Step into my office

There is a very swanky athletic club just around the corner from my office. It's the kind of place with oriental carpets in the lobby, dark wood furniture in the atrium, a bowling alley, squash courts, a lot of wealthy white men in their fifties, a swimming pool in the basement, and across the hall from lean people with goggles and pale skin getting in their daily laps, there is a bustling physical therapy practice.

The perky assistant at the front desk handed me a stack of papers to fill out. I sat in the elevator vestibule on one of two tired, gray waiting room chairs and balanced the clipboard on my knee. I wasn't even through the first page when Toni, the therapist, stood over me and said, "You can finish that up after. Come on back."

I followed her through a somewhat narrow, windowless room filled with people involved in various body bending, muscle mending activities. We walked almost to the back of the facility, through a set of paned glass doors, past a heavy red curtain and into a tiny room with an examination table in the middle. I took a seat in the only chair, a standard vinyl upholstered steel framed business-only chair.

Toni pulled up close on her rolling stool and used the exam table as a desk. She asked how I had been referred to her and what I perceived my illness to be. I gave her the referral form from the urologist. As I pulled out my typed list of medications (there are eight right now), I explained to Toni that I had been dealing with this problem for over 20 years and I was skeptical that there was any relief in sight. I went on to tell her that after the urologist's exam, I was in excruciating pain for weeks.

Toni had been using the exam table as desk while taking notes. She put down her pen, looked at me, and leaned closer. "May, did the doctor tell you what goes on in here?" Oh my god, did people come here not knowing that?

My eyes opened wide and I said, "Weeeeellllll, no, she didn't, but I looked it up on the Internet. Of course, everything I found was so carefully worded, it didn't really tell me anything, so I posted on a forum and said, 'OK, people, just be straight with me and say it in plain English. What am I in for with this physical therapy?' So, I guess I do know, but not because the doctor told me."

Toni laughed and said she was going to make up an information sheet for the doctor to give to patients. Apparently, quite a few patients come in for the consult and are horrified when the details of the therapy are explained. And then they get up and leave, sometimes leaving skid marks.

I have a nervous habit. Actually, I have many, but the most prominent is that I shake my foot. It doesn't matter if I cross my legs or my ankles, or if I have my feet on the floor (then I bounce my knee), I am almost always fidgeting some way. Toni noticed this, and interrupted her own sentence to say, "May...I want you to put both feet flat on the floor and don't shake anything. Why do you do that?"

"I don't know why I do that. I've always done that."
"OK, for now and the foreseeable feature, I don't want you to do that. Be still. Try to be still."

Our conversation went on, and although I hadn't realized it, I was now tapping my right foot rather quickly. Toni kept talking, but she very gently reached over with her own foot and softly placed it on top of mine. She never broke the pace of her conversation, but she was more aware of my nervous energy than I was.

As I wrapped up my medical history, Toni said something remarkable. "May, the first thing we need to take into account with you is that, based on your medical history and current conditions, we know that your brain and your entire central nervous system are wired very differently than other people's. That means you are going to think differently, but more relevant to your being here, you feel physical sensations differently. That presents certain challenges for any nerve-related treatment, but it's nothing we can't work with."

I crossed my legs, and Toni immediately told me to put both feet flat on the floor. She explained that the autonomic nervous system, when left to express feelings related to stress, will cause phantom or misdirected pain. Furthermore, it serves as a distraction and we don't focus on the true source of our physical discomfort. Stop shaking you foot, May.

We talked more about my abdominal pain and the upcoming therapy. Then, Toni asked me what I do for exercise. I was honest. "Nothing. I do absolutely nothing. Unless you count walking 12 minutes from my car to my office and then back again at the end of the day. I walk briskly." Toni looked at me and said, "I want to see you do more than that." Oh, yeah, you and everybody else.
She asked if there was ever a time when I did exercise. I went through the whole history. "Well, yes. I was never athletic, but in my quest to be unnaturally thin, I exercised. I spent my twenties going to 5:30 a.m. aerobics classes six days a week, only to return and do it again after work. On Wednesdays I took an abs class. I never did lose any weight or look any better, even though I lived on salad and chicken breast. In my thirties, I went on to ride my bike hundreds of miles every month. I got down to 123 pounds, but I had to keep eating less and less and exercising more to maintain it. I also used to walk for exercise, I rode my bike to work, and then I took up running. I used to get up early and run around Municipal Park every morning. that didn't work out too well because I ended up needing knee surgery and now that I don't have much cartilage left behind my patella, the surgeon has forbidden me from running or walking for exercise. I had a YMCA membership for a really long time, and I used it. Ask my husband. For about six years, I pent at least ten hours a week in the gym, including Body Pump classes an working with personal trainers, but I was still a cow. I stuck with it, though. Of course, right before my bipolar disorder peaked, something else went wrong in my brain because I lost my balance--guess that makes me unbalanced, ha-ha--and I couldn't ride my bike anymore. I have four bikes, including a stunning Italian steel touring bike, but I can't bear to even look at them. You know, I started taking all of those meds and I gained 50 pounds, so unless I can excercise in complete secrecy or under the cover of darkness, that's about it and me and exercise.

Toni nodded and wrote something down. Then she told me that thing. That thing that makes me roll my eyes and cringe. She told me that I needed to start a program of meditation or focused deep breathing, conscious relaxation, perhaps yoga or Tai Chi. And I burst out laughing. I think she is now the fifth medical professional to tell me this. She asked who was the last one. "Oh, the urologist. and before that, the doctor who treated me for shingles."

Toni pointed out that shingles hits the nervous system, as does bipolar disorder, as does interstitial cystitis and pudendal nerve damage. "May," she said, "the shingles episode was a wake-up call." Then she suggested Pilates because it improves balance and strength, and uses focused breathing, but doesn't require balance or strength when you start it." I laughed again. She just looked at me and said, "What?" "Let me tell you about the Reformer in my basement...As soon as the shingles inflammation goes away and I can lie on my back, I'll get right on that Pilates routine."

Pain. If only we never felt it, think of how productive we would be... I haven't decided if I'm going back for the icky part of this PT. Probably not.