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I'm a mom, a wife, a best friend. Sick with CFIDS/ME/CFS and Fibromyalgia since 1975 as a result of a nasty flu while still in grad school, it wasn't until the late '80's that I received a diagnosis. Until that flu I'd never really been ill before. With each year I get progressively worse and add to the bucket load of symptoms I'm living with. I've been blessed with an incredible family and best friend who've stayed with me through my struggles as we continue to find a way out of this monstrous illness and its complications. We've tried seemingly every approach to find my way back to health. Often I think our best weapon in this undesirable and unasked-for adventure has been laughter.

Wednesday, September 5, 2012

A Model Life: Especially For Her Time

I have lived in a very special world - a world of love and security; beauty and serenity; opportunity, adventure, and variety; challenge and achievement; and the appreciation of my peers. I have had a sufficiency of everything that I desired and a surfeit of nothing."  -Dr. Travell, from Office Hours: Day and Night, 1968

This weekend I found myself thinking about the contributions that women have made over the years - and even in centuries past - in certain fields.  Yet all too often these phenomenal women have been forgotten.  It started off as a spoof I wrote to my BFF about the roles of women and men.  However, it developed into something else completely as that evening I got really sick and somehow my thoughts came around to a huge pioneer in pain management whom I felt many who read my blog should know about, especially the younger women I come across.  She's the mighty fine lady who was a definite pioneer in trigger points and myfascial pain syndrome.  And I love this part: though trigger points started their rounds amidst a tiny group of (male) doctors, through the 1920's, '30's and 40's, she outlasted her male counterparts.  They gave up, but she persevered, really discovered it and ruled it! 

Janet Travell (born in December of 1901) has been on my personal radar for decades for all too many reasons that I won't go into at the moment (did I just hear a collective sigh of relief???) and has fascinated me for decades.

At a time when men overwhelmingly ruled the medical profession, Janet Travell went to medical school in NYC, to Cornell.  She studied in a equally prestigious training program at New York Hospital, while also serving as an ambulance surgeon for the New York City police force - go, JT!  As a research fellow at Bellevue, she studied digitalis for lobar pneumonia, but it was during her years at Beth Israel Hospital in NYC that she became so fascinated in skeletal muscle pain, and which rocketed her career into the stratosphere.

Some of you very young readers may not really comprehend the magnitude of this sort of achievement. I'm old enough to remember having a pediatrician for a brief period who was a woman - and boy oh boy, did people ever notice - and criticize! (How unfeminine! How unseemly!)  Because of her devotion as a physician my pediatrician never married nor had children, which was quite the norm in all too many cases back then: choose a career or a family, but not both! Better yet, stay home bare-foot and pregnant.  At least now we have choices.  Back then, it was really tough to do much of anything for a woman.  And if a woman dared to become a doctor, the two "acceptable" fields seemed to be OB/GYN or pediatrics.

Yet Dr.Travell managed medical school, doing research, training, practicing, and then to marry and have two daughters.


In the 1950's, she took on a protegee, David G. Simons, who had served as an Air Force flight surgeon.   Many years later, they went on to write the seminal textbooks on  myofascial pain syndrome, aptly titled, Myofascial Pain and Dysfunction: The Trigger Point Manual; Vol. 1. The Upper Half of Bodydealing indeed with the upper half of the body from the waist up and then Myofascial Pain and Dysfunction: The Trigger Point Manual; Vol. 2., The Lower Extremities dealing with the bottom part of the body, from the waist down.  Both volumes are available at Amazon and the second edition of the first volume was published with Dr. Travell, though when the time came for the second edition of volume two, Dr. Travell had passed away.

In the 50's, when a certain politician happened to hear of the successful procedures that Dr. Travell had had with back pain the politician's orthopedic surgeon asked for her help.  This politician had sustained massive back injuries during WW2 and the many invasive back surgeries he'd then had to endure made his pain almost unbearable.  When this young man was later elected President, he asked Dr. Travell to be the "Personal Physician to the President" and she humbly accepted, thus becoming the first female physician to serve in this position.  After President Kennedy was assassinated, President Johnson asked if she would continue to serve as the White House physician but she left in 1965 for "greener pastures," as a professor, lecturer, and many other incredible "feats." 

Two bits of trivia.  First: if you've read any biographies of JFK, you might mistaken Dr. Travell as the infamous "Dr. Feelgood" who was often slipped into the back doors of the White House in order to give JFK questionable pain cocktails. This was most certainly not Dr. Travell.  Secondly, it was because Dr. Travell "perscribed" a rocking chair for the President's back that the rocking chair became wildly popular during the Kennedy years and long after. (Can you tell I love trivia?)

In an interview I'd done at one point, I asked a doctor who'd known Dr. Travell, why is it that we rarely hear of myofascial pain syndrome but so many are familiar with fibromyalgia?  Before he could answer I jumped in and asked if it was because fibromyalgia now has a "magic pill" in the form of Lyrica, Cymbalta or Savella and thus is advertised on TV an awful lot.  Yes, many are relieved by these medications but there's also huge profits to be made in these medications.  (Pharmas: if you happened to be reading my teeny tiny blog, I'm hardly worth your while and have left instructions as to what to do in the case of my  sudden death: joking!)  It's just the way the medical industry works: not good or bad, just IS, for many reasons.  (Remember, I don't do politics!)

On the other hand, myofascial pain needs the skills of a trained physician to hit those trigger points just right and, indeed, to even identify them.  (Poor man couldn't get in a word edgewise with me there!)

I asked him what precisely is the difference between fibromyalgia and myofascial pain syndrome?  Before I could jump in with an answer for him, he told me that myofascial pain syndrome is a condition that affects the muscles, and, of course, the famous "trigger points" are involved.   Fibromyalgia, on the other hand, involves the brain, in the central nervous system, and has "tender points." 

These two fields evolved separately.  On the whole, myofascial pain syndrome is addressed by physiatrists (not a spelling error!), and physical rehabilitation medicine physicians, even anesthesiologists at times.  I've read that chiropractors who practice kinesiology are often involved in this field also. (And I can attest to one chiropractor who practiced "applied kinesiology," which helped me tremendously.)  Furthermore, many of her techniques are still in use today, especially in sports medicine treatments.

Some of us who have CFIDS/CFS/ME often have fibromyalgia (there is much overlap) and/or myofascial pain, as is in my case.  The overlap of CFIDS and fibromyalgia is often hard enough to distinguish.  The physician who isn't well-trained in both fibromyalgia and myofascial pain often has trouble distinguishing the two fields as well, and in too many cases doesn't know about either field, though that is changing, albeit slowly.

After President Kennedy's death, Dr. Travel continued with an ever-increasing successful career.  I've heard from a couple of doctors who knew her that she was charming and witty.  She continued going to conference well into her 90's, despite a wheelchair, and kept up a practice seeing patients up until the year before her death, at the age of 95.  She was always encouraging to the talented young doctors coming up along the way and kept up a steady correspondence with many.  One doctor told me how he came to see something that Dr. Travell hadn't realized in her book but was uncertain as to whether or not he was seeing things correctly and had so much respect for her that he called her, gingerly addressing the bind he was in.  Rather than be discouraging, she was thrilled that he'd made this observation and encouraged him to publish and indeed nominated him herself for the Janet Travell award, twice!   Yet when this doctor was even younger, a (male) mentor was afraid of publishing findings because he feared alienating anyone in his field, despite the new evidence.  And you wonder why I think she's so incredible?

And, you may wonder, why in the world did I bring up Dr. Janet Travell in the first place, other than to be present a piece on what to some may appear to be trivia?

The answer is that I've realized that many of the people who read this blog are young, more often young women as opposed to young men.  They (you) have dreams, often life-long dreams, which have been put on hold.  They (you) need to rest up and take care of themselves in order to beat these "invisible" illnesses.  The odds, they (you) often think, are against them.  (Oh good heavens: we can be here all night with the semantics!)

I'd like for them to consider two things.  First, you may have to take a leave of absence from the life you envisioned for yourself in order to give your body the rest and healing it needs.  

But secondly, your dreams may change as you make this new journey.  Your dreams may become even more rewarding than you might have ever imagined before coming down with these various illnesses.

To give you a good feel for the magnitude of what Dr. Travell went through: it was only in 1920 that women in the US got the privilege of casting a vote.  But, in 1920, Dr. Travell would have been only 18 years old, but everyone - male or female - had to be 21 years of age to vote, so she had to wait for the following election to place her first vote!   And yet in just a little over 35 years later, she was the official physician at the White House.  Oh, how I love that!!!

I don't care for the fact that too many doctors, advisers, etc., are giving out advise that is "one size fits all."  Think how wrong a bathing suit that "one size fits all" looks like, or even a T-shirt.  Why would we want medicine that does?

So, again my message to all is, learn to read your bodies.  No one will ever know it as well as you do.  Then give your doctor or doctors the info she (or he!) needs in order to work as a team to get you better, no matter what illness you or your loved ones may have.  Knowledge is power!

So, to Dr. Travell: hats off to you.  Another fine example to all, certainly an inspiration.

And in the meantime, I hope all are feeling as best as they can be, only better.  Ciao and paka.

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