When Shannon McQuaid was 13-years old, she started experiencing jaw pain that was so severe, her jaw would lock open. After a year of going to dentists, orthodontists, physiotherapists and chiropractors, Shannon was diagnosed with Temporomandibular Joint Dysfunction (TMJD).
TMJ Dysfunction is when there is pain in the joint that connects the jaw to the skull. For Shannon, this pain makes speaking, eating and making facial expressions difficult, as well as causing migraines that have a negative impact on her mental health.
To manage this pain, Shannon, now 21 and in her second-year of university, has been seeing chiropractors and physiotherapists, first a few times a week then moving into a couple of times a month, for seven years. But the thing that helps her most is acupuncture.
“After acupuncture I feel like a million bucks and completely relaxed,” McQuaid said over the phone. “It is the only thing that makes the pain go away right away.”
However, after the-shelter-in place orders were put in place on Tuesday, Mar. 17, 2020, she hasn’t been able to receive this care.
On Tuesday, Mar. 17, 2020, the Ontario Government declared a state of emergency and officially closed public libraries, parks, theatres, schools, cinemas and any “non-essential” health care practitioners, except for “regulated health professionals,” including dentists, optometrists, chiropractic services, ophthalmologists, physical therapy and podiatrists.” However, these services are open for “urgent care only,” which is up to the practitioner’s discretion.
Dr. Colin Mandin is a doctor of chiropractics and a registered acupuncturist. Prior to the COVID-19 pandemic, he had not closed his practice, Bayridge Chiropractic, for over a week in the 20 years that it has been open.
“Knowing my patients want my help yet not being able to deliver it is very difficult and unnatural,” he said in an email.
For six weeks, he has been supporting his patients over the phone and has recently opened his doors to patients who are in desperate need of care, with specific regulations such as changing his lab coat and gloves with every patient, disinfecting the area after each patient, closing the waiting room, and only having one patient at a time in the office.
According to the Chiropractors College of Ontario, a chiropractic emergency would include: a sudden and debilitating change in functional abilities (such as walking, sitting, going up and down the stairs) and significant restrictions in mobility.
“We assess our patients by phone to determine how symptoms present and using our clinical judgement, knowledge of the patient, his or her circumstances and identified risk factors to determine how urgent an in-person visit is required,” Mandin said.
However, that is only for chiropractics. People who rely on physiotherapy and massage therapy have to turn to other means for care.
In order to manage her pain as best as she can, McQuaid has been doing “telephysio” with her physiotherapist over video chat, and he gives her certain exercises that she can do herself. But with each day that passes without acupuncture, “the pain gets a little worse every day,” she said.
The longest McQuaid has gone without acupuncture before this period was four months, a semester of university where she did not come home. By the time she got home, she could barely speak and knew that she needed to see her physiotherapist for acupuncture within the next week, otherwise she would not be able to function normally until she got the care she required.
“I am just afraid that the progress I have made in my pain management over the past seven years is going to regress the longer I go without pain management, and it will be harder to get to the place I was before all of this happened,” she said.
To Tabitha Lowndes, a registered massage therapist at Massage Addict in Kingston, this is the thing that worries her the most, as well.
“I have clients that I have been seeing for the six years I have been at this clinic, and I have clients that I have been seeing for a few months, but they have all shown progress in the improvement of their quality of life. But now we are losing a lot of progress,” she said. “What I am most worried about is that my clients’ quality of life is going to decline.”
Christine Surgue, the longest standing member of the Chronic Pain Support Group of Kingston on Facebook echoes this concern in a statement given to the Kingstonist.
“Discontinuation of therapy puts some chronic pain patients at risk of backsliding. Therapeutic gains are hard won, easily lost, and costly,” the statement reads
“Without frequent maintenance, some chronic pain patients are at risk of deteriorating very quickly, undoing months of progress in a very short period of time.”
According to McQuaid, social distancing makes the pain especially apparent because talking on the phone is her main form of communication with her friends and, as an extroverted person, talking to her friends is helping her through quarantine. But speaking for long periods of time is not always an option for her and, without other methods of communication such as body language and touch, it is hard not to feel isolated.
Lowndes and Dr. Mandin are both quite worried about their patients’ mental health, as well.
“Managing social isolation is challenging enough without the impact of pain,” said Mandin.
Surgue also says that the impacts of declining mental health can cause physical pain to increase, deepening a vicious cycle.
“Most chronic pain patients would agree that the anxieties they face in dealing with their pain are enough to deal with day to day without adding in those caused by all of the unknowns in our current COVID crisis,” the statement read. “Further, the mind-body connection ensures that when these anxieties increase, so do our pain levels.”
For pain management at home, Dr. Mandin and Lowndes both have advice for patients, while recognizing the varying experiences of people who live with chronic pain.
Mandin suggests “the basics of good nutrition, sleep and gentle exercise go a long way to provide well-being” as well as revisiting the steps and care that your health practitioner provided during the initial injury/diagnosis.
Lowndes says that hot baths, heating pads, light stretching and listening to your body is key.
“If you are about to do something and your body is screaming at you not to do it, don’t do that thing,” she said.
But both Lowndes and Dr. Mandin said that if symptoms are unmanageable and getting worse, to call your main healthcare practitioner immediately.
In the meantime, to satisfy their inherent need to help that comes with their jobs, Lowndes and Dr. Mandin are helping the community in any way they can. To do this Dr. Mandin is delivering groceries to elderly relatives. For Lowndes, this means answering questions about pain in local Facebook groups and delivering anything that fits in her SUV to anyone that needs things.
“It’s not the same theme, but it’s helping in some way,” said Lowndes. “I’m just trying to make a difference where I can.”
Jemma Dooreleyers is a Kingstonian who is about to enter her fourth year at Ryerson School of Journalism. She has been a contributor for the Kingstonist in the past and is excited to be a full-time intern. She has written for a number of student publications such as the Ryersonian, Kaleidoscope, the Eyeopener, Her Campus and the White Wall Review. This year, she was the Arts Editor for Ryerson Folio, a general interest magazine. She is currently back in Kingston for the time being, social distancing with her mom, a dog, and two cats.