm
- Medication and Medical Interventions
- Fulltime Work
- Working on Sleep
- Eating Well
- Starting Treatment When CRPS Symptoms First Began
That Didn't Help Recovery
- Lumbar Sympathetic Blocks
- Thermal Biofeedback
- Physical Therapy without clear goals
- Dealing with an HMO
My Goals for Therapy and Recovery from CRPS
Physical Therapy Exercises
Service to others has been the focus of my life and work.
I was reared in a parsonage where Jesus' command to love our
neighbor was part of daily life. Living next door to the church,
I remember a transient at our door that needed money for gas
and groceries. My parents provided what he needed. Such formative
experiences led me to follow my father's profession into the
ordained ministry. During my years in ministry, I helped resettle
refugees from Southeast Asia, organized congregations to respond
to the political causes of hunger, demonstrated against the
U.S. backed war in El Salvador, was arrested for civil disobedience
as part of the anti-apartheid movement, and spoke out for
the ordination of gay and lesbian seminary friends. In my
years as a pastor, I provided spiritual direction, preached
and taught classes, and prayed with the dying in nursing homes
and hospitals. I took a leave from parish ministry eight years
ago, but continued to be active in my congregation and also
volunteered at my children's school. My current work at the
University of Puget Sound is grounded in a desire to help
students obtain an education that will help them contribute
something of value to the world.
When I was diagnosed in February 2002 with Complex Regional
Pain Syndrome, a chronic and painful condition in my right
foot, the ability to serve others unraveled quickly. The demands
of therapy and recovery meant re-ordering my life, discarding
many activities to cope with the essentials of life: managing
my 40-hour work week and parenting two elementary-age children.
I was 42 and in the middle of divorce proceedings. The children
lived with me 9 of every 14 days. I write this essay after
16 months of treatment in order to provide support and hope
to others who experience the challenges of CRPS. Recovery
can happen. For those with CRPS in a lower extremity, it's
possible to enjoy an active life again. I walk 2.8 miles each
morning, mow the lawn for an hour on weekends, ride my bike
or swim four days a week, and play soccer and basketball in
the backyard with my children. I gradually have resumed volunteer
work at my church as the amount of therapy time decreases
and energy returns for other activities. I write also to share
with those in healing professions the multidisciplinary approach
to recovery that worked for me so it might help you understand
and assist those who have CRPS.
Before writing, I hesitated to discuss my recovery with
others for three reasons. First, I'm not yet healed. I'm not
even sure what it looks like with CRPS. People observe that
I'm walking with a bounce in my step again, and remark that
they're glad to see I'm fine. They are wrong. Yes, I've made
remarkable progress that I celebrate. But, I'm still not fine.
The pain persists even as pain medication has been reduced
significantly. My foot still turns red after certain activities;
the nerves still do not react normally at all times. I still
must follow a treatment protocol each day to keep the symptoms
from returning and retain my level of function. Setbacks continue
to flare up the pain and require that I return to exercises
needed at earlier stages of the recovery process. I must pace
myself at work and home and be clear with others when enough
is enough. The end of this is not yet in sight, but I have
accomplished all my functional goals in therapy. My hope is
that though I still deal with this illness, there is something
in my experience that might enable others to have courage
to move through the challenges and reach their goals in therapy.
Another hesitation in writing arises from the uncertainty
of exactly what was needed to return to a high level of activity,
and what's needed to stay in remission. In the months of treatment,
I entered a world of therapists who measured and evaluated
my progress with strict repetitions of quota-based exercises,
and doctors who prescribed medication to cope with the pain.
Recovery, though, included more than what therapists observed
and what doctors prescribed. My healing has included facts
that aren't easy to prove. Is it worth sharing these anecdotal
experiences that are outside the bounds of empirical science?
Dr. Denis Burkit once said, "Not everything that counts
can be counted." I found this to be true in returning
to a high level of function again.
My last hesitation to discuss my recovery is the obvious
realization that my experience is unique. I responded to the
symptoms and treatment of this chronic pain condition with
meanings and feelings that others might not share. I hope
that the particulars of my story might connect with something
familiar in your suffering and healing, or your practice of
therapy and medicine. Perhaps anything unique may offer new
hope, courage or wisdom in dealing with CRPS.
1. Remen, Rachel Naomi. Kitchen Table Wisdom: Stories That
Heal. Riverhead Books, New York, 1996, p. xvii.
The Onset and Diagnosis of CRPS
My podiatrist diagnosed Reflex Sympathetic Dystrophy on February
21, 2002 but it was four months earlier on October 13, 2001
when a throbbing pain in my right foot woke me at 2 a.m. from
my usual deep sleep. The next day the pain was unbearable
and the only shoes I could wear to work were a well-worn pair
of running shoes, with the laces as loose as possible without
the shoe falling off. I began limping, couldn't sleep well
and found driving was difficult because of the pressure required
to use the brake and gas pedals. I have never been one to
seek medical help quickly. I birthed two children without
taking drugs, and figured I'd get over this foot pain. I figured
I must have somehow broken a toe and the pain would just go
away in time. Instead the pain increased, and so after four
weeks I saw a podiatrist who determined I had "Morton's
neuroma", a swollen nerve between the third and fourth
metatarsal bone. I received two shots of cortisone near the
site of the neuroma over the next three weeks. The pain persisted.
Dr. Barrett then suggested orthotics, which made no sense
since I could barely tolerate the shoe on my foot. I couldn't
imagine jamming anything else into my shoe and making it even
tighter. My other option was surgery. Cut out the nerve, and
he promised that with each day I'd be getting better rather
than dealing with this downward spiral of pain.
I was not convinced, and so found a Chinese healer instead,
one highly recommended by a friend. A session of acupuncture
flared up the pain and triggered temporary swelling throughout
the foot. A follow-up session with acupressure, however, brought
welcome relief. Somehow, she was able to touch the foot without
stimulating more pain. But regrettably, it was only for the
hour I was with her. By mid-December I could not wear any
of my shoes, and was hobbling in a pair of newly purchased
Birkenstock clogs that had a gel pad built in for "added
comfort". I did Christmas shopping with catalogs, and
pared down grocery shopping to a ten-minute sweep for what
was on my pre-planned list. I learned to drive with my left
foot after an unexpected nerve spasm shot up through my right
leg causing the car to jolt to a stop in the intersection
on Proctor. Weary from the pain and lack of sleep, I opted
for surgery on January 16th.
Two weeks post-surgery, Dr. Barrett reported the surgery
a success. He removed a nerve that was looped up like a snake
forcing it to pop out when he made the incision. Never in
twenty years of practice had he seen a nerve under so much
pressure. At the next post-surgical visit on February 12th,
there was a marked reversal in his prognosis. He lightly touched
the surgical site and I immediately pulled back. His eyes
widened with concern and what seemed to express a personal
sense of failure. His only words were, "We've got to
get this under control or there could be serious long-term
problems." With that, he hurried from the exam room,
leaving me alone and bewildered. What happened to the glowing
success from two weeks earlier? He returned a few moments
later with a syringe and began injecting my foot without explanation,
leaving me more confused. Three syringes later, he finally
explained what he was doing: trying to warm up the foot with
anesthetic in order to produce a vascular flush. The foot
had swollen out of proportion to normal, and there was a dramatic
decrease in temperature and there was an aura of pain so great
that his nurse was particularly hesitant in changing the bandages
from the surgical site. He told me I had Reflex Sympathetic
Dystrophy, which I later learned is now known as Complex Regional
Pain Syndrome (CRPS).
CRPS is a painful condition that affects an extremity -
a foot or hand. When it develops, it often follows some trauma
or injury, sometimes as simple as tripping over a shoe or
minor sprain. Its cause is unknown, but the clinical symptoms
include burning pain, changes in skin temperature and color,
allodynia (i.e., pain elicited by stimuli that normally are
not painful such as a sheet on a bed, or the wind on the skin),
edema (swelling), and tropic changes such as shiny skin, hair
loss or abnormal nail growth. It can also involve loss of
bone mineral, muscle weakness and problems with motor coordination.
Those suffering with CRPS develop a pattern of protecting
or guarding the limb because of the severe pain. I was using
a walker at home at the time of the diagnosis and relied on
a motorized grocery cart to shop. I managed to limp about
work without the walker, as I was embarrassed to use a symbol
of disability in public. For some patients, they cannot recover
use of the affected limb because of the chronic pain and resultant
disuse. I experienced all symptoms except the tropic changes
to skin and nails.
With the CRPS diagnosis Dr. Barrett sent me home with instructions
to keep the foot warm. He gave me a prescription of Dibenzyline
to warm the foot, I took a hot bath each night and wrapped
my foot in a hot sock and blanket while at my desk at work.
A week later I returned to my podiatrist who still had no
good news. The nerves weren't responding to this heat therapy.
My foot was hypersensitive to any touch, and my ankle had
swollen to the size of my knee. On the day of this appointment,
I had taken the day off work because it was my children's
mid-winter school holiday, and planned to take them from the
podiatrist to their dental appointments and then a movie.
Dr. Barrett changed those plans. He and his staff made calls
to a nearby physical therapy clinic and to my primary care
physician and insurance provider. "You need to get into
therapy today. Reschedule the dental appointments." This
was medical urgency I'd never experienced. So, with one more
syringe of anesthetic, enough to relax my foot so the therapist
would be able to touch it, he sent me to a clinic down the
The owner was on vacation, and so I got Jennifer, the substitute
therapist in charge. Jennifer matched my podiatrist's alarm
over the condition of my foot. I sat on a molded plastic chair
across from her as my leg and foot rested on her arm, now
easy to hold with the anesthetic at work. She demonstrated
how to get my foot moving again: pump my ankle, draw the alphabet
with my toes, circle my ankle to the left, and round to the
right, press my foot against an inflated beach ball, and out
in the hall, I practiced rolling on my toes as I walked. She
watched as I tried to imitate her instructions: pump, circle,
draw, press, and roll through the toes. Good. Sitting back
in the chair with my leg in her arm again, she then measured
the swelling of my foot. Putting down the measuring tape,
Jennifer leaned closer while still holding my leg in her arms,
and with the clarity of a boot-camp sergeant she made clear
what was required
"You need to do these exercises every hour, on the
hour, and set a timer if you have to. Three times a day
you need to elevate your foot, way up high, above your heart,
for twenty minutes or more at a time, then massage the foot,
especially the toes that hurt and the surgical site. Your
priority is not your kids, not your work, not anything else.
Your priority is these exercises, or you'll lose the use
of your foot. Can you do it?"
Tears streaming down my face, knowing that my 8-year-old
daughter and 10-year-old son were awaiting my return home
and counting on Mom to take them to the movies, I nodded Yes.
I had little to say to this therapist. I felt like my life
was just blast to bits. Never had I stared into the face of
God and lived. I wondered how I could hold on. Being a religious
person, I took some comfort in the knowledge that it is far
more God who hold us than we who hold Him. Somehow, I'd get
2 2 mg. of Dexamethasone Phosphate plus 5
mg. of Triamcinolone Acetonide on the first visit, and then
20 mg. of Triamcinolone Acetonide mixed with Xylocaine and
Marcaine twenty days later.
3 These symptoms are described in Robinson,
J.L. Complex Regional Pain Syndrome. Bulletin: State of Washington
Department of Labor and Industries, November 1997, PB97-05,
4 The anesthetic used was Lidocaine,
1% and Bupivacaine, ½%.
5 Weatherhead, Leslie D. A Private House
of Prayer. Abingdon Press, Nashville, 1958, p. 23.
Transformation and Hope—The Means to Recovery
When I left the appointment with Jennifer Leyen, I drove
back to my apartment in tears. My kids were home alone and
waiting to go to the movie I promised them. I needed to regroup
and figure out how I could go on with my life and also deal
with the relentless pain and expectations for therapy. We
went to the movie anyway, and I began adapting to my new life.
We took a seat in the second row and I propped my foot up
and over the empty seat in front of me. I took along Jennifer's
beach ball and alternated between elevating my foot and pushing
my foot on the ball under the seat. Thus began sixteen months
of physical therapy.
Physical therapy exercises were just one component of what
made recovery possible. As I describe the therapy and other
means I used to overcome the CRPS pain and disability, the
quota-based physical therapy approach was likely most important.
The other strategies allowed me to deal with the challenges
of therapy. Putting all the pieces together has enabled me
now to walk with joy, dance in worship, bike with a friend,
kick the soccer ball around the back yard and taper off the
prescription pain medication. Over the course of treatment,
I put in nearly 800 hours of working on this, some at medical
appointments but mostly at home, the gym and the office. Doing
the time was overwhelming while also working and parenting,
but now that I can live well again, the ordeal was worth it.
Quota-Based Physical Therapy Exercises
The exercises were legion and evolved over time. I worked
with three therapists during the 16 months. Jennifer Leyen
got me started and instilled the fear of God into me so I
took the work seriously. Then I worked with Bob Brown for
two months until I ran out of insurance coverage. After a
month of working on my own, I discovered Roger Allen who taught
at the University of Puget Sound where I worked. He taught
in the Doctoral of Physical Therapy program at UPS. By chance
I was reading a staff newsletter and learned that he had a
particular research interest in CRPS and had just returned
from a continuing education event in Boston to train therapists
on the latest ideas for treating CRPS. He took me on and introduced
me to a quota-based approach to therapy. We worked together
for the last 13 months of treatment.
The quota-based therapy method would begin by seeing how
much of an exercise I could do, and then I was to do the same
exercise the next day at home with just 80 percent of the
number done at my appointment. I was then to add more repetitions
or time to the exercise each day. As one exercise accomplished
its purpose in helping my toes, metatarsals, and ankle move
more normally, other exercises were introduced one at a time
to help me move slowly and steadily toward more challenging
activities. They were introduced slowly because of the pain,
but became increasingly harder to help me reach my functional
Roger also taught me that therapy for CRPS meant moving
into the pain in order to feel less pain over time. Most every
exercise hurt before it helped. Paper shoving and rolling
on balls were two such exercises that fit this house of horrors
approach to recovery. Moving into the pain was counter-intuitive.
With acute pain, wisdom says to stop and rest. With the chronic
pain of CRPS, movement is essential, even if it hurts. The
best image I discovered to explain this was from a sermon
preached by Rev. Emanuel Cleaver, pastor at St. James United
Methodist Church and mayor of Kansas City. He describes sheep
caught in a storm.
When a storm comes up in the cold of winter, and the wind
comes from behind the sheep and blows the icy rain under their
wool, they will freeze to death. As the storm comes, the sheep
must turn to face into the storm. I do not suppose they choose
to do that. Sheep are not very bright and must be carefully
guided by the sheepdogs and shepherd. The shepherd and dogs
turn the sheep to face into the storm so that they will survive.
So it was with Roger in physical therapy. He showed me how
to move into the storm, and stayed with me during the process.
Eventually I found the pain would pass after a few days of
trying some new and more challenging exercise, with the results
being that I was able to accomplish all the goals on my list.
The PT exercises I used to recover are found in Appendix
2. I tried to list them in the order introduced. However,
as I experienced several setbacks during the 16 months of
therapy, it meant I needed to return to exercises used earlier
in treatment and begin again. Several exercises were done
simultaneously with others. Recovery was far from steady,
and the exercises evolved as pain and function ebbed and flowed.
Within the first two weeks of starting therapy I wrote down
a list of goals, the things I wanted to be able to do again
and couldn't at the time. I wrote down everything I could
think of - both the mundane activities of daily living and
the seemingly impossible hopes at this peak point of pain
and disability. As the weeks and months went on, I added to
my original list as I thought of things I wanted to accomplish.
(My list is attached at the end of this paper in Appendix
1.) As I achieved one of the goals, I checked it off and felt
a rush of satisfaction. This sense of joy in the midst of
the pain and suffering helped me move forward to other goals.
With more goals on the list, there were more reasons to celebrate
as I accomplished some new thing. When I could do the harder
activities on my list such as walking to work, riding my bike,
dancing in church, and kicking the soccer ball in the backyard
with Hannah, I treated myself to something nice - breakfast
out, a new pair of earrings, a good book, a new sweater.
Texts and Tales of Transformation and Hope
Having earned a master's degree and working at a college,
I live in a world of books and naturally seek out new knowledge.
The kind of reading that helped my recovery from CRPS had
little to do specifically with CRPS. I searched the web for
information on CRPS in the first week after the diagnosis,
but after that only read CRPS articles when someone passed
them on to me. Many of these I set aside for lack of time.
My priority was not reading, but healing. And that meant hot
baths, meditation, holding down my job, and hours of PT exercises.
The reading I found helpful included books on the mind-body
connection and inspirational stories of those who had conquered
a challenging illness or grief in their lives.
From a sermon preached by pastor Jon Short at my church,
I learned that transformation of suffering rather than acceptance
of suffering was the theological insight I needed for recovery.
The counselor I met with in the fall and winter told me that
I needed to learn to accept my chronic pain in order to cope
with the feelings of frustration and overwhelming demands
of therapy combined with work and parenting. I couldn't accept
it, and began to feel like I failed counseling. My years in
ministry were about challenging and changing unjust societal
systems, not accepting what is harmful and hurtful. I brought
that same attitude to my recovery from CRPS. It wasn't fair
and I wasn't about to "accept it" like some mature
stage of chronic pain akin to Elisabeth Kubler Ross' stages
of dying. Pastor Jon taught me that for people of faith, there
is another stage when dealing with trials in life: transformation.
By the grace of God, it's possible to move beyond it.
Philip Yancey also argues that transformation rather than
acceptance is the path to overcoming suffering in his book,
Where is God When It Hurts? As I reached out to others by
starting a chronic pain support group this year, learned to
dance in worship again, and taught a class at church using
Philip Yancey's book, the CRPS experience was beginning to
take new shape in my life. No longer was it simply an intrusion
in my life, but the means to inspire and help others.
Susan Sonnenday Vogel's book, And Then Mark Died: Letters
of Grief, Love & Faith, was important as she brought
hope in the midst of fear. When trying to cope with the searing
pain of CRPS and the four months earlier when the neuroma
disrupted sleep and my ability to walk, hope was elusive.
Fear abounds with chronic pain: Fear of the pain itself. Fear
of each new exercise that hurts before it heals. Fear it won't
get well. Fear I can't do my job right when medicated, tired,
confused and hurting.
What's the pain like? Like a thousand tiny paper cuts, never
cleansed, reopening with every step. Like scrubbing the kitchen
floor and ammonia spills onto an open wound. Like Fourth of
July sparklers spitting through my foot and leg. Like a Kansas
City hail storm raging through my foot. Like Dante's words
in The Inferno when he wrote [my pain is] "
burning, but never consumed." Sometimes I would get a
break from the burning, the worst kind of CRPS pain, and just
have these buzzing vibrations. These crawling sensations were
not so painful but a distraction like a bad itch. Occasionally,
I'd get a jolt of pain shooting up the leg, but this was rare
after the neuroma was removed. Many times, the foot just throbbed
and the ankle ached from moving through the day.
On an early spring shopping trip to Mervyn's I took my third-grade
daughter to buy new sandals. Remarkably, this daughter who
scoured every store at the mall, and also Fred Meyer, Target,
and K-Mart six months earlier for new school shirts, to no
avail, found a pair of sandals she wanted in only 10 minutes.
That was my outer limit for bearing weight and shopping in
March. Elated we'd be going home, my fourth-grade son who
came along also decided he needed new sandals. The strap on
his pair at home had broken. Willing my mind to calm down,
I told him, "Okay, but I've got to sit down, now."
And so I did: in the aisle, on the floor, as he opened boxes
from the open shelves and tried to find the right pair he'd
like and that would also fit. I hoped he'd figure out how
to read the shoe sizes and styles on the box ends. I wasn't
getting up. It hurt too much. The clerk saw me on the floor
as I waited for my son, my leg stretched out and pumping my
foot to ease the throbbing and burning. No doubt she also
noticed the heat wrap around my ankle, ever present in those
first weeks of therapy. "There's a bench over there,"
she offered, pointing two aisles away passed the men's running
shoes. "It's okay," I told her. "The floor
It was hard to believe the encouraging words of my physical
therapists. One day, maybe six months to a year from now,
I will be well, they told me. I felt like the caboose on the
Island of Misfit Toys who had square wheels, and instead of
hoping for round wheels, he simply hopes that Santa will take
him to some girl or boy who will like a choo-choo with square
wheels. I found it hard to believe the foot would roll smoothly
again, and some days found that just to endure was enough.
I am thoroughly American, enculturated with the belief that
hard work will be rewarded. But after weeks and months of
dutifully following therapy instructions and exercises, plus
meditating and massaging the foot morning and night, for a
combined total of two to three hours a day, my hard work did
not consistently pay off. After respites from the narcotics,
I'd be back on them as pain flared up with stress, setbacks,
and new weight bearing exercises. Recovery was ragged and
the fear persisted that the CRPS wasn't going away.
So whence does hope come? Susan wrote this about dealing
with the death of her son Mark 10 years earlier. She preached
these same words at the seminary chapel when the twin towers
collapsed in New York on September 11, 2001:
"The problem is that we always think of hope as
grounded in the future. Wrong. Hope is always grounded in
the past. Hope simply challenges us to remember, always,
that we have survived everything in life to this point
I tried hard to be optimistic and imagine a healed foot during
the months of treatment, a psychological strategy I've never
found helpful. I couldn't visualize the image. I had wrongly
thought about healing and hope as grounded in the future
a wish or dream that eludes me. From Susan's grief experience
after her son died, I discovered a hope that sustains me also.
It gave me strength to get up each morning at 5:00 or 5:30
to walk the treadmill, shove paper across the floor, practice
bearing more weight on the scales, and more.
Hope was not about being able to see a new future I'm
not optimistic enough. It's also not about a present hope.
My trust that the pain will someday end falters. I simply
don't have the faith to be made well. But I have found hope:
a hope in remembering that I have survived life to this point:
God saw me through the poverty of my seminary years when I
had $4 in my pocket and 10 days until the end of the month.
God saw me through a major depression in my late twenties
when I wanted to say "No" to life and my brain was
shutting down so I could not understand when others spoke
to me. God wept with my grief in burying seminary friends
who died of AIDS. God helped me endure the early months of
my husband's decision to move on and end our marriage. God
saw the Israelite slaves to the Promised Land. God brought
the Exiles home from Babylon. God raised Jesus on the third
day. Jesus healed those who had faith, and those who had none.
By remembering God's sustaining and mighty acts in my own
life and religious tradition, in both recent times and long
ago, I experienced a hope that sustained me through the tedious
exercises and unrelenting pain that let go in only brief fragments
of the day. My life was blast to bits for several months,
but it was also the beginning of wisdom and hope. I found
myself singing with Susan the song that expressed hope when
Mark died. The words from the hymn Amazing Grace describe
Through many dangers, toils, and snares,
I have already come;
'tis grace hath brought me safe thus far,
and grace will lead me home.
Other texts helped me find meaning, courage and strength:
Marva Dawn's Joy in Our Weakness: The Gift of Hope from
the Book of Revelation, Norman Cousin's The Biology
of Hope, the PAX television series It's a Miracle,
the audio tapes from Bill Moyer's Healing of the Mind series on PBS television, Bernie Siegel's audio tape, Humor
and Healing, and the book Mayo Clinic on Chronic Pain. Roger Allen also passed along some of the articles and
research he'd written and used with treatment of CRPS.
Keven Mosley-Koehler was featured in a May 2003 Good Housekeeping article on chronic pain. She e-mailed her article describing
her recovery, CRPS: Beating the Unbeatable. From her
recovery she taught me to focus on the process of treatment
and not the outcome. That allowed me to keep doing the daily
foot work even as pain levels flared up and down and when
functional goals were slow in coming. Her story was important
because all others I met with CRPS were unable to work, seemed
like a walking pharmacy shelf with all the medications they
were taking, and were often depressed. Keven recovered, and
so would I.
Keeping a log and journal of treatment
I kept a log that listed the exercises I did each day and
recorded the medication I was taking and how often I took
it. I felt like I had to keep fighting depression through
the months of treatment. Common symptoms of depression include
confusion, inability to concentrate and focus on a task. The
mental fog I experienced may also have come from the Vicodin
and Tramadol I was taking for pain, and difficulties sleeping.
The logs helped me remember and stay on task. I also wrote
out my feelings about treatment and the impact CRPS was having
in my life at home and work, and my response to other stresses
in my life that affected my ability to recover. Writing down
my fears, frustration, exhaustion, and search for meaning
and purpose helped me identify and deal with psychological
and spiritual issues embedded in the relentless pain and demands
of treatment. My writing was more fragmented than the exercise
and medication logs. It's scattered between a wire bound journal,
letters written to family and friends, and email correspondence
with my pastor and physical therapist.
Humor and healing
When diagnosed with CRPS I had already been walking with a
limp for four months, and the 70-yard walk from my office
to the bathroom down the hall at work was the extent of my
aerobic workouts during the day. Observing my one-mile per
hour pace, a colleague asked if I needed to request vacation
leave to use the bathroom. Darrell's humor took the edge off
the eight hours of pain at work.
Another woman in my office used to sing me songs as I got
new PT assignments to improve my gait. I practiced them while
passing her desk on the way to the office copy machine so
I could enjoy her songs. One gait exercise was to walk with
longer strides. Peggy thought it looked like I was walking
in the university's commencement parade and so she began humming Pomp and Circumstance as I passed by her desk that
week. Another gait exercise was to walk like Groucho Marx.
This meant walking with a slight squat and knees bent. She
then adapted Nancy Sinatra's These Boots were Made for
Walking and it became "These feet were made for walking,
and that's just what they'll do." Such episodes of laughter
at the office took my mind off the pain.
Dr. Bernie Siegel explains the physiological mechanisms of
why laughter promotes healing in his audiotape, Humor and
Healing. If you want to get well, it's good to laugh.
Thus, I checked out every Garrison Keilor tape in the Tacoma
library system, watched America's Funniest Videos and Candid Camera with my kids, and we rented comedies
from Blockbuster that included Saturday Night Live episodes, Shrek, Big Mama's House, K-PAX, Dr. Doolittle,
Miss Congeniality, and Bringing Down the House.
I took a break from my favorite action-adventures during therapy.
After five weeks of therapy, I found I could use the pedal
on my piano for short periods of time. For 5 to 10 minutes
each night before bed, I pedaled the foot, pumping right through
the metatarsal heads that brought so much agony, and sang
from the Songs of Zion, an African-American hymnal
I first used in Washington, D.C. while training for urban
When peace, like a river, attendeth my way,
When sorrows, like sea billows roll:
Whatever my lot, Thou has taught me to say,
It is well, it is well with my soul.
Refrain: It is well (it is well), with my soul (with my soul)
It is well, it is well with my soul.
A couple of months ago I began playing my guitar
again. The guitar case had been the prop to hold the blankets
off my feet at night, but I hadn't played for several years.
With the encouragement of my pastor, I got it out again and
I discovered that when I sang, my brain had no room for pain.
Often my fingers hurt from pressing on the metal strings,
which also helped me forget about the foot pain. Thus, for
a few moments each night I could make the pain stop by singing
old protest songs and hymns of faith. When my foot was especially
weary of walking across the floor at night, and my leg began
to drag, I would sing my way to belief:
Where He leads me I will follow
Where He leads me I will follow
Where He leads me I will follow
I'll go with Him, with Him, all the way.
He will give me grace and glory,
He will give me grace and glory,
He will give me grace and glory,
And go with me, with me, all the way.
God's grace and glory, invoked in the midst of therapy demands,
parenting, and work helped me make it through the night, and
also to get to the night with hope and faith.
I found that integrating spiritual practices with the many
physical therapy exercises a source of strength and healing.
For example, Bob Brown gave me a Theraband to exercise the
foot. He showed me how to place my foot in the center of the
band, grab both ends with my hands, and pump the foot 20 times,
then circle the foot to the right twenty times, and to the
left another 20 times. I don't like to count. I find it tedious.
If I sang a hymn with it, the time passed more quickly. I'd
find a verse or song that lasted the 20 counts of pumping
the foot in the band.
Several other spiritual disciplines were incorporated into
my recovery: journal reflections on biblical passages with
a prayer group at church, regular worship on Sundays, receiving
Communion each night at home, memorizing bible verses while
walking the treadmill each day, and spiritual direction and
counsel with lay and clergy family and friends.
The breath prayer was most helpful. I swim three to six days
a week, 20 to 26 lengths of the pool each day and use a breath
prayer. Each phrase lasts the four to six strokes I need before
coming up for air. Likewise, at the fitness center when walking
the treadmill or riding the recumbent bike, I would pass the
time using another breath prayer. With each stroke, step or
revolution, I'd pray: "Lord Jesus, thank you for healing.
Grant me thy courage, thy strength and thy peace."
Grant me courage
to roll on my toes when walking, to
do what my therapists tell me I must do move into this
pain, face into the storm.
Grant me strength
to get up an hour earlier each day
so I can do the exercises before getting the kids ready for
school and me for work, and to stay awake another hour after
my kids are in bed to do the exercises, elevation and massage
all over again.
Grant me peace
.to know that even when I cannot go on,
God can. And, takes me with Him. For new life is always given
in pain and with great cost, and I need God's peace to deliver
this new creation.
I also practiced meditation as a result of my work with the
second physical therapist, Bob Brown. He was less helpful
in prescribing exercises vital to walking and accomplishing
the goals on my list. He did, however, help me to relax during
this stressful year and a half of treatment. At the start
of each session he had me lie down for twenty minutes with
my foot wrapped in a warm compress, and elevated on a soft
leather box. I began to meditate in the comfort of the dark
room. It was a spiritual practice that returned easily to
me after discarding it when my son was born 10 years ago and
I found I was too busy in the midst of fulltime work and parenting
to pray. For the first six months of therapy, I'd meditate
for 20 minutes each morning and evening with my foot elevated
and wrapped in a hot sock. After the swelling in the foot
disappeared, I dropped the morning session but continue to
meditate each night and find it brings the peace I need to
One of the symptoms of CRPS is being hypersensitive to touch.
Bob Brown began massaging the foot at each PT session to work
on tactile desensitization. After just five minutes, the massage
seemed to normalize the skin color and temperature. The massage
seems to retrain the sympathetic nerves and promote better
circulation. For the first three months, I'd massage the foot
myself three times a day. I would first elevate my foot and
meditate for 20 minutes, and follow this with five minutes
After three months, I was able to cut out the mid-day session
that was frustrating and difficult since I had no quiet space
at my office. I work in an open work area with eight other
staff members and students coming and going. The so-called
staff lounge in our building was often used for meetings and
events of other offices on campus. Occasionally, I could use
the office of another co-worker, but mostly I just had to
prop my leg on my desk and put a sign next to my foot during
those 20 minutes asking students and faculty to "Please
excuse the foot on the desk as I recover from recent foot
surgery." It was humiliating and awkward to live with
this mark of disability. With much relief, I was finally able
to drop this part of the daily therapy routine after three
months. Only on rare occasions with a pain flare-up do I find
it necessary now to elevate and massage my foot at work. It
continues, however, be part of my nightly effort to keep this
My third therapist, Roger Allen, gave me an article he'd written
with two others that explained the importance of treating
CRPS in a multi-disciplinary manner. "The key disciplines
needed for the management of CRPS include medicine, psychology
and physiotherapy." Psychological support came primarily
from an informal network of family, friends and coworkers
who encouraged my efforts, listened to my fears and frustrations,
and nurtured my sense of humor. The mainstay of support came
from my best friend, Cindy, and my brother and his wife. My
brother and sister-in-law were pastors in Tacoma and they
knew from their own pastoral counseling the kind of advice
that was helpful, and they knew the patience of listening.
Since their children were the ages of mine, my kids often
ended up overnight at their home on weekends, an enormous
relief which gave me breaks from the stress of parenting,
fulltime work, the pain and treatment demands of CRPS, and
the divorce I was dealing with during my recovery. I attended
my brother's church in south Tacoma and was nurtured by his
wise and humorous preaching. I attended a small study/prayer
group at his church which included a couple of women who also
helped me bear the stresses of CRPS, divorce negotiations,
and court appearances.
I was beginning to get the CRPS in remission after six months
of hard work when psychological challenges increased. The
pain was down, I was tapering off medications, and I was about
to begin pliometric exercises to prepare for soccer. Several
major setbacks hit within a couple of months that summer.
My brother and his wife were reassigned to churches in Spokane,
my best friend Cindy took a job in New York, the divorce negotiations
broke apart and we ended up in trial to settle the division
of assets and parenting plan, I broke out with a shingles
rash on my CRPS foot and lower leg, and I fractured the metatarsal
bone in my CRPS foot.
The fracture meant I had to reduce weight- bearing activity
by more than 50% during the six weeks the bone healed. When
my podiatrist finally agreed I could return to physical therapy
I found I had lost six months of previous hard work. Most
of the goals on my list that I'd accomplished earlier I could
no longer do. And so I started again shoving paper on the
floor, twisting toes, and grabbing the washcloth - the
basic exercises of therapy I'd done months earlier.
With my brother, sister-in-law, and best friend gone, and
now attending a new church where I knew no one very well,
my psychological support fell apart. I found myself on the
verge of tears at work, unable to manage the pain and stresses
by myself. Having been through a major depression in 1986
and having some training about depression in seminary counseling
classes, I knew how to deal with emotional and psychological
turmoil. I found a counselor and met with him five times in
the fall and winter, worked harder reaching out to new friends,
entered a prayer covenant with my new pastor, and started
a chronic pain support group at my church. Gradually, I rewove
the fabric of my support network and healing began to unfold
Keeping My Foot Warm
For the first 13 months of treatment my right foot was cold,
likely because of the disturbance to the sympathetic nerves
that control circulation. The doctors and all therapists agreed
on one point: keep the foot warm. When it was warm, the pain
would subside. My doctor prescribed Dibenzyline to help warm
the foot. I found that had limited value. It may have helped
in the first few months, but didn't seem to help as time passed.
I tapered off the drug over a two-week period in June when
I was walking better, and the warmer weather was approaching.
I went back on it two months later when the foot began getting
cold again and pain started increasing, and continued it for
another 12 weeks from August through October. When I dropped
it, my foot was still cold at times, but I didn't like the
side effects of the drug and it didn't seem to help.
The other ways I kept it warm was to take a hot bath each
night, to sleep with a hot sock (a cloth bag of rice warmed
in the microwave), and to keep a heat wrap around my ankle.
At my desk, I sometimes put a heating pad under my right knee
to warm the artery sending blood to my CRPS foot. When really
cold, I had an afghan wrapped around my legs and feet at the
I worked for a few weeks with thermal biofeedback, using
a thermometer that would read the temperature of my skin.
I'd try to visualize my foot warm by picturing a warm fire
and a minister/teacher massaging the foot, someone I knew
who had the hottest hands I'd ever experienced during a healing
service some years earlier. I could raise my skin temperature
slightly doing this, but didn't work at it long enough to
have much significance in recovery. I suspect it might be
useful if the skin temperature of my foot drops again this
fall, and know others who've found thermal biofeedback techniques
helpful. I've not had a problem with temperature changes in
the foot for last three months, and no longer have a need
to work with heat therapy.
Medication and Medical Interventions
I rebelled against taking drugs throughout my recovery. I
didn't like the immediate side effects and was unsure about
long-term effects. Persistent high levels of pain have a way
of grabbing attention, and so I did need some relief.
Dibenzyline: To warm the foot (and thus reduce pain),
I took 10 mg/day of Dibenzyline for the first 20 weeks. I
then stopped taking it for two months, and then took it another
12 weeks until it no longer seemed to be having much affect.
I was unwilling to increase the dosage, and tried other ways
to keep my foot warm.
Vicodin: While taking Dibenzyline, I also took the
opiod (narcotic) Vicodin on an "as needed" basis
for the first 6 months. This was a combination of 5 mg Hydrocodone
and 500 mg Acetaminophen. Generally, I'd manage on 1 or 2
tablets per day.
Tramadol and Ultracet: In the seventh month I switched
to Tramadol (50 mg) and its lower dose version, Ultracet (a
mix of 37.5 mg Tramadol with Acetaminophen). This acts like
an opiod in that it interferes with transmission of pain signals.
It also triggers release of norepinephrine and serotonin,
neurotransmitters that help reduce pain. I experienced similar
pain relief as with the Vicodin, but was less dizzy. Thus,
I was able to concentrate better at work. Like the Vicodin,
I took this on an as needed basis, generally 37.5 mg (the
Ultracet) to 87.5 mg per day (1 Tramadol and 1 Ultracet).
I experimented for two months by taking it regularly three
to four times per day to see if I could control the pain by
having a constant dosage in my body. The maximum dosage I
ever needed was 187.5 mg in one day. Given that my doctor
told me I could safely take up to 400 mg, I felt fortunate
I was able to manage the pain levels with lower dosages, perhaps
because of the multiple means of recovery I utilized. The
high dosages were during a particularly busy time at the office
when I needed to do some overtime and focus as best I could
to get the job done.
Lumbar sympathetic blocks: Neither the Vicodin nor
Tramadol are used specifically for nerve pain, but since they
didn't need to be taken all the time like the medications
I learned about for nerve pain, I preferred managing the pain
with these. But after 11 months of relentless pain, I was
weary of fighting it. I tried another medical intervention:
In January 2003 I had two lumbar sympathetic blocks, which
brought relief for 3 hours the first time and only a couple
of hours the second time.
Neurontin: After the blocks I tried Neurontin, an
anti-seizure medication used commonly with nerve pain, including
CRPS. I worked my way up to 3,000 mg/day and for about a week
I found some relief from the burning and throbbing pain, but
not the buzzing and crawling sensations. I was anxious about
long-term side effects that seemed uncertain with the Neurontin,
and the short-term side effects were much worse than the Tramadol.
(It felt like I couldn't control my bowels, and was bothered
by mild tremors and increased appetite.) I was on and off
the Neurontin within a four-week period. I decided I would
rather live with more pain and manage it as I had earlier
with a low dose narcotic-like drug, Tramadol and Ultracet.
Since I was able to tolerate physical therapy exercises without
being heavily medicated, and I functioned pretty well at work
with the Tramadol/Ultracet taken as needed, I found this enough
pain medication through most of my recovery period.
Other medications I tried, but which didn't bring relief
included a lidocaine patch and EMLA cream. The literature
on CRPS and Dr. Robinson from the University of Washington
Pain Center recommended that I try an early anti-depressant
to control the pain, but my family doctor generally found
these to be "dirty drugs," interfering with other
medications and more often having unpleasant side effects.
I went with her advice, and continue to use the Ultracet or
Tramadol as needed. Once I reached all my functional goals,
I began to get breaks in the pain so that I don't need any
drugs for several days at a time. Becoming less reliant on
the prescription drugs doesn't mean I'm pain free yet, but
it's eased up enough with the help of regular exercise, and
I can manage it on most days with massage, meditation and
pacing my activities.
My job at the University of Puget Sound's Registrar's Office
is to evaluate credits for transfer from study abroad programs
and summer schools that our students attend. The 40-hour workweek
was a mixed blessing in my recovery. Working forced me to
get up and exercise the foot each day, even if only walking
from the house to the car, and the parking lot to the office.
Inactivity exacerbates CRPS symptoms and pain. Others I met
who had CRPS talked about spending days in bed and not needing
to put shoes on their feet (because it hurt) or sleeves around
their arms (if CRPS was in the hand and arm). The simple act
of wearing shoes each day meant I was able to overcome the
hypersensitivity present with CRPS. Even though frustrated
by not doing the level of volunteer service work I'd done
before, there was tremendous satisfaction and strength to
be gained in my work as I helped students make plans for study
abroad, summer school and completing their degree requirements.
Working meant I also had friends at work to support me and
I could also help them with their concerns. I wasn't isolated
by staying home, which was particularly important after my
divorce that occurred the same year of my recovery. Work provided
my need for community. A fulltime salary also had an obvious
financial advantage with the additional medical expenses of
At the same time work brought its benefits, there were days
I wished I could have worked only 5 or 6 hours rather than
the standard 8. Especially on days that my kids were home
(and not at their dad's home), it would have been less stressful
if I could have arranged 1 to 2 hours of sick leave to do
the requirements of home therapy, involving 2 to 3 hours/day
in the first few months. The chronic nature of CRPS made it
hard to explain what I needed, and in hindsight the help of
doctors or therapists would have been useful in this regard,
helping with the education of supervisors and developing ideas
to adapt to the needs of the work place. I didn't want to
be a burden to my coworkers by taking more time off. I knew
these extra demands of fulltime work added to the stress,
which then flared up the pain and made it necessary to take
more of the narcotics than I wanted. With my perfectionist
tendencies and loyalty to coworkers and our students, I was
also careful not to schedule medical and therapy appointments
during peak times. I often used my lunch hour for these appointments
in order to get the job done during this long illness. I did
came to work an hour or two late a few days because I hadn't
slept the night before, or because of the nausea when weaning
off the narcotics, but I never missed a full day of work except
for the week following neuroma surgery. Mostly, I worked in
spite of the pain, dizziness from the medications, and mental
fog during the four months I didn't sleep well.
Working on sleep
If I didn't sleep, pain and stress would increase. In the
three months prior to foot surgery and the first month after,
I rarely slept well. Bedsores were agonizing because I couldn't
roll over in bed or lay my foot on the left or right side
without pain. I woke up when I tried to change positions.
I had to work at sleeping through the night and used these
- I meditated each night and for months took a hot bath
- I swam up to six days a week to release the tension.
- I pushed the side of my foot against a beach ball to
help tolerate the pressure of the mattress on the sides of
my foot at night.
- I practiced lying down on the floor and rolling from
side to side so I could do the same when rolling over in bed.
- I propped the blankets off the bed to reduce the pain
from the weight of the blankets on my foot.
- I said "No" to PTA and church activities
I'd done earlier so I wasn't up late.
- I bribed my kids with a dollar if they'd get to bed
earlier if I were particularly tired.
I rarely needed medication to sleep except in the first month
following surgery. The pain medication allowed me to work,
but was rarely used because I couldn't sleep without it. These
other strategies have worked and within a few weeks I was
sleeping through the night. Even when sleep returned, I noticed
I still was tired for months, I suspect in part because I
was sleeping but not dreaming. I wasn't getting to the deeper
REM sleep. The first dream I remember was in February 2003,
a full year after the CRPS symptoms began.
I've always been healthy prior to CRPS and rarely missed work
from colds, flu, or other illnesses in part because I was
active, ate well and the stress I had was easily managed with
supportive friends at work, home and church. With the CRPS,
I took extra care to keep eating right so that I wouldn't
have other illnesses to deal with at the same time. I took
1200 mg of calcium plus a multivitamin to rebuild the mineral
lost from the CRPS. Seven months after developing CRPS I fractured
a bone in my CRPS foot. A bone density test showed osteopenia
and my podiatrist was concerned how ghost-like the bones in
my foot had become.
I reduced caffeine to make it easier to sleep. I brought
yogurt and banana smoothies to work. I cut back on evening
snacks to keep from gaining weight during the period of less
aerobic activity. I cooked at home with more whole grains,
vegetables, tofu, and other soy products. None of this was
new, but trying to reduce processed foods, trips to McDonald's
and Pizza Hut meant planning ahead before shopping and some
extra time in packing lunches for work. There were still nights
when I was exhausted after work or taking the kids to some
school or sport event in the evening, and it was just easier
to feed the kids a frozen dinner or order pizza. I exchanged
good nutrition to avoid the cooking and cleaning to get to
bed earlier. It was a constant challenge balancing the benefits
of healthier food with the benefits of less stress from processed
foods and meals out. Focusing on better eating helped maintain
overall health and energy as I only got one brief cold during
the 16 months of treatment.
Starting Treatment When CRPS Symptoms First Began
I was not like other people I met who had CRPS. All the others
spent several months moving from doctor to doctor trying to
learn why they were in so much pain. My podiatrist knew the
symptoms of CRPS and diagnosed it within the first month that
symptoms developed. I began therapy immediately and this may
be one reason I was able to accomplish all my goals and manage
the pain with fewer medications than others.
Because of the pain, most people understandably stop using
the limb that hurts. Unlike many signals of pain in our body,
the pain of CRPS requires movement and not rest. The months
of not using the foot or hand with CRPS can exacerbate the
pain and other symptoms, making recovery much more difficult.
If undiagnosed for long, a full recovery might not be possible
and the symptoms can spread to another limb. Knowing the added
pain and disability that came for others with CRPS, it feels
a miracle to have had a doctor who understood the need to
get me in therapy the same day he saw the first signs of pain,
allodynia, edema, and the changes to skin color and temperature.
More than once Roger kept reminding me I was doing well just
keeping the pain confined to my right foot. Keeping the pain
confined was a sign of progress.
Things that didn't help my recovery
There were several strategies not helpful to me which others
have tried with CRPS, most of which are named earlier. These
included two lumbar sympathetic blocks, acupuncture, and biofeedback.
I also tried a session of Reiki, but found it to be similar
to the meditation I was already doing at home and not worth
pursuing. Other things decidedly not helpful included the
Physical therapy without clear goals and strategies
Bob Brown, my second therapist, was very helpful in reducing
hypersensitivity I experienced early on as he massaged the
foot regularly and got me doing it at home. He also helped
reduce my stress by letting me elevate my foot and meditate
for twenty minutes at each appointment. He also got me started
on the treadmill that was so helpful in walking without a
limp. After the first couple of months when I ran out of insurance
coverage, I found I was not progressing. I began to increase
my time on the treadmill on my own because I knew I could
do more, but got no direction from Bob on how to keep moving
towards more challenging activity. I asked him how long he
thought it would take to "get better". His response
was that nature had a way of healing, and some patients he'd
seen take two months and others take twelve. It was as if
I just needed to sit back and watch healing unfold. The lack
of direction became frustrating as I approached the third
month of pain and was still far from reaching my goals.
When I began with Roger Allen at UPS, I got lots more direction
and the structure that I needed with the quota-based exercise
approach. Still, I returned to see Bob every week or two because
the massage continued to be useful in reducing my sensitivity
to touch. Scheduling a medical appointment was also the only
way I felt justified in taking twenty minutes during the day
to elevate my foot and meditate, which felt very important
in the first few months when the edema and pain were highest.
Dealing with an HMO
Midway through treatment my divorce was finalized and I had
to switch insurance coverage. I now had the Group Health Options
Plan. The "Options" piece meant I was allowed to
see my regular doctors, but it was cheaper to use the Group
Health practitioners so I decided to try them. I searched
the website to review the backgrounds of the Group Health
doctors and found one that seemed like a good match. She had
a particular interest in neurology and so might know something
about CRPS. On my first visit, I found I was right. She had
worked with CRPS and knew the options for medication and the
importance of integrating different disciplines in treating
it. I was very organized with a list of questions when I first
saw her, and was surprised as she got up to leave after 15
minutes. Unclear where she was headed, I told her I had one
more question. Her response was "My time is up."
I could check at the desk to answer the question I had about
their counseling resources. I never saw her again.
I tried later to get a referral to a pain specialist through
Group Health and was expected to drive to Seattle where they
have a Pain Center. An appointment in Seattle meant taking
a half-day or more off work for just one appointment, and
so I insisted on a referral to someone in Tacoma. I was referred
to a neurologist at the Tacoma center who also evaluated my
foot and discussed my situation for 15 minutes. As he entered
notes on my chart, he told me he would use the term "RSD"
in the chart since that's what most call it. The condition
was renamed ten years earlier in 1993. I couldn't work with
someone who refused to be current on the literature.
Fortunately, I budget well and had the financial resources
to pay the extra needed to see my regular family physician
and the podiatrist who first diagnosed the CRPS. While they
didn't have lots of knowledge about CRPS, they were willing
to read up on it and consult other colleagues with their questions.
I settled for that and continued my primary approach to treatment,
which was the physical therapy, combined with psychological
support systems and strategies, and spiritual disciplines.
The painkillers they prescribed provided what I needed from
Challenges and Setbacks
Recovery has been ragged. I'd improve my function and begin
to get breaks from the pain and then the pain would flare
up and functional progress would slow or reverse. This pattern
to recovery was frustrating and also means the long-term prognosis
is uncertain. Am I just having an extended period of success
or is this the beginning of remission? The challenges and
setbacks to recovery included the following:
Challenges of Stress
Since physical therapy exercises were added gradually, I didn't
experience many pain flare-ups from overdoing it. Increased
stress at work and home flared up the pain fairly regularly
during the 16 months of treatment. Roger Allen had done some
research to suggest that stress can result in a pain flare
up 10 days after the stressful event. This was a pattern I
found also, and helped me understand when I experienced a
setback in getting off the pain medication. There were five
particularly stressful events during the 16 months of treatment:
divorce proceedings that included a trial to settle parenting
arrangements and the division of assets, the unraveling of
my support network when my brother's family and best friend
moved from Tacoma, leaving the church where my brother was
pastor, buying a house and moving from my apartment, and two
periods of overtime at work. These stressors gave me ample
opportunity to observe this 10-day stress-pain pattern. When
the pain flared from these situations, it was generally only
for a day, perhaps two.
There were also three medical setbacks that helped me learn
more about the nature of CRPS and how to treat it. While these
setbacks were depressing, in hindsight I find the knowledge
gained from those experiences helpful as I move beyond therapy
to normal life activities. The first major setback was in
August - six months after treatment began. I developed a shingles
rash in my CRPS foot and up the inside of the leg. It took
me a week to realize I had something other than CRPS because
the burning and aching nerve pain from shingles was like the
CRPS pain, just more intense. I thought I was experiencing
another 10-day stress flare up. The rash of spots was unusual,
but because CRPS also involves skin discoloration, it took
several days before I realized the spots were different than
the more even changes in skin color from CRPS. By the time
I realized I had shingles, my doctor said there were no medications
that would help. I just needed to wait it out and continue
the Tramadol I was taking for the CRPS pain to manage the
shingles pain. Shingles slowed me down, but didn't stop my
activity. I could still walk the treadmill each day and swim,
but cut back the speed and time until the rash began to go
away over the next few weeks. Maintaining activity is important
in reducing CRPS pain, and it's important to do what I can
even when not feeling well.
The second medical setback was that I smashed my foot into
a bathroom cupboard one morning and developed a compression
fracture in my CRPS foot. The pain began increasing over the
next couple of weeks, and the color was not right after I
did this, but again it was hard to recognize something new
might be wrong. My foot never stopped hurting from the CRPS
and the pain from the fracture seemed to be more of the same.
It took a couple of weeks before I began to sense the pain
sensations felt different: they were sharper pains than those
of CRPS. Fortunately, Dr. Barrett did not cast the foot. Roger
warned me about the dangers of immobilizing the foot with
CRPS. Instead, the podiatrist asked me to reduce weight bearing
as much as possible, at least by 50%. He gave me an orthotic
to wear in my shoe, which would transfer the weight to the
heel and way from the fractured metatarsal head. I used a
cane to take some weight off while walking. With no cast,
I was able to keep pumping the ankle and drawing the alphabet
with my foot. Even limited activity helps fight off the CRPS
symptoms of swelling, cold and throbbing/burning pain.
It took 6 weeks for the bone to heal and Dr. Barrett let
me return to physical therapy. In those 6 weeks of inactivity,
I lost most all progress I'd gained in the 6 months earlier.
When I fractured the foot I had just begun pliometrics
hopping off boxes and other work to begin running for soccer.
I was within reach of accomplishing all my goals. When I returned
to therapy after the fracture, I had to return to the basics
shoving paper, grabbing a washcloth with my toes, and
back to slower speeds and reduced time on the treadmill. This
setback was overwhelming when I realized all I'd lost. But
after reaching my goals again, I realize that it's still possible
to come back after a setback. I also realized the importance
of continuing to stay active. This extended period of inactivity
brought back all the CRPS symptoms the burning pain,
the swelling, the muscle weakness and sluggish response, the
cold temperature. I have also noticed this relation between
inactivity and increased pain and stiffness every morning.
Even after a night of sleep when not moving the foot for a
few hours, it takes almost thirty minutes before I can walk
The third setback was relatively minor compared to the shingles
and fracture. A month ago I missed a step at home and banged
my CRPS foot into it. The bone did not break this time, but
the mishap flared up the pain just as I was getting 3 and
4 days without the Tramadol. Whatever maintains the pain of
CRPS was disrupted, and I needed the Tramadol each day again.
It took nearly three weeks before the pain from this incident
began to subside. I realized after this experience that it
might be important to avoid sports that involve contact. I
also suspect that I'll continue to have setbacks with minor
mishaps like this, but with setbacks I have been able to recover
with patience, work and time. What might take just an hour
or two to heal or stop hurting in my unaffected foot can take
days or weeks in the CRPS foot. This setback also seems a
clear indication to be cautious about any future surgery or
medical intervention in my CRPS foot and leg as it might trigger
a particularly difficult flare up of the pain and other symptoms.
Challenge to Find Someone to Oversee My Treatment Plan
The final challenge to recovery was trying to manage the many
aspects of treatment on my own. In the helpful article Roger
Allen co-authored in Bonica's Management of Pain, he names
the importance of a multidisciplinary approach to treatment.
Thus, it's important for someone to manage or oversee the
entire recovery process. The article suggests that generally
a medical doctor take on that role. This strategy made sense
to me, but was frustrating as I never could find a doctor
to fill that role. Dr. Barrett, my podiatrist who diagnosed
the condition, specialized in surgery, and freely acknowledged
he had a tendency not to look beyond the foot in the healing
process. It was hard to talk with him about anything beyond
x-rays and medications, much less the need for psychological
support, spiritual resources and the details of physical therapy.
Paula Schulze, my family doctor, was empathetic to the challenges
of chronic pain from her own plantar faciitis condition and
was familiar with medications used with CRPS, but didn't seem
to have interest in overseeing the treatment either. Her practice
seemed very busy and she was perhaps as stressed as many medical
doctors seem to be. The Group Health doctors I met were either
ignorant or were bound by company policies to limit time spent
with their patients. Dr. Jaspar, the anesthesiologist who
did the sympathetic nerve blocks, knew the most about CRPS
and treatment options, but was dedicated to his specialty
of blocks and spinal implants. He would not even prescribe
medications, as there was no money in this.
Dr. James Robinson, the doctor at the University of Washington
Pain Center who did a consultation with me in the fall, would
have been an excellent manager for treatment, but he was not
taking on new patients and I would not have wanted to make
the drive to Seattle for regular evaluations. Roger Allen
at the UPS Physical Therapy Clinic was the closest I had to
a manager for this as he put in the time to educate, treat
and advise me on different aspects of treatment. I also thought
about my pastor Joe Miller. He was helpful in that he understood
something of chronic pain from his personal experience with
cluster headaches and back pain a number of years earlier.
He was familiar with some of my medical options even though
neither of us had expertise in this area, and he was the only
professional that I could discuss my theological issues and
spiritual disciplines used in recovery.
In the end, I managed the components of recovery myself.
It was lonely not having one person who understood it all.
I may have felt that way even if I found someone to manage
it. Even if someone understood CRPS, he or she may not have
understood me and the feelings I brought to this. Not finding
a manager may have been a blessing as it meant I took charge
of my own healing. Not relying on any one person during the
treatment process means I found a whole community of support.
It means I got to know and experience many who taught me the
art of healing in their own way: My physical therapists, Roger,
Bob and Jennifer; my physicians, Dr. Barrett and Paula Schulze;
my pastors Joe and Jon at Mason United Methodist Church; my
new friends in the pain support group at church, Dana, Jill
and Phyllis; members of my congregation who shared their own
stories of overcoming suffering in the book study I taught
on Yancey's, Where is God When It Hurts?; and Keven,
a CRPS patient who modeled and shared her process of recovery;
my parents and siblings who listened well; my coworkers who
helped me laugh and supported my treatment process; my friend
Cindy who kept listening even after most went to bed; and
Susan who taught me that hope arises from the ashes of the
past. I am indebted to them all.
During a time of stress a hormone, thyroxine, is released
from the thyroid into the blood stream. This hormone can increase
pain with CRPS, make others irritable, cause insomnia, anxiety
or digestive upsets. The thyroxine doesn't have an immediate
effect because it is wrapped with protein when it is released.
After about 3 days the protein starts to wear away and by
the 10th day, it's fully removed, resulting in the anxiety,
irritability, increased pain, etc. This stress-pain pattern
doesn't explain all CRPS pain flare-ups, but explains some
situations when other factors, such as increased activity,
are ruled out. The same pattern has been found with heart
patients at Boston hospitals. Following heart surgery, patients
had "relapses" about the 9th day, after being released
days previously. Doctors are beginning to bring back patients
on the 9th day to monitor the heart.
Appendix 1: My Goals for Therapy and Recovery from CRPS
I want to put on my socks without pain.
I want to cut my toenails without pain.
I want to shop without a motorized grocery cart.
I want to drive with my right foot again.
I want to rollover in sleep without waking up from
the pain and bedsores.
I want to sleep with blankets on my feet again. (One
of the early strategies for better sleep was to keep the blankets
elevated over the guitar case at the foot of my bed.)
I want to stand barefoot on the linoleum of the kitchen
and bathroom floor without wincing in pain.
I want to walk without a limp (a normal gait) on the
tile floor at the swimming pool.
I want to pivot on my foot and toes when taking a shower.
I want to dance in church - barefoot and with grace
on the oak floor of the sanctuary.
I want to wear my running shoes, oxfords, sandals,
thongs and dress pumps again.
I want my Jamie Moyer shoes to get a crease in the
right shoe. (I had purchased a new pair of tennis shoes in
the middle of treatment, and noticed after three weeks a clear
crease in the left shoe and not the right. I was not able
to push through the metatarsals and toes of my right foot
to bend the shoe leather. Getting the crease meant I was walking
well again. I had them autographed by Mariners' pitcher, Jamie
Moyer, at the Festival of Lights at Safeco Field in December
knowing he'd be starting Spring training soon, and so would
I for my foot.)
I want to walk faster and pass others on the sidewalk.
I want to play the pedal on the piano again so hymns
and songs of faith have more fullness and joy.
I want to believe this pain and disability will finally
I want to balance on my right foot while putting on
the left leg of my slacks.
I want to walk down steps correctly.
I want to push down on the pedal of the blue revolving
file cabinet at work with my right foot.
I want to ride my bike to work and around town.
I want to swim with a kickboard.
I want to play soccer with Hannah, my daughter. (I
want to run for short distances and take the impact of the
I want to play catch and basketball with Isaac, my
I want to drive without pain.
I want to walk to work and home (4 miles a day) without
I want to walk to the grocery store and shop on foot
again (about 2 miles and an hour of "foot time").
I want to stand at a cupboard, pushing up off my right
toes and reaching for something way up high like I do with
my left foot.
I want to be able to mow the lawn and take care of
I want a pain-free day at work.
I want the pain not to flare up when under stress or
Appendix 2: Physical Therapy Exercises
Circles, Drawing, Pumping, and Flexing
While sitting at my desk throughout the day, at least once
an hour for the first 3 months of therapy, I circled my foot
to the right and to the left and pumped the ankle up and down.
I drew the alphabet in the air with my toes, and spelled out
my name in block letters and cursive. With my shoe off, I'd
then flex the toes up and down through the day. Basically,
I was told to develop a "nervous" foot - keep it
in constant motion.
The Beach Ball
I pushed my toes and metatarsals onto a beach ball for five
minutes every waking hour for the first three months also.
I would sometimes miss an hour but never went longer than
two hours without doing this. Hence, I brought the ball to
work, church, my kids' piano lessons, and family activities.
After a few weeks, I realized that if I pushed on the ball
with the sides of my foot, over time it helped me tolerate
the pressure of the bed mattress so that I could lay my foot
on both the right and left sides, enabling better sleep.
I placed my foot in yellow, red, and blue Therabands and circled
my foot to the left and to the right, and pumped my ankle
with the bands. I did 3 sets of twenty times each when I got
up each morning and before bed each evening for the first
five months. The darker colored bands are thicker and require
more force, and so were used later. When I got to the blue
one, I decided to tie it underneath a pullout computer keyboard
shelf at my desk at work. I wasn't using the shelf for my
keyboard, and having the Theraband looped under my desk at
work meant I could keep my foot moving throughout the day.
I was constantly looking for ways to integrate therapy at
the office to free up time for taking care of my kids when
I got home at night.
Rocking Side-to-Side, and Front to Back
While making photocopies at work or washing dishes and brushing
teeth at home, I would stand and shift weight from the left
foot to the right foot. Over time, this helped distribute
my weight evenly on both legs. In May I added rocking backwards
and forwards, shifting weight from the heels to the toes.
This helped me put weight more evenly on the front of my foot
as my heel was carrying about 80% of the weight on my right
foot when I began this.
This was crucial to produce a normal gait. I walked the treadmill
every day at the fitness center for 13 months. Often, it meant
getting up at 5:00 to drive to the gym, walk, and drive back
home and shower in time to get my kids up at 6:30 for school.
The early mornings meant I had to cut out most every church
and school volunteer activity I'd done before getting CRPS.
It was essential I get to bed as soon as the kids were down
so I had energy the next day for work, parenting and therapy
I began the treadmill using just my CRPS foot. I put my left
foot on the metal track next to the revolving belt and let
my right foot and leg practice a normal motion, setting the
speed at 1.0 mph for 5 minutes a day. After a week of this,
I was able to walk with both feet on the treadmill, still
at 1.0 mph and 5 minutes a day. I added a tenth of a mile
per hour every few days and added another minute or two every
few days also. After two months I reached 2.3 mph for 16 minutes
a day. When I then began working with Roger Allen in therapy
he had me reduce my speed to 1.8 mph and shorten the time
in order to increase the grade. A 7% incline would force me
to roll through the toes when walking. I began with a 3% incline
and added a higher grade each week until reaching the required
After one year of walking the treadmill, I reached 3.0 mph
(average walking speed) and was walking 24 minutes. By then,
I also was walking a couple of minutes each day backwards
on the treadmill. Backwards meant landing first on the toes
that hurt, and helped with my desire to move in different
directions for liturgical dance at church. It also meant I could recover if I stumbled or tripped, being
able to move well in both directions.
These were done on a Total Gym at the therapist's office or
the Leg Press at the fitness center each day primarily to
strengthen my leg and knee. Normally this was 5 minutes a
day and with 5-15 pounds of weight. For 30 seconds to 1 minute
I would push up on my toes as well. Except for pushing off
the toes, this was gentle and easy to do. It didn't seem to
add much in the way of muscle strength but helped reactivate
"muscle memory" of how to bend up and down with
I added the bike at the second month, beginning with 5 minutes
and increasing a minute or two each week until I was up to
20 minutes. The bike helped with overall aerobic conditioning,
and helped achieve my goal to ride my bike around town again.
I "rode" the bike most every day for the next two
months, though if pressed for time I would skip it to be sure
I had time for the daily treadmill workout. After two months,
I was able to ride my regular bike from home to the store,
a 5 mile round trip.
Shoving Paper on the Kitchen Floor
It was pure agony bearing weight on the front of my right
foot. Roger asked me to put a piece of paper on the kitchen's
linoleum floor and then shove it backwards using the front
of my foot. This exercise was one of the first that stretched
my tolerance for therapy. Doing it each morning and evening
was always an act of courage. I hated the pain and was not
good at it early on, but did it anyway. Courage meant determination
more than strength and ability. Courage meant trusting it
would help me accomplish something on my wish list. The paper
barely moved on my first attempts each day. I couldn't press
hard enough. Eventually I got the hang of it, and several
pieces sailed under the stove and refrigerator during these
weeks of pushing paper.
Grabbing the Washcloth
I took a warm wet washcloth and laid it on the floor with
my heel in one corner and toes diagonally across to the other
corner. The task was to try to "gather up" the washcloth
by pulling it with my toes toward the heel. I did this ten
times each morning and evening for 3 weeks in the spring and
then again in the fall after I fractured a bone in the CRPS
One of my first assignments with Roger was to grasp the bottom
and top joint of all five toes between my thumb and center
finger. I would then twist both bottom and top joint of each
toe twenty times. I did this every morning and evening. Still
holding each toe between my thumb and third finger, I moved
both joints up and down, also for twenty repetitions each
morning and evening. The purpose for this was
Standing on the Bathroom Scale
Roger's research with CRPS and approach to therapy involved
lots of measurements to see how I was progressing. Early on
he wanted to see if I had symmetry when standing. That is,
did I bear weight equally on my left leg and my right (CRPS)
leg? To assess this, we laid two bathroom scales side by side.
I stood with one foot on the left scale and the other foot
on the right scale. This was easy, as I had spent the last
two months rocking side-to-side at the copy machine and while
I suspected, however, that I was not bearing weight equally
from the back to the front of the foot. To assess this we
put the two scales at the right and then placed a book the
same thickness as the scales next to the scales on the left.
This created a "triangle" with the book at the left
and the two scales on the right. I stood with my left and
unaffected foot on the book and then placed the back half
of my right CRPS foot on the bottom scale and the front half
of my CRPS foot on the top scale. My weight varies between
125-130 pounds. The right leg should normally bear half my
weight, or 62-65 pounds. This amount should be shared equally
between the front and the back of the foot for standing and
other weight-bearing activities. Our first assessment showed
I was only putting about 12 pounds or 20% of my weight on
the front of the foot.
Newly aware of the imbalance, I began standing on my bathroom
scale at home each morning and evening and gradually increased
the weight on the front of my CRPS foot until I was able to
reach 30-35 pounds or 50% of the weight carried by my right
leg. That's all Roger said was necessary, but for a long while
I tried to get to the place where I could take my full weight
on the front part of the CRPS foot, and so while holding on
to a towel bar in the bathroom, I kept trying to add more
pounds each week and got to about 80 pounds before giving
up. It was just too hard. I wanted to reach 130 pounds to
give me more moves for dancing. I also wanted to be able to
reach for something on a high shelf at the office or home
by pushing up on my right toes in the same way I could do
with my left foot. It was not a necessary function since I
could grab the just-out-of-reach object by pushing up on the
toes of my left foot, but it would mean a lot knowing I could
do the same activity with the right foot.
The same week I was discharged from 16 months of therapy,
I discovered I could do it. I pushed a container of frosting
to the back of the top shelf in the kitchen so I couldn't
reach it standing on flat feet. With my unaffected left foot,
I stood on the toes and grabbed the frosting. I pushed it
back to the same spot and tried the same with my CRPS foot.
Taking a deep breath, I pushed up on my right toes, and got
As a child I grew up in a small town and two blocks from the
public pool. I took lessons in the morning, swam in the afternoon
with friends, and returned often in the evening with my family.
My favorite family vacations were to the beaches at Ocean
Park. During college I chose swimming over coffee to help
stay awake through long nights of reading and writing. I swam
through the ninth month of my pregnancy with both children.
After five weeks of therapy, I figured out on my own that
I could swim in spite of the foot pain. The pool was not just
a place for physical therapy. It was the chance to be immersed
in familiar memories of home. The pool was the only place
I could move during the day without pain. It was the only
activity that wore me out, and thus helped reduce stress and
made it easier to sleep at night. Occasionally I'd practice
walking in the pool because the buoyancy of the water took
weight off my foot as I practiced walking. Mostly, though,
I just swam to add joy to my day. Once started, I swam between
3 to 6 days a week. For about a month in the winter I began
having neck pain, which seemed to worsen at the pool. Adding
new neck and shoulder exercises has allowed me to return to
the pool three days a week.
Throwing a Golf Ball
Why Roger suggested I learn to throw a golf ball I'll never
know. This exercise was a particular challenge as I couldn't
pick up a golf ball with my good foot, much less throw one
with my CRPS foot. After two months of futile attempts, I
finally managed to spread the toes wide enough to get around
the ball and tolerate the hard surface well enough to toss
it across the living room. While it had no functional utility,
it was nevertheless delightful when I finally had something
I could do with my foot that my kids couldn't do!
The first real bike ride felt like flight! The recumbent bike
at the fitness center helped me regain strength and motion,
but the gym is boring, noisy and smells like sweat. The freedom
to ride gave me a huge boost of confidence. I was surprised
that it seemed fairly easy once I started. In fact, it was
much easier to ride the bicycle than walk because walking
required rolling through the toes and metatarsal heads that
hurt so much. I was able to bike around town a full year before
I was able to exchange the treadmill work at the gym for walks
on real ground. It baffles me why it is also less painful
to ride the bike than drive a car. It may be because riding
requires more dynamic motion than operating the car, and this
may help ease whatever causes the pain of CRPS.
Rolling on balls - Pressure desensitization
This began late in therapy after a consultation with Dr. Jim
Robinson at the University of Washington Pain Center. He noted
in his report that while I was able to tolerate his gentle
stroking of the foot after 10 months of therapy, I was still
wincing and experiencing significant discomfort when applying
pressure over the bottom part of the foot under the metatarsal
heads. It meant it still hurt to drive the car. It also meant
that even though I wasn't limping, my goal to walk pain-free
seemed impossible. To desensitize this part of the foot to
pressure, I began a schedule of rolling different balls under
the toes and metatarsals. The first week it was 3 minutes
rolling a fuzzy and soft tennis ball, 2 minutes of rest, then
another 3 minutes with the same ball. The next week I rolled
an "Incrediball" for three minutes, followed by
2 minutes of rest, and then 3 minutes of the prior week's
tennis ball. The third week was 3 minutes of Incrediball,
2 minutes rest, and 3 minutes of Incrediball. The fourth week
exchanged a softball in the first 3 minutes and kept the Incrediball
the last 3 minutes. I continued this pattern of adding a new
and more irritating ball every other week for three months.
The pain and pressure increased weekly as I moved to harder,
smoother and smaller balls. I progressed through following
balls: tennis ball, Incrediball, softball, baseball, wooden
croquet ball, golf ball, and a metal ball sold at Asian markets
and normally used to roll in the hand while meditating. (It
was the same size of the golf ball, but smoother and colder.)
During the weeks of rolling balls under my foot I'd come
to therapy and press on a dynamometer with my foot. The dynamometer
has a dial to measure pounds of pressure. The needle on the
dial moves like a clock hand when pushing the "pedal"
attached to the meter. Roger strapped the dynamometer to a
block of wood with several layers of duck tape. We put this
contraption on the floor to imitate the gas and brake pedal
of a car. I would come each week and see how much pressure
I could apply to the dynamometer pedal. The pressure desensitization
was a huge success as eventually I was able to push the needle
off the scale. More significantly, I was able to drive farther
with less pain. And even better, was that I found my goal
to walk pain-free was possible. The process of increasing
pressure on the balls meant that I could take more pressure
on the sole of my foot. This was the most joyous breakthrough
of my entire 16 months of treatment when I realized the same
was true in walking each morning. The distance I could walk
pain-free expanded each week.
In the last couple of months I was finally able to work on
pliometrics exercises which required more force on
the foot such as stepping off a box, hopping and bouncing
back and forth between each leg. Pliometrics would allow me
to run again for soccer in the backyard with my daughter.
I started with about 1 minute each night, making small leaps
from one foot to the other, adding 15 seconds more each night.
These leaps became more varied each week, as I began hopping
side to side, then in diagonal patterns and around in circles.
Dribbling a Soccer Ball
I started with a soft Koosh ball as the impact of a real soccer
ball brought on too much pain. I kicked the Koosh ball 20
times each night against the wall of the garage for a couple
of weeks. Once comfortable with that, I switched to a rubber
ball for another couple of weeks. Finally, I was able to tolerate
the impact of a real soccer ball. I also worked on my aim
with my daughter volunteering to be a goal post as I tried
to shoot the ball through her legs. Having done the pliometric
hops for several weeks, I then began dribbling the soccer
ball for a couple of minutes each night in the yard in my
final weeks of therapy. I still keep it to just a few minutes
a day. That's enough to allow me some time to play with my
daughter again as soccer team practices begin this summer.
Walking the Neighborhood
After a year of work on the treadmill, I wanted to see if
I could walk without a limp by practicing on real ground.
I began with just 20 minutes, a few minutes less than I was
doing on the treadmill. The real ground would be more tiring
given the varying surfaces and steps up and down at curbs.
I walked daily and each week I added another block to my route.
I would also step off the sidewalk and walk instead along
the grass to help the nerves and muscles respond to uneven
surfaces. I now walk 2.8 miles each morning in 45 minutes
- which is 3.7 mph and faster than average pace. I sometimes
think this distance is not necessary to keep CRPS symptoms
away, but with early signs of osteoporosis that runs in my
family, it feels important that I continue to walk these longer
Walking Barefoot on the Wood Aerobic Floor at the Gym
Dancing to the End of Therapy
This was an exercise I developed myself. I wanted to do liturgical
dance for an Ash Wednesday service at church, and it meant
moving across a wood floor barefoot. The choreography seemed
easy compared to tolerating the pain on the floor. Having
learned that getting over the pain means moving through it,
I spent time each morning at the gym walking on the wood aerobics
floor. For five minutes each morning I walked forward, backward
and sideways, trying to desensitize my foot to the hard surface
that was similar to the sanctuary floor at church. After six
weeks at the gym, I spent the last week at the sanctuary reviewing
the dance movements in my bare feet every day for 15 to 30
It was really too much, as I pushed the time on the wood
floor faster than a quota-based therapy method would suggest,
and the foot ached more that week. But the night of the service
made the effort worth it. Those longer walks on the wood floor
meant that I'd managed to move my feet in a way that brought
hope and inspiration to others as I danced to Be Not Afraid.
This service also included an anointing and healing service.
There were others that night that were more overwhelmed by
life than I: a friend going through chemotherapy, a woman
mourning the death of her husband and daughter, and a woman
with CRPS in both feet and legs. We all understood the victory
of faith and healing as I danced,
Though you pass through raging waters in the sea,
You shall not drown.
Though you stand amidst the burning flames,
You shall not be harmed.
Though you stand before the power of hell and death is at
Know that I am with you through it all.
Be not afraid, I go before you always.
Come, follow me. And I will give you rest.
I danced again four months later on Pentecost, this time
inviting 20 others to join me. The syncopated rhythm moved
quickly and the lyrics were about the transforming Spirit
of God, which gives vision and strength to preach good news
to the poor, to bring release to the captives, recovery of
sight to the blind, and liberty to the oppressed. It was a
fitting song to celebrate my own release from therapy and
the accomplishment of all goals on the list I made 16 months