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A world without pain
In a previous post about PJ Bear's broken radius and ulna I said that there would, no doubt, be more about his lack of pain at the time. We have discovered that our little PJ's high pain threshold explains a lot but raises more questions all at the same time. Thus, making this post. PJ Bear lives in a world without pain, at least, without physical pain.
PJ Bear has always been a risk taker. His very methodical brother pulled off interesting climbing feats as a toddler and preschooler using a logical process of furniture arrangements. His brother watched and copied but lacked the same finesse and often took a fall. He would often cry and we assumed it was out of pain but have now discovered that it is more about the 'shock' of the fall than the sensation of pain in the same way that my 7 week old baby girl will cry when her startle reflex is tested by allowing her torso to drop with gravity.
In hindsight, we should have picked this up much earlier as many, many years ago he was part of a vaccination trial and comment was made then about how well, as a toddler, he managed the process of having blood tests without crying or squirming. If only we knew then what we know now.
It explains his total lack of fear of injury. It explains many incidents including his wilful climbing of the pergola and refusing to get down until I had Dad on the phone so that he could tell him of his achievement. Thank goodness for bribery, that Milo was worth it just for the fact that it lowered my anxiety levels.
So, with the new level of mindfulness that came after the accident we have watched PJ Bear closely and the fact that his pain response is primarily emotional rather than physical has become painfully clear. (Excuse the pun). We are now the proud owners of a referral to a neurologist but have the long wait till October to be able to exchange it for an appointment.
This potentially explains so much of his behavioural issues that we have faced also. One of his compensations seems to be his heightened emotional response to circumstance. Everything in PJ Bear's world is surrounded by triumph or tragedy with no middle ground. For over a year now we thought there was perhaps a sensory (aural) processing disorder meaning that he did not hear all that we said. (This may also still be the case). Nonetheless, his reaction to 'yes' and 'no' responses to his requests are extreme. The other issue is the ineffectual nature of most discipline measures either because physical punishment, such as a smacked hand, is a pointless punishment because there is no significant sensation of feeling associated with it and the emotional response is so extreme that it makes his behaviour worse not better.
But, for those who are fans of 'non-violent parenting' don't be fooled into thinking that non-violent techniques are any better. Due to PJ Bear's emotional sensitivity non-violent consequences are the equivalent cutting him with a knife. Non-violent techniques that we would support in normal circumstances have led to responses such as, 'I hate you,' and, 'Leave me alone. I want to die.' For this, we have been seeing a peadiatric psychologist for some time now, well before PJ Bear's broken arm. Believe me, I am a proponent of non-violent parenting techniques as PJ truly is an exception.
So, where does that land us now?
Well, on Good Friday PJ Bear took a fall off a 1.8 meter high Hills Swing Set onto his back. He cried from the shock and came for a cuddle. We checked his back which showed no bruising at the time and as routine asked if his back hurt to which he said 'no', asked if he hurt anywhere else to which he responded by grabbing the break site of his arm. His memory tells him that this is a place where pain exists or existed though he felt no pain there on this day. So, we reassured him and off he went as normal.
Then yesterday, when changing his shirt after church for lunch a bruise was noticed on his back. Closer examination showed the protrusion of three vertebrae in his lower back when he bends forward. As a result he was taken to hospital[1]. I didn't take him myself, and I am glad I didn't, as I probably would have been quite curt with some of the staff. One staff member commented that, 'It had been a week so it couldn't be that bad'. Now, correct me if I am wrong but I would expect that 99.9% people that turn up conscious at Emergency have pain assessed as part of triage. The location and level of pain is then used as an indication the potential injury and it's severity assisting in the determination of priority for treatment. So, when you present with a child who cannot indicate the location of pain you are in a pickle to begin with.
Later, when my husband commented about PJ's lack of pain, another medical staff member was so brazen to comment, 'Well lepers don't feel pain...' Clearly, this person has no idea of the severity of the injuries that people with leprosy face! My sentiment was shown by the character 'Perry' in Scrubs when asked being stupid question by an intern led to him yelling the question again out loud to all in ear shot followed by, 'Potential doctor people! Potential doctor!'. Except, in this case the person seeing PJ was a Doctor! (Season 9, Episode 9)
So, PJ Bear was dismissed without so much as an x-ray. How very helpful the staff at this hospital were! (Please read the sarcasm in).
This morning I arranged for him to see a physiotherapist tomorrow. The physio is also arranging for a chiropractor, who works in paediatrics, from the practise to also be there for the consultation, if possible. They will arrange x-rays if necessary at the time.
In the mean time, PJ was taken to an appointment with his Orthopaedic Surgeon as a final follow-up visit for his arm. The Surgeon specialises in extremities and does not work in back injuries. When it was mentioned, he took a look anyway, and observed swelling on either side of the bruising. Apparently, our worst case scenario is a fractured vertebrae, which in a child, would naturally heal anyway. I rolled my eyes and responded, "Great!" when dear husband relayed this to me after the appointment.
So, today I find myself in the world of the unknown. We prayed over PJ Bear at Church that he would be filled with a spirit of knowledge of safe and unsafe situations for his body and that he would choose to remove himself from those that were unsafe.
There won't be much more to tell until October at this stage, unless another neurologist puts up their hand to see him sooner.
In the mean time, I am going to do my best to be a calm mother when it comes to PJ's energetic approach to play. I will also try to be accepting of Google's shortfalls as I can only find information about high pain thresholds as associated with Autism, Intrauterine Growth Reduction and Russell-silver Syndrome none of which are a diagnosis for PJ Bear. (For the record, doubling up on acronyms is a problem especially when trying to Google for the full text version of RSS in the medical variety).
I now have a book that I am after, if anyone wants to get it for me for my birthday then that would be awesome! It is called 'The Gift of Pain' by Dr Paul Brand and Phillip Yancey. Anything that can bring perspective between now and October is appreciated.
[1] Said hospital shall remain nameless.
As PJ has speech ability I would be looking more towards Aspergers (the other end of the spectrum to Autism) as they have sensation difficulities and some social issues. Just an opinion but I would be interested to hear what the pro's think.
Hi there!
PJ has already been professionally assessed, whilst at kindergarten, to see whether he falls anywhere on the Autism spectrum, including Aspergers. He does not. He does, however, have a sensory processing issues that we need to work out. In fact, just this afternoon we have located an Adelaide based OT that will examine his sensory processing across all seven senses. This will happen Friday week.
I suspect i could shed some light on pain and processing if you want to chat. Voice over phone or skype, give me an email to arrange. I have had a LOT of time to research pain and processing. I als have a daughter with ADD, suspect Asbergery tendencies in myself (ahh, good geeky type), and have learnt a ridiculous amount about how brains process pain and why.
The emotional sensitivity is a rare symptom for bys with ADD, more common in girls. Social issues being one of the top indicators among others.
If so, do I have some reading for you:)
Anyway,if i can give/give use of my experience in anyway, i would be so glad to help.
Absolutely, you are more than welcome to get in contact with me!
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