Like most couples that have been together for any length of time, my husband and I have developed our own traditions and routines. Some of these are annual traditions and others are small, everyday rituals.

Our first date was on New Year’s Eve afternoon for oysters and beer. Every year since then, on New Year’s Eve, we’ve gone back to the same little hole in the wall and repeated the tradition of slurping bivalves and suds. To this day he tells people that he was immediately smitten when he saw how much horseradish and hot sauce I put in the cocktail sauce for the oysters. (Actually, it was the infamous 3-inch high heels in the Houston airport a year previous, but that’s another story.)

Every evening (that we’re both in town), we have dinner together and we share goodbye kisses when we leave for the day.

There have been a couple of instances lately where Jack had to leave early and for some reason, it didn’t register that he had left. Even though he no doubt came in and gave me a kiss, it didn’t register that it was the goodbye kiss, and I would wander through the house only to find that he had gone. This may sound trivial, but after 13 years of goodbye kisses, it is a point of consternation. So now we have a running joke. When Jack leaves in the morning, the goodbye kiss comes with a disclaimer: “This is your goodbye notice. This is the last kiss before I leave. I won’t be back to give you more kisses until later today.” That way, I’m clear that he’s leaving the house.

So the end of last week, I did a pre-London check out blog post, saying it would be the last post before we left for our Thanksgiving trip. Then yesterday I did another post (no doubt confusing those of you who are paying attention).

So, in the essence of fair disclosure, this is your goodbye kiss/blog. I am leaving now. I won’t be back until next Wednesday to do another post. Have a wonderful, relaxing, joyful, fun Thanksgiving.

And thanks for checking in.

One of the very first things I can remember learning, even before how to tie my shoes, was to color within the lines of my coloring book. I found out very quickly that coloring in the lines made prettier pictures and a better result than scribbling all over the page. I also figured out that coloring in the lines meant I was a big girl. Some kids that would come over to play didn’t get to color in my coloring books because they were too young to know how to stay within the lines and I didn’t want messy pictures in my book.

That lesson has stayed with me all my life and I’ve come to understand that our society as a whole operates best when we stay within the lines. Even today I pay my taxes, wait my turn at the deli counter, and (unlike my husband who thinks those pretty white and yellow lines on the pavement are simply design elements) obey traffic laws as well or better than most people in Dallas.

Needless to say, some of my pet peeves are people who don’t color within the lines. You know, the ones that take an overloaded basket of groceries to the 10-items-or-less line at the store. And the ones that weave recklessly in and out of traffic at high speed only to expect you to let them into your lane so they can exit ahead of you.

Some diseases are well-behaved and actually color within the lines. For example, if you stay home and take care of a cold, you’ll get well in about 7 days. If you don’t, it takes a week to get over it. Three-day measles were aptly named because they last, well, about three days.

RA, like a spoiled child that scribbles the sky a Martian red color, is not one of those diseases. There is no predictability between one person and another. There is not even any predictability within a person — except that when you really don’t need a flare, that’s when one shows up.

So what do you do?

All of us have different approaches to the disease. I do what works best in the rest of my life. I color within the lines. I exercise even when I don’t feel like it. I eat well even though there are yummier things to be had. I take drugs that have as many side effects as benefits. And I see my doctor who tries to give me hope and always gives me compassion.

So this Thanksgiving, I am grateful that I have been given the 64-color box of crayons that include a wide range of options to treat my disease as well as a wonderful community of kindred spirits who are walking the same path I’m on.

I hope that you and yours have a happy and safe Thanksgiving and that you have wonderful blessings for which to be thankful.

Thanks for checking in.

We leave Tuesday, 11/23 for London for Thanksgiving, so this is probably the last post I’ll make until December 3, so I thought I’d give a brief update.

The mouth: If you follow the blog, you know that three weeks ago I went in for a root canal. Went back two weeks later to get it finished, but was still having problems. As it turns out, that molar had an extra root, so I got to get a second procedure done on the same tooth and go on antibiotics for a week. I called the dentist a week later (this past Tuesday) because I was still having issues, so he sent me to an endodontist. It turns out that not only did the original/first molar need a root canal, but the molar next to it also needed one. So now I have two unfinished root canals in my mouth waiting to finalize when I get back from London.

RA: The Simponi shot is still in effect after 10 days. I’m starting to feel a few twinges here and there, especially today as the weather is damp and cool. However, I’m hopeful that I won’t have issues in London next week because their weather promises to be even damper and cooler.

Stress Management: I need all the stress management I can manage (no pun intended). My life is overscheduled between now and Christmas and my boss just put two or three new initiatives on my desk, starting immediately. Means working all this weekend prior to leaving for London and working late/weekends after I get back, but I guess that’s why they pay me.

Happy Thanksgiving:  If I don’t get a chance to update this before I leave, I wish you and yours a happy, healthy holiday with basketloads of things for which to be thankful.

Thanks for checking in.

Another stress management technique (which I think is closely associated with STP) is making sure you’re solving the right problem — and at the right time. This is not as obvious as it sounds and it applies to both immediate and more long-term issues.

A few years ago my car was having electrical problems and one Friday morning I went out to go to work and the car would not start. My immediate reaction was to figure out how to get roadside assistance out to give me a jump or otherwise revive the car. Then I realized that the real problem was not the car, but that I needed to get to work. If I didn’t have someplace I had to be, having a dead car wouldn’t have been an issue. I managed to get a lift to and from the office, then the next morning (Saturday) when I had more time to deal with it, I was able to get my car into the shop and resolve the car issue. If I had tried to solve the car problem first on Friday morning, I would have been (at best) late for work and frustrated by having to wait for roadside service.

About that same timeframe, my step-mother, siblings and I were in a discussion about which nursing home we needed to choose for my father. He had Parkinsons and my step-mother was no longer able to manage the situation. Then we stopped and asked ourselves if we were solving the right problem. Did my father really need to go to a nursing home or were there other alternatives that would allow him to remain at home? Given the lack of elder-care services available in the small community where they lived, as it turned out, the best solution was to place my father in a nursing home. However, we made that decision with the knowledge that we first asked the right questions and were solving the right problem.

How does this apply to RA? Living with the disease means an increasing number of important decisions need to be made. Do I have to have surgery? What are the alternatives? If I have to have surgery, does it need to be done now, or will postponing it have implications good or bad? Is the medication treating the disease or is it treating the symptoms (pain)? If you’re having a flare and aren’t ambulatory, you have a number of issues to solve: managing/postponing those things you would be doing if you could as well as managing your care during the flare.

None of this is easy. However, having a clear understanding of what the real issues are, leads to better management, better results, and less stress.

Thanks for checking in.

I’ve done some interesting things in my life, but probably one of the most rewarding (personally and for others) was teaching a stress management class. This was several years ago, but the lessons learned through that process have served me well in the ensuing years. I am a type-A, micro-managing, perfectionist (rhymes with witch), which means I create a lot of my own stress. Learning how to manage that which I create as well as the stress that is thrust upon me, has saved my sanity over the years as well as probably avoided having me jailed for assault and battery. (Just kidding, my temper isn’t that bad, and I don’t believe in hitting people.)

Stress management techniques have also come in very handy as I not only deal with my day-to-day stress, but now also contend with the various medical issues that come with RA. There are some nuggets in the stress management course, and I thought I would share some of these with you in the coming blogs.

The first is STP.

STP stands for Stop, Think, Proceed, and it works wonders for mini-crisis management as well as dealing with longer-term issues. When a situation hits, it’s very human nature to react (i.e., run screaming out the door when someone yells fire). Many times that doesn’t result in the best outcome. It’s better to stop (take no action); think (make a plan); and proceed (carry out the plan). Even if it’s a short check list, any plan is better than no plan.

A few years ago, we hosted Thanksgiving dinner for various friends and had a full house. I had set the table the night before, which took a bit of effort squeezing everyone it, and it took every china plate and good silver setting I had. About 10:30 on Thanksgiving morning, when I was in the midst of cooking, one of the people who had initially declined the invitation called to say that he would be joining us after all. Of course I was delighted, but I had no place to put him at the table and I was already stressed to the max trying to get everything cooked and out of the kitchen on time. STP thinking to the rescue. I put my cooking on hold for a minute and quickly thought about what we needed to do to accommodate another guest. I then recruited my husband, who rearranged the table, found another chair, and gave my place setting to our newcomer. I ate off the everyday plates and mis-matched stainless, and no one was the wiser.

The thing that STP thinking does best, I think, is make you prioritize what really needs to get done and helps you with a plan to make it happen. In the above example, I didn’t need to make more food, but I did have to find a place for my guest to sit and eat it. It works with RA, because living with RA is all about dealing with priorities.

Several blogs that I visit have discussed the subject of dealing with a flare. I’ve been fortunate that I’ve only had a couple of times when I absolutely did not feel well enough to get out of bed. But when that happened, STP came in to play. The first thing I did was make a list of what I had on my calendar that day and figure out which ones I could handle remotely, which ones I could postpone or cancel, and which ones required creative handling. Then I added some planning on taking care of myself for the day — big jug of water by the bed, Tylenol and TV remote close by, etc. That done, I was able to effectively handle what I needed to, then focus on taking care of myself.

I believe that stress contributes to so many illnesses. The hormones it releases can create havoc on the body, and while I personally haven’t read anything linking stress and RA, there is evidence that stress can make you more susceptible to illness. Anything we can do in our day-to-day lives to reduce or manage our stress will go a long way in improving our lives and our health. So while you may not use STP to help manage your RA, try it in other parts of your every day life, and reduce your overall stress.

Thanks for checking in.

I just recently got a Kindle. For those of you who aren’t sure what that is, it’s a small, thin, electronic device sold by Amazon to which you can download thousands of books as well as subscribe to various periodicals. I like to read when I travel or am sitting in a doctor’s office (the only two times I get to read for pleasure), but I hate carting a book around. Worse yet, I hate to leave on a trip when I’m at the end of a book, because then I have to carry both the old one and the new one. My Kindle, even with its new black leather cover, is smaller than any hardback and lighter than most paperbacks. And the good thing is, if I finish a book, within a minute I’ve got a new one downloaded from Amazon. Cost of the books range from free to about $10 for NY Times best sellers.

You know what I like best?

It has a little button on the bottom that lets you change the font size.  That means I enlarge the type and I don’t have to wear my reading glasses. (smile)

I absolutely hate glasses, but I’m finally of an age where reading glasses are no longer an option. I’ve taken to wearing progressive contacts during the week at the office, but on the weekends, or when I’m otherwise not working, I like to give my eyes a rest from the contacts, so that means reading glasses.

So I guess you could say that my Kindle, like my glasses, is an assistive device. It helps me keep up with current fiction in spite of my failing eyesight. And it’s a really cool assistive device.

Rheumatoid Arthritis Guy (www.rheumatoidarthritisguy.com) talks about thinking of his sleek new crutches more as a fashion element than an assistive device. Although  like my Kindle they certainly are both. The difference is, my Kindle isn’t viewed as an assistive device. With my Kindle, I’m not an over-the-hill woman who needs her granny glasses to read. Instead, I’m an in-the-know techno geek with the latest gadget.

Now if they could just do something with the rest of the assistive devices in my future. Instead of canes and orthotics, perhaps they could invent some really neat jet-propelled or hover-craft shoes that would just let me zoom effortlessly wherever I wished. (Yeah, I know, still hung up on the shoes.)

Or maybe we just all need to work a little harder at perceiving those assistive devices as the super cool inventions they really are. I work in communications where perception is reality.  And like RA Guy, we (and others) need to see our assistive devices as marvelous inventions that open the door to freedom and self-reliance. They liberate us and save us from being condemned to a life of isolation and dependence.

So twirl that cane, scoot that scooter, and smile with the knowledge that you’re members of a secret club of true super heroes with more gadgets and gizmos than Batman.

Have a good weekend. Thanks for checking in.

I took my fourth Simponi shot yesterday afternoon. I have usually taken my injections (both Simponi and Humira) at the end of the day before I went to bed. I took this one at about 3:00 in the afternoon. It was amazing. I felt so bad before I took the shot. I hurt all over and the fatigue was awful. After I took the injection, I could literally feel myself feeling better. By the end of the night I was feeling better than I had the previous two weeks. The pain was greatly relieved and the fatigue had lifted. My joints actually quit sounding like a hailstorm on a tin roof. I was actually energized. This morning, the improvement had continued. While I had some morning stiffness, it was nothing like usual and my knees, which often wake me a night, didn’t hurt at all. I didn’t even notice them when I went up the stairs to my office this morning.

This drug truly works miracles for me. I just wish (1) it would last longer or (2) insurance would pay for more than one injection per month.

My next injection is due the same day I have my next rheumatologist appt., so she can see how little effect the drug has by the end of the month. Hopefully we can work something out.

In other news, we’re off this weekend to Phoenix for the NASCAR race, so I may not be posting for a few days.

Thanks for checking in.

Just a quick update. Be aware that if you’re going to try to get the H1N1 vaccination, it hurts like the dickens. I couldn’t figure out why the nurse asked me to take a deep breath, then blow it out slowly. It’s hard to scream when you’re blowing out your breath.

Dentist appointment didn’t go as well as one could wish. I’m home from work taking it easy this afternoon. Am going to take my Simponi injection in a bit, and hopefully that will help me feel better.

Thanks for checking in.

When I was a little girl, like most little girls (and little boys too, I imagine), I hated shots. I don’t remember them every really hurting, I just didn’t think it was right that I should sit still while someone stuck something sharp in me. One of those natural survival instincts, I guess.  I always swore I could never be a drug addict because I could never stand to shoot up.

When I was in elementary school, one of the kids in my school was bitten by a rabid animal. We were all grossed out (is that still a term?) about this kid having to take shots in the STOMACH. And guess what? The first time I ever had to give myself a shot was … in the stomach. After my hip replacement surgery I had to take two weeks of Lovenox (blood thinner) injections and the injection site was the fatty area around the navel (or at least mine has some padding). You can go back and read the blog — I didn’t like those either. They didn’t hurt, but I felt like an invalid every day when I had to give myself the injection.

This Wednesday I get lots of  injections. It is finally, finally time for my Simponi shot (again)! It’s been a miserable 10 days or so as the drug’s effects have worn off.

The second shot is my H1N1 flu shot. I have been searching Dallas high and low for one. I leave in two weeks for a trip to London. They’ve had their fair share of swine flu cases over there, but just traveling in a closed airplane for 10 hours each way, as well as being cooped on the tube and on buses, I’m sure my risk of exposure is going to be higher than it is driving in my personal car in Dallas. It takes a bit of time after you get the shot to build up the immunity and I’ve been getting a bit fretful that I wouldn’t be able to locate the vaccine. More than that, I’m a bit aggravated that there’s a major imbalance between the amount of doses than have been going to the free health clinics, and those of us with health insurance are having to wait. (You can tell what a great job the government is doing running your flu vaccinations — are you sure you want them running your health care program?)

Then it dawned on me.

For once, being female has its advantages. Being a woman, I have an OB/GYN. In fact I’ve had the same OB/GYN for longer than either one of us would like to remember. He’s known me for three out of my four husbands. Of course, OB guys have the vaccine because of their pregnant patients. BINGO! I called the doc’s nurse. Left a message including why I needed the shot even though I’m not expecting twins any time soon, and they came through with flying colors. They have a “few” doses left and they’ve put my name on one.

My OB/GYN is in the same medical campus as my dentist, so day after tomorrow when I’m over getting my root canal finished up, I can drop by and get the vaccination.

So I’ll get not one, but three shots on Wednesday (Novocaine from the dentist, H1N1, and my Simponi injection).

And this little girl who used to run screaming out the door at the thought of getting a shot, is very thankful that come Wednesday, she’ll be one happy little pincushion.

Here’s hoping that the little things in life that you need to make you happy come your way as well.

Thanks for checking in.

This post was going to be an update on how I’m feeling, etc. But when I sat down at the computer to start drafting, I bought a goat instead. I thought about a water buffalo, but there was just something about the goat that I liked. (If you think that’s weird, someday I’ll write about when I went out for some milk and came home with a new car. Seriously.)

I got a catalog the other day from Heifer International (www.heifer.org/gift). They provide farm animals to impoverished regions all over the world. A goat can lift a family out of poverty, provide milk for protein, manure for fertilizer, and baby goats that can be sold or used to increase the herd. There are gifts of all price ranges from a flock of chickens ($20) to a gift ark with a pair of everything (except the guinea pigs, rabbits and ducks — they come in threes for some reason). Or you can purchase a share of animals. A share of a goat costs $10. It’s nice to think that somewhere a goat is going to go to a new home just in time for Christmas.

I also ran across the following article indicating that there is a Chinese  herb that has shown to reduce inflammation in RA patients. I’m a bit wary of mixing supplements with prescription meds, but this is really fascinating:

(HealthDay News) — An ancient Chinese herbal remedy called “thunder god vine” helps reduce inflammation in people with rheumatoid arthritis, a new study shows.

The remedy is an extract of the medicinal plant Tripterygium wilfordii Hook F (TwHF)—known in China as “lei gong teng”—and has been used for centuries to treat a variety of inflammatory diseases.

The study compared reduction in joint swelling among people with rheumatoid arthritis who took either the herb or an anti-inflammatory drug.

Rheumatoid arthritis causes chronic and painful inflammation of the joints that, over time, can lead to joint damage and loss of function.

The 121 participants in the study all had at least six swollen joints. One group took 60 milligrams of TwHF root extract three times a day, and the others 1 gram of sulfasalazine (Azulfidine), a prescription anti-inflammatory drug, twice a day.

After 24 weeks, about 65 percent of those taking the herbal extract showed at least a 20 percent improvement in their joints, based on American College of Rheumatology criteria, a standard measure of the effectiveness of arthritis treatments. About 33 percent of those taking sulfasalazine improved to that degree.

A report on the findings is published Aug. 18 in Annals of Internal Medicine.

“This study is a reminder of the potential importance of supplements and herbs in the management of arthritis,” said Dr. John H. Klippel, president and chief executive of the Arthritis Foundation. Even so, the study involved a relatively small number of people, Klippel noted. Clinical trials for pharmaceuticals typically involve many more participants studied over several years, he said.

“The findings are encouraging, but [TwHF] is not likely to be recommended by rheumatologists based on the findings of this one study alone,” Klippel said.

And, though sulfasalazine used to be very popular as an arthritis treatment, the drug is not used that often today in the United States, according to Dr. Stephen Lindsey, head of rheumatology at Ochsner Health Systems in Baton Rouge, La.