By Scott Scanlon – Refresh Editor
If you’ve never been in a serious car accident or diagnosed with a chronic disease, maybe you don’t understand the rigors of dealing with such a traumatic experience.
It doesn’t make it any less real – or challenging – for those forced to confront it.
Is it so outlandish to believe that someone face-to-face with such an ordeal may want to take some time to assess its impact?
That’s where Stacey Donahue comes in.
Donahue, subject of today’s “In the field” feature in WNY Refresh, is a licensed clinical social worker who is part of the mental health and wellness team at Buffalo Spine and Sports Medicine, which has locations in Batavia, Orchard Park, Lockport and Amherst.
She is proof that going to see a counselor is a sign of good mental health.
Expect to see a lot more folks like Donahue as medical practices seek a holistic approach to treating injuries and conditions that can benefit from a range of treatments.
Dr. Leonard Kaplan, head of Buffalo Spine and Sport Medicine, said the need for a mental health and wellness component became obvious after the practice began in 1988, but that things didn’t gel until the state Workers Compensation Board determined in 2010 that mental health services should be covered as part of an overall treatment plan for those with traumatic or chronic health issues.
“Folks who have pain always have emotional distress along with the pain,” Kaplan told me earlier this week.” It can either be clinical depression or it can just be pain-related mood problems, but they become barriers to recovery. You can tell that from the way they are in the office, you can tell that from the way they interact with the physical therapists during rehabilitation. It impedes their work ability, their return to normal activities. Even as their bodies get better, their mental well-being lags behind a little bit. So we’ve been dying to get somebody like Stacey in here for a long, long time.”
Donahue started in the office in August and is building a caseload. She is part of a practice that includes PTs, chiropractors and a yoga instructor.
Here’s what Donahue told me about painkillers, and about the people who have the strength, and wisdom, to avail her of her counsel:
Where do painkillers fit in, in terms of chronic disease?
The doctors are selective in prescribing medications here to begin with. Everybody here comes in in pain. Anybody can legitimately argue a case that ‘I need these pain pills.’ Maybe (the doctors don’t need) immediately to prescribe them. First, they haven’t explored what things might be more helpful. And the other thing is that when the pain pill wears off, you have all this pain that you’re dealing with, and you have this sort of psychological awareness, the ‘Oh, now my pain is increasing, I’m tapering off to the end of that six hours,’ that is sometimes difficult for people to deal with. They want to be in this state of being pain-free and then their pain meds wear off. When that pain starts to onset again, they almost have more stress around dealing with it. They really just want to be pain-free.
I know the need for painkillers plays a role. There are people here who have had surgery, people here who are in need of surgery, should get surgery but can’t. I know they do play a role but … you don’t want to be in that situation where they’re readily given out. I do think there are other options. Pain pills aren’t the only thing that happens here. They are one of many treatments that happen here, whether it’s mental health or PT or (cortisone and botox) injections, chiropractic, yoga. And then people do things on their own. They’re looking for massage therapists, they’re looking for acupuncture people. They’re trying to stay away from pain pills, too. A lot of the people I deal with don’t really want to be prescribed pain pills. It’s sort of like a last stop for them.
They want to really try everything else first. More and more, we hear about the dangers of painkilling medications and the addiction and the feeling of being numbed out and not really with it.
So it sounds like what you’re saying is folks need to do the best they can to try to take some control of their own health care and their own health improvements?
A lot of time, people will come in here and say, ‘You know, I want to come in here and have a holistic approach. I don’t want to take all these pills, be on all this medication.’ I think between the physical therapy and the yoga and the chiropractic care, you really do have that here. You really do have this kind of holistic care instead of, ‘Here, take a pill and sweat it out for the next four hours.’
When that’s the only coping strategy, sometimes patients say, ‘I know it’s every four to six hours, but it’s only been two hours and I need another pill.’ A holistic approach helps them deal better in those spans of time, so if they do have medications they’re not so reliant upon them.
How does this work here? Do they see a doctor who might say, ‘I think you might be helped with mental health services?’ You must get some interesting reactions to that.
Sometimes people will get to my office and say, ‘I don’t really know why I’m here.’ When we start talking about it … then they get it. Sometimes they just have this idea that they’re going to come to the practice, we’re going to do whatever to them, and they’re going to be able to go on with their lives. The expectations of what treatment is doesn’t always meet up with their vision of what they’re going to be doing. … Sometimes, getting people to where they have more reality based expectations is important. They just don’t necessarily understand why do they have to do all this stuff, why can’t they just come in (get things fixed) and get on their way?
Sometimes it’s not so much anxiety and depression. You have people living their lives, and doing what they do, and then they can’t. I’ll see people who have family members dependent on them, then they have an injury or something happens and now they can’t be there for their people the way they’ve always been. And sometimes pulling out of roles is very challenging. They feel stuck in a way … Sometimes it’s helping them understand their priorities and putting themselves first. A lot of people here are middle-aged and they’re responsible for older people and they’re helping them to do things that aren’t always in their interest to do physically. It’s almost helping them to realize things are different now, at least for a while. You have to put yourself first and your recovery first, really get better.
A lot of folks probably don’t know how.
It’s that whole thing, Eastern versus Western medicine. Even at UB, the person who I trained with, Dr. Kim Dobson, gave us a training at one point and said in the medical school they’re starting to teach Mindfulness-Based Stress Reduction. It comes out of the University at Massachusetts Medical Center, and what they were finding at their stress clinic – for anxiety, depression and chronic pain – they were seeing these amazing results. People who were not able to function well were feeling a greater sense of well-being. So they were saying, ‘What’s up with this? It’s just breathing and meditating? How are we getting so much mileage out of this?’
What would a typical 45-minute session be like?
It’s ‘How’s it been since the last session? How are you doing? Did anything come up for you? Sometimes, we’ll talk about different things that stressed them out or how they were stressed out by their pain. Sometimes it’s problem solving around that. If they’re not getting good sleep, we’re focused on how improve their sleep, trying to get more restful sleep so they’re not feeling so emotionally tattered by the sleep deprivation. Sometimes it’s trying to deal with the worries they have.
I do tend to use cognitive behavioral therapy, which is really focused on the inner dialogue that they’re having, where they’re saying, ‘This is awful, I can’t deal with this.’ Really trying to break down a situation that’s negatively affecting their emotions. They might not necessarily be able to change their pain or change their situation but they can change their perception of it. Helping them to realize they have more control that they think. Trying to help them find where they have control in their lives, instead of having them feel disempowered by their pain or their situation.
We’ll do that for a while and then we’ll get into meditation, exercise. There are different mindfulness strategies. There’s meditation, there’s body scans, and then there’s yoga. We don’t do yoga in my sessions but that’s something that’s offered here.