Jessica is a 63 year old homeless woman who presented to clinic today for complaints of lower back pain that started four days ago. She does not remember a clear inciting event for the pain, and denies partaking in any physical activity that could have caused it (lifting heavy objects, sports, etc). She saw a chiropractor the day after the pain started for a correction, which had little relief. Since then, the pain has stayed the same in severity and location. Reassuringly, she denies any tingling or shooting sensations down her leg, and bowel/bladder problems that could indicate a more serious neurologic problem of the spinal cord. On exam, there is no pain on palpation of the vertebrae, but pain is elicited when she flexes at the waist, and there is significant muscle spasms in the bilateral lumbar paravertebral regions.
I remember from the last time we treated Jessica a few months ago that she had been in an unstable living situation, couch hopping from one friend’s apartment to the other. Today, she acknowledges little improvement of her living situation, and complains about the cleanliness of her friends’ apartments and the discomfort of their couches. In the context of her housing situation, the most likely diagnosis is musculoskeletal low back pain from lack of back support when sleeping at night. We provide her with some extra-strength Tylenol and ibuprofen for pain, and encourage her to increase her back support when sleeping.
The irony of the situation is that Jessica has her real estate license, and used to be in the business of high end rentals in Boston’s most prestigious neighborhoods. I do not know how she became homeless, as she is a highly guarded person with large fluctuations in her mood. What I do know is that so long as she remains a migrant with no power over her nighttime residence, there is little hope for improving her back pain.
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Carrie is a 76 year old woman who I also saw in clinic today. She became homeless many years ago after her husband passed away, and is a long-time Women of Means client. On top of many chronic illnesses, Carrie is plagued with recurrent MRSA skin infections, which includes most recently, an infection of her bilateral hands superimposed on top of her chronic eczema. MRSA, short for methicillin-resistant staphylococcus aureus, is a nasty antibiotic-resistance bacterium that can cause serious infections. While it was previously most common in hospitals, it is now rampant in community settings such as homeless shelters and nursing homes.
Carrie’s best bet at preventing further infections would be to transition into a stable housing situation. In fact, our dedicated nursing staff helped her qualify for housing nearly three years ago, but Carrie has been resistant to committing to an apartment, as she has long adjusted to shelter life. She has a daily routine moving from her overnight shelter to the day shelter, and a strong community of homeless women with whom she likes to commiserate.
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Jessica and Carrie are two examples of how lacking a roof over one’s head can be detrimental to the daily health of homeless women. At the same time, finding housing is not a quick fix, as women can have many psychosocial reasons for being homeless, including resistance to change.
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