A patient with hip pain who is retired and living alone. Henry was a 70 year widowed father of 2 and grandfather of 6 who had worked for 40 years as an attorney.  He was an avid runner in his youth and early adult hood but had developed severe degenerative arthritis in his left hip at age 60. After the failure of traditional medical management he proceeded with a hip replacement surgery. Following recovery he still had persistent pain that has not resolved. Repeat surgery did not help and he has come to an understanding that this is just how his pain is going to be.  He has found that the use of daily morphine is helpful but is having difficulty maintaining his prescriptions due to his doctors becoming nervous about his increasing doses. He decided to come to HELP for assistance in finding experts who could maintain the optimal medication management for him. He wants to maintain his independence of living alone but finds that as his pain increases he needs more assistance.

Henry's 70 years of life had provided very god experience. He did not have unreasonable expectations. He knew that there was no fountain of youth and no cure. His focus was very aligned with HELP due to our ability to assist in maintaining his independence.

The Evaluation: Creating Henry's Clinical Path The first event on Henry's clinical pathway: What is causing Henry's pain?
This step requires that the HELP medical team educate Joe about what an artificial disc is, how the surgery is done and how his tissue healing around an artificial disc proceeds. Henry's x-rays and MRI scans held part of the lessons that Joe needed to learn. HELP's anatomy models and surgical illustrations complimented the lessons to allow Joe to learn. As Henry's knowledge increased about what was causing his pain the next treatment event of helping him learn about what his pain meant emerged.

The second event on Henry's clinical pathway: What does Henry's pain mean?

Throughout life pain is a warning. Pain usually tells us about new or potential tissue damage. However, each time there is an injury healing occurs. With healing there are different levels of imperfection. The presence of a scar on your skin after a simple cut is evidence of this imperfection. As Joe applied this information to what he had learned about the healing of his disc replacement he began to understand that his pain was a consequence of imperfect healing and not a message of new or potential damage. With this learning event completed Henry's clinical pathway expanded to encourage his return to a more active life.

The Life skills goal setting event: What are Henry's roles?

These events in Henry's clinical pathway lead to his progressive awareness of how he could be safe doing things even with his pain. As he understood that his pain while real, was not dangerous he learned that when things were important to him he could choose to do them safely even with pain. This knowledge and awareness coupled with the Life skills analysis to identify the most important roles in Henry's life. The treatment event of life roles analysis revealed his role as husband and father as most important. The exploration of those treatment events allowed for the identification of yet more detailed information about the activities that Joe wanted to get back
to with his spouse and kids to feel like a father again.

Functional activities, learning to perform important activities.

Joe started with his need to help his wife perform some of the chores around the house. Cleaning dishes, helping with laundry and taking out the trash were all activities that he used to do before his injury but the pain of standing and reaching had kept him from returning to them. With the help of the trainers, physical and occupational therapists Joe learned how to improve his body mechanics and posture, to employ a foot lift to off weight his spine to perform these activities again. Through progressive observation changed the way that he performed each of his important tasks to minimize pain while still getting the job done.

Fitness activities, learning to strengthen your body.

During his functional activities the treatment team members noticed that the years of Henry's inactivity lead to tremendous atrophy in his healthy tissues. As he began to simulate his chores at the HELP program we taught him to build strength in those healthy tissues to support the damaged ones. His daily fitness routine quickly gave way to a regular exercise program that allowed each day to be experienced with greater physical strength.

Nutrition training.

Like many patients Henry's injury had made him inactive and caused him to gain weight. His dietary habits had deteriorated and he was 30 pounds heavier than when he was injured. At age 35 years he had already experienced a decline in his metabolism that caused him to gain weight faster when he ate the same amounts he had been accustomed to. Joe needed to lose weight. He wanted to learn what to eat and how much he could consume while still reducing his waist line. At a lower weight Joe realized his back would probably hurt less and he would be healthy.

Remote treatment events, HELP when you need it.

During the day treatment at HELP Joe was introduced to the remote teaching modules that are available to patients thru the internet via HELP remote care. The individual video programs and live video broadcast provided an orientation to the way that these same lessons could be used by Joe when he returned home. Whether he needed the instruction available through the familiar voice of a care coach or reminders of the same content that he received from his direct treatment.

Interdisciplinary clinical pathways are designed to help patients recover. These paths include all facets of the decline and are linked in a continuous fashion. Understanding pain is a first step in the pathway of treating chronic pain. Patients learn what is causing their pain and how pain can persist despite the injured tissues having healed. Patients learn that pain is real. Enen though the pain is real, it may not mean there is a new and progressive risk. Pain results from old and imperfect tissues that have replaced previously healthy tissues. Each of these learning steps build from the previous learning to create the progressive steps out of the darkness of pain into the light of understanding. Each of these steps is called an event. We use event based treatment to provide the usual time and resources necessary to let you learn what you need to learn through medical, psychological, physical or spiritual changes that improve your condition. With each treatment event we choose a measurement of attainment and follow that measurement until we have attained the goal which allows you to move on to the next event.

Event after event will build into a patients treatment experience. Some of the events that patients need may occur only in a hospital like the event of medication detoxification, while other events require one on one teaching with a doctor like reviewing your diagnostic studies to help you learn why your injury still hurts even though your body has healed. Other lessons can occur at home or with other health care providers. Learning to set your goals based on what you life priorities are is a lesson that can be taught over the phone. Event based treatment to help patients integrate weekly goal setting and daily activity monitoring can be taught with remote support in your home. Event based treatment means using the correct resources in the correct environment to optimally treat your condition. As the events are linked in time the progress of your treatment in the clinical path occurs. Each patient becomes their own true story of injury, pain, loss, enlightenment and recovery.