In Your Pants with Dr. Susie G - Paving your recovery w/ pain science

Episode Date: November 8, 2018

Today we'll be debunking pain through a patient's perspective using a pain science lens. So if you're in pain, know someone in pain or a healthcare provider who cares for people in pain, listen up ���because this episode's for you.

You're listening to In Your Pants with Dr. Susie G, the physiotherapist for your private, helping you get in the know down below. Hey friends, it's Dr. Susie G and welcome to the In Your Pants podcast. This is where I'd be telling you it's a show about destigmatizing private parts. But today we'll be destigmatizing pain through a patient's perspective using a pain science lens. So if you're in pain, know someone in pain or a health provider who cares for people in pain, listen up because this one's for you.

All right. So if you could see me right now, I'm smiling from ear to ear because I've got the honor to have Joletta Belton on the show today. Joletta Belton is the co-founder of the Endless Possibilities Initiative, a non-for-profit with a mission of empowering people with pain to live well through experiential learning, workshops and retreats and a pain blogger at mycupofjoe.com where she reflects on her lived experience of pain through a pain science lens. Both projects were born of her own experiences living with ongoing pain, her academic background in psychology, neuroscience and human movement

and her work in paramedicine, wellness and fitness and coaching youth and adults with disabilities or disadvantages. She shares what she has learned of the science through her own story to provide hope and empowerment to people living with pain and insights into the lived experience of pain and recovery to practitioners. In early 2018, Joletta has been on a patient perspective panel at the San Diego Pain Summit, a breakout session leader and co-presenter with pain physician Dr. Chris Caldwell at the Montana Pain Conference and a speaker at the Pain Cloud Convention in Oslo, Norway. Joletta, thank you so much for being on the show today. Thank you so much for asking me. I'm really honored to be here and grateful for the opportunity.

And you're doing some pretty powerful things in this world, honestly. You're impacting so many with your message. And I think it'd be great to start with you telling us how your experience with pain and living with pain has changed your life and impacted you to do all of what you're doing in the current moment. Yeah, sure. So this was a completely unexpected path for me. I was working as a firefighter paramedic when my pain first started. And it started just with a simple step off the fire engine where I missed the step went straight from cab to ground and felt a twinge in my hip and it was just a twinge I didn't think much of it at the time and thought that it would resolve itself fairly quickly but that that step and that twinge led me down a path of worsening

pain failing a number of treatments from physical therapy to injections to surgery to alternative medicine to posture therapy, all sorts of things that I had tried and failed. And in the vernacular of healthcare, the patient always fails the treatments, the treatments never fail us. I was also in the medical legal world of workers' compensation, which is kind of an adversarial system by nature. So I like to say that it's a really bad system. There's a lot of good people in it, but the system itself can be very adversarial and kind of make you feel like you're always having to prove that you're deserving of care and prove that you're not lying. That makes it a very difficult situation to get better within, always having to prove that you're in pain

while you're trying to get better. So through all of that process and those years that I was in the workers' compensation system, years that I was getting worse and not better despite having surgery and injections and physical therapy and chiropractic care and massage and all of these other things, I ended up having to medically retire from my job as a firefighter paramedic. And after my retirement, I went back to graduate school. And I thought that I was going to figure out my pain. My kind of thought process was I'm going to go back to school and figure out my pain. And back then, I still had very biomechanical notions of pain, that it had to be my posture or movement that was keeping me in pain, that I was re-injuring myself over and over again.

And I think some of that comes from being in the workers' compensation system too, because they don't treat pain, they only treat injuries. So everything is always classified as an injury. So you feel like you're still damaged, that you're still keeping yourself in this injured state and not healing. So I went back to school in human movement and earned my master's degree. But thankfully, I studied pain science as my research focus. And when I started learning more about the complexity of pain and learning more about how pain is this biopsychosocial phenomenon, that there's all of these different aspects of your life that contribute to the pain experience felt very validating for me. And as I was going through

school and learning all this stuff, my first thought was like, why hasn't anyone shared any of this information with me before? Like, why is this the first time I'm being exposed to some of this information? So for me, it was very validating because I felt like my pain was very real and it had these biological explanations for it because all of our psychosocial factors are underpinned by biology too. And things started to make sense to me. My experience started to make sense to me. And then learning about the complexity of pain, learning that it was biopsychosocial in nature, also taught me that there were ways that I can modulate my pain myself, that there were things that I could do within my experience, you know, to change that experience, even if I didn't change my pain. And I felt like I kind of had permission to get back to living rather than trying to figure out what that cause was in my hip. My pain was always in my right hip.

And so, you know, I just started doing things. I started going to pain conferences and things like that, learning all I could about pain. And that all stemmed from during my graduate school experience. I interviewed Laura Mermosley for a class project. Nice. My crush. I think he's a lot of our crushes our pain crush or I call him my favorite neuroscientist and people look at me funny and they're like you have a favorite neuroscientist I'm like yes doesn't everybody yeah right like everybody should and I I interviewed him and I grilled him for 45 minutes about pain science because I still felt like like the answer was in there somewhere like the one answer you know was still kind of searching

for that one thing that was going to change everything. And at the end of that 45 minutes, I was like, what is the one thing you would want people in chronic pain to know or to do, you know, to change their experience? And his response was to love and be loved. And I was, I was floored by that. You know, this is this preeminent neuroscientist in the pain world who knows more of the science than than most people and his answer was to love and be loved and it was that moment that I realized you know that all of the answers aren't in the science that all of the answers aren't going to come from somebody else and that maybe I was looking at my my pain problem or or my life kind of through the wrong lens that I didn't have to be rid of pain to get

on with living that I could get on with living and maybe the pain would take care of itself or at least not impact my life so much. Because when you're in pain for that long, it becomes the center of your universe. You plan everything around pain. Your whole day is consumed by thoughts of pain and paying attention to the pain. And the more that that happens, the more you withdraw from the world, the more you stop engaging with the people, the places, the experiences that are meaningful to you. At that point, along my pain journey, I was three years into it at that point, four years into it, I wasn't doing much. I was rarely leaving my house. My whole universe was my kitchen where I would stand at the kitchen counter all day long because it was too painful

to sit, or, you know, taking a short walk into the backyard. Because at that, before learning the pain science, I felt like every step that I took that was painful, I was doing more harm to myself, but I was doing more damage to myself. So everything became so limited, my movement became limited, my life became limited, my relationships became limited. I just withdrew inward and had stopped talking to people had stopped talking even to my husband, even though we lived in the same house. And you don't feel worthy of love when you're in that kind of situation. I didn't like who I had become in pain. I didn't like the person that I was. I was no longer fun. I was no longer funny. I was no longer this strong, capable, athletic, fit person that I was as a

firefighter. Before this injury, if you had asked me to define myself, I would have just said, I'm a firefighter. And to me, that encapsulated all that I was. So I had such a loss of sense of self and sense of worth and value as a human being after all of these years of living with this pain and withdrawing from everything that was meaningful to me. So to hear, to love and be loved, to essentially be told that you're worthy of love and loving was really profound for me and just having that that long conversation with with him was was profound because he never talked down to me he just talked to me like a person and he was very warm and engaging and we just had a discussion you know it wasn't like the expert and the the student it was it was just

a discussion a shared dialogue between two people and that that whole experience was so meaningful to me. And I learned then that he was going to be the keynote speaker at the San Diego Pain Summit the following year, which was like nine months away, but I bought a ticket the moment I got off Skype with him. So I had kind of been learning all of this stuff, learning the science, kind of getting confirmation from him that I was on the right track and having this notion of maybe thinking about my life a little bit differently rather than being rid of pain to get on with my life, getting on with my life with the pain, but it was still hard. And I talk about how it takes some time to go from learning a thing and knowing a thing to living a thing. So over the course of

that, you know, nine months, I started engaging with my life a little bit more, started engaging with people a little bit more, started doing things a little bit more, but it was going to the San Diego pain summit where there was all of these pain experts there that I really felt like I kind of had permission to get back to living again, not having to wait. And that uncertainty was okay, that nobody knows everything when it comes to this, that all the answers aren't out there. So to continue to put my life on hold in search of those answers wasn't going to benefit me. So it was after that, that things really started to change for me. I made space for pain so that there was room for all of the things that mattered to me. And my life got so much bigger,

even though the pain kind of stayed the same size, but it wasn't impacting my life as much. And, and I had a life again, which was really, you know, powerful and meaningful. Like I could still live even with pain. I could live well, even with pain. And that was, that was pretty revolutionary to understand. And then I started talking about pain to everybody I met on the street. One of those people that I met was a development coach for the National Sports Center for the Disabled. And I met him at a shoe store in Colorado. And I have no idea how we started talking about pain, but he was like, I have an athlete that I want you to meet. And that athlete was my co-founder. She ended up being my co-founder in our nonprofit Endless Possibilities

Initiative, Beth. And Beth is paraplegic. She broke her back, I think it's seven years ago now, jumping off of a cliff into the Colorado River. She was on a rafting trip with a bunch of friends and everybody did this. But when she did it, she just hit the water wrong and broke her back and became paralyzed. And at the point that I had met her, I think she was five years into being paralyzed. And she had just had another surgery to fix, in quotes, her pain. She was told that she was a poster child for this surgery, that it was like essentially 100% sure that it was going to fix her pain. And it was dorsal root entry zone lesioning, where they go in and actually like sever the sensory nerves under that outdated kind of biomedical notion that it has to be the nerves

from the periphery sending these pain signals to the brain. And it didn't fix her pain. She became more paralyzed and her level of pain rose with the level of paralysis and her pain intensity increased as well. So she was in a pretty dark place when I met her and I started sharing with everything that I had learned in grad school, everything that I had learned from going to the San Diego Pain Summit. And I had been to a couple other conferences and things since then. And we just started having these discussions. And the first thing she said was, why hasn't anyone told me any of this before? And so we started having that conversation. That was both of our first reaction when we learned this information. Why has anyone told us this before? So we started

the nonprofit so that we could tell other people. I had been writing my blog for some time. So I kind of had an avenue for trying to get information out, you know, telling my story through a lens of pain science, but the nonprofit kind of formalized that. And we used the curriculum development template from Explain Pain Supercharge to develop our curricula for our workshop and retreats. We bring in a lot more like stress biology in the lived experience because we really feel like teaching pain science through a peer-to-peer format and through a lived experience lens is really valuable for people because it really shows them the relevance to real lives and what people can do with that information to move forward. Because that's, to me, what is

the most valuable thing about pain science is that it's validating, that it shows people that their pain is very real and that there's very real biology underpinning it, that it's complex, you know, that it's biopsychosocial, that there's so many factors that contribute to pain, which can seem overwhelming, but that also means that there are many ways in to modulate pain and then how to use that information, that knowledge of bioplasticity and what's going on in our bodies to make change and to move forward in a more empowered way. So that was a really long answer it was a beautiful answer and and thus all that you're doing certainly does not go unrecognized because I mean you are are sharing such profound knowledge that can be life-changing

as it was life-changing for you in hopes that people will hear this message sooner than later so yeah exactly it's it's great it's it's awesome and and be as long as you want i mean you can't hear it more than enough and and you know people as you know have to hear the message many many many times for it like you said it goes from knowing to to learning to knowing to actually living the thing it takes a process doesn't it so yeah that's great i want to ask you because you mentioned lorimer and the words that he chose to use with you how important is it to choose our words wisely when helping someone navigate out of pain? Oh, it's so, so important.

And it's something that I try to stress all the time. At my talk recently at Pain Cloud, I had a whole slide about the language that I remember from my time in healthcare. And none of it is good. and none of it was said to me in malice or with ill intent. Like it was all said with good intentions, but I think it's really important to draw attention to it because we say these things

without realizing the impact they may have on people. And I'm guilty of it too. I mean, I was a paramedic and when I was a firefighter, I was a peer fitness trainer who thought I knew so much about health and human bodies and all of this stuff. And I've said really ridiculous things to people that I regret now and wish I could go back. But at least knowing this now, I can go forward and say things a bit differently.

Because the things that I remember being told were, you know, that my posture was bad, that I was asymmetrical, that I was out of alignment, that I was torqued or twisted and in all of these different things that I had failed treatment. You know, so much was about all of these flaws and dysfunctions within me that all of these notions of me being damaged and broken or or weak, unstable, like all of this language that that gets told to you over and over and over again becomes a part of your belief system about yourself. so that you begin to think that you're weak and unstable and that you know out of alignment and and that starts to affect how you move how you see yourself how you you know your confidence in yourself all of these things and then when you're in the medical legal world too then you have things added to that like permanent and stationary which essentially means it's been determined by a doctor that you are never going to get better that you have plateaued and that your current state is your future state, and it's never going to change, which is so disheartening and

demoralizing. And then you're given a percentage, a level of disability, like all of these things become a part of your beliefs about yourself. And then being in work comp too, I had all of these no's in my paperwork, no lifting over 20 pounds for a long time, no running, no squatting, no awkward positions no climbing no sitting for longer than than 20 minutes at a time just no no no and those all become a part of your belief system too that I I can't do these things not just legally but like I physically can't do these things and then it becomes a bigger hurdle when you when you start to feel like you can't like maybe getting back to these things would be useful It's such a huge hurdle to get over because it's become a part of your belief system for so long.

So I think that we do such a disservice both to patients and to clinicians by always using this negative language and finding fault in people and telling them what's wrong with them. Right. Rather than telling them what's right, rather than emphasizing their courage, their persistence, that they're still trying to figure this out and still trying, you know, to do something about their pain, which is why they're in front of another health care practitioner. Their patients, especially for those who have lived with pain for a really long time, like they are courageous and that should be emphasized. They are, you know, resilient for even still being around. And so I think if we can emphasize to people that they're strong, adaptable, capable, resilient, and reinforcing that message over and over again, we would do so much better in healthcare in general, but in pain in particular, because people feel so beat down. You know, they have failed treatment time and time again. Treatment never fails them in the vernacular of health care. You know, they're weak. They're unstable. They're dysfunctional. They're damaged. They're degenerated. All of these words that are constantly thrown at them become this weight that makes them smaller and smaller and smaller and more and more withdrawn into themselves and disconnected from the world, you know, disconnected from all of the things that are meaningful to them.

Because it's really hard to engage with things that are meaningful to you if you feel like you're weak and incapable and dysfunctional. So language is a big one for me. I think that it's so, so important. And that as a part of that too, recognizing how difficult it is for people in pain, especially if they're in a lot of pain and have been for a long time, how difficult it is for them to verbalize that experience or to find the right words to describe it. So I love the work of Mike Stewart in that regard, where he brings in metaphor and story and music and poetry to help patients kind of express their pain, artwork. I brought that into my presentation too at Pain Cloud. It was Elaine Scarry in her book, The Body in Pain, The Making and Unmaking of the World, where she talks about how pain robs us of language.

We lose our words. we lose our ability to express ourselves and to express what that pain is like and how much it affects everything. So having some patience with people who are in pain, who are having difficulty verbalizing that experience, and maybe having other ways of helping them to express that is really useful too. Because if they've lost their language, they might need to borrow someone else's. That could be, you know, blog posts from someone who has lived in pain, or it could be song lyrics. And I feel like artwork is a really powerful way for people to express their experiences too. And it doesn't have to be their own. It could be images that they're shown or

that they find. But language is so, so important. And as a part of that too, listening. I know I just said patients can lose their language, but usually that's in regard to explaining their pain. They can still talk about themselves and talk about their lives, which are going to give so many clues into what's what that person finds meaningful you know where their values are and and where care might be directed towards I think listening is another big one and that's something that that Lorimer did so well in that conversation like I said it was a dialogue between you know just two people and I always felt like I could could share my story I mean the reason I don't even know why he said yes to the interview in the first place because when I emailed him it was like

five pages long of my whole entire life story and pain experience but in retrospect I think that's part of why he said yes because he's he's so skilled at listening to the patient's story and he wants to know the patient's story that's what makes him such a good clinician and such a good researcher is that it's always done with a patient, not to a patient. I've had the great fortune of being a patient demo for Peter O'Sullivan too. And he's another one that really gets that. And I think that's so often missed for the people who follow their work. Like they follow the explain pain stuff and think that it's all about educating people about pain. And they miss that listening part and that just being human and being a compassionate presence and

listening first, you know, and having a discussion, not a lecture. When I was the patient demo for Peter O'Sullivan, the first thing that he said to me was, tell me your story. And at that point, I was seven years into all of this. Like I knew so much and I was, you know, I'm still a firefighter at heart and a little egotistical at times. I'm like, what kind of patient demo am I going to be? I know so much about all of this. But I was having pain in my other hip when I was the demo for Peter at the San Diego Pain Summit last year in 2017. And I hadn't even realized how much I had gone back to my old beliefs that there had to be something wrong in there. And I had started limiting my life again I had stopped running which is when it would become most noticeable

and I had gone back to like those postures again that you know sitting upright you know scapula back chest up chin up like all of these things that I used to do and I'm like holding myself in these tense braced protected positions all the time and I didn't even realize I had started doing that again but the first thing he said was tell me your story and and my first response was where should I start he said wherever you'd like and that was powerful too like that was the most powerful element of that whole demo and I went straight back to seven years before when I stepped off that fire engine and felt that twinge in my right hip because the pain in my left hip felt so similar. And having this discussion with him made me realize how afraid I was of going

backwards. How afraid I was of losing everything again. Sorry. Because I had lost so much that first go around and I had rebuilt this life. I had started the nonprofit. I was writing, you know, I was living a life that I wanted to live. And I was so afraid of losing all of that again. and I didn't I wasn't even aware I had never vocalized that I it had never come into my conscious awareness until he asked me that question even though it had consumed my whole life it's not like I was consciously thinking oh I'm so afraid about going back to where I was before to those years of pain in darkness I call them my dark years because I don't remember much all I remember is pain. And, and I think that those types of things are so important to realize

like the most powerful things to me ever said by clinicians were love and be loved and tell me your story. You know, it was, it wasn't a lecture. It wasn't, you know, I don't even know what I'm trying to say, but I think those are the elements that are often missed when, when people are trying to figure out how best to help people with complex and chronic pain. That listening, just being a compassionate presence, being a human, bringing your own humanity to the table is so meaningful and so powerful. Just feeling of worth, feeling that our story is worth hearing is so valuable because healthcare can be so dehumanizing and so demoralizing. And we can feel so dismissed and disbelieved for so long that just having someone care about our story

is powerful in and of itself yeah what do they say it's not how much you know it's how much you care yeah yeah it's very true and we're always like you said we're very dehumanizing in what we do in medicine and and and not everyone of course because you're you've kind of experienced what it's like to work with a provider that does listen, right? People who do care and are human beings to you and say, you know, we're going to get through this together. You don't have to do it alone. I'm here with you, not power over, but power with, you know? Yeah, exactly. And, and, you know, so much of it, like, and there's so much blame that goes around in, in healthcare, that rather than looking at the system and the failings of the system as a whole,

we try to blame people. So patients often get blamed for not getting better. And I'm sure there's plenty of patients that blame clinicians for them not getting better too. And I think it's so important to stress that there's good people within these systems and there's good people who are patients that it's this situation that we're in that's really complex and difficult. And figuring that out is complex and difficult. So I don't want to make it sound like I'm like I'm blaming anyone for for my experiences in those early years, because I realized how much of their hands are tied to like my surgeon was a wonderful human being. And he never once made me feel like my pain wasn't real or that he didn't believe me even after my surgery and I was anatomically perfect. He never once made me feel like I was at fault for my pain, but he also didn't have any tools to help me. He didn't have anything else to offer. I mean, he's a surgeon, so that makes sense. But there was no like referral network that would be approved by the work comp system that he could send me to to learn more about the complexities of pain and other ways forward.

It was actually upon his urging that like I got out of the workers comp system altogether because he knew I wasn't going to be able to be helped in a traditional health care model that it just wasn't going to be possible. So there's really good people who are just kind of hamstrung by the systems they work within and the education they receive. Because no one learns all of this stuff in school, like not even just the pain science stuff, but just how to be a compassionate presence, how to listen and actually hear, how to use the patient narrative to move the treatment forward. Like these things aren't taught and they should be. And that's part of the frustrations of all of us, I think, patients and clinicians alike. Right, right. And that brings me to my other question of this can, you know, as you live this experience yourself, you know, finding the right provider, you know, you kiss a lot of frogs before you

can find the one that's going to give you, you know, a positive message and bring hope and recovery back on the table. you know when somebody you know for those that are listening right what what would be a good place for them to start i guess is what i'm asking you know this is this is very heavy it's it can be exhausting as you know and where where should someone start if they're really feeling like dark they're having these dark moments and they just feel stuck you know what would you tell them to start with well first thing i would want to do if i was in their presence would be to hug them and to tell them that they're not alone. I think that one of the most profound

things for me has been, especially when I started writing my blog, was to realize that I wasn't alone because our experiences can seem so deeply personal and like no one else could possibly understand what we're going through. And when I started putting it out into the world, people would write me and say, you're telling my story, which would floor me every single time. I'm like, how is that possible when you hear it so many times you're like wow this is just a very human experience you know suffering living through a very difficult time it's a very human experience that we we've always been going through and it's it's part of why I think that reading literature not not scientific literature but actual like literature from like the 19th century like

Tolstoy and Dickens and that sort of stuff was so helpful for me because writers and philosophers and poets have always been trying to tell the truth of the human experience. So we are not alone. So the first thing I would want people to know is that they're not alone and that there is hope, that there's realistic hope for change and that that hope can look like different things. It doesn't necessarily mean that the pain is going to change, but the life can absolutely change. And it's about finding those guides, those people who can be good coaches and be that that power with and finding resources be it online or at the library library that that can help them to find that that realistic hope and plot that path forward are there any

that you oops sorry sorry i was gonna say the power of of pain science for me was was that validation piece you know wow pain is complex there's all of these things that that contribute to the experience of pain. And that makes sense to me that resonates with my experience. It was very validating, you know, learning about the immune system, you know, contributions to pain and learning about neuroplasticity and how things can kind of go awry with the with those things was empowering for me, because then I also knew that there was ways in to change it, you know, that there was things that I could do that could actually change my physiology, you know, that learning that we're bioplastic was such an empowering moment for me. And it makes sense.

We're constantly changing and adapting based on our experiences and those things that we repeat and do over and over again. And we can have some say in what those things are, what those thoughts that we repeat are, what those actions and behaviors that we repeat are. And that's really empowering. So the things I would want people to know are that they're not alone, that there's realistic hope and that they're worthy you know that they're they're worthy that they're capable of love and of being loved and and that they're worthy of it because I think that we can start to feel so unworthy and devalued when we live with pain for a long time so I just want them to know their their worth and that they're worth taking the time for for self-care and doing some of

these things that as hard as the message can be to receive that there's nobody out there that can fix us there are people who can facilitate healing but only we can really fix ourselves and change our experience but finding those facilitators is important too and it's it's not always easy right not everyone's going to go back to graduate school like I did to try who would want to do that number one i'm a very weird individual no beautifully it's not feasible for most either that's right that's right as they say wonderfully and fearfully made right yes love it love it and i and sorry for interrupting at that point but um the resources because you're mentioning such really delicious stuff what what top resources would you say are

that really impacted your you know your knowledge and your transformation are there any key books or articles or posts or anything that you can share yeah so one and for me but and I also come from a science background like my first graduate school stint 20 years ago was in in neuroscience so I come from a neuroscience kind of bent and background so actually reading the pain science stuff was really helpful for me but that's not going to be a first in road for a lot of people. But explain pain and, and that sort of thing I really like. But I think that the best in road to that, especially for people who aren't ready to or will ever be ready to read explain pain, tame the beast is such a great video. And from everyone that that I have talked to that

I've shared videos with, you know, other people living with pain, I've shared all like the brain man stops his opioids and the brain man videos and the explaining pain in five minutes. Those don't really resonate with people living with pain as much as Tame the Beast did. And I think it's because Tame the Beast starts with the patient perspective and how difficult it is to live with pain. And I think that's such an important thing that a lot of the other videos miss is not telling it from that patient perspective first and not validating that experience and how difficult it is to live with pain. So I think Tame the Beast is a great introduction to these other ways of thinking about pain and kind of modern pain science and

then how we can use that information to move forward. Retrainpain.org is another one that I think is a great intro to the science for patients and it's free. The one for people living with pain is free. And then along with Explain Pain and something that's a little bit more accessible, I think is the protectometer or protectometer. And there's a website for that too. But the book I find really useful. And it's something that we use at our retreats. Because I think that the dims and sims, the danger in me and safety in me is a really easy concept for people to grasp. And being able to identify the things in their life that they can kind of try to change, you know, minimize as many dims as possible, make space for those dims that they can't change,

because there are going to be some things that we can't change and that's okay. And then really focusing on increasing the number of sims that people can engage with and creating super sims, combining sims together. So Beth, my co-founder and I, we always talk about how nature is a big one for us. Hanging out together is a big one for us. And she's a mono skier. She does downhill skiing and a sit ski and I'm a snowboarder. So being on the mountain is another one for us.

So when we can combine those three things together, being outside, doing this activity that we enjoy doing and being together, like that's a super sim for us. So encouraging people to start adding some more of that stuff into their life and then doing things that can start calming their systems down a bit, you know, to get out of that like fight or flight and freeze mode and be more in that calm and grounded state. so there are other resources that I really like too like the calm app which is a meditation app and I love it like I've tried so many different meditation apps and none of them stuck but I love calm and I'm pretty sure it has to do with the nature sounds and the background is all blue

which is my favorite color so it probably won't be for everybody but if you like nature sounds it's definitely for you and there's so many different nature sounds that you can just play in the background that I find really soothing just when I'm working on the computer and that one also has sleep stories, which is like bedtime stories for adults, which I really enjoy as well. Sleep is so important, too. And it's something that I think we often don't talk about enough, but it's, it's such an important aspect of health in general, and can be so affected by pain. So those are my top ones. Greg Lehman's recovery book is another really good one, too. right right i'm glad you plugged that i mean it's free to download and it's something like 73 or 74

pages there's so much good information in there and he has a recent blog post out about the cup the overfilling cup and like so like the idea of it's kind of like this allostatic load idea like all of these different things that go into the cup each day and how even good things add to that can make the cup start to overflow and become a little bit more unmanaged so then your options are either to decrease what's in the cup or to increase the cup's capacity and we use the same analogy at endless possibilities initiative we use a bucket so we need a bucket but use we use the bucket analogy alongside the protectometer because because to us they're both the same like the more dims you have in that bucket the bigger the dims are the sooner it's going to get to

overflowing right and the sims are kind of that spigot that you can open up that starts to let some of some of what's in that bucket out and the bucket analogy became shorthand for me and it still does. Like my pain doesn't affect my life much anymore. But I still have anxiety. I have anxiety that long predated my pain. And the bucket analogy works for anxiety and stress and things like that too. It's just when you're feeling overwhelmed. So the bucket analogies become shorthand for me to like my husband, I can say my bucket is overflowing. So he knows I'm going to be less able to make decisions. We're going to be shorter of temper. It's a very easy communication method. Beth and I use it with each other too. So we know like if someone's bucket is overflowing,

they're not going to be able to do as much work that day. Um, but that's going to be more load for that bucket. It's going to be more difficult for them to manage and that's okay. Cause we all have bucket overflowing. Right. Yeah. Everyone. Yep. Yep. Yep. Everyone. And then, um, figuring out how to kind of manage that bucket or that cup as Greg says is really important too. But yeah, his resource is another phenomenal one and another one that is free which is incredible that he put together all of that work and put it out there for free same with retrain pain another great resource a lot of work that went into that and that's free for patients as well oh so many nuggets you guys listening i hope you take at least one and ride with it honestly and geletta

can you tell us a little bit about the endless possibilities initiative and what what's what you guys have planned in the future any upcoming retreats or anything like that yeah so endless possibilities initiative or we we call it epic and our website is epicolorado.org we provide experiential learning workshops and retreats for people living with pain and for clinicians as well and we do joint sessions as well like we have an one coming up in july in steamboat springs that's for both clinicians and patients, which I think is really cool. And we've done one for clinicians, patients, and carers in Colorado Springs, which is even cooler. Having like all of those people who are involved with helping someone recover in the same room is pretty powerful stuff. And then

we can start having different discussions around all of this stuff, which I think is really important. But all of our workshops, we try and do in collaboration with other organizations or clinics or healthcare providers. So the one that we're doing in Steamboat Springs is with a pain management clinic, but we're doing it at the hospital and it's going to be available to the whole community. The one we did in Colorado Springs was with another nonprofit called Bridge for Pelvic Pain. We're doing a workshop for first responders in the Denver area later this fall. And that one is done through, it's going to be collaborated with through Building Warriors and Responder Strong. So we're really trying to work with as many other organizations who are already

dealing with populations of people living with pain to bring this information to them. We're also developing six or it might be eight week programs as well, where we do a session every single week for two hours at a time to get even more into those workshop sessions. And we're developing train the trainer curricula as well because we would like for communities to be able to have this this type of thing going in perpetuity that we don't have to be there for it to continue because we really believe that this peer-to-peer education support and resources is incredibly valuable for the people living with pain but also the health care providers in those communities as well because it it provides an avenue for this education piece this listening to stories piece

that takes so much more time to take place outside of the clinic where people might be more comfortable, especially being around other people that have a shared experience. We will have a retreat coming up this summer. The date is not set yet. And then we have one in October that will be for first responders. And our retreats are all just based on funding. We do not charge for the retreat. We use a pay it forward model. So people give a donation within their means, which means that we have to get grant funding or donations in order to be able to put the retreats on. So as we get funding, we put on more retreats. We're also looking to collaborate with other organizations on retreats too, like with hospitals and healthcare systems that might

want to provide this for their patient communities. So those are the types of things that we're doing. Well, Asheville is a great place. I'll tell you what, I have a lot of people that might be interested to have you guys come down to Asheville. We would love to do that. I love North Carolina. Yeah, sweet. I'm going to put my brain together here and reach out to everyone here. Because honestly, I think it is such a needed resource in smaller towns, especially, you know, because, yeah, Asheville, you know, it's growing, but it's still a small town. And when you leave Asheville, it's really very, very rural, you know, so. Yeah. And that's the thing that we have here in Colorado, too. And like when I talked at the Montana PIN Conference, another issue that they have there, Utah, there's a lot of states where, you know, things are really spread out and towns are pretty small.

all right that we we hope to be able to to go to those areas and provide some good this has nothing to do with pain but one of my best experiences ever in life was with ncobs that were bound and i did a 28-day classic course in north carolina where i went rock climbing and did whitewater canoeing that is awesome i flew i we flew into north carolina and they drove us by the side of the road and dropped us off but i love it there so we would love to come oh my gosh yeah well i'm gonna work my magic here and and we'll we'll keep in touch so many like i said so many can benefit from from your message from from both of your messages i mean and what you're doing i think is just super fantastic and and inspirational honestly and thank you from the bottom of my

heart for what you're doing i i i thank you so much i that is all i can say is thank you one thank you that means a lot to me um so thank you yeah and so any other ways that listeners can connect with you if they'd like to i know you have your blog my cup of joe.com is it yep and and then epic which is epi colorado.org i'm on twitter as my all my social media handles are MyCuppaJo. It's M-Y-C-U-P-P-A-J-O. So people can always hit me up on social media too. I'm not on Facebook very much, but I'm on Twitter and Instagram. Great. And I'll make sure to link all of your information to the show notes and all the wonderful resources that you've shared with us today. Priceless, thank you so much for those nuggets for not only patients and people

in pain, but also clinicians who are listening to this as well. It's such a valuable, valuable episode. So thank you again, Joletta, for being on the show. Much appreciated for your time and your efforts and everything that you're doing to change the world one person at a time. So thank you so much again. And to all your listeners. Oops, sorry. Go ahead, Joletta. I was going to say thank you so much for having me and thank you for all that you're doing in the world as well. It's very much appreciated. Thank you. Thank you very much, love. And guys, for all you guys listening out there, thank you so much for listening to the show. And as always, in loving wellness for your pelvis.

This is Dr. Susie G. Until next time, I'll see you later. Thanks for listening to today's episode. Be sure to head on over to drsusieg.com where you can get more information, show notes and related articles on today's topic. Also, if you like what you're hearing, head on over to iTunes,

subscribe to the podcast and leave us a rating and review. We'd love to hear feedback. Thanks again. so many nuggets