Get The Right Help For Your Pain
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How Much Does It Hurt?
Sometimes, a medical professional will ask us to “rate your pain on a scale of 1–10”.
It can be tempting to avoid rating one’s pain too highly, because if we say “10” then where can we go from there? There is always a way to make pain worse, after all.
But that kind of thinking, however logical, is folly—from a practical point of view. Instead of risking having to give an 11 later, you have now understated your level-10 pain as a “7” and the doctor thinks “ok, I’ll give Tylenol instead of morphine”.
A more useful scale
First, know this:
Zero is not “this is the lowest level of pain I get to”.
Zero is “no pain”.
As for the rest…
- My pain is hardly noticeable.
- I have a low level of pain; I am aware of my pain only when I pay attention to it.
- My pain bothers me, but I can ignore it most of the time.
- I am constantly aware of my pain, but can continue most activities.
- I think about my pain most of the time; I cannot do some of the activities I need to do each day because of the pain.
- I think about my pain all of the time; I give up many activities because of my pain.
- I am in pain all of the time; It keeps me from doing most activities.
- My pain is so severe that it is difficult to think of anything else. Talking and listening are difficult.
- My pain is all that I can think about; I can barely move or talk because of my pain.
- I am in bed and I can’t move due to my pain; I need someone to take me to the emergency room because of my pain.
10almonds tip: are you reading this on your phone? Screenshot the above, and keep it for when you need it!
One extra thing to bear in mind…
Medical staff will be more likely to believe a pain is being overstated, on a like-for-like basis, if you are a woman, or not white, or both.
There are some efforts to compensate for this:
A new government inquiry will examine women’s pain and treatment. How and why is it different?
Some other resources of ours:
- The 7 Approaches To Pain Management ← a pain specialist discusses the options available
- Managing Chronic Pain (Realistically!) ← when there’s no quick fix, but these things can buy you some hours’ relief at least / stop the pain from getting worse in the moment
- Science-Based Alternative Pain Relief ← for when you’re maxxed out on painkillers, and need something more/different, these are the things the science says will work
Take care!
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Perfectionism, And How To Make Yours Work For You
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Harness The Power Of Your Perfectionism
A lot of people see perfectionism as a problem—and it can be that!
We can use perfectionism as a would-be shield against our fear of failure, by putting things off until we’re better prepared (repeat forever, or at least until the deadliniest deadline that ever deadlined), or do things but really struggle to draw a line under them and check them off as “done” because we keep tweaking and improving and improving… With diminishing returns (forever). So, that’s not helpful.
But, if we’re mindful, we can also leverage our perfectionism to our benefit.
Great! How?
First we need to be able to discern the ways in which perfectionism can be bad or good for us. Or as it’s called in psychology, ways in which our perfectionism can be maladaptive or adaptive.
- Maladaptive: describing a behavioral adaptation to our environment—specifically, a reactive behavioral adaptation that is unhealthy and really is not a solution to the problem at hand
- Adaptive: describing a behavioral adaptation to our environment—specifically, a responsive behavioral adaptation that is healthy and helps us to thrive
So in the case of perfectionism, one example for each might be:
- Maladaptive: never taking up that new hobby, because you’re just going to suck at it anyway, and what’s the point if you’re not going to excel? You’re a perfectionist, and you don’t settle for anything less than excellence.
- Adaptive: researching the new hobby, learning the basics, and recognizing that even if the results are not immediately perfect, the learning process can be… Yes, even with mistakes along the way, for they too are part of learning! You’re a perfectionist, and you’re going to be the best possible student of your new hobby.
Did you catch the key there?
When it comes to approaching things we do in life—either because we want to or because we must—there are two kinds of mindset: goal-oriented, and task-oriented.
Broadly speaking, each has their merits, and as a general topic, it’s beyond the scope of today’s main feature. Here we’re looking at it in the context of perfectionism, and in that frame, there’s a clear qualitative difference:
- The goal-oriented perfectionist will be frustrated to the point of torment, at not immediately attaining the goal. Everything short of that will be a means to an end, at best. Not fun.
- The task-oriented perfectionist will take joy in going about the task in the best way possible, and optimizing their process as they go. The journey itself will be rewarding and a tangible product of their consistent perfectionism.
The good news is: you get to choose! You’re not stuck in a box.
If you’re thinking “I’m a perfectionist and I’m generally a goal-oriented person”, that’s fine. You’re just going to need to reframe your goals.
- Instead of: my goal is to be fluent in Arabic
- …so you never speak it, because to err is human, all too human, and you’re a perfectionist, so you don’t want that!
- Let’s try: my goal is to study Arabic for at least 15 minutes per day, every day, without fail, covering at least some new material each time, no matter how small the increase
- …and then you go and throw yourself into conversation way out of your depth, make mistakes, and get corrections, because that’s how you learn, and you’re a perfectionist, so you want that!
This goes for any field of expertise, of course.
- If you want to play the violin solo in Carnegie Hall, you have to pick up your violin and practice each day.
- If you want to be a world-renowned pastry chef, you have to make a consistent habit of baking.
- If you want to write a bestselling book, you have to show up at your keyboard.
Be perfect all you want, but be the perfect student.
And as your skills grow, maybe you’ll upgrade that to also being the perfect practitioner, and perhaps later still, the perfect teacher.
But just remember:
Perfection comes not from the end goal (that would be backwards thinking!) but from the process (which includes mistakes; they’re an important part of learning; embrace them and grow!), so perfect that first.
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Beyond “Make Your Bed”—life lessons from experience
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Beyond “Make Your Bed”—life lessons from experience
This is Admiral William H. McRaven, a former United States Navy four-star admiral who served as the ninth commander of the United States Special Operations Command.
So, for those of us whose day-to-day lives don’t involve coordinating military operations, what does he have to offer?
Quick note: 10almonds’ mission statement is “to make health and productivity crazy simple”.
We tend to focus on the health side of this, and in the category of productivity, it’s often what most benefits our mental health.
We’re writing less for career-driven technopreneurs in the 25–35 age bracket and more for people with a more holistic view of productivity and “a good life well-lived”.
So today’s main feature is more in that vein!
Start each day with an accomplishment
McRaven famously gave a speech (and wrote a book) that began with the advice, “make your bed”. The idea here doesn’t have to be literal (if you’ll pardon the pun). Indeed, if you’re partnered, then depending on schedules and habits, it could be you can’t (sensibly) make your bed first thing because your partner is still in it. But! What you can do is start the day with an accomplishment—however small. A short exercise routine is a great example!
Success in life requires teamwork
We’re none of us an island (except in the bathtub). The point is… Nobody can do everything alone. Self-sufficiency is an illusion. You can make your own coffee, but could you have made the coffee machine, or even the cup? How about, grown the coffee? Transported it? So don’t be afraid to reach out for (and acknowledge!) help from others. Teamwork really does make the dream work.
It’s what’s inside that counts
It’s a common trap to fall into, getting caught up the outside appearance of success, rather than what actually matters the most. We need to remember this when it comes to our own choices, as well as assessing what others might bring to the table!
A setback is only permanent if you let it be
No, a positive attitude won’t reverse a lifelong degenerative illness, for example. But what we can do, is take life as comes, and press on with the reality, rather than getting caught up in the “should be”.
Use failure to your advantage
Learn. That’s all. Learn, and improve.
Be daring in life
To borrow from another military force, the SAS has the motto “Who dares, wins”. Caution has it place, but if we’ve made reasonable preparations*, sometimes being bold is the best (or only!) way forward.
*Meanwhile the Parachute Regiment, from which come 80% of all SAS soldiers, has the motto “Utrinque paratus”, “prepared on all sides”.
Keep courage close
This is about not backing down when we know what’s right and we know what we need to do. Life can be scary! But if we don’t overcome our fears, they can become self-realizing.
Writer’s note: a good example of this is an advice I sometimes gave during my much more exciting (military) life of some decades ago, and it pertains to getting into a knife-fight (top advice for civilians: don’t).
But, if you’re in one, you need to not be afraid of getting cut.
Because if you’re not afraid of getting cut, you will probably get cut.
But if you are afraid of getting cut, you will definitely get cut.
Hopefully your life doesn’t involve knives outside of the kitchen (mine doesn’t, these days, and I like it), but the lesson applies to other things too.
Sometimes the only way out is through.
Be your best at your worst
Sometimes life is really, really hard. But if we allow those moments to drive us forwards, they’re also a place we can find more strength than we ever knew we had.
Keep on swimming
It’s said that the majority in life is about showing up—and often it is. But you have to keep showing up, day after day. So make what you’re doing sustainable for you, and keep on keeping on.
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How White Is Your Tongue?
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝So its normal to develop a white sort of coating on the tongue, right? It develops when I eat, and is able to (somewhat) easily be brushed off❞
If (and only if) there is no soreness and the coverage of the whiteness is not extreme, then, yes, that is normal and fine.
Your mouth has a microbiome, and it’s supposed to have one (helps keep the conditions in your mouth correct, so that food is broken down and/but your gums and teeth aren’t).
Read more: The oral microbiome: Role of key organisms and complex networks in oral health and disease
The whiteness you often see on a healthy tongue is, for the most part, bacteria and dead cells—harmless.
Cleaning the whiteness off with your brush is fine. You can also scrape off with floss is similar if you prefer. Or a tongue-scraper! Those can be especially good for people for whom brushing the tongue is an unpleasant sensation. Or you can just leave it, if it doesn’t bother you.
By the way, that microbiome is a reason it can be good to go easy on the mouthwash. Moderate use of mouthwash is usually fine, but you don’t want to wipe out your microbiome then have it taken over by unpleasantries that the mouthwash didn’t kill (unpleasantries like C. albicans).
There are other mouthwash-related considerations too:
Toothpastes and mouthwashes: which kinds help, and which kinds harm?
If you start to get soreness, that probably means the papillae (little villi-like things) are inflamed. If there is soreness, and/or the whiteness is extreme, then it could be a fungal infection (usually C. albicans, also called Thrush), in which case, antifungal medications will be needed, which you can probably get over the counter from your pharmacist.
Do not try to self-treat with antibiotics.
Antibiotics will make a fungal infection worse (indeed, antibiotic usage is often the reason for getting fungal growth in the first place) by wiping out the bacteria that normally keep it in check.
Other risk factors include a sugary diet, smoking, and medications that have “dry mouth” as a side effect.
Read more: Can oral thrush be prevented?
If you have any symptoms more exciting than the above, then definitely see a doctor.
Take care!
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What is ‘doll therapy’ for people with dementia? And is it backed by science?
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The way people living with dementia experience the world can change as the disease progresses. Their sense of reality or place in time can become distorted, which can cause agitation and distress.
One of the best ways to support people experiencing changes in perception and behaviour is to manage their environment. This can have profound benefits including reducing the need for sedatives.
One such strategy is the use of dolls as comfort aids.
Jack Cronkhite/Shutterstock What is ‘doll therapy’?
More appropriately referred to as “child representation”, lifelike dolls (also known as empathy dolls) can provide comfort for some people with dementia.
Memories from the distant past are often more salient than more recent events in dementia. This means that past experiences of parenthood and caring for young children may feel more “real” to a person with dementia than where they are now.
Hallucinations or delusions may also occur, where a person hears a baby crying or fears they have lost their baby.
Providing a doll can be a tangible way of reducing distress without invalidating the experience of the person with dementia.
Some people believe the doll is real
A recent case involving an aged care nurse mistreating a dementia patient’s therapy doll highlights the importance of appropriate training and support for care workers in this area.
For those who do become attached to a therapeutic doll, they will treat the doll as a real baby needing care and may therefore have a profound emotional response if the doll is mishandled.
It’s important to be guided by the person with dementia and only act as if it’s a real baby if the person themselves believes that is the case.
What does the evidence say about their use?
Evidence shows the use of empathy dolls may help reduce agitation and anxiety and improve overall quality of life in people living with dementia.
Child representation therapy falls under the banner of non-pharmacological approaches to dementia care. More specifically, the attachment to the doll may act as a form of reminiscence therapy, which involves using prompts to reconnect with past experiences.
Interacting with the dolls may also act as a form of sensory stimulation, where the person with dementia may gain comfort from touching and holding the doll. Sensory stimulation may support emotional well-being and aid commnication.
However, not all people living with dementia will respond to an empathy doll.
It depends on a person’s background. Shutterstock The introduction of a therapeutic doll needs to be done in conjunction with careful observation and consideration of the person’s background.
Empathy dolls may be inappropriate or less effective for those who have not previously cared for children or who may have experienced past birth trauma or the loss of a child.
Be guided by the person with dementia and how they respond to the doll.
Are there downsides?
The approach has attracted some controversy. It has been suggested that child representation therapy “infantilises” people living with dementia and may increase negative stigma.
Further, the attachment may become so strong that the person with dementia will become upset if someone else picks the doll up. This may create some difficulties in the presence of grandchildren or when cleaning the doll.
The introduction of child representation therapy may also require additional staff training and time. Non-pharmacological interventions such as child representation, however, have been shown to be cost-effective.
Could robots be the future?
The use of more interactive empathy dolls and pet-like robots is also gaining popularity.
While robots have been shown to be feasible and acceptable in dementia care, there remains some contention about their benefits.
While some studies have shown positive outcomes, including reduced agitation, others show no improvement in cognition, behaviour or quality of life among people with dementia.
Advances in artificial intelligence are also being used to help support people living with dementia and inform the community.
Viv and Friends, for example, are AI companions who appear on a screen and can interact with the person with dementia in real time. The AI character Viv has dementia and was co-created with women living with dementia using verbatim scripts of their words, insights and experiences. While Viv can share her experience of living with dementia, she can also be programmed to talk about common interests, such as gardening.
These companions are currently being trialled in some residential aged care facilities and to help educate people on the lived experience of dementia.
How should you respond to your loved one’s empathy doll?
While child representation can be a useful adjunct in dementia care, it requires sensitivity and appropriate consideration of the person’s needs.
People living with dementia may not perceive the social world the same way as a person without dementia. But a person living with dementia is not a child and should never be treated as one.
Ensure all family, friends and care workers are informed about the attachment to the empathy doll to help avoid unintentionally causing distress from inappropriate handling of the doll.
If using an interactive doll, ensure spare batteries are on hand.
Finally, it is important to reassess the attachment over time as the person’s response to the empathy doll may change.
Nikki-Anne Wilson, Postdoctoral Research Fellow, Neuroscience Research Australia (NeuRA), UNSW Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Cross That Bridge – by Samuel J. Lucas
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Books of this genre usually have several chapters of fluff before getting to the point. You know the sort:
- Let me tell you about some cherry-picked celebrity stories that overlook survivorship bias
- Let me tell you my life story, the bad parts
- My life story continued, the good parts now
- What this book can do for you, an imaginative pep talk that keeps circling back to me
…then there will be two or three chapters of the actual advertised content, and then a closing chapter that’s another pep talk.
This book, in contrast, throws that out of the window. Instead, Lucas provides a ground-up structure… within which, he makes a point of giving value in each section:
- exercises
- summaries
- actionable advice
For those who like outlines, lists, and overviews (as we do!), this is perfect. There are also plenty of exercises to do, so for those who like exercises, this book will be great too!
Caveat: occasionally, the book’s actionable advices are direct but unclear, for example:
- Use the potential and power of tea, to solve problems
Context: there was no context. This was a bullet-pointed item, with no explanation. It was not a callback to anything earlier; this is the first (and only) reference to tea.
However! The book as a whole is a treasure trove of genuine tips, tools, and voice-of-experience wisdom. Occasional comments may leave you scratching your head, but if you take value from the rest, then the book was already more than worth its while.
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Surgery is the default treatment for ACL injuries in Australia. But it’s not the only way
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The anterior cruciate ligament (ACL) is an important ligament in the knee. It runs from the thigh bone (femur) to the shin bone (tibia) and helps stabilise the knee joint.
Injuries to the ACL, often called a “tear” or a “rupture”, are common in sport. While a ruptured ACL has just sidelined another Matildas star, people who play sport recreationally are also at risk of this injury.
For decades, surgical repair of an ACL injury, called a reconstruction, has been the primary treatment in Australia. In fact, Australia has among the highest rates of ACL surgery in the world. Reports indicate 90% of people who rupture their ACL go under the knife.
Although surgery is common – around one million are performed worldwide each year – and seems to be the default treatment for ACL injuries in Australia, it may not be required for everyone.
PeopleImages.com – Yuri A/Shutterstock What does the research say?
We know ACL ruptures can be treated using reconstructive surgery, but research continues to suggest they can also be treated with rehabilitation alone for many people.
Almost 15 years ago a randomised clinical trial published in the New England Journal of Medicine compared early surgery to rehabilitation with the option of delayed surgery in young active adults with an ACL injury. Over half of people in the rehabilitation group did not end up having surgery. After five years, knee function did not differ between treatment groups.
The findings of this initial trial have been supported by more research since. A review of three trials published in 2022 found delaying surgery and trialling rehabilitation leads to similar outcomes to early surgery.
A 2023 study followed up patients who received rehabilitation without surgery. It showed one in three had evidence of ACL healing on an MRI after two years. There was also evidence of improved knee-related quality of life in those with signs of ACL healing compared to those whose ACL did not show signs of healing.
Experts used to think an ACL tear couldn’t heal without surgery – now there’s evidence it can. SKYKIDKID/Shutterstock Regardless of treatment choice the rehabilitation process following ACL rupture is lengthy. It usually involves a minimum of nine months of progressive rehabilitation performed a few days per week. The length of time for rehabilitation may be slightly shorter in those not undergoing surgery, but more research is needed in this area.
Rehabilitation starts with a physiotherapist overseeing simple exercises right through to resistance exercises and dynamic movements such as jumping, hopping and agility drills.
A person can start rehabilitation with the option of having surgery later if the knee remains unstable. A common sign of instability is the knee giving way when changing direction while running or playing sports.
To rehab and wait, or to go straight under the knife?
There are a number of reasons patients and clinicians may opt for early surgical reconstruction.
For elite athletes, a key consideration is returning to sport as soon as possible. As surgery is a well established method, athletes (such as Matilda Sam Kerr) often opt for early surgical reconstruction as this gives them a more predictable timeline for recovery.
At the same time, there are risks to consider when rushing back to sport after ACL reconstruction. Re-injury of the ACL is very common. For every month return to sport is delayed until nine months after ACL reconstruction, the rate of knee re-injury is reduced by 51%.
For people who opt to try rehabilitation, the option of having surgery later is still there. PeopleImages.com – Yuri A/Shutterstock Historically, another reason for having early surgical reconstruction was to reduce the risk of future knee osteoarthritis, which increases following an ACL injury. But a review showed ACL reconstruction doesn’t reduce the risk of knee osteoarthritis in the long term compared with non-surgical treatment.
That said, there’s a need for more high-quality, long-term studies to give us a better understanding of how knee osteoarthritis risk is influenced by different treatments.
Rehab may not be the only non-surgical option
Last year, a study looking at 80 people fitted with a specialised knee brace for 12 weeks found 90% had evidence of ACL healing on their follow-up MRI.
People with more ACL healing on the three-month MRI reported better outcomes at 12 months, including higher rates of returning to their pre-injury level of sport and better knee function. Although promising, we now need comparative research to evaluate whether this method can achieve similar results to surgery.
What to do if you rupture your ACL
First, it’s important to seek a comprehensive medical assessment from either a sports physiotherapist, sports physician or orthopaedic surgeon. ACL injuries can also have associated injuries to surrounding ligaments and cartilage which may influence treatment decisions.
In terms of treatment, discuss with your clinician the pros and cons of management options and whether surgery is necessary. Often, patients don’t know not having surgery is an option.
Surgery appears to be necessary for some people to achieve a stable knee. But it may not be necessary in every case, so many patients may wish to try rehabilitation in the first instance where appropriate.
As always, prevention is key. Research has shown more than half of ACL injuries can be prevented by incorporating prevention strategies. This involves performing specific exercises to strengthen muscles in the legs, and improve movement control and landing technique.
Anthony Nasser, Senior Lecturer in Physiotherapy, University of Technology Sydney; Joshua Pate, Senior Lecturer in Physiotherapy, University of Technology Sydney, and Peter Stubbs, Senior Lecturer in Physiotherapy, University of Technology Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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