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אני לא קוסם! מאמר ראשון על שיטת הטיפול שלי.

אנשים ששומעים עלי סיפורים תמיד אומרים לי שאני קוסם, מחולל פלאים.

וזה לא שיש לי משהו נגד קוסמים, אבל כשמתייחסים למה שאני עושה כאל קסם, זה גורם לחשוב שמדובר בפלא לא מובן. משהו שרק אני יודע לעשות אותו.

וזה ממש לא נכון.

האמת היא שמדובר בצורת חשיבה ובשיטה שאפשר ללמוד ולהבין, ומי שיעשה את זה יוכל גם לעזור לעצמו בהרבה מקרים ומובנים.

בפוסטים הקרובים אני רוצה לחלוק אתכם את הידע שלי ולשתף אתכם בעקרונות של השיטה (נשתדל לעשות את זה קליל ובעברית מדוברת..), איך ולמה זה עובד.

למה זה חשוב לי, לשתף אתכם גם בחשיבה ולא רק בסיפורים? יש לזה שלש סיבות.

סיבה אחת – אני מאמין שהבנה של העקרונות עוזרת מאד לריפוי. אם במקום לחשוב שאני קוסם תבין טוב יותר איך זה עובד – אתה תרפא את עצמך הרבה יותר טוב. ובסוף, מי שמרפא זה ה' – דרכך. אני רק השדכן…

סיבה שניה – באמצעות הבנה של העקרונות האלו, יש סיכוי טוב שתוכלו לשפר את מצבכם בעוד הרבה בעיות אחרות, בכלל בלי לבוא אלי.

וסיבה שלישית – הבשורה. מהתגובות שלכם לטיפולים בקליניקה אני מבין שיש כאן בשורה של ממש, שלא פוגשים אותה בהרבה מקומות אחרים. ואני רוצה לבקש מכם להיות שותפים בהפצה של הבשורה הזו. לספר עליה לאחרים, להפנות עוד אנשים להיעזר, ולשנות את התפיסה, בוודאי בנוגע לבעיות אורטופדיות, ומי יודע? אולי לכל הרפואה בכלל. נשמע קצת מפוצץ? אני מתנצל, אבל אין לי דרך אחרת להגיד את זה. מקווה שעד סוף המייל כבר יהיה יותר מובן למה.

אז קדימה, בואו נצא לדרך.

נתחיל בסיפור.

יעקב גליקמן (שם בדוי) עבר בשנת 1998 תאונת אופנוע קשה. האופנוע הכבד מחץ לו את הרגל הימנית והוא נותר עם ריסוק של עצמות הקרסול בכמה מקומות. לא נעים בכלל.

בניתוח להצלת הקרסול, שהצליח ב"ה מעל למשוער, הוכנס מסמר אחד ארוך לעצם השוק הגדולה ועוד 15 (!) ברגים. לאחר שיקום פיזיותרפי מפרך (לא אצלי, הייתי אז בסך הכל סטודנט…) הוא חזר לתפקוד מלא ללא כאבים, והצליח לשחק כדורגל עם חברים בימי שישי…יעקב היה מאושר.

עד לפני חצי שנה.

בבוקר שבת חורפית, התעורר יעקב שלנו עם כאבים עזים בקרסול ימין. לא מסוגל לדרוך על הרגל. מבט חטוף הספיק לו כדי להבין שהקרסול נפוח הרבה יותר מהרגיל. המחשבות התרוצצו והוא החל להזיע (בחורף!). אולי אחד הברגים יצא מהמקום? אולי פג תוקף הצלחת הניתוח? מפלס הדאגה עלה ועלה.

למחרת בבוקר, משלא חל שיפור, מיהר יעקב להזמין תור לרופא ששלח אותו לצילום מיידי. הצילום הראה שכל הברגים במקומם ואנחת רווחה נפלטה מפיו. הבעיה, שגם הכאב נותר במקומו. הוא המשיך ללכת עם קביים בלי יכולת לדרוך על הרגל.

הדאגה הפכה לעצבות ממשית ועם הזמן המצב הלך והחמיר. הרגל הפכה לכבדה וקרה. הוא התרוצץ באינספור תורים ובדיקות שהעלו השערות שונות ומשונות. בחלוף הזמן, הכאבים צצו גם כשלא דרך על הרגל, ובהמשך הכאבים גם העירו אותו מתוך שינה. למרות שבדרך כלל נמנע מטיפול תרופתי, יעקב התחיל ליטול משככי כאבים חזקים וכדורי שינה.

בשלב הזה הוא פנה אלי.

לאחר שסיפר לי את כל הקורות אותו, התחלתי כהרגלי בבדיקה פיזיקאלית. עד מהרה התברר שקיימת בעיית גב מסוימת המקרינה לרגל ימין. ליעקב זה נשמע מוזר, כי הגב לא כאב בכלל, אבל במצבו הוא הסכים לנסות..

אחרי שביצע סדרה של תרגילי גב פשוטים, הכאב בקרסול פחת במידה מסוימת וזיק של תקווה נראה בעיניו.

אבל אז הגיע החלק המורכב יותר. 

בזמן שעבר, המוח של יעקב "סימן" את הקרסול הימני שלו כמקום בעייתי. ככל הנראה, בעיית הגב המקרינה כאב לרגל מתמקדת דווקא בקרסול הימני, בגלל הרגישות של המוח לאזור הזה. כעת, לא מספיק לשפר את מצב הגב, צריך גם "לשכנע" את המוח להנמיך את הרגישות.

נוסף על כך, בחצי השנה האחרונה נגרמה ליעקב גם עוגמת נפש רבה. הביקורים התכופים אצל רופאים, שורת הבדיקות האינסופית, חוסר היכולת לתפקד והתחושה שאין פתרון למצבו הפכו אותו לאדם הרבה פחות סבלני לסביבתו. יחסיו עם אשתו התערערו ומצבו הכלכלי הורע. מצב נפשי זה השפיע לרעה גם על המצב המוחי-קוגנטיבי, ומשם הדרך קצרה להחמרת המצב הפיזי (וחוזר חלילה במעגל סגור).

כדי להביא לשיפור, ניצבת בפנינו משימה קשה, אבל אפשרית. אסור להתייאש. צריך לפעול במישור המוחי ובמישור הפסיכולוגי במקביל.

מבחינה מוחית – הרגישות הזו ממוקמת באזורים הלא-מודעים של המוח, דבר המקשה מאוד את הגישה אליהם. על מנת להשפיע על הרגישות של המוח צריך לעבור תהליך חווייתי יותר מאשר לימודי (המתאים לאזור המודע של המוח). יעקב יצטרך להתאמן על החזרת האמון שיש לו – למוח – בקרסול, על ידי חשיפה הדרגתית לעומסים על הרגל.

במישור הפסיכולוגי התמודדות עם נכות היא משימה לא פשוטה כלל. על קצה המזלג, יש שלושה שלבים להתייחסות הטיפולית בהיבט זה:

  • יעקב ילמד להפנים שמצבו הנוכחי, רע ככל שיהיה, "תפור על מידותיו". אין כאן "אשמים" במצבו, והוא האחראי היחידי לרפואתו.
  • יעקב ילמד להפסיק להגדיר את עצמו באמצעות הבעיה שלו. הבעיה היא סוג של טפיל ולא חלק אינטגרלי ממנו.
  • יעקב ילמד כיצד הבעיה שלו משרתת אינטרסים מהותיים שלו, ולכן מהווה מנוף להתקדמות אמתית בחייו.

חייבים ראיה כוללת.
המודל המוצג כאן מכונה בעולם הרפואה מודל ביו-פסיכו-סוציאלי. ובאופן מדויק יותר ניתן לכנות אותו מודל ביו-קוגנטיבי – פסיכולוגי או בעברית גוף-מוח-נפש.

בכל בעיה רפואית המודל הזה עשוי לכוון את המטפל להתייחסות המתאימה ביותר.

במקרה של יעקב, הבעיה התחילה להיווצר בכלל מעומס על הגב (גוף), בגלל הפגיעה הישנה בקרסול נגרם כאב חזק מאוד וחוסר יכולת תפקוד ברגל (מוח), ומצב זה הביא לתוצאות התנהגותיות (נפש) שיעקב עצמו הגדיר אותן כשליליות מבחינתו (כמובן שבמקרים אחרים הסדר יכול להיות שונה ואף הפוך לחלוטין, והדומיננטיות של הבעיה עשויה להיות בכל אחד ממרכיבי המודל).

אז מה היה לנו היום?

אם החזקתם ראש עד לכאן  שמתם לב כי כאשר יש בעיה אורטופדית, אנו צריכים ללמוד להסתכל באופן כללי יותר על החיים והעבר שלנו, לבחון אם ישנם השפעות פסיכולוגיות ומוחיות ולדעת לשלב בטיפול את כלל המרכיבים האלו.

ואם הגדרנו את זה ככה, אז אפשר להבין שהעקרון הזה נכון לא רק בבעיה אורטופדית, אלא בכל בעיה רפואית בכלל.

ועכשיו אולי אתם מבינים קצת יותר מה התכוונתי בפתיח. כמו אצל יעקב, במקרים רבים הטיפול חייב לכלול את הגוף, המוח והנפש.

וזה ממש לא קסם, רק צורת הסתכלות.

ובקשה אישית לסיום – בפוסט הזה, ובאלו הקרובים אני מרגיש שיש ידע עצום שיכול לעזור לעוד ועוד אנשים לטפל ולעזור לעצמם. אשמח מאוד אם תעבירו את הידע הזה הלאה (בחינם..) לחברים ובני משפחה. יתכן שיש פתרון לסבלם.

הרבה בריאות לכולנו,

עמית.

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