The number deaths due to suicide, accidents and opioid overdoses also fell, the report says

Overall, 12,959 people died in the county last year.

Of those, 2,060 fell under the Medical Examiners jurisdiction, including suspicious, sudden, unexpected or violent deaths.

 Other findings in the report:

• Traffic fatalities declined by nearly one-third over the past ten years, falling steadily from 220 in 2001 to 150 last year.

• While accidental drug overdoses declined from 2009 to 2010, they still comprised more than a third of all accidental deaths.

• Firearms were the most frequent instrument of death in homicides and suicides.

Opioid deaths down

There was a substantial decrease in the number of methadone and oxycodone deaths from 2009 to 2010.

• Methadone was present in 77 deaths in 2010, compared to 129 in 2009, and was the primary cause of death in 67 of those deaths in 2010, compared to 85 in 2009.

• Oxycodone was present in 77 deaths in 2010 compared to 105 deaths in 2009.

To learn more:

• For a copy of the full King County Medical Examiner’s 2010 annual report, please call 206-731-3232 or visit www.kingcounty.gov/health/examiner
  .

Jim Young and his children

In January 2010, after beginning treatment for chronic Lyme disease, 53-year-old Jim Young lost significant weight and struggled to breathe.

Doctors admitted him to a private room in the hospital, but within 15 hours, his wife Erica Kosal received a call about his imminent transfer to the intensive care unit (ICU).

The first time seeing him in the ICU came as a shock to Kosal, 42, a college professor. “I can remember he was hooked up to all kind of machines. He looked so deflated. He was out of it and really sleepy and confused. He didn’t look like the same person and I wasn’t prepared for that,” Kosal said.

Several days after giving birth in 2003, marketing agency owner Ann Albergotti, then 35, woke to a throbbing headache and temporary blindness.

After doctors diagnosed her with a stroke in the ER, she spent 5 days in the ICU. Her nurses and doctors kept her and her family well informed: “I knew what was happening, what was going to happen and why,” Albergotti said.

But when her 76-year-old mother was admitted to the ICU last year for a collapsed lung, the flow of information between staff and family didn’t run so smoothly.

“When her condition worsened, it happened overnight and at a time when the family had left for the night to return in the early morning. We didn’t find out what happened until our return and we had specifically asked that if her condition changed while we were away, that we get a call. That was upsetting,” Albergotti said.

Like Young and Albergotti, every year more than 5 million people in the United States spend time in intensive care units for acute injuries or life-threatening illnesses.

For patients, family members and friends, the ICU experience is often emotional and confusing.

Who’s Who in the ICU

If you or a loved one is in the ICU (sometimes referred to as critical care), you’ll come in contact with a variety of medical professionals. Here’s a brief who’s who:

Intensivist:

Doctors who diagnose ICU patients and direct their care and treatment are called intensivists. These physicians, also called critical care doctors, have specialty and subspecialty training in treating critically injured and ill patients. Intensivists usually work in the ICU full-time.

 ICU nurse/critical care nurse:

ICU nurses implement the intensivist’s plan of care. They monitor the patient, assess pain, administer medications, and perform tasks such as placing tubes and managing ventilators and dialysis. They also work closely with families, explaining the patient’s condition and care.

Nurse manager:

The nursing unit manager, or charge nurse, oversees the nursing care in the ICU and assists the nurses when necessary.

Specialty physician:

“Whatever the patient’s primary sickness is, those doctors will be there in addition to the primary critical care doctor,” Adalja said. Inside the ICU, you may see other specialists, such as gastroenterologists, surgeons, neurologists and infectious disease doctors.

Pharmacist:

Pharmacists prescribe medicine dosages for ICU patients. Like intensivists, ICU pharmacists have specialty training in prescribing medicines for critically ill and injured patients.

Therapist:

Several types of therapists work with the critical care team. Respiratory therapists help ICU staff monitor the patient’s breathing. Physical therapists work to minimize permanent disabilities. Occupational therapists in the ICU help reduce patient’s disability at work and at home.

Social worker:

Families in the ICU may benefit from talking to a clinical social worker (sometimes called a case manager), a person trained to help with communication between medical team members and family. An ICU social worker may offer emotional support, provide referrals to community resources, assist with the transition out of the ICU and help families navigate the end-of-life decision making process.

Clergy/chaplains:

Hospital clergy members provide emotional and spiritual support to ICU patients and their families. Some ICUs have their own dedicated chaplains; others have a hospital chaplain that serves patients and family in all hospital units.

The Sickest Patients

Photo by Hamma

If you’ve ever visited a family member or friend in the ICU, your stomach sick with fear and worry, you may have wondered — why the ICU? Why not some other hospital unit?

“ICUs take care of the sickest patients in the hospital,” said Amesh A. Adalja, MD, FACP, a clinical assistant professor in the department of critical care medicine at the University of Pittsburgh Medical Center.

People who’ve experienced heart attacks, strokes, surgical complications and severe respiratory problems receive care in the ICU. The ICU also provides trauma care for those who’ve been severely injured in automobile accidents or from gunshot wounds, fires, falls or industrial accidents.

What sets the ICU — sometimes referred to as the critical care unit — apart from the emergency department or other hospital units is that ICU patients require continuous monitoring and sometimes, advanced machinery to support their life functions.

For example, a patient whose kidney function is impaired may receive intermittent dialysis in other areas of the hospital. But a patient who needs dialysis around the clock requires ICU care.

Patients who need regular suctioning of the respiratory tract, who require a ventilator to help them breathe or who need infusions of medicines to keep their blood pressure stable are other examples of those requiring ICU monitoring.

The ICU also differs from other hospital units in its much lower ratio of nurses to patients. ICU nurses typically care for only one or two patients. In other areas of the hospital, nurses may be responsible for six or more patients.

Not all ICUs are created equal, and the size of the hospital you’re visiting plays a role in the type of ICU environment you’ll experience. Smaller hospitals may have only one ICU that takes all types of patients.

In larger hospitals, there may be multiple ICUs, each specializing in a certain type of critical illness, such as stroke or cardiac or thoracic surgery.

How the ICU looks also varies from hospital to hospital and unit to unit. In general, though, ICUs tend to be more open, compared to other areas of the hospital. ICU “rooms” may not have a door, they may be enclosed only on three sides, or the door or room may be transparent so that staff can more easily monitor patients by sight from a central desk.

“Compared to other areas of the hospital, ICUs are also busier, faster, with a large number of people and lots of equipment around each bed. There is also more ambient noise than in many other hospital areas from things like monitors, ventilators and other medical devices,” said Linda Bell, MSN, RN, a clinical practice specialist with the American Association of Critical-Care Nurses.

Putting Family at Ease

Most of the time, patients admitted to the ICU come from other areas of the hospital. Like Erica Kosal, family members may receive a call from emergency services or another hospital unit letting them know their loved one is being transferred to the ICU.

“They’re stressed, so it’s important to put them at ease. We try to give them an overall picture of what’s going on with the patient,” said Michael Bergman, MD, director of the ICU at University Hospital of Brooklyn at Long Island College.

When families first get to the ICU, the nursing staff typically explains what will happen at the patient’s bedside, what type of monitoring they’re on and what the plan of care will be, said Barbara Maffia, RN, ICU Nurse Manager at University Hospital of Brooklyn at Long Island College. Nurses in the ICU may also ask the family whether the patient has a health care proxy, a person to make medical decisions for them.

Bergman points out that ICUs are stressful environments for both family members and medical staff. “In other hospital units, doctors may know the patient’s diagnosis before the patient is treated. In the ICUs, the diagnostic process goes on while treatment goes on. In ICUs, if the patient is sick, a lot of times we don’t have all the answers of what’s going on. You’re trying to stabilize blood pressure, fluid status and other issues while trying to figure out what caused all this,” said Dr. Bergman.

Keeping Family and Friends Informed

For some people, a phone-tree is an efficient way to pass along information (one person calls three people with updates, who each call three others, etc.) But for many, there’s no longer a need for a phone tree: the families of today’s ICU patients can easily keep out-of-town friends and family informed by creating a simple blog-style, privacy-protected patient website. Family members can update everyone on the patient’s condition at once, share photos and receive messages of support. Try these free resources:

• CarePages
• Caring Bridge
• LotsaHelpingHands
• MyLifeLine

Seeing Your Loved One

Finding out your loved one is in the ICU is difficult. Seeing your loved one in the ICU environment often proves startling and upsetting. Though this experience is usually emotional, knowing what to expect may help you remain strong when first arriving.

Your loved one’s appearance may have changed drastically from the last time you saw him or her. ICU patients may have bruising because of blood tests, clotting problems or injury. Many patients in the ICU experience facial swelling due to medications or from injury. The patient may have tubes in his or her nose or mouth. You may see bandages to help hold tubes in place. Your loved one may need a catheter to collect urine or a temporary or permanent opening in the stomach to collect urine and stool.

If you’re visiting someone in the ICU, don’t be surprised if you’re asked to leave during certain medical procedures, such as central or intravenous line placement or catheterization. The medical staff informs family of the need for these procedures beforehand, but encourages them to step away from the patient’s room—but with good reason.

“You may think that they’re being put through discomfort when they’re not. These procedures can be quite traumatic for families to watch,” and having family members in the room can cause added stress for medical personnel performing the procedures, Bergman said.

The aftereffects of certain procedures, such as breathing tube insertion, can cause pain in the throat, making speech difficult. In addition, fluctuations in body fluids and chemicals in the blood can interfere with a person’s cognitive ability, making it difficult to think clearly or talk.

Finally, the medicines used to manage the pain associated with critical illness may cause big changes in how your loved one talks and acts, causing disorientation, hostility or confusion.

Managing pain is an important aspect of ICU care for critically ill patients. “Many patients have pain, discomfort or agitation, either because of illness or because of the procedures being done. ICU teams put a great emphasis on relieving pain and discomfort,” Bergman said. Patients in ICU may receive analgesics, or pain-relieving medications, as well as sedatives to reduce anxiety.

As part of ICU care, nurses reassess pain regularly and administer medications as necessary. But if you notice distinct changes in your loved one’s personality or feel that the patient looks uncomfortable, it doesn’t hurt to advocate for your loved one. You should approach the ICU nurse, and say “to me, she looks uncomfortable,” Bergman said.

A Family Affair

When it comes to family member visitation in the ICU, the policies vary from hospital to hospital and from unit to unit. Nurses often have some discretion to either expand or limit family access, but generally any adult who wants to visit during visiting hours will be allowed to, Adalja said.

Bergman noted that his ICU limits patient visitation in the morning, when nurses and physicians are busiest assessing pain levels, performing procedures and administering medications.

In the busy ICU environment, family members may feel that getting the answers to their questions is a challenge. Bell recommends designating a single family member to act as the conduit for information for the rest of the family who is prepared to write down questions they may have to discuss with the clinical team at a convenient time. Critical care is full of jargon, so stopping a doctor to politely ask, “What does that mean?” is a useful strategy to get answers to your questions, Bergman said.

While you’re visiting your loved one in the ICU, it’s easy to feel helpless among the medical machinery and highly trained staff. But Bell notes that patients may benefit from the touch and assistance of friends and family.

“They might also want to ask if it’s okay for them to help with some of the routine care, things like combing hair, swabbing the mouth, massaging or putting lotion on the arms or legs,” Bell said.

To help ease Young’s ICU recovery, Kosal brought in photos of their children and a special pillow for him to use after his tracheostomy. Both Young and his daughter designated a special stuffed animal that they could hold when missing each other, Kosal said.

In the wake of stress and worry that invariably accompanies a loved one’s ICU stay, don’t neglect your own needs. “The hard part for family members will come when the patient is discharged and in need of additional care at home. So it is vitally important that family members take time to eat, rest and take care of their personal needs,” Bell said.

Photo of the ICU monitor by Hamma

Health Behavior News Service is part of the Center for Advancing Health

The Health Behavior News Service disseminates news stories on the latest findings from peer-reviewed research journals. HBNS covers both new studies and systematic reviews of studies on (1) the effects of behavior on health, (2) health disparities data and (3) patient engagement research. The goal of HBNS stories is to present the facts for readers to understand and use for themselves to make informed choices about health and health care.

Whether caused by injury, surgery or a toothache so bad it slams you awake in the middle of the night, acute pain is difficult. Receiving prompt and helpful treatment can make all the difference in the world. But lack of care or inadequate care means that the acute pain may develop into chronic agony.

Fortunately, acute pain is not always long lasting or overwhelming, such as when you have a short severe cramp or multiple bee stings that can be handled with time, over-the-counter medication and other home remedies [See Sidebar: Pain Treatment Options].

Since individuals’ tolerance for pain varies widely, the question of when pain itself requires urgent medical attention is difficult to answer.Chest pain should prompt a visit to the emergency room, of course—but other types of pain are trickier to call.

“If it hurts like hell, come to the E.R.,” says Dr. Sergey Motov, assistant program director for emergency medicine at Maimonides Medical Center in Brooklyn. “The problem is that it’s so subjective, there’s no really good objective way to tell when [help is required]. If it’s the worst pain you’ve ever experienced, [come].”

Once you seek medical attention, you should be treated promptly and with compassion. “If you don’t treat acute pain properly, it can become chronic,” Motov says. “If someone comes in with acute pain and it’s sub-optimally treated, they go home and come back in three days and it’s sub-optimally treated again and later on they’re in chronic pain, that started with us because we did not address the acute pain properly in the first place.”

So how should extreme acute pain be treated? Jan Adams, a retired general practitioner herself, describes receiving excellent care after she had back surgery following an injury. She was immediately given strong opioid medication because of the intensity of the pain.

“What they did right was allow me to manage how much pain medication I needed for the first few days,” she says. “I needed more at first and what they did right was to allow me to manage the pain, understanding that there’s a big difference between abuse of pain medication and acute pain use of narcotics.”

Mike Gaynes, a media consultant, received similarly caring treatment with opioids when he reached the ER suffering with kidney stones. Although he does not normally have high blood pressure, the pain had made it skyrocket.

“This was cork-popping,” he says, “They gave me I.V. morphine and it helped somewhat, then they gave me more and it helped a little more. It took the edge off but did not shut [the pain] down entirely.”

Toughing it out with severe acute pain is not recommended, because of the possibility that it could become a chronic problem. However, Dr. Kenneth Goldschneider, director of pain management at Cincinnati Children’s Hospital, says that complete elimination of pain is often an unrealistic goal because of the side effects of drugs.

Adams’ bad experience of pain management came during an emergency colonoscopy, which she needed during treatment for a rare form of mouth cancer. Radiation therapy had left her weakened and malnourished, cutting off the blood supply to her colon. Because of the painful cancer treatment, she was already taking an extremely strong opioid called fentanyl and had developed a tolerance to it.

That same medication was used for anesthesia during the procedure. Because of Adams’ tolerance and the physician’s choice not to use an additional anesthetic along with it, she was left in agony. “He’s pumping air into my colon and I’m feeling like raw hamburger,” she recalls. “The entire floor heard me screaming but he wouldn’t give me anything more,” she says, explaining that she has typically been stoic when in pain

To avoid having a similar experience, Adams suggests a conversation about pain management before surgery. She says to ask explicitly, ‘What do you think is appropriate pain management?’ “One thing you want to hear is that ‘I’ll be sure that either I or the nursing staff will be trying to evaluate your pain [regularly] to make sure you’ll be as comfortable as possible,” she says.

Patients should also discuss any medications they are taking with their doctors before surgery. If someone has a tolerance to a particular medication, the anesthesiologist needs to be prepared to use higher doses or choose a different drug.

Pain Treatment Options:

Pain can be treated in a number of ways, depending upon its severity and cause. Treatment options might include one or more of the following:

• Non-steroidal anti-inflammatory drugs (NSAIDs), a specific type of painkiller such as Motrin® or Aleve®
• Acetaminophen (such as Tylenol®)
• Narcotics (such as morphine or codeine)
• Localized anesthetic (a shot of a pain killer medicine into the area of the pain)
• Nerve blocks (the blocking of a group of nerves with local anesthetics)
• Acupuncture
• Electrical stimulation
• Physical therapy
• Surgery
• Psychotherapy (talk therapy)
• Relaxation techniques such as deep breathing
• Biofeedback (treatment technique in which people are trained to improve their health by using signals from their own bodies)
• Behavior modification

Some pain medicines are more effective in fighting pain when they are combined with other methods of treatment. Patients might need to try various methods to maintain maximum pain relief.

Adapted from The Cleveland Clinic Foundation.

“I would always encourage people to change physicians or get another opinion if something doesn’t seem right when you talk about pain,” Adams says.

A decade ago, the Joint Commission on the Accreditation of Health Care Organizations (now known as the Joint Commission), which sets standards for medical centers, labeled pain as the “fifth vital sign.” Hospitals are now required to assess pain when other vital signs are taken after surgery or more frequently with especially painful conditions.

Dental pain is one of the worst forms of common, acute pain. Lys Fulda, then in her early 20s, had a toothache so severe that she went to her dentist’s office before it opened to make sure she’d be seen as quickly as possible.

The dentist injected her with Novocain, but it didn’t completely alleviate the pain as he began to drill. He tried another injection, this time directly into the tooth. “It felt like lightning went through my entire body. It created innate deep fear of dentists,” Fulda says.

While it’s not always possible to avoid such incidents because people’s nerves are sometimes anatomically unusual, experienced dentists can almost always prevent them.

“You need to take pain seriously,” says Dr. Dennis Bohlin, a Manhattan dentist and the educational coordinator for the New York State Dental Association’s committee on chemical dependency. “Part of it is reassuring [patients] that there is going to be end to it. Part of the anxiety about pain is the fear that it will last forever. It’s not going to, we can handle it. That reassurance is really important.”

Organizations That Can Help

American Pain Foundation

The American Pain Foundation web site is an online resource for people with pain, their families, friends, caregivers and the general public. This site is devoted to patient information and advocacy, and provides many links to additional resources. www.painfoundation.org

Anxiety itself actually increases pain—so techniques that reduce anxiety are an important part of dealing with acute pain. With children, Bohlin says, it’s particularly important to calm the parents as well so that they don’t transfer their own anxiety to the child.

Incidents like what happened to Fulda or negative childhood experiences with dentists can create what Bohlin calls “subliminal anxiety,” which can drive avoidance of dentistry below conscious awareness.

“It’s hard enough to come as it is,” he says, adding that this type of anxiety makes dragging yourself to the chair even more difficult. Fulda found that a reassuring, sympathetic dentist was able to help her overcome her fear.

If dental pain strikes in the middle of the night or on a weekend, Bohlin suggests taking a drug like ibuprofen, naproxen or aspirin—all of which fight inflammation, which is a big part of dental pain. Don’t take antibiotics, which can make the dentist’s job harder when he or she tries to diagnose the problem.

Acute pain can be harrowing, but fortunately in most cases it can be rapidly relieved.

Treating Acute Pain at Home

Most acute pain is not serious and can be handled with home care methods. Some advice from Dr. Kenneth Goldschneider, director of pain management at Cincinnati Children’s Hospital:

For minor injuries, use a cold pack but for no longer than 20 minutes, he suggests.

For sore throats, gargle with salt water— the only advice that has changed since grandma’s time is that aspirin is no longer used for children or adolescents. Use children’s ibuprofen or acetaminophen instead, he says.

He adds that for infants under six months, sugar water has been found to have a short-term analgesic effect: In many hospitals it is now used for giving shots and placing IV’s and other procedures that produce brief, acute pain. It doesn’t work for older children or adults, however.

For toothache, Manhattan dentist Dennis Bohlin says that when you cannot immediately get to a dentist, use an NSAID drug like ibuprofen or naproxen that has anti-inflammatory properties, since inflammation is often a big part of the problem.

Health Behavior News Service is part of the Center for Advancing Health

The Health Behavior News Service disseminates news stories on the latest findings from peer-reviewed research journals. HBNS covers both new studies and systematic reviews of studies on (1) the effects of behavior on health, (2) health disparities data and (3) patient engagement research. The goal of HBNS stories is to present the facts for readers to understand and use for themselves to make informed choices about health and health care.

Living Beyond Pain

For people with severe chronic pain like Kelly Young and Teresa Shaffer–both of whom have become patient advocates–coping with agony is a fact of life. Young suffers from rheumatoid arthritis while Shaffer’s pain is linked primarily to another degenerative bone disease.

Chronic pain is one of the most difficult-and common-medical conditions. Estimated to affect 76 million Americans–more than diabetes, cancer and heart disease combined–it accompanies illnesses and injuries ranging from cancer to various forms of arthritis, multiple sclerosis and physical trauma.

Acute pain or chronic pain?

Acute pain is pain from an injury or illness, typically lasting only hours or days-and definitely not continuing once the original cause has cleared up. By contrast, chronic pain lasts months or years and continues even when the initial problem has been resolved.

Chronic pain is itself considered a disease because it reflects pathology in the brain and nervous system — which transmits pain — that persists and affects all aspects of life functioning.

Pain is defined as chronic when it persists after an injury or illness has otherwise healed, or when it lasts three months or longer. The experience of pain can vary dramatically, depending in part on whether it is affecting bones, muscles, nerves, joints or skin.

Untreated pain can itself become a disease when the brain wrongly signals agony when there is no new injury or discernable other cause.

Fibromyalgia–a disease in which pain in joints, muscles and other soft tissues is the primary symptom–is believed to be linked to incorrect signaling in the brain’s pain regions.

Finding a Doctor

The first step to deal with chronic pain is to find a physician or medical team who can accurately diagnose your condition and work with you to lessen pain.

“It’s not easy,” says Shaffer. “You have to find someone [with whom you can] build a relationship of trust and open communication.”

Dr. Russell Portenoy, chairman of pain medicine and palliative care at Beth Israel Medical Center, agrees. “You need to identify someone with a high level of knowledge and competence, good communication skills and a network of professionals with whom they work, someone who has compassion,” he says.

Dr. Paul Christo, director of the multidisciplinary pain fellowship program at Johns Hopkins School of Medicine, also suggests looking for someone who has completed at least a year-long certification in pain management. This information can usually be obtained on the doctor’s website or by asking about his or her qualifications.

Comprehensive Treatment

Experts agree that comprehensive care–which can involve medications, exercise, psychological therapy, massage, physical therapy, injections and complementary treatments, depending on the patient and condition-is essential.

“The reason we now call chronic pain an illness is that we recognize that it is more than just a sensation in the body,” Portenoy says. “It affects your ability to function as a human being, your relationships, your ability to be productive, to think straight.”

Unfortunately, because they have so often been dismissed as having a problem that’s “all in your head,” many people with chronic pain resist considering talk therapy as a part of treatment.

“A lot of people have the misconception that what I’m telling them [when recommending therapy] is that their pain is a figment of their imagination,” Christo says. “That’s not what we mean. Pain has such an emotional component and psychotherapy is extremely useful in terms of helping patients reorganize and rethink how they interpret it and how it affects their lives.”

Says Shaffer, “Pain encompasses the entire person. It’s not just in your leg or back. It encompasses the entire being of who you are and what you can do and don’t do. So physically, mentally psychologically: you have to take care of all of those things.”

The Opioid Question

Although drugs like aspirin, ibuprofen and even some antidepressants can help relieve pain, the most effective medications for most severe pain remain the opioids, like Oxycontin and morphine. Both doctors and patients tend to fear these drugs because of concerns about addiction and overdose.

However, of patients without a prior history of addiction, less than 3 percent of patients who take opioids regularly for pain will become addicted to the drugs, according to a Cochrane review of studies. Opioids are currently under a cloud because of a sharp rise in overdose death and addiction, mostly resulting from misuse by people who aren’t pain patients. The majority of overdoses occur in people who abuse the drugs along with alcohol and depressants like benzodiazepines (for example, Xanax).

Virtually everyone who takes opioids on a daily basis will become physically dependent, however: They will suffer withdrawal if the drugs are not slowly tapered. But that is not the same as addiction, which is defined by craving, negative consequences, reduced ability to function and compulsive drug-related behavior.

Kelly Young avoided opioids for years, relying on high doses of ibuprofen (Advil) and similar drugs. But when the pain became excruciating, her doctor suggested she try an opioid. “I was afraid of side effects,” she says. “One night it was really bad so I took it.” At first, she felt severe dizziness. “But in 30 minutes, the pain started going away and I thought, ‘This is amazing, this is the first time in 4-5 years that I’ve been without pain,’” she says.

To reduce the dizziness, she cut the dose, starting with a liquid usually given to children so that she could find a level that allowed her to be most comfortable. Neither Young nor Shaffer, who also manages her pain with opioids, has ever developed addiction.

Two-Way Trust

Because doctors can lose their licenses or go to prison if they don’t detect addicts who fake pain, patients find themselves in a difficult position when they want to discuss opioid medications. Asking for a drug by name, for example, which might be fine with other conditions, is seen as a “red flag.”

“When you initially go to an appointment, you don’t want to go in there saying I need medication; that’s the worst thing you can do,” Shaffer says. “You want to ask for relief. Explain to the health care provider, ‘This is my life. I can’t get out of bed. I can’t do laundry. I can’t pick up my child. I need quality of life, that’s why I’m here.’”

Shaffer adds, “You have to be upfront and honest and build that relationship of trust with your doctor.”

Shaffer also notes that it is the patients’ responsibility to store opioids in a locked box safely: Many people who abuse and overdose on these medications get them from friends and relatives who do not secure them.

Acceptance and Hope

Shaffer and Young both recommend a mix of realism, mutual support and fighting spirit when it comes to facing pain. Young runs her Rheumatoid Arthritis Warrior website and Shaffer moderates online discussion groups for people in pain at the American Pain Foundation site Experts agree that support from family, friends and people facing similar problems-so long as there’s some type of social support-is essential.

“You have to accept what your life is going to be, but you don’t have to give up,” says Shaffer, “OK, yes I have pain but that pain doesn’t own me or define who I am today.”

 Pain Management Resources

American Pain Society is a “multidisciplinary community that brings together a diverse group of scientists, clinicians and other professionals to increase the knowledge of pain and transform public policy and clinical practice to reduce pain-related suffering,” their website says.

American Academy of Pain Medicine This is a directory of physicians whose practice is primarily devoted to pain and offers its membercontinuing medical education in pain. The site’s Patient’s Center page provides general information and helps patients locate pain specialists in their area.

Health Behavior News Service is part of the Center for Advancing Health

The Health Behavior News Service disseminates news stories on the latest findings from peer-reviewed research journals. HBNS covers both new studies and systematic reviews of studies on (1) the effects of behavior on health, (2) health disparities data and (3) patient engagement research. The goal of HBNS stories is to present the facts for readers to understand and use for themselves to make informed choices about health and health care.

Photo of the Bell Helicopter that will perform the aerial survey.

The flyovers will start in Seattle and Bellevue before moving to other areas of King and Pierce Counties, including Tacoma.

During the Puget Sound flyovers, the helicopter will be based at Boeing Air Field and will make daily flights between July 11 and 28.

The helicopter will fly a grid pattern at an altitude of about 300 feet.

The measurements will be used to determine what normal radiation levels are various locations. The data will provide a baseline that can be used for comparison should there ever be a nuclear accident, the Department of Health said.

After the recent nuclear reactor accident in Fukushima, Japan, Japanese officials measured radiation levels in the surrounding area, but could not tell how elevated they were because they had no pre-accident measurements for comparison.

State radiation experts expect to find natural radioactivity and material produced by licensed radioactive material users such as hospitals, the Department of Health said.

After review, the results of the survey will be available to the public, the Department of Health said, though some information may be withheld for national security reasons. If levels of radioactivity are high enough to pose any health concern, the source will be investigated.

Department of Energy’s Remote Sensing Laboratory Aerial Measurement System will conduct the flyover. The project, which the Washington State Department of Health is overseeing, has been in planning since 2009 and is funded by a grant from the U.S. Department of Homeland Security.

To learn more:

• Information about the project is available on the agency Aerial Radiological Survey website (www.doh.wa.gov/ehp/rp/rep/aerial.htm).