זה לא חייב להיות תסריט גרוע

אני שם לב שמזמן כבר לא סיפרתי סיפור..

אז הנה סיפור אחד שממחיש את התועלת הרבה בגישה שדיברתי עליה במאמרים הקודמים (טיפול בבעיות אורתופדיות במודל גוף-מוח-נפש).

בוקר אחד, שרה (שם בדוי) בת ה 52 השקתה את העציצים באדנית שבביתה, לפתע הרגישה כאב חד מפלח את הכתף השמאלית שלה. היא ניסתה להרגיע את עצמה "זה בטח רק שריר שנתפס, תיכף יעבור".

שרה הוציאה מהבוידם בקבוק תרמי שבעלה קנה בעבר בבית המרקחת ומילאה אותו במים חמים. בתוך דקות ספורות הרגישה הקלה משמעותית בכאב ונשמה לרווחה.

אבל זה לא החזיק מעמד הרבה זמן. הכאב חזר, התעצם והיא שמה לב שגם יכולת התזוזה ירדה מאוד. שרה הרגישה שזו כבר "דלקת" של ממש. בצר לה פנתה בדחיפות לרופא.

הרופא אמר שצריך לבצע בדיקת אולטראסאונד כי הוא חושד שיש קרע של ה"שרוול המסובב" של הכתף, דבר שעלול להצריך ניתוח. בינתיים המליץ על כדורי ארקוקסיה ואם הם לא יספיקו – זריקת קורטיזון, והפנה אותה לאחות לצורך התאמת מתלה ליד, כדי לשמור על הכתף שלא תזוז הרבה.

כעת בואו נקפיא את התמונה (שלא תזוז..) ונשים לב לכמה עובדות פשוטות ויבשות:

1. בגיל 52 לרוב האנשים יש קרע של ה"שרוול המסובב" והם בכלל לא יודעים על זה.
2. גם אם יש כאב, הוא בכלל לא בגלל אותו הקרע.
3. אי לכך; על מנת להחלים מהבעיה, אין צורך ל'תקן' את הקרע.
4. לאחר ניתוח כתף סיכויי ההחלמה המלאה יורדים בהשוואה לטיפול שמרני.
5. דלקת היא רק סימפטום של בעיה (ממש כמו דלקת גרון שהיא רק סימפטום של סטרפטוקוק או וירוס) ולכן אין שום יתרון בנוגדי דלקת כמו ארקוקסיה על פני אקמול פשוט.
6. טיפול בסטרואידים עלול להזיק לטווח הרחוק.
7. מניעת תנועה מהאזור הפגוע מגדילה את הסיכוי שהבעיה תהפוך כרונית.
8. הגורם ה"אמיתי" לבעיות אלה אינו ידוע, אך שכיחותן עולה במצבים של מתח נפשי בהווה ובעיקר בעבר הקרוב.

עכשיו נוציא את הסיפור מההקפאה ונשרטט שני תסריטים אפשריים.

התסריט האופטימלי:
ברמה הפיזית (גוף) בעיה כמו של שרה עשויה לנבוע משיבוש כלשהו במפרק הכתף, או הגידים באזור, וכן עשויה להיווצר כתוצאה מהקרנה מהצוואר (גם אם אין כאבי צוואר).

הדרך הטובה ביותר להתמודד עם הבעיה, בהיבט הפיזי, תהיה תרגול מותאם אישית. כל זה כמובן בהנחה שהבעיה היא אכן אורתופדית. במקרה של שרה בהחלט רצוי לחשוב על אפשרות שמדובר בבעיה לבבית, ובאופן כללי תמיד יש לקחת בחשבון אפשרות שהבעיה אינה אורטופדית.

ברמה הקוגניטיבית (מוח) שרה צריכה לקבל ולהפנים היטב את העובדות היבשות שהזכרנו לעיל. זה עשוי לשפר מאוד את סיכויי ההחלמה.

ברמה הפסיכולוגית (נפש), שרה צריכה לזהות את מוקד המתח שנשאר בלתי פתור, ולהתמודד אתו בצורה המיטבית.

התסריט הגרוע:
שרה תבצע בדיקת אולטראסאונד, שתגלה קרע באחד הגידים. לכן היא תפחד יותר להזיז את היד, ומצבה יחמיר. החמרת המצב, וההבנה שכדי להחלים הגיד חייב להתאחות, תדרבן אותה לפנות לניתוח (למרות שהיא מאוד פוחדת מניתוחים). הניתוח עצמו יהיה מקור למתח נפשי נוסף על המתח המקורי, שאף אחד לא הציע לה לקשר בינו לבין הבעיה. אפשר עוד להפליג עם התסריט הגרוע אבל אני משער שהעיקרון ברור..

הבחירה בתסריט האופטימלי אפשרית וחיונית עבור כל אחד, לכן הדברים הללו עשויים להיות מאוד משמעותיים לאנשים רבים.

אנא שתפו אותם.

עמית

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