Cold Turkey

In my office, I have a crate in which I put recycling. Everything from frozen food meal trays to paper to plastic gets tossed into the crate. When it gets full, I bring the crate home and empty it into my recycling bin. Nice and efficient.

Toward the end of March, after picking up breakfast at Dunkin', I removed the tea bags and prepared to toss the styrofoam cup into the crate. There was a slight problem.

The crate was full and most of it was Dunkin' styrofoam cups. I smushed these down to make room for another and, that night, took the crate home for recycling.

Dunkin' is quick and easy, but not the healthiest of breakfasts. I looked at this and was kind of floored by what this represented. There were 2.5 weeks of Dunkin' cups in here. Those you can't see are under the paper and plastic miscellany added to the crate. I can't keep eating donuts for breakfast. That's not, at all, healthy. And, in reality, stuffing the money for this habit onto my Dunkin' card is not good for the budget, either. I would have to start making plans to get up in time to make myself breakfast AND have the food on hand to make that breakfast.

I didn't realize how difficult this would be for me. Then, the Dunkin' I frequent made it easy. The owner of that store sold the franchise to another couple. All the people I knew in the store were let go. I walked in and the coloring contest, the balloons, the merchandise had been replaced. The people behind the counter were efficient, but they were not nearly as friendly. It was "get us in and out as quickly as possible" mode.

This made cutting back, way back, on Dunkin' for breakfast, much easier. There are two Dunkin' on the way to the office. I thought I would see how friendly they were. Not any better. They are bigger stores than the one by me, but the whole tone of these places, the whole atmosphere, is one of "get people out as quickly as possible". I added more money to my Dunkin' card back at the beginning of June. Normally, I would add something every month, but I have not had to add anything in July. I don't see I will use up what's on my card before next month. I have no desire to.

Part of me is sad. One of the reasons I had this habit was that I was recognized at the local Dunkin'. They took the time to get to know me, know what I liked. Yes, they did things as fast as possible, but a testament to a place is the line out the front door. Since the change in ownership, I haven't been to this place when there has been a line, even at the most popular times.

I needed to cut back on my habit. It was a crutch. I didn't have to get up with any speed because I could swing by Dunkin' to get breakfast. But, this was not a healthy obsession to have. While I could afford it, my budget is better off not spending $15-$30 per month on donuts. I miss the camaraderie with the people who used to work there. A friendly, "Hello" on a morning when I stumble in at 5:45 because I have to be somewhere by 7:00, always started my day off right. It's certainly not what I experience now when I choose to go there.

What's the aphorism? "The only constant is change."

Beverage:  Scottish Breakfast Tea

Deb

A Wee Touch o' Sadness

I was going through my photos on Flickr today, as I ate my lunch, trying to put a bit more organization to them. I still have a ways to go to get through some 6,000 photos taken since 2009, but I made a bit of progress. I stumbled across this photo.

Oh man. I remember this event. I went to the store and bought these beers, and a few others not shown, all of them of Scottish origin. Belhaven was, at the time, my favorite, but I'm thinking I wound up liking the Old Engine Oil best. I found the blog post which used this photo but it doesn't say how I liked Dark Island. I don't remember. Perhaps worst of all, I don't remember how any of these tasted.

Now, mind you, life changes on you and what you once took for granted can be gone quickly. With rheumatoid arthritis drugs in my body, my liver cannot handle extra things like alcohol. I will, on extremely rare occasions, drink a teaspoon of something, but when the choice is RA drugs or a damaged liver, I'm going to choose the drugs.

Still, I'm feeling nostalgic for the time I could look in the fridge and find a wide variety of Scottish beer. In 2012, there were times I'd be out for dinner and feel so awful about not being able to share a drink with friends. In 2016, I don't think twice about it. I've given away almost all the alcohol that was in my house. I have some unopened bottles of things in the basement. They are going this year. It's all about your perspective. Making this choice was easy for me, if the implementation was a bit hard. The photo represents a time in my life that was different. I'm happy with where things are now.

Beverage:  Raspberry Seltzer

Deb

Part of the System

This is going to be a bit of a rant. You're welcome to skip over today's post.

I had a CT scan of my colon to better help the gastroenterologist, now added to my health team, determine if I have problems related to the recent bout of diverticulitis. The fact that I have to add another doctor to my list of health care professionals is annoying enough. A double annoyance was the need for the scan. The insurance stepped in and sent me half-way across the suburbs to an imaging center not affiliated with my doctor. Their hours for scans were not conducive to my schedule and I had to be more than a little firm that I can't just drop my life for a CT scan for a non-life threatening medical condition. They were not happy but we worked out a time I could come. The technicians were very nice. The front office staff, not so much.

Now comes word there are cysts which need to be looked at. These require ultrasounds, two, to be exact. Fortunately, ultrasounds do not require insurance approval so I can go to the center I know and where they have hours conducive to working people. But I'm told the cysts are benign so I'm puzzling over the need to have the scans at all. "Because you have RA," I'm told, "we need to watch these things." Seriously?

And, speaking of RA, I'm supposed to be taking Orencia. While the Humira gave me pain-free days, it wasn't doing enough to stop joint damage, according to Dr. Francis. I felt fantastic, as you know, if you've read the blog for any length of time. To me, being pain-free is my number 1 quality of life issue. If the joints are being damaged, wouldn't I have pain, or is the Humira masking that? I don't know the answer to that question, but I'll trust Dr. Francis' judgement and try the Orencia. Might as well asked for the moon.

The pharmacy I had been using is not where the insurance sent me for the Orencia. The first contact with the new pharmacy was pleasant, but the gentleman giving me the hours they are open neglected to tell me the time zone. I had been dealing with a pharmacy in Atlanta. I knew their hours. Just saying you're open 8 a.m. to 5 p.m. doesn't help me. That could be Central Time or Hawaiian Time, for all I knew. Add to this, the amount of travel I've had to do and I'm not home much before 5:30, my time. Those days I haven't been traveling, I don't remember that I need to call this pharmacy because I have this thing called a "life" and clean underwear is more important than dealing with people on the phone.

When I do get in touch with them, I find out I have a rather large co-pay to get Orencia. There is no patient assistance for which I qualify. I'm directed to yet another number to see if they have anything.

Tests. More tests. A new doctor. New drugs. More phone calls. I feel less like a patient and more like a commodity. This is not how health care should feel.

I realize that, as one ages, more things start to simply wear out. It doesn't matter in what shape you find yourself. We're not designed for the same longevity whales achieve. There are more working parts to break. I also realize I have a chronic illness, an illness where my body turns against me. Add to that another illness which can have repercussions with my RA should I have another attack and we want to not have that. One of my friends, who has a number of issues said, "Welcome to the system. It doesn't hurt as much if you hand them your wallet and bend over." Graphic, to be sure, but perhaps not an all-together unfitting image.

I don't want more tests. I don't want to have to call 5 different places for drugs which may, or may not, let's be clear that we're not sure the Orencia is going to do what Dr. Francis wants. I don't want yet another specialist. I'm struggling with all of this because, until 2012, I rarely got sick. Honestly, I don't know how people with worse diseases than me handle a stable of doctors. I remember reading that people in the fire zones in California were told to pack up quickly and one woman grabbed her medications, all 17 of them. 17! I can't even imagine.

So tonight I have list of phone numbers, dates and times of calls and whom I talked to. I have another trip in the morning to finish up a couple of jobs and then, knock on wood, it appears there's a lull before crazy sets in again. I can stay in the office, work some overtime to complete reports and take an aspirin if my joints ache. We measure things on a "quality of life" scale. When I step back, my actual "quality" of life is good. I'd even go so far as to say "great". Yes, I have the occasional twinge, but who doesn't? I have no quarrel with the treatment I get from my doctors. They seem to be looking out for my interests, but I've always been a person who wants to go low on the medical scale. What's the lowest, cheapest thing we can do now, first, to see if it works? Then, if that doesn't work, we step up. Tests, tests and more tests. Changing drugs. Phone call after phone call is not the lowest, cheapest thing we can do. I feel sucked into a whirlpool I don't know I can get out of. That's my biggest frustration.

Beverage:  Water

Deb

I've Had Worse

Add another doctor to the list. I guess this is to be expected as one ages. Things simply start wearing out. There are doctors for this and doctors for that. Add a chronic illness and I've got doctors for X subset A.

The diverticulitis combined with the RA means a gastroenterologist needs to see me. For someone who, for years, didn't get sick, even with a cold, all of this is jarring. I don't know how I would do if I had cancer. Health care is the fastest growing segment of the economy and it never saw a recession during the Great Recession. Expansion of hospitals and the construction of buildings dedicated to specific illnesses on hospital campuses kept our office going. And, in adding this doctor to my list, I'm contributing to that expansion.

Prior to this upcoming visit, I needed a CT scan of my abdomen. The doctor needs to look at the diverticula and assess whether I have completely healed or if there is something still to worry about. You know what a full scan means? My choice of beverage is not my own.

Well, it's not the worst thing I've ever consumed.

I guess, in years past, it was akin to drinking ground chalk. I was to put it into the fridge and that was to make it more palatable. It was berry flavored which made the chalkiness less apparent.

I had to drink this full container the night before. That was tough. There's a lot in this. I felt full after I'd consumed half of it. In the morning, I could have a "light" breakfast, but when the technician couldn't give me an example of a "light" breakfast and kept vetoing what I proposed, I gave up the idea of actually eating before the test. My test was at 4:00 p.m. so that day was hunger-filled. As I was bemoaning my fate, I realized that some people don't get a meal every day. I needed to shut up and endure. We can be such babies sometimes, blind to the realities of other people's lives. An hour before the test, I drank 2/3rds of a second bottle and finished off the rest while sitting on the table at the image center. When I got home, I ordered a large sausage, bacon and double cheese pizza and ate 2/3rds of it.

I now have a CD for the doctor with images of my colon. They were going to write up a full report and send that to my primary physician. I don't know if I will hear about the results or if that will come from the specialist. There hasn't been another attack of diverticulitis, thank goodness. The worst thing going on, right now, is the sheer volume of travel I've had to do to get work done. That's making me tired and with excessive tired comes achy joints. It's nothing I haven't experienced before.

Another step down the road of health care. As good as I feel most days, this reminds me that all is not 100% and I need to be proactive to keep going.

Beverage:  Dr Pepper

Deb

Sunday Supper

After thinking about it for several weeks, I finally decided to make popcorn for supper. Popcorn, as a meal, has a long been one of my family's staples. I remember dad making 2 large roasting pans full of popcorn on Sunday nights. We'd watch Ed Sullivan and Hollywood Palace. Mom would buy a 6 pack of Pepsi and that would be Sunday supper.

Down through the years, popcorn has always been a meal preference. With the arrival of air poppers, we could make it without oil, which saved the need to shake the pan to keep the kernels from burning. I haven't done the shake the pan route in a very, very long time, but I'm pretty sure I could still manage, if I wanted popcorn and there wasn't an air popper nearby. I used to buy microwave popcorn, but always found the "butter" contained therein to be a horrible fake, overly greasy and not tasting at all like butter, substance. I finally quit buying it about 10 years ago, long before the concerns over just what was in the stuff surfaced. It does mean I don't eat popcorn at work, but that's okay, really.

I pop myself a nice big bowl of corn and add more butter; real butter, not fake butter or, horrors, margarine; than I probably should. Add more salt than I should probably be consuming and it's heaven.

But August came and with it that bout of diverticulitis. I heard from friends that popcorn was going to be on the "no eat" list. "The kernels get stuck 'down there'," I was told. This made me sad. I don't eat popcorn every week, as we used to do, but I will eat it one or two times a month. I used to have a cat who would eat a few bits with me, but these two aren't interested. Mija thinks it smells great but when offered a nice gooey, butter-covered piece, she gives me a look like, "You actually eat this?" I fretted that my meals with popcorn were over.

My doctor told me not to worry. "As long as you stay away from the little bits and those ones that aren't completely popped; you know, the ones that sink to the bottom of the bowl; popcorn is fine," he said. Still, I worried. Finally, the lure of popcorn overcame my worry. I know what the symptoms are for diverticulitis. If I start to have the slightest feeling of distress, I'm to contact my doctor right away. I decided to try a big bowl full of popped goodness.

So far so good. I did not eat the little bits at the bottom. I would have cleaned the bowl clear but felt I should leave those. Since I don't eat popcorn but once or twice a month, I don't think I have anything to fear unless I would be in the throes of an attack. I never want to go through an attack again and when I was hurting, food was the last thing on my mind. I think, therefore, I can return to having popcorn on Sunday nights. Now, if someone would have a variety show and a bottle of Pepsi, it would be just like it was when I was growing up.

Beverage:  Huckleberry tea

Deb

"Now is the August of my discontent"

In this soliloquy, which begins Shakespeare's "Richard III", he talks about the reversal of his family's fortunes. "Now is the winter of our discontent" is the exact line. "Winter" in this case, meaning the end of problems. We all know how the play, and the real life Richard the III's, life ended.

It's been a bad month for me. "Discontent" in all it's glorious meaning, is the perfect word to describe this month. So many days have slipped away. So many photos unblogged. There is, however, a reason. I came down with diverticulitis.

On August 1st, I went shopping with Pam. We had a glorious day of laughter and friendship, as we usually do. The next day, I thought I'd eaten something bad. It continued into Monday, August 3rd. I felt like I had the flu. Lots of sleep and on Tuesday, August 4th, I was tired, but I felt reasonably fine. That "reasonably fine" feeling grew ever more tenuous. It seems as if every other day was a bad day. Pain. Excessive tiredness. I felt like my abdomen was full of gas. "If I could just fart, I'd feel better," I would say as a wave of pain overtook me. Finally, self-treating didn't seem to be working and I went to the doctor on August 12th.

I was put on Cipro and Flagyl, two strong antibiotics. One of the problems with an infection is my compromised immune system thanks to the RA. I had to go off all my RA meds and carefully watch when I took my vitamins because they would counteract the Cipro. Unfortunately, one of the side effects of these two antibiotics and going off the RA drugs has been incredible tiredness. I finally gave up trying to remember when I took the Cipro so I could take the vitamins. Even little notes to myself would leave me perplexed. "Why does this say 8:10 and this one say 8:35?" Confusion is a side effect, too. I took to walking around the house with a note pad and pen, writing down what I was trying to remember. This went beyond the "Why did I come into this room?" This was an "I have no idea what I'm doing" memory issue.

Blogging was impossible. I tried, oh how I tried. There are a large number of photos to talk about. A month of photos has come and gone without a comment. I have missed me.

It took 5 days for the pain to subside. I've been off both drugs now since Saturday. I'm still tired, but I know that to be the cost of RA. I'm having twinges of pain in joints that were pain-free just a month ago. Heck, I was reveling in being pain-free. I need to mow the lawn now, after a month of not needing to do it. The idea now scares me. It won't be a 45 minute exercise. I may not be able to do it in one day. I feel I've been sent to jail and I have no "Get out free" card.

Through all of this, I've kept working. The pain wasn't so bad during the day that it interfered with work. It only got bad when I went home at night. I have been lectured about taking time for me. Perhaps I should have. I guess I'm of the mind-set that sick days are for when you're really sick and I wasn't into what I'd call "really sick" state. I did think I'd take this or that day off and then work would get crazy and I'd feel that I'd really inconvenience the office if I called off, so I didn't.

Depression set in. I have stuff all over my house, piles of stuff. I deal with a little bit but I wear out so quickly, that things don't get done and the knowledge that, just last month, none of this wouldn't be put away, mocks me. Even though part of learning to live with RA involves breaking tasks down into smaller, more manageable pieces, when I can't clean all the litter boxes because just doing one leaves me tired, that's minute pieces and even though that's what I should be doing, it depresses me when I can't do more without pain (because I'm off my RA meds) or getting overly tired.

There is a silver lining in all of this. My rheumatologist wants to change my RA medication. She feels the Humira was not stopping the progression of the disease. I measure progression by days without pain and I had a handful in July, before the diverticulitis. She measures it in a different way. So, having to go off all RA meds is good for her because we can go back to tweaking them. She wants to start me on Orencia, another injectable biologic drug. Unlike Enbrel and Humira, it's used only for RA. We're going to see if that helps. I'm not noticing any deformities in joints and, prior to getting sick, I could do a lot of things I hadn't considered before. I have another appointment for the diverticulitis on September 2nd and we'll go from there.

All of this has worn me down. I'm not eating properly or drinking adequate amounts of water. Pam had to come to my "rescue" and get me to Target to buy groceries so I would have things in the house I'd actually eat. Soup is my friend, but there are days when even that looks unappealing. I know this is a side effect and part of my brain says, "You need to eat." But the louder part says, "Shut up. She's tired. Go ahead. Sleep in the recliner." And, lately, that sleep in the recliner has involved a cat scan.

It's kind of hard to see her, but she loves to stretch out in my lap. When we sit, we can sit for upwards of 2 hours. If only the purrs of a cat would cure what ails me. Mija will often jump up next to me and demand ear scratches. With the two of them next to me, I can almost forget this set back.

It feels like I'm going up hill through molasses. I keep telling myself that the aches and pains are old familiar territory. I'm not nearly as bad as I was in 2012, when I first saw Dr. Francis and, once we get the infection cured, I'll be back on the drugs that help with the pain. Things will be back to "normal", or what passes for normal. It's just getting there that is the depressing part.

Beverage:  Water

Deb

Pain Free, Sort Of

Ah, the life of flexibility, when I can cross my legs while propping them up on my office desk and not wonder if it will take a crane to get down.

I've dealt with sciatica, an inflammation of the sciatic nerve which runs through your hip and down into your legs, since December of last year. It would flare up and then go away, depending upon how much I was moving. Aspirin would help, occasionally, but I can't take a lot of aspirin due to the other drugs I take for RA. By April, the pain was affecting how I walked, sat, slept. It hurt to roll onto my side at night to fall asleep. Sitting for a day at the computer, writing reports, was painful but getting up and moving around was worse. It just seemed to be a spiral.

Dr. Francis ordered x-rays of my lower back. I have severe arthritis in my lower back and sciatica. She ordered a regimen of physical therapy. A lot of people have PT because I couldn't get my first appointment until after I came home from my Minnesota vacation. It hurt. I have a bunch of exercises designed to strengthen muscles around my "core" and then around the hip. I found that as I did those exercises, the occasional problems with my knees eases. The pain eased. On one day, when I had PT scheduled, I was half-way through the day when I realized, I wasn't in pain anywhere, not my hands, not my feet, not my knees or hips, nothing.

That weekend, an amazing thing happened.

I mowed the entire lawn without a break, the whole thing, front and back, without stopping other than when I ran out of gas. I swear I filled the mower, but, obviously, I didn't. Not only did I mow the lawn in one pass, but I ran errands after a shower, all without pain. I decided I had earned lunch so I stopped at Culver's and brought it home.

I wound up taking a nap 2 hours after coming home from running errands, but, hey, I'll take it.

Since that weekend, I've had some achy days. The drive back from my vacation to Virginia was long. I didn't get a car with cruise control and I realize that's kind of key to my comfort. That may mean I have to pay more for a rental, but that's the way it goes. My left index finger is swollen in the morning and "clicks" when I bend it. I've had minor achy joints in both hands and my knees. The sciatica is back, but it is very mild compared to where I was when I walked in that first week of June.

You know what? I'll take this. It makes me happy not to have the pain I had in my joints. Is it all from the Humira and drug combination? Is it simply the result of physical therapy? I don't honestly know. I just know that I'm feeling better than I've felt since 2010 and these little aches are easy to dismiss. Dr. Francis is talking about a change in my medications so I'm hoping it will be a reduction. I"m okay with that.

Beverage:  Coca-Cola

Deb

With 25% More Energy...

...I can wrap 90% of my Christmas presents.

I shouldn't be surprised, but I am. Getting a full night's sleep without waking up once means there's more energy for things like wrapping gifts when I get home from work. I have one more box of stuff to go. There is a package missing, a flat that came on Tuesday. I need to find that. I remember bringing it in the house but where did I lay it down?

I love this wrapping paper. It's from Hallmark and it's one of their giant rolls. Hallmark wrapping paper is printed on the back with a grid for easy straight cutting, but I love this paper because I can use the design to not waste paper. I have a lot of small "wallet-size" gifts this year so I've had some strips left, but most of the time, I am spot on in paper usage thanks to the plaid. If I could find more like this, I'd be all over it. I use a paper until it's gone and then start on another roll.

The local grade school used to have a wrapping paper sale in September. The kids, and my daughter was one of them, would go door-to-door with books of paper samples. I always, always bought a couple of rolls, realizing that what the school took in from sales was maybe half of what I was paying. But the paper was good and heavy and they had some really cool designs. I think I got this roll about 3-4 years ago and it was, as I said, the big roll. I don't have a lot of huge gifts to wrap so paper lasts me a long time.

I'm waiting on a few more deliveries, but I'm done with my shopping. Yes, I did a lot of it via the Internet. For someone like me with endurance issues, Internet shopping is a godsend. Some things, like the books I'm giving, come from my local independent book store. Some things I've never seen anywhere. I might, if I had a shopping buddy, head into the nooks and crannies of local downtowns to see what I could find. Since I'm on my own, I shop online. I will wrap everything this weekend and package it for shipping. Monday you'll find me on line at the post office. Twenty-five percent more energy means I can last 50% longer.

I'll take it.

Beverage:  Dr Pepper

Deb

The Cost of Tired

I have been missing here for almost a month. The girls know where I've been and have spent a lot of time with me there. Bed. Struggling to sleep and get rested.

Since coming back from a quick trip to Virginia at the end of October, I've felt myself slide. It's not that I'm in pain. There isn't "pain" associated with my RA. It's more a case of a dull ache here and there, but a dull ache every day. Maybe it's the left thumb or the right wrist or my right shoulder or my left pinkie finger. It's never enough to say, "Oh wow. Does that hurt." I can work through it, but it's there. And please understand that I'm not trying to pull pity out of you. I'm merely recounting what's going on so you know where I've been for the last nearly a month.

One of the markers for RA is fatigue. It figures. Your body is fighting yourself, attacking your joints and your joints are trying to fight back. That internal war just wears out your body, making sleep attractive. RA sufferers are a tired lot and when it gets into the severe area, where mine is, fatigue is as common as sunshine.

Also, we have been extraordinarily busy at work. Since Labor Day weekend, we have received two projects requiring weeks of work in the city. Now, I love the city. I enjoy driving in. You've seen my photos of sunrise over Lake Michigan and over Chicago. I've had a lot of overtime and more is needed as I do the reports for the field time. But, when you suffer from RA, getting up early, working late, being on your feet as much as I have been, comes with a price. That price is added fatigue on top of what you already experience just in fighting the disease. I come home after 12 hours on the job, get the mail, sit in the recliner, add a cat and boom, it's 2 hours later and nothing's been accomplished. I pick one thing to do, say a load of laundry, do that and then I have to sit, which leads to dozing, which leads to, "I should just go to bed". It becomes a sorry cycle.

This can also lead to depression because you just don't have the energy to do anything other than what absolutely has to be done. I'm out of pants. I have to do laundry. Dishes pile up in the sink until something smells. Then, it takes 3 days to do them because I only have the energy for a couple loads. At least they are stacked on the stove. That's good, right? Not really. I come in the back door and have to walk right by the pile which reminds me that I need to do another couple of loads which I don't have the energy to do.

So, I make a conscious choice NOT to eat at night or eat something which doesn't need much in the way of prep time or dishes. Peanut butter  or turkey and cheese sandwiches have been my meal of choice. Frankly, I don't want to fix anything and I've gone to bed without supper many, many times in the last month because I'm too tired to even unscrew the lid off a jar of peanut butter, let alone cook the hamburger I took out of the freezer so I could make meatball vegetable soup. It's a great cold weather soup and it's reasonably easy to make, but not as easy as peanut butter on bread which is harder than just having a cup of tea and calling it a night. Yes, my doctor is not pleased.

I find that I spend much more money eating out. As you know, Dunkin' Donuts is a favorite place and it's been frequently a lot in the last month. Just this week, I've gone there 3 times. A couple of donuts and a large hot tea and I'm set for hours. I also frequent Panera but breakfast there is more expensive as their pastries are more expensive. Still, going to both frequently means I've earned free drinks both places, which does cushion the cost. I also have another person almost "trained" at Dunkin' as to what I get when I walk in. Let's not talk about the healthiness of this breakfast choice.

Lunch is also a conundrum. If I'm out in the field, I can justify having lunch expensed to the client. It's built into the cost of the work. But if I'm sitting at my desk working on reports or processing data, I have to foot the bill for lunch. Recognizing my tendency to take an "easy" way out of procuring food, I bought a bunch of frozen dinners and yogurt which could be grabbing in the morning and eaten for lunch. The operative word in that sentence is "could". When I get up with less than an hour to be at the office, even grabbing a frozen dinner and yogurt doesn't happen. So, when it gets to be 12:45 and I realize I need to eat lunch, it's off to Panera or Subway. There are a lot of choices near the office, but those are my go-to places and are far more healthy than a lot of the other places. With a hearty lunch, I can go the rest of the day without feeling the need to eat, not that that's a good thing, mind you.

All of this leads to feelings of inadequacy. I can't care for myself adequately. I look at the girls. Am I doing right by them? I have Christmas gifts I want to sew yet looking at the patterns stacked neatly on the table in the living room leaves me feeling exhausted and I haven't done anything with them. My house is dirty. I need to clean. The best I can do is sweep a room with a glance and try not to write my name in the dust. All these things I want to do get tossed aside because I have no energy. And let's not consider the cost of breakfasts and lunches out. Uh oh. That's a very real effect of not feeling that I can adequately care for myself.

There was a doctor's visit on November 14th. We went over all of this. You know how, sometimes, you don't feel you can tell your doctor everything you're going through. You're afraid that you'll be labeled a scaredy-cat or obstinate or who knows what else. I don't want to be thought of as a hypochondriac. I know people who fit this description and that's not what I want to be. But I've come to see that telling Dr. Francis everything, all the aches, pains, bumps, non-eating, bad sleeping, falling asleep at my desk at 10 a.m. leads to frank discussions of what's going on and what can be done to help me. She put her hand on my arm and said, "You have to stop trying to tough it out. That's not working well, is it?" No, it's not. I think I'm more tired when I try to simply push on than when I admit that it's not working. I find it so hard to ask for help, so hard to say, "I can't do this".

There was, at the end of November, an article in an online RA newsletter I receive which talks about the tired. That appears to be the number one issue people with RA report. Exercise can give you more energy, but you need a certain pool of energy to begin with to even attempt the thought of walking or running or swimming or, man, that makes me tired just thinking about it. The author of the article said we know we are tired so we, wisely, scale back our expectations. So instead of, "I'm going to clean the house", we decide, "I'm going to clean the bathroom". But, when we are fatigued, cleaning the entire bathroom becomes an exercise in futility which leads to a cycle of mental shaming and sadness. She said that you need to pare a project down even further. Instead of "I'll clean the bathroom", it needs to be, "I'll clean off the mirror", "I'll clean off the sink", "I'll wash the floor". Yes, this may mean the project goes from what you could do in 2 hours to what I need a week to accomplish, but this is what I have to do.

I also need to give myself permission to nap. I can't do it at work, unless no one is here and both the post office and UPS have made their deliveries. Then I can turn off the lights and snooze. But on weekends, I need to give myself permission to say, "I'm tired. I'm taking a nap" and to sleep however long my body tells me I need to.

I also need to give myself permission to admit that this is a struggle and that some days I will win and some days I will "lose". I need to stop seeing those days as losses and see them as adjustments in the road I have to travel. Not blogging has weighed heavily on my mind. I have hundreds of photos to share and have written thousands of posts in my mind as I drift off to sleep. I sometimes think that, perhaps, an iPad would be a good investment because I could write a blog post while I am in the recliner, with my feet up. But I don't want the cost of an additional item on my Internet service.

There has been a change in medications in response to this. I'll detail that in another blog post as this one is getting long. I don't know if the medication has made any sort of difference in my quality of life. Dr. Francis said it could take 2-3 months to see a change. She says this heavy fatigue will lift. You know, the recent end of November cold was rather energizing. I didn't mind it at all.

I also added back into my medications a nightly sleeping pill Dr. Francis prescribed. I thought I was tired enough that I could fall asleep without it, but that's not the kind of fatigue which promotes sound sleep. I found myself waking up two or three times at night. Fractured sleep is not good sleep. Since adding that back into my regimen, I notice that I'm not falling asleep during the day, nor do I need a nap when I come home after work. The brain fog one gets when one is overtired is lifting.

So, if you've stuck with this post this far, this is what's been going on in my life. I can't promise I will be better. I need to carve out time to actively post and my days and nights have been akin to mashed potatoes. Bear with me. Life is a journey and I seem to have hit a slightly bumpy stretch of road.

Beverage:  Dunkin' Donuts tea

Deb

Bubble Bubble Toil and Bah Humbug

It's that day again, the one day out of the year when I am certifiably cool because I am owned by a black cat. I used to be excited for today but, as I sit here, looking out my office window at precipitation-laden clouds, I'm about as amused as Pilchard is.

It could be because I was gone at the end of last week to be with my daughter. The original intent of the weekend was to be at the Central Virginia Celtic Festival and Highland Games. Since it was held in Richmond, that gave me an excuse to see her again. But I was weirdly affected by this trip.

My knees, on Saturday, were painful. Ironically, I got the most relief from standing. As long as I stood and could take my time to move about, it wasn't bad. But I can't stand for long periods of time so I had to sit and sitting without elevating my knees caused pain. I'm assuming it was related to my RA, but I don't completely know. I haven't had that kind of pain in years. Later, as I was getting ready for bed, I noticed my right knee was swollen and slightly discolored. It was gone in the morning, however. We wound up leaving the event early because I simply couldn't tolerate it.

My allergies acted up, big time. I got out of the car at my daughter's on Thursday night and my head instantly filled up. She said the weather had been cool and damp prior to my arrival. The weekend was impossibly beautiful with a wind on Saturday and a breeze on Sunday and highs in the upper 70's. The sky was clear and although the trees were just beyond their peak color, it was so pretty out. But, there wasn't enough allergy medication on the planet to keep my sinuses open. I have a cough now that can wrack my body and make my chest hurt. I know that this will pass but, man, it's not what you want to happen when you go visiting.

So, I don't want to be getting up and down all the time to answer the door. I don't want to open the door and dissolve into a coughing fit. Parents have no idea if it's allergies or the flu or a cold. Why scare them? And this allergy reaction has me tired. Being over tired leads to RA flare ups. I want to get better, not prolong this.

But perhaps my deeper reason is that it's not fun anymore. It feels like there is a great deal of pressure to pass out candy. It feels as if it's required. If you give something else, as I used to do, you run the risk of being called something unprintable to your face as you close the door. Why can't I give out pencils or stickers? I don't feel like contributing to nutritional deficits by giving mini-Mounds bars. I also don't feel like having left over bags in my house where I will eat them. If I'm going to have candy in the house, it will be 50% off holiday M&Ms. I have standards, low ones, but I have them.

I don't like that kids lean on the doorbell if you don't open the door within 3 seconds of the initial ring. I don't like that if I don't have my front light on, which has always been the standard for knowing which houses were participating, kids still stomp up on the porch and ring the doorbell. Then they stand there and ring it three or four more times. If there are more than one child in the group, over the age of 8, they all ring the bell. Would it be bad of me to disconnect the bell tonight?

This holiday terrifies the girls. It's always terrified all my cats, except Shakespeare. For some reason, he was never scared. Everyone else hid. I've got Pilchard, right now, asserting her irritation with me for being gone by peeing at the edge of the litter box. This is a known habit. I'll be switching this litter box out for a clean one and the availability of my lap will cause this behavior to go away over the weekend. Not having additional stress in her life would be very welcome for both of us.

Maybe it's because I'm older now and I'm not taking a little one around. Maybe I'd feel differently if I had an under age 8 who wanted to go out. I didn't drag out my minion costume from last year. The cat pumpkin I made still sits on the table in the living room. I love it, but I never did put it on the front steps with the spiders from 3 years ago, as I envisioned I would. I was too tired to decorate when I came home. Maybe if I simply felt physically better.

Whatever the root cause of this, I just don't feel Halloween this year. I have this big "back off" vibe going on. I just want to go home, make myself some hot cocoa and be all nice and quiet in my house, without stomps on the front steps and ringing doorbells.

Beverage:  Dunkin Donuts Tea

Deb

Trauma

I've been missing the past week because I fell. If you don't like to look at bruises, this isn't going to be a post for you.

If you're a certain age, you remember the "I've fallen and I can't get up" line which advertised an electronic monitoring system for seniors. I have had elderly friends all my life and the one thing they mentioned when they reached a certain age was how falling was a death sentence. Your body just never recovered. I vowed that I would never live my life being afraid to tumble. How horrible it would be to be that afraid. Having fallen in 2011 and then again in January, although that was into a snow bank, I suddenly came to the realization that I had reached the "scared to fall" age. And then I fell.

I was working. It was an inspection. The reception area had two kinds of ceilings, drop and drywall. I went to the location where the drywall ceiling was because, if there were any defects, they would be in that area. What I didn't know and no one told me, was there was a step up of about 3 inches. Everyone in the office knew it. The carpet was a dark green and black fleck. I looked around but never saw the step and it wasn't illuminated well. My foot hit the step and I tipped right over, landing on my right knee.

My right knee and I have a somewhat stormy relationship. I hurt it in the 1970's while crawling across the living room floor. It swelled up and there was a thought that I tore something. Those where the days when knee surgery involved slicing the thing open, seeing what was wrong, maybe fixing it, and sewing it back up. If you ever walked normal again, you had an "L"-shaped scar across the knee itself. The days of arthroscopic knee surgery were a decade away. That kind of surgery was not used for teenage girls who may have simply twisted something while crawling across the floor.

Over the years, I have had my share of skinned knees, twisted knees, swollen knees and bruised knees. When I fell in 2011, it never really bruised. It swelled but didn't bruise. Instead, fluid collected behind the knee cap to the point that walking was an exercise in endurance. Once I had the knee drained, I felt like I'd been given a new lease on life. Then things started to ache again and I worried, at the beginning of 2012, that the fluid was returning. Was draining going to be my way of life from now on? Nope, it was merely rheumatoid arthritis.

January's fall didn't cause trauma. I tripped getting out of the Jeep and landed, face first, of course, in one of the piles of snow from all the shoveling I'd done. Other than my ego, nothing was damaged. But I did start to feel that falling was something to be scared of. You reach a certain age and there is no "bouncing back". Any sort of elasticity you used to experience is not a part of your body anymore. The collision with the ottoman leaves a quarter-size bruise on your shin or you can't remember where you got that quarter-sized shin bruise.

I couldn't, after I fell, stop what I was doing, go to my mom's because, of course this would happen when I was out of town, and put ice on it. I had to carry on. I did dash to her house once I was finished and she has the most amazing dog-eared ancient ice bag that we quickly used to cover my knee. I raised it up and continued reading the book (reviewed below) that I'd brought along. The next day, once I finished the rest of my inspections, I filled the car with gas and drove straight home. I had grand thoughts of seeing my brothers after work, but the only thing on my mind was getting home to ice, ice and my own bed, where I could prop up the knee and the foot.

By Sunday, the bruise had spread all across the knee and down the leg.

On Monday, the whole knee was purplish blue. And swollen. Holy cow. Think cantaloupe size. I tried to wrap it, but discovered that I couldn't get my pants on over the wrapped swollen knee. I tried to elevate it at work, but the way my desk sits in my office, I have to twist my torso to do my work. My gait has been radically changed and my hips will ache at the end of the day.

Honestly, I did not think I banged it up as badly as I have. I had a regularly scheduled RA appointment on Thursday and the swelling was easing in the knee. The bruising was subsiding. I have always been able to bend the knee, although only to 50%. I had gone down the basement stairs only once, to get the clean pants I knew were there, but I iced and elevated when I could. I tend to sometimes be too independent for my own good. I should have, just this once, used the valet parking considering where I had to park in the lot to get to Outpatient Services.

My rheumatologist was very worried. An x-ray was taken along with the regular blood work that I anticipated. The x-ray came back with nothing chipped or broken. She was worried a hematoma had built up behind the knee cap but there's no evidence of that. She felt something squishy and tried to drain it. I was expecting something like the first time my knees were drained. Oh lordy, not by a long shot. This was excruciating pain. She got blood not that mustard colored stuff I'd seen before. It's bruised and it's slowly, slowly healing.

The other thing that happened was a bruise at the spot where my blood was drawn.

Now, I have had blood drawn for years, decades even, to test for any number of things. I do not remember ever having a bruise at the drawing site. Maybe it's part of the trauma my body is going through. I don't know. The bruise is about an inch long by a quarter of an inch wide. I'm kind of embarrassed by it but putting a band-aid over it only draws attention to it. I, um, don't have any "flesh" colored band-aids. It's minions or nothing. I'm opting for the nothing.

My doctor called an orthopedist who said I need to get a knee immobilizer and wear it for a week. I looked at this thing and thought, "What the...?" This is well and good if you are living with someone who can drive you to work, do the laundry in the basement because you're out of pants for work or go to the grocery because you happen to be out of detergent to do that laundry. I've never been able to teach the cats to drive and neither one of them likes crowds to begin with. I'm also not interested in spending $50 on something I will wear once, even if insurance might cover it.

The more I thought about this, the more irritated I became and the more determined I was to find a solution that worked for me. I went to CVS and found a stretchy knit brace. I can't quite get it over my swollen leg yet, but it will be fine once the swelling drops a bit. I have at least 5 ace bandages, so I wrap the knee in the morning with a couple of them. Icy Hot cream was recommended and I've used that not on my knee but on my hips. It helps ease the ache from sitting or walking "funny". This has been the best purchase, however.

This is an adjustable gel wrap made by TheramaCare.

Once this one gets expended, I'm going to get another to keep in the freezer, assuming I don't still need it. It's lightweight and has 4 pockets containing freezable gel. It wraps easily around my knee, applying cold where I need it. The minute you mention you need an ice pack, people tell you to use frozen peas because they will conform to the body contours. Yes they will, but I love peas and think that's a waste of a vegetable. This is more expensive, than a bag of frozen vegetables, but it won't turn to mush after the 4th freezing.

So here I am, one week from the event. The swelling and bruising has traveled down the leg.
I was kind of surprised it would do that but I was informed that's normal. My right foot is swollen and tomorrow I'm taking my slippers to work because I don't have a pair of shoes that I can wear all day and be comfortable. I went to the grocery and CVS and did laundry yesterday. Then, I slept most of the afternoon. I find that I am more tired and I'm not sleeping as well as I could be. The knee hurts at night and wakes me up when I roll over. I am meticulous about where I go in the house. If I have to get up, I make sure I do a number of things while I'm up.

My doctor sort of scolded me. "You have to be careful," she said. I was rather hurt. There was a slight implication that I hadn't been careful. I looked at her and said, "I didn't want to fall. I was careful. You think this is fun?" She looked at me and I could tell she realized that she hadn't phrased her comment correctly. I'm not sure she needed to even say this in the first place. It's not that I will go around trying to trip and fall. She patted my arm and said, "I know. I know. You are careful." None of us who have reached this age and have endured a fall would go out of our way to throw ourselves against the ground, even for a physics experiment.

This is where I have been the past week, nursing a badly bruised knee and leg. I couldn't have a cat scan because every time Pilchard jumped up on the leg, the pain was too much. She was her diva self so when I'd try to get her to lie down, she wanted to stand. I've been so frustrated, too, because there are things I want to get done, things I need to get done, like cleaning litter boxes, but standing on the leg is painful. I'm told it will take 6 weeks to completely heal. Well, I'm not wearing shorts until July, that's for sure. And then I need to get into a walking regimen which will help me bounce back a bit better.

Still, I have reached the age where a fall is a life-altering event. I don't want to fall. It scares me, really scares me. It's going to take me a bit to get over this, mentally as well as physically.

Beverage:  Dr Pepper

Deb

Noshing News

When I'm playing World of Warcraft, that's when I want to nosh. I don't do it when I sit in front of the TV. My hands are usually otherwise occupied. I'm cross-stitching, crocheting or petting a cat. Something about sitting down at the front of my computer with a beverage brings out the nosh monster. For one's health, however, this is not the best thing. That's why I tend not to have a lot of noshing foods in the house. I will eat them, all of them, in a couple sittings. Not good.

I sent a friend some candy goodies for her birthday. She should be receiving the parcel today. I filled a rather silly container with her favorite and some other silly things, but I overestimated just how big the container was. The Runts I bought wouldn't fit.

They have turned up next to the computer. Added to them were the rest of the Reese's Pieces that didn't fit in the container. The nice thing about Runts is that I can't eat a lot of them in a sitting. The Reese's Pieces look a lot like the Runts so I'm not eating them by the handfuls. This is a satisfying mix to nosh on while playing the game.

I saw these on the ThinkGeek.com web site, some time ago.

I can get lost in those pages for hours. This probably doesn't look like anything spectacular but here these are out of the foil liners.

If you know gaming, you will recognize these shapes as being the dice commonly used in Dungeons and Dragons or other tabletop pen and paper fantasy games. I got Carole a set and, well, had to have one for myself, naturally. They are made out of dark chocolate, 60% dark Ghirardelli Chocolate, no less. This is the ultimate in noshing.

The problem is that, as much of a chocoholic as I am, 60% dark chocolate, while good for me, is rich and I don't sit down and consume that wantonly. I've eaten the 4 sided die and it took me a couple sittings to do it. It's good, oh it's good, but these really aren't the "pop in your mouth" kind of dark chocolate one consumes when one is playing a game.

I discovered something else I would nosh a whole bag of, which also isn't a good thing.

Oh my gosh are these good. They are expensive; notice the package contains only 8 rolls. But fresh from the oven with a teaspoon of butter, they are heavenly. I can't keep these in the house. I'd make the whole package and that's all I'd eat some weekend. If you have more restraint than I, they get a huge thumbs up. I need to try them hot from the oven with jam, although that's not something I can eat in front of the computer. I did eat the last 3 rolls in the package while playing the game. I'm also willing to bet that they will be in scarce supply on Wednesday night next week.

Yesterday, noshers of the world rejoiced, just a little. There was a report, published in the New England Journal of Medicine, which stated that people eating a handful of nuts daily had a 20% reduction in heart disease, cancer and type 2 diabetes. That's a significant reduction. It didn't matter the kind of nuts, either. One handful, once a day, was enough to lower risk. Nuts are almost the perfect noshing food, but they are high in calories so must be consumed in a small amount. A "handful" translates into an ounce or 1/4 cup. If you actually measure 1/4 cup of peanuts, it looks like a lot and if you eat them one at a time, you can make them last a long time.

My friends know me quite well. Several of them sent me a link to the news reports of the study along with the comment, "The nuts you eat should be plain, not contained in the middle of M&M's."

Dang. There's always a catch, isn't there?

Beverage:  Huckleberry tea

Deb

"We are such stuff as dreams are made on and our little life is rounded with a sleep."

"To sleep, perchance to dream."

A good night's sleep to someone with RA can, sometimes, be an illusion. I have struggled, in the last 3 years, to find a good night's sleep. It didn't help that the mattress and box springs were old. Consumer Reports recommends you replace the mattress every 10 years. Well, um, yes. That's nice. There are so many kinds and brands out there that you can be overwhelmed trying to decide what to buy and the prices match that confusion.

I felt that a new mattress and box springs would help me handle my RA. Dr. Francis agreed, but warned that the usual 2-5 days of getting used to a new mattress will be longer for me. I just needed to remember that. So, I set up a mattress fund with the target of getting a new one Veteran's Day weekend. Why then? Because that's the weekend for mattress sales. There's probably some reason lost to the mists of time, but the best deals on mattresses is Veteran's Day.

The week before, I spent hours perusing every sale flyer I could find. I had no idea what brand I wanted. I had a budget and I wanted the box springs so the price had to include the set, sales tax and delivery. I eliminated anyone who would not set the thing up for me or haul the old set at least as far as the curb for free. It does me no good to have someone drop them off at the front door if I have to do the rest. I can't.

After a week of reading and rereading and searching through ads, I settled on Bedding Experts. First of all, everything that seemed to meet my needs was at or below my target price. Secondly, there is a store in Wheaton. Lastly, they haul away the old mattress and box springs. Although it would have cost me just one garbage sticker per piece, they recycle old mattresses and box springs so nothing goes to a landfill. That's worth it to me. Sunday, November 10th, I bought a new set and scheduled delivery for the 15th. I took the day off to make sure all the furniture was moved, the floors swept and the bedroom made ready.

The girls knew something was up.

When I change the sheets, I use lavender linen spray on the mattress and the sheets. Lavender promotes relaxation and a restful sleep. I rolled up the mattress pad I have had on this bed for at least 2 years and set it aside. I received it from a friend who was replacing it. Given it's age, I'm going to just toss it. The delivery people wouldn't take the pad.

That was the first sign that something was up. My moving out some of the things I have in the bedroom was another clue. No sheets on the old mattress was yet another clue. I swept the bedroom and living room floors. The final clue something was up was when I moved the love seat recliners away from the wall directly adjacent to the front door.

It's so funny when I move furniture. Cats gravitate immediately to the now open spot. "OOOH. Look at the floor!" But, it looks like any other part of the living room floor. When I do the monthly thorough sweeping, the one where I move their boxes and the rugs and the chairs and the other furniture to sweep around and under and behind, they have to check out the newly opened space.

At 1:15 p.m., the delivery men were here. I marveled at how one guy lifted the mattress onto a shoulder and carried it to my front door. The girls fled with the footfalls on the front steps and the unknown people in the house moving things around. It took about a half hour to bring in, move out and set everything up.

My new set. This is a Sealy Posturepedic.

The big question is how am I sleeping?

Dr. Francis was right. (She should be, but sometimes you think you know more than they do, but I digress.) I am slowly adjusting. This set is taller than the old set. That is wonderful. Instead of getting down into bed, I bend my knees and slide across.

Mornings are always, always, rough for RA sufferers. Doctors don't know why. We seem to have the most pain in the mornings. Because this is new, I'm feeling that pain. I needed to use a cane to stand up Saturday through Monday. Tuesday was just sore. This was in my lower back. Today, there was no pain in my lower back until I sat down for breakfast.

Friday night was rough. I don't think I got more than 2 hours straight at any given time. I tossed and turned. The tossing and turning has eased. Last night, once I fell asleep, I stayed asleep until morning. I still toss and turn to fall asleep as I have not adjusted to the bed yet, but it's better. I'm thinking by Thanksgiving, I will be used to this and will find a quality of sleep I have not enjoyed in years.

I spent a decent sum on this. However, this is for my health. Once I have adjusted, I will be very happy and I think it will improve my RA.

The girls have adjusted happily to the new bed. They didn't seem to have any problems falling asleep on it right away. Oh to be a cat and able to sleep pretty much anywhere.

Beverage:  Huckleberry tea

Deb

Into the System

I'm half-way between visits with Dr. Francis about my RA. It's been nice not to have to plan life around her visits. I do have minor flare-ups but I take it easy and, after a couple of days, it goes away. I sometimes get achy for, what I can determine, is no discernible reason but this is still new territory and will be for a couple more years.

What I have not counted on is the peripheral amount of time spent in various doctor offices having a variety of tests done under the guise of "maintenance". I remember having a friend who lives with a chronic illness complain about seeing yet another doctor. Today, I am saying I should be shamed for thinking to myself, "Just go. Why are you complaining?" I didn't know. I hadn't walked even so much as 15 feet in her shoes. I know now what it is like and I am not amused.

I understand the need to make sure you are in the best health you can be as you progress from one life stage to another. In my case, RA elevates your risk of heart attack. They do not know why, at this point, they just know it does. So, it does make sense to have a blood work panel done. And I guess it does make sense to see your general practitioner, the one who started this all, after not seeing him for 18 months. Yet, I'm really disliking all the people who are suddenly involved in my care.

My glucose and triglyceride levels are high. There is another doctor's appointment scheduled to address those. I believe it's because, at the time of the blood draw, I wasn't eating well. I'm eating much better and had the blood been drawn this week, I firmly believe the results would have been completely different. I'm going to push back on adding new drugs to the line-up I keep on the microwave. A drug is not always the answer. I think diet modification is the key here to lowering both of those numbers.

The nodules on the thyroid necessitated a trip to a specialist. "And why are you here to see me?" he asked. "I have nodules on my thyroid," I replied. He chuckled and said, "Who doesn't?", which made me feel that getting up at 5:45 to get to a 7:40 appointment with him only to be faced with filling out 8 pages of medical history, information that is available in my online profile to which he has access, worthless. I came really close to saying, "Why am I here then?" But he quickly added that, in my case, the nodules were at or over 2 centimeter in diameter which is grounds for doing a biopsy just to be sure. "95% of these are benign and of the 5% that aren't, the cure rate on thyroid cancer is 97%," he said. "I'm willing to bet your nodules are benign but we should look at them." Again, the word, "Why?" entered my mind. I realize, partially, that it is probably in my best interest to have this done but he only takes appointments from 8:30 to 1:30 and I refuse to miss work for this. I'll get it done on the end of my vacation, not an ideal time, either, but one that is better able to accommodate something like this.

I was asked if I have sleep apnea. Then I was told that my neck interior is a bit on the small side and my tonsils, which swell a little with age, were throttling my airway, probably making it tough to breathe. "I'm going to prescribe a sleep study for you. I think you should see about this."

Now, here's where I part company with the medical establishment. I have lost count the number of friends who have come back from a doctor's visit with the comment, "...and he wants me to have a sleep study." I remember, back in 2011, when I was being treated by an orthopedic surgeon for pain in my knees. He told me, "If any doctor tells you that you need your knees replaced, you come talk to me and you get two more opinions. I'm telling you right now, knee replacements are lucrative for doctors. I refuse to do it until there is absolutely no cartilage left in your knee and the joint is starting to deteriorate. Before then, it's just a money maker for a doctor. The rehabilitation for run of the mill replacement like that is excruciating and you are NOT a candidate for it." It was refreshing to hear such honesty and I wish this would come into play in the area of sleep.

Not all my friends have sleep apnea. I have friends who sleep deeply, friends who sleep lightly. I have friends who must have a completely pitch black room to sleep and some who can fall asleep anywhere at any time including broad daylight, and not because they are exhausted. They just have the capability to sleep wherever they are. I can't sleep well the first night I'm in a hotel room. It takes the second night for me to get comfortable with the noise and the feel of a different mattress. I can sleep like a rock or I can't get to sleep to save my soul. I'll have the weirdest dreams and the next night not remember anything. I have allergies and that contributes to snoring as does my weight gain. Sleep apnea, however...?

A friend who works in the medical field told me the usual treatment for sleep apnea, a C-Pap machine, is a lucrative money maker for a doctor or hospital. The sleep study is also a money maker requiring not a lot of personnel to watch the sleeper or to interpret the results. Therefore, I look at the sleep study in the same fashion as the orthopedist looked at knee replacements. If I really am having problems sleeping, waking up repeatedly in the night, feeling exhausted in the morning, then I may have a problem. Until that time comes, I am not interested in that kind of a study. Dr. Francis wants my eyes checked as that's where I first notice a flare-up; my eyes get very itchy and red. Dr. Burandt wants a colonoscipy. To me, these things are far more important than feeding the medical system for a sleep study. So, the next step is the thyroid biopsy. Then, when the results come back from that, I take the next step.

I guess, as one ages, more things simply start to wear out. Add a chronic or auto-immune disease to this and you find yourself in multiple doctors' offices. I'm still not used to the fact that I went from seeing the doctor every other year to seeing the doctor every four months and adding names to my list of physicians. I'm working on convincing myself that I'm doing what I need to in order to stay healthy, even if it does mean getting up at 5:45 in the morning for a 7:40 appointment.

Beverage:  Raspberry Seltzer

Deb

And Now For Maintenance

With the RA stabilized, it's time to handle all the other things that fit into this. I've had almost as many tests as I remember having during finals week in college. These are the kind I can't study for. I checked in with my general practitioner and everything was ordered.

Blood tests. One of the side effects of RA is an increased risk of heart disease. The best I'm given to understand, doctors don't know why RA sufferers have this increased risk but my cholesterol has to be monitored yearly, every 6 months if there is a concern.

Now, I have genetically low cholesterol. Heart disease does not run in my family. For that, I am eternally grateful. But the results showed a high triglyceride level. Sustained high triglycerides can be precursors of heart disease.

The other, perhaps more bothersome, result was high glucose levels. Sustained high glucose number are one of the markers for diabetes. Again, this does not run in my family, but diabetes doesn't seem to be a genetic thing unless your mother had gestational diabetes.

Still, I'm worried, to be honest. I think this is a diet thing. I have to admit that my diet is crap, not to put too fine a point on it. When I come home from work, I have an agenda, tasks I want to accomplish. Many times, those tasks don't include cooking something for myself. Hence, I'll grab the quickest, easiest thing to eat or, believe it or not, skip supper altogether. I always, always eat breakfast. I cannot imagine a day starting without some form of breakfast. Cereal. Waffles. Pancakes. Fruit and yogurt. Peanut butter toast and milk. Oatmeal with raisins and walnuts. I don't eat those all in one sitting, but those are my preferred items for breakfast. The day always goes well when I have breakfast.

After that, it's a crap shoot. I've been known to skip lunch or skip dinner. Then I get really hungry about 9 p.m. and I'll grab a bowl of cereal or crackers or half a bag of M&Ms. This greatly influences what shows up in the grocery cart. I look around the kitchen and have nothing to grab and eat. So, while shopping, I add 3 boxes of granola bars to the cartand then eat half a box at 8:30 p.m. some night because I was too tired to cook at 6.

I love fresh fruit and vegetables. But buying them and then preparing them to be eaten during the week are two different things. What looks so inviting in the grocery on a Saturday morning looks quite a bit different after I've dragged it home and shoved it in the fridge.

Moving on to other health items. I have nodules on my thyroid. These were seen last year in a CT Scan. I had an ultrasound of the thyroid and they are still there. One of them is large enough to have the potential for a biopsy. Now, so as to not frighten me more than I already am about this, I was told that if you pull 10 people off the street and ultrasound their thyroid, 8 of them will have nodules. It's part of the aging process. I'm told that I shouldn't worry.

Unfortunately, these nodules have to be checked and I have the name and number of an ear, nose and throat specialist to call. I just don't like the idea of having to take off work time to do things. I feel as if I'm inconveniencing the office when I can't get an appointment except at 1:30 p.m. I'm awaiting the results of the mammogram which should be normal and not require any further follow-up.

The next steps are to call the ENT and check into an appointment. Wait for word on the mammogram.  I have a follow-up appointment with my regular doctor to discuss the high glucose and triglyceride levels. The more I read into these, the more I realize that my diet is probably wholly responsible for the skewed numbers. I've done a lot of things just because I've had to, but this diet thing...I just don't know. Convenience and familiarity seem to win out, more often than not, over what I should be eating. If I were cooking for more than just me, I can guarantee that my numbers wouldn't be as askew as they are.

This doesn't feel like a set back. I have felt so much better than in the last two years. There are bad days, to be sure. I kind of overdid it over the holiday weekend and am paying the price in stiffness and soreness for that overindulgence. I'm looking at all of these things as shoring up my ship which has become leaky over the last few years. We fix these leaks and I'll be as close to good as new as I can be. At the very worst, I'll get to know some people at the hospital by name.

Beverage:  Blackberry tea

Deb

One Year, An Overview

It was a year ago that I received the diagnosis of Rheumatoid Arthritis. Thursday, March 29th, my world view shifted. I had a last glass of alcohol on Friday, March 30th. I started taking methotrexate Saturday, March 31st. It's been a process, with ups and downs. Where am I?

Well, Thursday, March 21st, I had no pain, none, nothing. No joint ached or gave me any pain. I've been dealing with very painful knees and they had nothing to say to me on the 21st.

I didn't realize I was pain free until about 9:30 in the morning when I came back to my desk from the microwave where I'd made hot water for tea. Wait. I'm moving freely and without pain. I had to actually think about it, take a mental survey of my body parts.

• Thumbs - okay
• Wrists - okay
• Shoulders - okay
• Hips -okay
• Knees - okay
• Ankles - okay 

Everything's okay and not hurting. Someone pinch me or something.

This has been my companion for over a year now.

I have used it to get out of bed, out of the recliner, off the floor when I've had to get down there to clean, go up and down the basement stairs or ever the deck stairs, and simply to stand up and get my feet under me to start walking. I have it hanging on the office door, but I have not used it since my flare up at Christmas.

Since early February, I've been going to physical therapy in an effort to strengthen the hip and upper leg muscles which will then help the knee joint. The cartilage in my knee is wearing, but it does that in everyone's knees. Eventually, you won't have any or it will be a thin strip and osteoarthritis sets in. If your other muscles are strong and as healthy as they can be, you'll avoid knee replacement or, if it's necessary, come back from the surgery much faster than someone without such healthy muscles. I try to do my exercises daily and no, I fail, but there are some I can do every day that help the knee. It paid off and was proof of what finding 15 minutes a day can do, last Thursday when I was pain free.

Do I miss alcohol? Sometimes. It seemed, in spring of last year, everywhere I went, there were advertisements for all the good beers that I certainly would try either because the name was interesting or because I knew the brewer wouldn't make something awful. And I couldn't have any of it. Now, I barely notice the bottles or the advertising. I still have bottles of spirits in the basement as I can cook with alcohol. The alcohol burns off in cooking, leaving the flavor. Beyond that, I don't miss it, not at all.

I get around just fine, although the whole point of getting the knees to work without pain was to begin walking for exercise again. I've learned so much about this disease and what are the things I should be doing to manage it. I take my pills. I consult with my doctor. I need to lose weight. One of the problems with RA is that it will increase cholesterol in the blood stream which can lead, as we know, to plaque build up in the arteries. I'm not genetically programmed to have high blood pressure so I would like to keep it that way. But when walking around the house just doing chores makes my knees scream in pain, something had to be done.

I hope, this year, to take real vacations, go places, see people and do things. I have adapted to a more limited mobility but my doctor believes that was just temporary. I have actually enjoyed learning about rheumatoid arthritis and how I can combat it. I should look into RA support groups, too. There is strength in numbers.

So, this new path I find myself on still has the same sunshine, the same cats, the same chores, the same places for gratitude as the old path. Nothing has changed and everything has changed. I find it's not about my physical limitation, it's about what I think I can't do. It's about speaking up when it hurts. It's about working together with my doctor and my body to figure out how best to make me the best I can be. If ever a year for gratitude in the small things, this has been it. The things that get me down are not from my health. And I have learned to be even more grateful for robins and sunshine and pencils and purring cats and clean underwear and frozen dinners and friends.

Perspective. I might finally have that.

Beverage:  Huckleberry tea

Deb

Understanding

My mom's husband, at age 81, has some health issues that come with slowing down and getting older. He's got one of those weekly pill strips and sits down to sort out the myriad pills that get taken at different times of the day. He really needs a full check up, probably with a doctor specializing in geriatric medicine but he has resisted, very strongly, the suggestion that he see one.

"I don't want to see another doctor," he argues. "I don't want to take any more pills." Now, never mind that a geriatric doctor could look over everything he's taking and make some decisions to reduce the number of pills. In his mind, it's a doctor and all doctors want to do is add to your pill intake.

The attitude never resonated with me until this month when the blood tests to gauge my rheumatoid arthritis were done. Although they only took 2 vials of blood, a whole host of things are looked at. I gave blood on Friday and on Monday afternoon, had the results. Everything was normal except my vitamin D levels. They were too low for my doctor's liking. I remember reading a study from the Mayo Clinic which said that vitamin D seemed to be necessary to the absorption of RA drugs as well as the easing the symptoms. The pharmacist where I fill my brown bottles feels that vitamin D is the newest "wonder drug" and will, like other vitamins, be downplayed once more studies are done. "Now, folic acid, well, you better be taking that," he said. At the time, I shook my just picked up bottle of folic acid.

I take a vitamin D supplement once a week, but that is not enough. I was to add 1000 iu to my daily intake. Suddenly, I understood the "I don't want to take any more pills" feeling. Above is Sunday morning's set. I take zinc. I take magnesium because it helps with calcium absorption from all sources. I take 4 methotrexate. I'm to take 8 over the course of a weekend, but taking all 8 at once upsets my stomach so I take 4 on Saturday and 4 on Sunday. That yellow pill is folic acid. On Saturday, I take a dark green gel capsule of concentrated vitamin D. Enter the horse pill, the glossy white long pill in the photo.

That's my calcium with 1000 iu vitamin D supplement that I have now added to my mix. If I were male, that pill would be smaller and would just be vitamin D. But, being female, I needed to get additional calcium to prevent osteoporosis, which is a problem in people with RA. Calcium is not absorbed very well when there are other things going on.

Another pill. I sat at the table looking at the line up. "I don't want to take any more pills." Even if I go to an injectable RA drug, I'm still going to have to take supplements and methotrexate. Nothing really gets eliminated, cut down to be sure, but not eliminated. For the first time in awhile, I felt rather depressed at this disease.

I remember, years ago, a spurt of press was given to the over medication of ourselves. We take a pill for this and a pill for this side effect and then another pill for that side effect. We were, at the time, the most over prescribed nation on earth. Are we still? I don't know. What's not shown is the pill I take for the tingling in my toes at night. It can be like you've spent hours sitting on your legs, cutting off the circulation and then it comes roaring back and lasts most of the night. I couldn't sleep. It's just in my toes and no other place. I have to have a reminder note because I have to take that an hour before bed. It has, however, allowed me to get a solid night's sleep.

Given all this, I certainly could be justified in saying I feel over prescribed. I know what everything is for and why I need to take it. The zinc helps keep my immune system, as compromised as it is, as strong as possible. I swear by it and recommend anyone take it unless you have a medical reason why you can't. I believe it's one reason I don't get sick as much as someone else nor does any cold I get last as long. Still, this is a lot of medication. I would really love to consolidate everything into one pill, but that's not possible right now. I keep telling myself that it's for my good, that it keeps me as healthy as possible. I try not to think about it as I line them all up on the weekend and knock them back, 3 by 3, with a nice glass of orange juice. At least, with vitamin C, I can drink it.

Beverage:  Lady Grey Tea

Deb

But Mooooooo-ooooooom...

...does I hafta come out?

It was check-up time at our house Thursday and Friday. I have now gotten used to the idea that I don't have to be at the vet every month or week. It's only taken 3 years.

Pilchard went on Thursday. It was good to do her first. She can't really hide in a place where I can't get to her. The second I pulled the cat carrier out of the closet, Mija was gone. Scotty couldn't have beamed that cat away any better. I still don't know where she went, but I think, based on Pilchard's behavior after we got back, she was under the bed for a time. I have to remember at the end of this year that the carrier needs to come out at least 48 hours in advance of the visits so they are lulled into a sense of complacency. (Is this the point I do my evil laugh?)

Pilchard, being the chunk that she is, is overweight. I have to restrict food and no more treats. I didn't know that wet food tends to be more balanced. Cats must have meat because they don't produce taurine, a vital nutrient. Dr. Zollinger said, the problem is that the protein needed to produce taurine doesn't work well in dry cat food. Dry cat food, while many are nutritionally adequate for cats, contains more calories than wet. It's just the nature of wet versus dry cat food.

I have to look at the kind that I'm feeding them. If 40% of the calories are from carbohydrates, it's not good. I will have to look at a different kind. It will be more expensive, but not as expensive as wet cat food. They do not really like wet although, with any change of food, you go slowly, mix a little with the existing and then, as they learn to eat it, the current food will be gone and they will be eating what you want them to eat. I have a couple of names and I know what to look for on the label. There's a chance that what they currently eat is within dietary guidelines. I can hope.

Mija is only a pound over the 10 pounds the girls should be at. But she was like that when I got her and has stayed at this weight. I know I have used food to placate them when I've felt guilty about having to be gone for an extended time. The no treats edict is going to be hard because they have me quite trained and I just bought a bunch. I guess this will last me a long time.

I have decided Mija will continue to enjoy the number of treats she currently gets. Pilchard will get two, period. And I'm going to stop giving them treats when I'm home all day. They don't need it and are happy with me showering them with attention.

Both got rabies shots so we are good for another year. They got distemper last year and that's a three year shot. We're good for awhile on that.

Next year, I should consider doing the senior panel on each of them. A cat is considered "elderly" when they reach age 7. Having a baseline on blood work helps diagnose anything that might come up.

I want to urge you, if you haven't already, to take your pet to your vet once a year. I could get a 3 year rabies shot but knowing I have to take them in every year to get that is good for me. It keep tabs on their health; are they drinking and eating okay, lethargic, dull eyes and coat, etc. A vet appointment gives me an extra measure of comfort.

Our pets give us such an abundance of love. We should return the favor and make sure they are healthy.

Beverage:  Lady Gray tea

Deb

2013

So January 1st of 2013 has dawned clear and chilly. We're actually getting January weather without the snow cover. I stayed up late and got up late and sort of feel as if I'm behind my time, as it were.

This is the day where we tend to look back wistfully at what we didn't do in the year past and then resolve over college football games, to be better. We're going to lose weight, be more active, call Aunt Mable or write Cousin Boris and what was his wife's name, read more books, you name it. Those resolutions last about 2 weeks and then, what was it I had resolved to do?

I'd like to be more active, I tell myself. I used to walk, everywhere. I still think about the times, in the past, I used to walk the 2 miles, one way (not uphill, barefoot or in snow) to work when I knew I wasn't going to be driving anywhere during the day. Sometimes I think, if I started at 7, it wouldn't be that hard to walk it. And then, I get out of bed in the morning and my knees complain and I shuffle down the hallway to the kitchen like the guy from the Dunkin Donuts commercial who said, "I got to make the donuts." Yeah, walking much more than down the block to the mailbox is hugely problematic for me right now. There is still no approval from my insurance company on my getting Orencia for my RA. Some days are worse than others, but it's not anywhere close to what I experienced back in February 2012. For that, I am grateful.

I'm told tai chi would be good for me to do, keep flexibility and promote movement. I know where I can go to take tai chi. It would cost me $55 and force me to be up and around on Saturday mornings. But try as I might, that $55 has eluded me. There is always something else in the budget that needs that $55 more than tai chi classes. It's going to be a rough January. I have expenses that I had budgeted for before the plumbing and the computer died. Things have to be pushed back into February. It's just the way it is. I am grateful I could fix things when they broke.

I try, every year, to make the ends meet. Life often has other plans. It can get depressing when you look over the bills and realize this won't get paid, this won't get paid, this won't get paid at least not this month. But I have a job and although we've seen a downturn in business, it will be okay. I'm grateful for a place to go on Monday mornings.

One of my friends said I should "monetize" the blog. With a click of a button, I can have ads at the bottom, side or top that offer you items based on what I type here in the body of the blog. If you read the blogs I link to on the side to the right, you'll see that many of them do that. "Oh here's something you might like" and there's an ad for quilting or crafting or whatever. Some of the blogs make a tidy sum doing that.

I thought about it and decided I can't do that. I want this space to be ad free, a place you can go without being assaulted by an ad for cereal or financial planning or craft supplies. You get that enough on the web. I'll not add to it. (See what I did there?) Whatever money I might get is not enough to get me to assault your senses with advertising. I'm grateful you come to visit and I want your stay to be a respite from the world, so to speak.

So, as I look back at the year passed, I realize my grand experiment in gratitude really did work. It didn't change the things life threw at me. It changed how I looked at those things. In the Christmas letter this year, I mentioned the RA and I received a great number of "Oh my! I am so sorry for you." I'm not sorry for me. My poor savings account was decimated by things breaking in December and the carry over will be harsh. I'm not sorry for me. I really want to take a couple of vacations this year, one to Minnesota to see Patt and one to Virginia to see Carole. Probably, that's not going to happen, but I'm not sorry for me.

I am grateful for what I have, all of it, from fresh strawberries for New Year's breakfast to friends far away to sunshine streaming in the windows, every last thing. I am grateful for it.

I have learned it really is about your mindset. It really is about how you view your life. I think I finally understand the curious comments made by people living far below my means, "God is good". How could they say that when the roof of their house is gone and they have no means to repair it? How could it be good when they have had a string of deaths in their family in maybe not so natural means? How could it be good when they just lost their job and have no prospects of getting another? I struggle with faith so this attitude was baffling to me. This year has taught me what they see.

It's about being grateful for what you have, even the tiniest thing. Every day there is something to be grateful for and that can be as simple as opening your eyes in the morning. I haven't always been grateful this past year. I know it and it's something I need to work on.

Therefore, I have no resolutions going into 2013. I'm going to continue to be grateful for what I have, the large and the small. I feel, for me, it all flows from that. Today, I am grateful for sunshine and fresh strawberries and hot cocoa and my girls. I'm grateful you're stopping by to read my blog. I hope you'll continue to come here.

Here's to 2013. May it be another year of gratitude.

Beverage:  Wild Huckleberry hot cocoa

Deb