Cure

That night was unremarkable in many ways, a middle day of a working week I had gone to bed as normal around 12am.  I’d eaten quite late and taken my last tablet of the day with dinner.  Nothing out of the ordinary, I turned out the light to wait the new day.

I was on the cusp of sleep when the pain began its slow but ominous walk.  This alarmed me as I had by now become quite proficient at minimising all pain.  Not least by increasing the dose of indomethacin to a fairly regular 4 tablets per day.  Maybe it was due to the late evening meal?

An hour passed by, I was now pacing the house.  5, 10, 20 who cares how many minutes more,  I was sat in the middle of my bed head clasped tightly between my knees. I tried to resist in the normal ways but the pain was ruthless and unforgiving.

Something that always provided me with minor but natural pain relief in the past was a technique I was aware of through my experience of scuba diving. Scuba divers regularly equalise the pressure between ear, nose and sinuses while diving. This is due to the discomfort that is commonly felt in the ears as pressure builds while descending to greater depth.

 

Pressure equalisation is achieved while trying to slowly breathe through the nose while both mouth and nose are closed. As there is nowhere for the air to escape, pressure starts to build until the imbalance is equalised. A light popping sensation in the ears signals successful application.

 

I would often try this during severe bouts of pain and always felt instant, gratifying but very fleeting relief from the pain. I would repeat the action countless times but would invariably give up and resign myself to wait until the indomethacin started to work its magic. The very fact that there was some level of pain relief was important and often made me think that the cause of my HC pain was somehow related.

Two more hours passed by, my eyes were now dry, tears long spent. I welled up inside and in pure desperation let out a scream, a silent scream. A scream may have lacked decibels was easily compensated by the sheer intensity of what I now know must have been engaging the enemy within. As mind and body tensed against the pain, I felt a wave of pressure building. Moments later and with a gasp I expelled all air, slumped back on the bed and in complete submission anticipated the next round of pain.

Several seconds elapsed, a relative eternity when the tick-tock of a real clock is supplanted by the jab-stab of the pain clock. I realised all but the slightest twinge of pain had retreated and on this occasion not for a fleeting 1 or 2 seconds. My moment was a comparatively infinite 1 or 2 minutes.

Had the indomethacin finally started to work?  My hope was soon dashed as the pain crept back as brutal and unrelenting as before. This was not the sequence of events I had become accustomed to. It was however something I was determined to explore. I replayed my actions and screamed another silent scream but this time I meticulously observed the whole proces.

Deep breath inhaled, abdominal muscles tensed, I braced as if to anticipate the extreme exertion required when lifting a very heavy object.  Resisting the reflex action to breath out I had unwittingly begun to perform the eponymous Valsalva manoeuvre.

 The Valsalva manoeuvre is a well-understood medical procedure. It is named after a 17^th-century anatomist, Antonio Maria Valsalva and is defined as the action of attempting to exhale against a closed airwave. Many sports professionals routinely if not knowingly perform the Valsalva manoeuvre during physical exertion.  Indeed, many tennis professionals can be easily observed as completion is often punctuated by a tell tale grunt or groan.

The stars were beginning to line up for me. The term can also be used to describe the action I was so familiar with, that being equalising pressure in the ears.  On this occasion my actions were magnified tenfold. No popping of ears was experienced as I was blocking the passage of air below the mouth and nose.  The glottis, part of the larynx, was acting as a valve and the more I resisted against the natural flow of air the more the pressure built. Seconds later I released all the tension and pressure by breathing out.  Again the pain receded.

Was I actually making a difference and causing the pain to fade or was it the medication? Regardless, I continued to dispense my newfound pain relief and as incredulous as it seems I was making the difference. The time in-between my mute scream’s was growing.

Cont…