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Miranda Tripp holds the Difficult Day Box she assembled at the Mayo Pain Rehabilitation Center. (Beth Rickers/Daily Globe)

Pain relief: Young woman finds help for chronic condition

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Today, Miranda Tripp is a bubbly young woman with a big smile and bright future ahead of her.

But not too long ago, Miranda’s day-to-day life was clouded by despair, her smile dimmed by cries of anguish, and her ability to function normally stifled by constant visits to the emergency room.

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Miranda was in pain, and no one seemed to know what caused it.

For Miranda, the daughter of Tim and Kris Tripp of Worthington, the strange odyssey of pain started during the fall of 2009, her sophomore year in high school. She began to suffer pain in her stomach and lower abdominal area, and it intensified when she would engage in physical activity such as basketball.

“Even just going up and down stairs,” caused her significant discomfort, said Miranda.

In the ensuing months, Miranda would have a couple CAT scans and see a pediatric gastroenterologist.

“Through all this, they couldn’t find anything,” said Tim. “As a parent, you’re glad they’re not finding anything serious, but you still want to find out what’s wrong.”

In the spring of the following year, a pelvic ultrasound showed a serous cystadenoma — a benign cyst filled with fluid on her ovaries — and it was surgically removed.

For about a month, Miranda felt pretty good, but then the pain resumed. It became a weekly recurrence for the Tripps to spend time in the ER, hoping to find relief — and the underlying cause — of her continued pain. Ensuing tests included a capsule endoscope, for which she had to swallow a pill containing a camera.

“It takes 50,000 pictures while it’s going down,” explained Miranda. “But it got stuck in my chest, so it took 50,000 pictures of my chest. The second one —I was the first to have it — took 75,000 pictures.”

Another procedure involved stimulating her gallbladder, and it indicated a slight abnormality. Miranda’s gallbladder was removed on July 20, 2010. Tim jokingly asked if they should also remove her appendix as a precaution and was told that they couldn’t if it was healthy, and pictures showed that the appendix was indeed pink and normal-looking.

But this time, when Miranda went home after the surgery, she felt no relief.

“I laid on the couch and cried and cried and didn’t move,” she recalled. “I was in worse pain than before or after the surgery.”

Another trip to the ER resulted in a diagnosis of appendicitis. Three days after the gallbladder was taken out, her appendix — now shriveled and decidedly not healthy — was removed through the same incision.

This time around, Miranda had a bit longer reprieve from pain.

“It was gone for about a couple of months,” Miranda said, “but then it came back — the same strange, stabbing pain. Activity made it worse.”

After another round of scans and tests and increasingly high doses of painkillers, the Tripps scheduled an appointment for Miranda at the University of Minnesota Amplatz Children’s Hospital, but once again came home without any diagnosis.

Kris secured an appointment for Miranda at the Mayo Clinic in Rochester, but that was still a couple months away when the severity of the pain necessitated another ER visit in January 2012. By chance, the doctor on call was affiliated with Mayo and had connections to get her in immediately.

With a sedated Miranda in the back seat, the Tripps drove to Rochester in the middle of the night in a snowstorm, desperate to get answers for their daughter.

“When she was in pain, she would scream at the top of her lungs, and she’d look at us and say, ‘Why can’t I be normal?’” recalled Tim. “You would do anything to trade places with her, to take away that pain.”

After Miranda was checked into the hospital in Rochester, a staff member from Mayo’s Pain Rehabilitation Center (PRC) was summoned. But it wasn’t what Miranda expected or wanted at that moment.

“This woman comes in with a guitar and starts playing,” Miranda recounted. “I guess it’s supposed to be a distraction. She’d try to get me to sing with her.”

“They took us out of the room, but we could still hear her screaming from down the hall,” said Kris.

The Tripps were told to keep the February appointment at Mayo, but were also given a tour of the PRC by its director, Dr. Barbara Bruce.

“She pulled two kids out of class and had them talk to Miranda,” recalled Kris. “One girl told her that ‘just a couple of days ago I was in a wheelchair like you and couldn’t walk, and now I’m playing field hockey.’”

The Tripps were told there would be an opening in the PRC’s pediatrics program in March, but Miranda was against it from the beginning, not wanting to miss more school than she already had.

“We knew we had to do it,” said Kris.

“We just had to convince her of it,” added Tim.

Their decision was supported by Miranda’s boyfriend, Aaron Pavelko, and her two older brothers, Alex and Connor.

“I was telling my boyfriend, ‘I’m not going to do it,’” related Miranda. “He said, ‘You have to do it. It’s going to make you better. Do you want to live like this for the rest of your life?’”

By this time, Miranda was missing more and more days of school, and she was reluctant to go anywhere for fear of having a flareup.

“Her pain held us all hostage,” said Kris. “She’d text me, ‘Come pick me up. I’m in so much pain.’”

On the return trip to Rochester, the Tripps were finally able to put a name to the condition that had turned their lives upside down. After testing the nerves in her stomach, the doctor pronounced that Miranda had Chronic Pain Syndrome.

“When a doctor asks you to rate your pain from 1 to 10, if it’s a 1 or a 2 for you, it’s a 14 for me,” described Miranda, adding that it’s thought to be caused by extremely sensitive nerve endings.

A month later, in March 2012, Miranda entered the PRC for a three-and-a -half week outpatient program. The Tripps were able to stay at the Ronald McDonald House and took turns being with her and participating in the treatment.

“While she’s in there, the parents are also going to class, learning how to deal with it,” said Tim.

“It’s to teach her how to handle pain and what we can do so it doesn’t take over her life,” explained Kris.

The Mayo pain rehab program was one of the first of its kind in the world. Its team of health-care providers includes doctors trained in pain management, physical medicine and rehabilitation and mental health conditions; clinical nurse specialists; nurses; physical and occupational therapists; biofeedback therapists; pharmacists; nutrition specialists; vocational rehabilitation psychologists; chaplains; and other therapists.

“The team in the PRC uses a behavioral therapy approach to help restore physical activities and improve the quality of life for people with chronic pain conditions,” explains the Mayo website. “The program emphasizes discontinuation of pain medications.

“Mayo's pain rehabilitation program focuses on a comprehensive physical therapy program for people to improve overall physical strength and endurance to regain function.”

For Miranda, it was a revelation to learn that she wasn’t alone — other people her age were dealing with similar pain issues. She also learned that pain was not an excuse she could use any more to not participate in life.

“You learn there are only five reasons to miss anything: a fever above 102.8 degrees; profuse bleeding; unconsciousness; protruding bones; or suicidal thoughts,” she recounted.

Structure was a key component, with the patients assigned to complete chores and allowed only eight hours of sleep each night. If assignments aren’t completed, the patient learns there are consequences.

“If I sat there and complained about pain, there were consequences,” said Miranda.

“If you acknowledge pain, it makes it worse,” explained Tim. “We were never to ask her about her pain, and she was never to tell us about her pain unless it was a 9 or 10.”

“We had to let her know that we do care, but we were not going to ask her,” emphasized Kris.

Miranda also learned breathing and relaxation techniques to cope with the pain, and there were biofeedback exercises to learn to control her body. She also created a “Difficult Day Box.”

“You fill it with things that make you happy,” Miranda said, pulling out music CDs, cards given to her by other PRC patients, a container of play dough and other small trinkets intended to take her mind off her discomfort.

After graduating from the PRC program, Miranda was able to return to Worthington High School. The staff was enlisted to provide the support Miranda needed, the Tripps noted.

“Her teachers were told not to ask her about the pain,” related Tim. “If she needed to, she was to get up and go to a quiet area and get it under control.”

It was a big step for Miranda to be back in school regularly. In the year leading up to the PRC program, she had missed all or part of 60 days of classes, but she had managed to keep up with her studies, and now was able to get back into some activities, including attending prom. She weaned herself off the pain medications and relied solely on the coping strategies she’d learned.

“Before she went to the PRC, we didn’t know if she’d be able to go to prom or walk across the stage at graduation,” noted Kris.

“I got better,” Miranda said. “My senior year was going good, and I was in hardly any pain. I’d get little pain spurts, and I probably had a constant level 3 pain, but I could deal with it.”

A setback occurred, however,when Miranda was in a car accident in January 2013. She had pain in her neck and back and later into her hip and groin. Despite those issues and a regimen of physical therapy, she was able to attend prom again her senior year and graduated with her class.

Eventually, it was determined that she had a torn labrum (ring of cartilage) in her hip, which required surgical repair. By this time, she was enrolled at Southeast Technical Institute in Sioux Falls, S.D., so Kris lived with her for two weeks in order to facilitate her studies.

A few weeks ago, Miranda met her post-surgery goal of waterskiiing on Lake Okabena. In the fall she will return to STI, where she is studying to become an electroneurodiagnostic technologist. ENDTs use specialized equipment to monitor how well a patient’s nervous system is functioning, so doctors can identify and treat neurological problems. Her personal experiences certainly played a large role in her career plan.

“Somebody asked me, ‘What made you decide to go into the medical field,’” she related with a laugh. “I said, ‘Do you have an hour to sit down and talk to me about this?’”

As she reflects on the trials she’s gone through and what she achieved with the help of PRC, Miranda remembers thinking, “Why is God putting me through this?"

“I think one of the most helpful quotes was, “God gives his worst battles to his toughest soldiers.’”

Miranda knows there still may be pain ahead in her future, but now she has the weapons to win the war.

Daily Globe Features Editor Beth Rickers can be reached at 376-7327.

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Beth Rickers
Beth Rickers is the veteran in the newspaper staff with 25 years as the Daily Globe's Features Editor. Interests include cooking, traveling and beer tasting and making with her home-brewing husband, Bryan. She writes an Area Voices blog called Lagniappe, which is a Creole term that means "a little something extra." It can be found at http://lagniappe.areavoices.com/.  
(507) 376-7327
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