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Wednesday, 29 January 2014

Creating Your Own Job When Disability Strikes

When encumbered by a disability many people are faced with sudden unemployment. In many countries there are financial options for helping you survive. In the United States there's help through Social Security, and Canadian provinces have various disability assistance programs. The full scope of countries that have help available is not something I'm going to waste time listing, because the whole point to this post is to help you figure out what you can do to become self-sufficient, or at least get you thinking about the possibilities. Not everyone has that option, perhaps, but there are far more alternatives than a lot of people may realize, and that's what needs to be discussed.

This is where the term 'play to your strengths' comes in. One of the first things you need to do is assess your personal strengths and weaknesses. It's a lot like what you probably did back in high school when you were trying to decide what career you were interested in. After all, in high school you needed to know where you were going, so that you could take the appropriate classes in later grades. You didn't want to discover that the college or university program you were looking to get into was only taking students with physics, when you took biology or chemistry.

The same thing applies when you're faced with disability, and a lot of the same methods can be used to figure out a few things. You've probably discovered by now that the world isn't the same as you thought it was going to be, so you've got a much more realistic perspective on what you consider to be your dream job. Another thing to consider now, aside from the nature of your disability, is whether or not you even want to work for someone else. There's your personality to add into the equation. Are you at a point in your life where you really don't want to be taking orders from someone else, or do you need to have a boss to keep you doing what you're supposed to do? In other words, you need to be seriously self-motivated if you're going to be self-employed, and you also need to be realistic about a few things when it comes to being an entrepreneur of any kind.
  1. It takes time and work to build up business and income, and a large amount of the income will need to be reinvested into your business for the first little while. Do not expect your business to be an overnight success, and be grateful that you aren't likely to be afflicted with that. Overnight successes tend to blow up in people's faces. Lack of knowledge and experience cause companies to implode from over-expansion.
  2. You're going to have to wear a lot of hats at the start of your business. You're not usually going to be able to afford to hire people to do the things that you don't know how to do. This means a very steep learning curve. Business ownership means everything from accounting to marketing to website building - never mind whatever product or service you're selling. You'll need to understand social media, and find ways of utilizing it without overwhelming yourself. If you don't know how to build your own website, most hosting companies provide programs to help you with that, but they can get confusing when it comes to selling online with e-commerce sites.
  3. You have to be comfortable selling, either yourself or your products. Every business involves the exchange of something for money - sales, in other words - be it products or services. If you can't or won't sell, you're not going to get very far. That being said, there are a large number of ways to sell if you're uncomfortable with face-to-face interaction. You can sell through auctions, or market electronically and by mail, and there's the old stand-by of using flyers. Word-of-mouth helps, too. If you have friends that are willing to spread the word, don't be afraid to ask them for help. If you're good with phrasing or writing in general, you may find the electronic world to be your oyster.
There's a little more to it than that, but those particular issues are the ones that you really have to consider. If you feel you're equipped to handle them, now you can start taking stock of your assets. Assets can be anything. Maybe you've got money stashed away, maybe you've got a hobby you've been puttering with, or maybe you've got skills no one has seen yet. Those are all things that can be used to get you started. We'll start with something really simple.

Let's suppose your grandmother taught you to knit or crochet, and we'll assume that your are still physically able to perform those tasks without assistance. Not every hand-knit item is going to have monetary value to the general public, so you'll have to do a bit of research to find out what's currently in fashion that might involved handmade goods. Once you figure that out, you can get to work using either your own pattern, or one you can probably find on the internet or in a craft store.

Now, what if you're no longer able to knit or crochet? What then? If you still have the power of speech you can direct a group of people to make the items that you think will sell, and direct someone else to handle to marketing and sales.

The same goes for any kind of handmade goods. Some items will have huge monetary value, whereas some will never sell. You might find a niche market for a unique product, too. Maybe you can crochet clothing items that look like spiderwebs. There's a pretty big Gothic market out there for anything seeming to do with vampires, and for some reason spiderwebs fit the bill. Of course, you'll have to keep your target demographic in mind when you design your marketing scheme. If you make your website look like the lace-and-daisies crowd shops there, you're not going to bring in the teenagers and twenty-somethings who call themselves Desdemona, Elvira and Esmeralda, and wear patent leather bustiers.

Maybe your skill-set is more esoteric. What do you know that others would be willing to pay to learn? What are you good at? Let's go back to the guidance counselor tactics from high school. Time for those aptitude tests again, and that means it's time to go to a library or bookstore. One book that's been around for a very long time is called, "What Color is Your Parachute?" It's by Richard Nelson Bolles and has been around for decades. New editions get published all the time in order to keep up with the latest changes in the employment market. The latest edition is for 2014, which is as fresh as it gets when it comes to print work. There are plenty of other books out there that will help you discover your strengths when it comes to either employment or self-employment, so take advantage of them. Once you know the kinds of things that fit with your temperament and interests, you can start to look in those directions.

Something else to consider is diversification versus focus. Many people who are employed are surviving on multiple part-time jobs. The same goes for small business owners. They often find themselves operating different businesses and bring in small amounts of money from each. There's a catch-22 here. In order to make a business successful, usually you need to focus specifically on that business. However, it's a risk to drop a business that's providing income that you probably need right now. In some cases the business are the kind that will never really grow, and the market is small for the products or services that are being offered. In that case you may find yourself having to continue operating more than one business. In the long run, though, if one of your businesses has long-term growth potential you're far better off taking the risk of focusing solely on that endeavor. One very good reason is paperwork. Every business generates it, and the more businesses you operate, the more paperwork you have to do. If you can pare down your operations to a single entity, you'll automatically have more time to focus and grow your company.

Don't overlook your previous work experience either, just because you are no longer physically able to do that exact job under the requirements of your previous employer. Maybe you can still do some of the work, but at your own pace. Maybe you have some good periods where you can still do your old job. One option is to sub-contract or do piece-work for your old employers, or even for their competition. In some cases your former employers can make adjustments so that you can go back part-time, or doing a slightly modified task.

If you actually like to sell, and happen to be good at it, there is always a market for that skill. Inside sales is nothing more than making or receiving phone calls, which can be done from home. You have to educate yourself on the products, and sometimes that means taking courses if a field is very specific or complicated. Industrial sales usually requires knowledge of the field in some way or other. If you used to be an electrician, and can no longer walk around job sites, but you know the supplies really well, chances are good you have all the knowledge you need in order to sell those kinds of supplies. Maybe you were a mechanic and you know the parts, particularly for a specific manufacturer.

The key to real happiness with self-employment, though, is finding something you actually love to do. Hence the aptitude and interest tests. You've probably heard this before, but it still applies:
What would you do for free because you love it so much?
Now the challenge is to find a way to turn that passion into profit. Have you always done sketches of costumes in your spare time? If you want to see those sketches turned into reality, you'll need to learn how to make sewing patterns, and you'll need to know how to sew. Once you've done that, you're ready to go. If you know how to make patterns, you can also do custom work, and that can mean a bigger profit.

Often by the time the dust settles, after being diagnosed with a disability that results in sudden unemployment, your financial resources can be strained to the breaking point. Don't let people tell you that you need to have tons of money to start up. Maybe you have to start small, and the amount you bring in is a pittance in comparison to what you used to earn, but gradually you can branch out until you're making a living wage again.

The most important skill you'll need at this point is the ability to be creative in overcoming challenges. That means going to the library to use their computers for going online, or maybe going to a friend's house if they're willing to let you have access to their computer, if you can't afford your own computer or internet service. Maybe you have no choice but to hire a staff if you're going to make your business work, and in that case you'll need to consider either free or subsidized labour - by that I mean students. In high schools there are often co-op programs where the students get credit for going to a job for part of the school day. In colleges there are intern programs. Talk to the guidance counselors at nearby schools and see what they have to offer. Don't forget family members, or friends, or even people you only know online. Get your message out that you're looking for help to get started.

If you need specific supplies that you can't afford to buy retail, there are other places to go for materials. If you need wood, there are pieces getting chucked out at various types of stores or manufacturers. If you need small pieces of fabric you might be able to get scraps from places that need to use a lot of yardage, and have no use for the cuttings. Whatever type of material it is, look for big companies that use those materials, whether it's plastic, fabric, metal, wood, or glass, and then see if they have scraps. They'll either charge you a very small fee, or simply be grateful they have fewer scraps they have to pay to have hauled away.

Not everyone is going to be able to work once disability is a factor in their lives. Some who might be physically capable of working do not, and often because of depression and other factors. However, there are stories out there of people who make it against all odds. They're determined not to rely on others for their existence, and it's not hard to understand why. Even when a person is deserving, and truly in need of, public or disability assistance, there's not only a stigma still attached to it, but often there are so many strings and so much red tape that even qualifying for it can seem an impossible feat. At a time when your emotional and physical reserves are already low, facing social workers and medical tests to prove your case can be very daunting. A lot of people want to avoid that at all costs, so that means becoming financially independent. Not wealthy, but at least independent.

A word of caution, here. Desperation drives many to click on the advertisements for making money online. In most cases, if not all, they're a complete waste of time. In many cases they're also a waste of your money because they ask you to pay for the information that in all probability won't help you make any money of your own. The only people who seem to make money from those schemes are the ones asking you to send in your money. Starting and running a successful business is not something that happens instantly. As is states above, it takes time and work. If you're looking for that fast buck, it's going to lead you to losing money rather than making it. It's a mindset that you have to stomp out, so that reality can be faced.

There's a break in a person's life when they've become disabled. Sometimes it's sudden, and sometimes it's gradual. However it occurs, there's always 'then and now' in a disabled person's life. People look back on how much easier things were when they had their health and mobility, not to mention their full independence. Even if you can't get back your health or mobility, you just might be able to regain your freedom, and that's worth every bit of work it takes to be self-reliant.

Friday, 17 January 2014

Drug Juggling with Chronic Pain

"The person who takes medicine must recover twice. once from the disease and once from the medicine." William Osler, M. D.
One of the biggest issues with chronic pain is pain management and the complications that arise from taking medications to counteract that pain. Addiction to narcotics can become a big problem, but it's not the only danger patients face when dealing with long-term use of pain relievers. Not by a long shot.

Whatever drug you take, there are physical or mental sensations that come along with their use. In many cases there is a rush that patients experience, identical to the rush experienced by those using illicit drugs such as heroin or cocaine. In fact, because many strong pain relievers are opiates - derived from opium, or synthetically engineered to behave like opium - their similarity to street drugs is quite strong. Heroin is derived from opium, but so is morphine. Heroin is actually morphine diacetate, and is only called heroin in its illegal form. It's not exactly the same as morphine, but it metabolizes and becomes morphine within the body.

Narcotics aren't the only available pain relievers, and they aren't the only ones that can become addictive, either physically or psychologically. Anything that alters the way you feel, either mentally or physically, can become addictive. Not just because you get high from it, but because you become accustomed to the sensations generated by the drug. When you no longer feel those sensations, you can become anxious, or any other number of feelings that relate to withdrawal.

Other pain relievers can be things like anti-inflammatories. NSAIDs, or non-steroidal anti-inflammatories, are commonly prescribed to anyone with no history of intestinal issues. That doesn't mean you won't develop intestinal issues from taking them. It's a very real danger of NSAIDs. Ulcers, intestinal bleeding, and other complaints are notoriously common with this type of pain reliever. Some pills are part stomach buffer for this reason, but even the stomach buffers have been known to cause intestinal issues.

Acetaminophen, commonly marketed under the Tylenol brand, has its own set of problem. The biggest downfall is liver damage. Not everyone is impacted, but if you have to take handfuls of pain relievers, and acetaminophen is your drug of choice, you may find yourself experiencing some of the symptoms of liver damage. It's called hepatoxicity, and is a form of hepatitis brought on by the use of medication.
"Drug-induced liver injury is responsible for 5% of all hospital admissions and 50% of all acute liver failures." Wikipedia
Strangely, one of the symptoms of liver damage is low blood sugar, and it's not something that most patients are aware of. Your age can increase the damage done by acetaminophen, and if you're malnourished or dieting you're also much more susceptible to acetaminophen-induced liver damage. Additional symptoms of liver damage include the following:
  • fatigue
  • weakness
  • abdominal pain
  • loss of appetite
  • jaundice (yellowing of the skin)
  • itching
  • susceptibility to bruising
  • edema (swelling) often in the legs
  • mental confusion or coma
  • kidney failure
  • vulnerability to bacterial infections
  • gastrointestinal bleeding
Another type of drug used for chronic pain, depending on the type of pain the patient is experiencing, is something called a neuropathic pain reliever. They're actually given post-operatively as well, because they reduce the need for narcotic pain relievers. Gabapentin (marketed as Neurontin), and Pregabalin (marketed as Lyrica), are two of the more common drugs prescribed for neuropathic pain. Both drugs were initially developed for seizures and epilepsy, but it was later found that they could be used to treat pain in a certain number of patients. They don't work for all types of pain, and they're only effective for a portion of the population for some reason. The benefit to these drugs is that they are non-narcotic and have fewer side-effects than many other pain-relief medications. However, both drugs have issues with withdrawal and neither should be discontinued abruptly.

It would be impossible to list all available drugs used for pain relief, as the gamut ranges from aspirin to OxyContin and morphine. Some are extremely dangerous, and some are also extremely addictive. A small mistake can be responsible for a patient ending up either in the hospital, or dead. Taking pain relievers with anything other than water can be disastrous, unless it's recommended they be taken with milk to slow absorption even further. Taking medications with grapefruit juice has caused a number of fatalities, mostly in the elderly population. It's not the citric acid or flavonoids in the juice (despite information released in earlier reports) that causes the problem, it is organic compounds that are furanocoumarin derivatives, which increase blood concentrations of the drug. The problem is actually called 'The Grapefruit Juice Effect' and as last reported at least 85 drugs are susceptible to this effect.

Chronic pain has to be treated differently than acute pain. Acute pain is generally short-term, and it's much safer to give strong pain-relievers to someone over the short term, than it is to give them over many weeks, months, or even years, of a patient's life. All medications have an impact on the human body, or there would be no point in taking them, and that impact is only increased over time. Our tolerance to a drug may increase, but that does not mean the long-term effects aren't just as dangerous.

One approach is to juggle different drugs at different times, to lessen the impact of long-term usage. For example, you might take a narcotic for a few weeks, but then switch to a less addicting drug such as regular acetaminophen. Your pain level will likely increase, but you're aware it's a temporary thing until it's relatively safe to go on something more effective. Maybe you're put on Tylenol 3s, which contain codeine (another opioid, but far weaker than morphine). After a while the Tylenol can become a danger to you, so your doctor may try a neuropathic pain reliever. And so on...

This approach is only going to be necessary for those who are on very long-term medications, but since that does happen it's worth taking a look at. In my own case, I've faced all of these potential issues. I've been on one form of pain-reliever or another for the last several years. I've experienced a trip to the hospital from hepatoxicity, as well as a massive drop in blood sugar from another incident with liver damage. After being on certain medications for a while, I start to feel like I'm being poisoned, which is quite likely exactly what's going on. I have a sensitivity to narcotics which makes me nauseous, and means that I have to take Gravol (dimenhydrinate), also known as Dramamine in the United States. The pain medications that have been prescribed for me include morphine, Percocet, OxyContin, Tylenol 3s, and Gabapentin, though not usually in combination. At one point, after surgery, I was given morphine and OxyContin together, along with an antiemetic for nausea. It's not surprising that I have first-hand knowledge of the difficulties faced by anyone who requires long-term pain management.

It's not uncommon for patients to become rather expert on the various medications available for pain. They start mixing and matching, trying to find the most effective solution. You absolutely must talk to your pharmacist about contraindications, however - otherwise known as drug interactions. Some medications should never be taken with other types of medicine. Some will cause severe psychosis, some will cause death. Your pharmacist is your best friend if you need to take any pills whatsoever. They know far more than your doctor will ever know about the medications that are being prescribed for you. A good pharmacist will not only know about prescription drugs, they will also know about the over-the-counter (or OTC) drugs. A great pharmacist, however, will understand the interactions with herbal medications and supplements as well. Do yourself a favour and look for one of those. Find a pharmacist who is concerned enough to take an interest in your medical care. Not only can they help after you've been given a prescription, but they can also make recommendations that you can discuss with your doctor. It might just be the medication you've been searching for that will give you the right balance of pain-relief with as few side-effects as possible.

Don't forget to be vigilant about what is going on in your body. Pay attention to symptoms and make sure you tell your doctor and pharmacist what's happening. You're the only one who knows what's going on there. Your doctor can't feel your pain or symptoms. Above all, be honest with yourself. If there's even the smallest part of you that thinks you're addicted to your medications, do something about it. Have your doctor wean you off the medication and put you on something else. Many patients know they're addicted to their pain medications, but they've given up on kicking the habit simply because they still need pain relief. Don't fall into that trap. There are usually other options for pain relief, but you're only going to know about them if you go looking for answers.
"We are prone to thinking of drug abuse in terms of the male population and illicit drugs such as heroin, cocaine, and marijuana. It may surprise you to learn that a greater problem exists with millions of women dependent on legal prescription drugs."  Robert Mendelsohn, M. D.