Healthy for Whom? On Salicylate Sensitivity and Defining “Healthy” Foods

Walk with me into the grocer as I pick up some healthy items. Stroll right past the spinach, peppers, berries, and ginger. Continue past the vitamin and supplement aisles, and for good measure cruise right past the yummy teas and spices. Cross off the popular kids in nutrition: agave, soy, turmeric, spirulina, stevia, flax, guarana, chicory, monk fruit, quinoa, apple cider vinegar, fermented foods, yogurt, and whole grain anything. Reach over the dark leafy greens and select Iceberg lettuce and the white cabbage, not red. Pick up some white rice, heavens no — not brown rice, nor anything with a hull or seed. Skip the wine and the craft beer. And oh, those organic cosmetic products look soooo soothing, but wait — they contain resveratrol, aloe vera, willow bark, calendula, and rosehips. If you’re sensing a pattern here, this is what it’s like to live with Salicylate Sensitivity.
Healthy for Whom? On Salicylate Sensitivity & Defining “Healthy” Foods.Photo Credit: David Taffet
Nearly two years ago, I ended up in fight or flight mode in the emergency department with an allergic reaction. The culprits: a lovely strawberry and a popular new biologic drug. Television commercial actor Xeljanz (tofacitinib) for Rheumatoid Arthritis proved to be the catalyst that launched existing food and chemical sensitivities into the stratosphere (researchers, please take note). I had complete nasal blockage for four days, in which I could not draw air through my nasal passages and my blood pressure was low. I was sick with neurological symptoms for weeks: sunlight and breezes were uncomfortable, and my face was numb from forehead to chin. Long story short, I underwent multiple allergy tests including the blood-based ALCAT, and dozens of intradermal skin tests (single item injections gauging my tolerance level for each food). I was the one who connected the dots: the only thing linking items such as strawberries, almonds, and rose essential oil was the pesky salicylate. Add in a decade of known aspirin and NSAID allergy, and it suddenly made sense. Salicylates are chemicals that occur naturally in plants’ bark, leaves, roots, skin, and seeds that protect plants against diseases, insects, fungi, and harmful bacteria. They are also found in many medications, cosmetics, fragrances, household products, and preservatives. I have a history of unusual reactions to medications, foods, and chemicals, some going back to my teens. For the salicylate sensitive, the body rather reaches a lifetime limit and simply cannot process them. My reactions are often grade 2 anaphylaxis, and include: shortness of breath, facial and nasal swelling, lip, mouth and facial numbness, flushing, syncope, heart palpitations, lips peeling, nose bleeds, skin discoloration, rash, urinary urgency and tinnitis. An odd effect of salicylates (SALS) has been that my hands would clench for days, leaving me intermittently unable to straighten my fingers. This symptom had greatly puzzled my rheumatologist, along with my perpetual, tender rib inflammation that is not costochondritis. If you are an autoimmune patient, I cannot emphasize enough that you should consider possibly a food intolerance adding to symptoms.
Salicylate Feast: I am allergic to each and every one of these beautiful foods. Photo Credit: Ola Mishchenko
All of this underscores the fact that there is no one, true diet for each human body, and the word “hypoallergenic” is frankly, bullshit. “Healthy foods” is an oxymoron when applied to all humans. Our society is conditioned to believe that allergies consist of either: a) seasonal and dust mites, or b) the person who is at risk of death from often a single food allergy. There are far more types of allergies and sensitivities, and a host of possible symptoms. And yes, mine warrant that I carry Epinephrine. I am often asked what CAN you eat? The standard response is the Meat, Potatoes & Water Diet for the SALS sensitive. Actually there are variances in levels of salicylate content in each plant based food, and each person will have a different threshold. Despite reactions and exhaustive testing I myself have continued to question, can this even be real? The answer time and again is unequivocally, YES. In the interest of what food “should be” healthy, I have tried to push the barriers, and find myself with serious reactive symptoms, and increased systemic pain and inflammation. So how did this occur in me? The Oscar likely goes to Ehlers-Danlos Syndrome, and it’s supporting actors Mast Cell Activation Syndrome and Dysautonomia (often called the trifecta). My body simply reads things very differently, and hypersensitive reactions have nearly always been with me. I’ve had new doctors do an eye roll at my list of drug allergies, but more recently, the ER doctor brought the hospital pharmacist in four times to be certain their care was safe and adequate. I am under the care of an excellent allergist/immunologist who works with a number of Ehlers-Danlos patients who have mast cell disorders. Even she was surprised to hear that I could smell mold in homes from the sidewalk, and that I was even having reactions to the plain baking soda I used as toothpaste. Salicylate Sensitivity was new to her, to my rheumatologist, to my nutritionist, and it was new to the world-class, last resort allergy clinic where I tested. There does seem to be a number of SALS sensitive people who also have mast cell disorders, and a few who have Ehlers-Danlos. Again, researchers please take note.
Low salicylate, agreeable cauliflower, YUM!Photo Credit: Jennifer Schmidt
In the meantime, I am the girl who cooks with sea salt, fresh garlic, lemon juice, and technique to elicit flavor. I can get by with wee bits of dried spices, every few days. I can eat most meats, including chicken, beef, pork, lamb and shellfish, but am now allergic to fish, all nuts, most legumes, and every oil except canola. My staple foods are cauliflower, white cabbage, white potatoes, celery, shallots, figs, Bartlett pears, bananas, Golden Delicious apples, eggs, fresh dairy, limited wheat, rice, oatmeal and a lesser amount of carrots, onions, mushrooms, tomatoes, and watermelon. Coffee is high in salicylates, but I drew the line for my soul here, and enjoy two cups daily. I mean, I really, really enjoy them! If this were not enough fun, I also live with Mast Cell Activation Syndrome that leaves me incredibly sensitive to sunlight, to heat, chemical odors, and to that fragrance you’re wearing. Not wearing fragrance? Ask your dryer sheets, shampoo, hairspray or deodorant if they are. I am the girl who uses very specific SALS-free cosmetic and personal care products by Cleure, and a handful of lightly scented goods. If I were to eliminate all fragrance under my roof, I would have greater difficulty in public places. I am also the girl who tosses junk mail quickly, as the ink odor makes me ill, along with new fabrics, and many synthetic products — including my new hairdryer! The great irony is that I feel best when in the fresh outdoors — I simply do not suffer seasonal allergies, it is about ingesting plant matter. For this I have the greatest gratitude, as nature is one of my huge joys, and my solace. Having Rheumatoid Arthritis and Hashimoto’s also, I am in a bit of a spot medically. I can only tolerate limited medications, so it is a constant balancing, re-balancing, and a damn good bit of mettle. I adjust my sails and chart a new course. This life is not easy, but it has made me focus far more on life itself. There is so much beauty everywhere, and joy to be found or created each day. To that end, I am shifting my blog sails to focus more on interior design, and wild and bygone places that nourish my soul. Questions? Ask away. And I’d love to hear how you balance salicylate sensitivity, or your mast cell disorder.

Traveling Europe with Rheumatoid Arthritis – Lessons Learned

Sometimes you end up in the wrong city in a foreign country.  Like confronting the onset of Rheumatoid Arthritis, each situation requires a new language.  Testing positive for Resilience Factor is a plus.  As I wrote previously for Cure Arthritis, my husband David and I traveled to Paris, fulfilling a dream to travel abroad.  Just as in life, we had loose-knit plans, and were determined to live, laugh, and confront any bumps in the road together.

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After the 9-hour redeye flight, we were surprisingly alert arriving Paris.  The flight caused a good deal of pain and stiffness, but I was eager to greet this romantic city.  At Charles de Gaulle airport, our first task was to navigate to the Paris Metro.  A very kind French woman led us down the stairs, up the stairs, and around to find our transfer.  She spoke only a couple words of English, but her smiles and gestures communicated a beautiful welcome to France.

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The Paris Metro is an artful, historic wonder, but not very disability-friendly.  Traveling a mile or two requires multiple flights of stairs, and the system resembles an ant colony.  Finding the exit is often confusing, as Sortie (Exit) signs were sporadic.  We learned to simply follow the rush of fresh air.  Emerging on a sidewalk in the center of Paris was thrilling.  My hips, shoulders, and hands were in revolt, but I rolled luggage through the narrow maze of Paris streets to the oasis of our hotel.

We visited some of the usual sites, but were just as intrigued by the very texture of life.  Artistic detail is everywhere in France:  architectural, social, and culinary.  There is a constant forward bustle of activity, yet conversely, meals at cafes were protracted affairs, allowing time for conversation and observation.  Cell phones were scarcely observed.  It struck me that Parisians possess a brisk efficiency at the art of life.

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We planned our trip to be pedestrians, relying on the excellent train systems of Europe.  Despite public transportation, I logged as many as 6 miles per day on my Fitbit.  I cannot believe I was physically able to do this, but of course my body rebelled.  Given the difficulty with differing electrical currents, my therapeutic-grade heating pad stayed home.  In its place were menthol heat patches and a large dose of fortitude.  When the latter failed, we attempted to find a heating pad at a pharmacie.  Communication was difficult, and my only option was a hot water bottle.  Charming, but I opted out.  What was incredibly thoughtful is that each pharmacie is clearly marked with the same neon green cross sign.  Instant visibility and access when glancing down a narrow street.

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Waiting in line at historic sites was quite uncomfortable for my hips and ankles.  Still, I focused on the Now.  The Eiffel Tower is a staggering, romantic wonder of engineering, and centuries old cathedrals were alight with stained glass and collective emotion.  Despite strong will, Rheumatoid pain and exhaustion meant I simply had to cross a couple of must-do’s off of my list.  Just as I often do, I found other simple pursuits beautiful and enriching.

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Desiring to see more of Europe, we took advantage of the rail system and journeyed to enchanting Strasbourg and Colmar, France, and to Triberg, Germany, in the heart of the Black Forest.  We left Strasbourg on a pre-dawn regional train, with a transfer in Offenburg, Germany.  Having 5 minutes to transfer and not finding signage, we hurriedly asked a station employee walking past.  He replied, “You have 3 minutes!  It’s the red train!”  That’s when hilarity ensued.

I’m bumbling with luggage, the morning difficulties of RA, and boarded just as the doors on the red train were closing.  David asked two passengers, “Triberg?”  Yes, Triberg they nodded, despite being puzzled by the town’s spelling on our ticket.  Out of breath, we settled on the train and watched the morning mist rise across the rolling farmland of Germany.  Sublime.  Yet all along, I had a growing feeling that we were not on the correct train.  Then we pulled up at the Frieberg station.  Yes, Frieburg, which is pronounced “fry,” where Triberg is pronounced “tree.”  Huge crash course in foreign travel!

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There we were in the wrong town, luggage in hand, and me struggling with pain and stiffness.  So we went for coffee.  We sat and giggled over our predicament, and took the attitude that we’ll get there eventually, or we’ll explore Freiburg.  The clerk at the train station was able to re-route us on a couple of trains to reach Triberg, which is the home of the cuckoo clock.

At last we boarded the correct train, and then the movie scene played out.  The German conductor in spotless uniform and cap viewed our original ticket and queried.  We explained, and were fearful of being financially penalized.  Instead, he dryly replied in precise, but strongly German-accented English, “You did not take the most direct route.”  Lifting his brow, he traced our route in the air with his finger.

Triberg is a tiny, beautiful storybook town in the Black Forest.  The train station is more akin to a bus stop, and was situated about a mile from our little hotel.  Tugging luggage, I walked and rested, walked and rested, along the uphill route.  We checked into the quiet hotel and sat down in the attached cafe for a slice of Black Forest Cake.  The cafe was run by a lady whose manner reminded us of Mrs. Patmore of Downton Abbey.  The decor was straight out of grandma’s parlor in the nineteen-eighties:  brass light fixtures, mauve floral wallpaper, and artificial greenery.  We giggled over our cake when Jimi Hendrix’s All Along the Watchtower wafted through the cafe.  Followed by Frank Zappa.

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The most difficult day for me happened in Triberg.  Having slept on a bed that felt more like a hard box spring, every fiber of my body hurt.  RA seemed to be asking, what the hell are you trying to do??  I felt ill, and incredibly depleted.  However, I had a goal so I hydrated, put on cushioned socks, Birkenstocks, and my Cure Arthritis t-shirt.  The mountainside hike was fairly short, though quite steep.  My clogs were not the best footwear choice, but still are the most reliably comfortable.  I made my way up toward the waterfall, pausing along the way with nature photography.  The Autumn air was crisp, and we overlooked the village with plumes of smoke rising from chimneys below.  I reflected on friends for whom each step is difficult, and was filled with gratitude for my capability.

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Traveling with Rheumatoid Arthritis was made possible thanks to my biologic medication, steroid injections, opioids, fortitude, and adrenalin.  Opting for hotels as old as the 14th century, I balanced thrilling life experience vs. personal safety.  Navigating tiny, awkward bathrooms was difficult.  I also encountered stair railings that were build an age ago for people of shorter stature.  Cobblestones threatened to spill me forward, but I focused on the story they told.  Despite packing a small, capsule wardrobe, I’d do this again with half the items and fewer bottles of supplements and what-ifs.

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The single best decision was pre-paying for hotel breakfast.  I would stiffly navigate down the ancient stairway, and enjoy an array of French delights with fumbling hands.  Cafe Creme was presented with artistic flourish in warmed pitchers.  With a fussy autoimmune appetite, my favorite foods were farm-fresh yogurt and a delectable pastry, Pain au Chocolat.

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The greatest lesson of the style of travel was patience.  One of the tenets of Tibetan Buddhism is the “perfection of Patience.”  I fall so short, but this learning experience has had a profound effect.  Had I not traveled, I would have missed the wisdom of 16th century St. Francis de Sales, who observed, “Nothing is so strong as gentleness; nothing as gentle as real strength.”  As life would have it, St. Francis is the patron saint of writers and journalists.  Isn’t the world simply neato?

Appreciating IS in the Midst of Chronic Disease

What an absolute delight to learn that Dr. Carlo V Caballero shared my writing on his Rheumatology 2.0 journal.  Dr. Caballero is president of PANLAR (Panamerican League of Assoc. of Remautology).  Thrilling to see greater communication between the physicians who treat us and patients who live chronic conditions.
There is a soft breeze drifting through morning light, a dove fluttering by, the industry of traffic humming in the distance, and an insistent woodpecker hammers out his intent.  There is the man of smiling brown eyes I found so long ago, and his gently hilarious approach to life.  There is the good cheer and by necessity, calm industry of my tall son who has learned to live with what could be perceived as a limiting condition.  There is the friendship of my son and his bride across the way, who share creative pursuits and forward goals, while contending with the onset of disease. There is the love of my daughter and her bridegroom, a few mountain ranges away, living creatively in different sunshine.  There is the knowledge that this daughter is stepping down from tall mountains today, choosing to live fully in the face of what could be only debilitating disease.  There is the story of the friend who helped her reach the second mountain peak. There is the story of old friends who remind me of who I have been, and new friends living similar conditions, who remind me who I can be.  There are unspoken words of wonder, and the shifting mystery I find in studying Tibetan Buddhism. There is the wonder of gazing skyward at night, of looking forward to winter evening walks under a sparkling velvet canopy. There is the at once cautious and bold doe who steps out of our woods, watching us watching her, glancing back for her fawn.
Sleepless nights and difficult mornings followed by trying hours can easily dictate the chronic condition.  I prefer to appreciate the IS.
There is the simple act of kindness that touches another soul. There is laughter shared, truths exchanged.  There is the possibility of possibility. Always.  There is IS.

National Pain Strategy: The Opioid Crisis Truth

Page through a magazine, and you see the ads: gaunt, defeated faces of those destroyed by addiction. Rheumatology patients look much the same when pain is poorly controlled.

Given our family history in the trenches of autoimmune arthritis, I was asked to support, and blog about the National Pain Strategy (NPS) petition.  Well, I never take things at face value, so I decided a little investigative journalism was warranted.  I am in no way affiliated with the NPS, and opinions contained within are my own.

There are brilliant tools for pain management in the National Pain Strategy, and it is a thing of beauty to see acknowledgement of attitudes, biases, and patient stereotypes as barriers to treatment. On the surface, this seems a reasonable and broad-based approach to caring for patients in chronic pain.  In reality and practice, rheumatology patients are now bearing the undue burden of cautionary care.

Everywhere I turn, there is another news story hammering the Opioid Crisis.  At what point did chronic pain become criminal?  The NPS data focuses on drug abuse, yet most articles about the Opioid Crisis imply negative stereotypes for patients managing chronic pain. So often there is an assumption that patients with chronic pain do not pursue a holistic approach.  If I relied solely on my opioid for pain management, I would be miserable, depressed, and would suffer significant loss of motion. My use of meditation, yoga, walking, clean eating, and creativity is self-prescribed — with unlimited refills.
We’ve been lead to believe we have a champion in our fight for functionality. Instead, implementation of the National Pain Strategy is a bit of a sales job.  I recall Marge Simpson’s lesson in the fine art of sales:

 

“There’s the truth (shaking head), and THE TRUTH (big grin).”

Autoimmune arthritis patients are being lumped into this crisis purely by association with necessary treatment.  It feels as though we are under assault by legislation, medical personnel, the media, and society.  Truth is, we must hedge against ourselves in treating our unceasing chronic pain.  Each prescription bottle of opioids is a Hedge Fund:  balancing each day’s productivity against future physical activity vs current dosage and disease progression.

Despite the NPS acknowledgement that “74-96% of chronic pain patients use their prescriptions without suffering from opioid addiction,” rheumatology patients are suddenly hitting roadblocks in acquiring opioids to facilitate life.  Not existence, but life.
Earlier this year, my rheumatologist moved across the country.  I wrongly assumed his diagnosis and plan of management would carry over.  After reviewing my lab results, and a brief, clothed exam, my new rheumatologist declares my disease is under control.  Ah, thank the heavens!  I responded that my labs looked the same the day I was diagnosed with Seronegative Rheumatoid Arthritis.

She responded by reducing my opioid dosage by 60%.   And just for glee, my body decided to view all NSAIDs as allergens nine years ago.  The body was done with these, finis.  Try selling an NSAID allergy to a new physician.  I am most fortunate that my previous rheumatologist documented my reaction as a severe allergy.

The mission of the National Pain Strategy (full draft here) is a brilliant and reasonable collusion of physicians, researchers, and patient input. Yet somewhere between brilliance and reality, autoimmune arthritis patients are suffering.  We are forced to ration our pain relief.  In real terms, this means rationing our functionality as productive humans — both physical and mental activity is hampered.   People who have never experienced the pain of autoimmune arthritis cannot grasp the distraction of unrelenting systemic pain.

I’ve been puzzled at the sudden focus on this Opioid Crisis, and mused at all of the other public crises we could declare.  I looked into the sudden escalation of opioid prescription abuse, and it seems my hunch is shared:

Bob Twillman, executive director of the American Academy of Pain Management said the “new initiative is a fine idea,” but he’s more concerned with how the National Center for Health Statistics (NCHS) reported its data this year.
“It appears to me that illegally-manufactured fentanyl is being lumped in with legal prescription opioids, accounting for the apparently huge one-year increase in prescription opioid-related overdose deaths.”  He added: “I’m very concerned that this inappropriate lumping (assuming that is what is happening) could result in even greater pressure on opioid prescribing, further increasing the access problems we’ve been hearing so much about.” – Arlotta, CJ. White House: Opioid And Heroin Overdoses Are On The Rise (Contributor) Forbes.

I have to ask, what is the motive of declaring a crisis?  The bipartisan Comprehensive Addiction and Recovery Act (CARA) was signed into law 22 July 2016.  The act authorizes $181 million in new funding each year, which must be funded annually through appropriation.

In general, the mission of the National Pain Strategy is a brilliant and reasonable collusion of physicians, policy makers, researchers, and patient input.  Still, I have to ask:  who profits in the Opioid Crisis?  Clearly not the autoimmune arthritis patient.

We are on the front lines of a war in which our immune systems fired the first shot.

 

 

 

Motion & Stillness: Balancing Rheumatoid Arthritis (#RABlog Week)

RA Blog Week  topic du jour is Exercise!  The answer for me is a mix of physical and mental exercise.  As I’m fond of saying, there’s no right answer, and there’s no wrong answer for each of us.
When stricken with autoimmune arthritis, it’s easy to go into protective mode. Don’t move that joint, use those hands, walk on that ankle.  That simply could not be a worse approach.  Nearly three years into my battle, I’ve found the mantra of Motion Is Lotion to be a guiding force.  Our family physician in Alaska was fond of tossing this around.  Walk in his office beneath the Chugach Mountains, and this big guy might use some blue language, rough up your neck, adjust a hip, and emphasize that motion is lotion.  I’ve heard his voice so many times over the years, and especially now with RA.
As Rheumatoid Arthritis advanced from my hands to my wrists, shoulders, ribs, jaw, hips, toes, and ankles, the easy option would be to stop moving.  Instead, I’ve slowly tied my laces and headed down my country lane.  I’m a big advocate of fresh air and have returned to favorite hiking trails.  At my worst, I clocked a twenty-minute mile.  I’m especially proud of that.
After a slow walk in crisp air, on a very high pain day.  
 
I also use a recumbent stationary exercise bike, an inflatable exercise ball, and do (so far) seated yoga.  There are times that this motion will help ease pain, other times not so much.  I keep my focus on the bigger picture.  I recognize that at times I must be gentle with my body, and there are those moments when the couch is the right location.  Most often, the challenge of motion is what will care for body and soul.
Equally important to my management of Rheumatoid Arthritis is the concept of stillness.  As we all know, the emotional aspect of chronic illness is perhaps tougher than the physical.  There is no separation between the two.  A spiritual approach to pain management and chronic illness is a very personal thing.  I find comfort in the mix of Nature, attending a Tibetan Buddhist temple, and remain culturally Christian, being especially moved by the stories of the Catholic saints.
View from the meditation cushion this morning.
The stillness of meditation at times brings a literal physical lifting of pain.  I feel it rise and float away.  My soul is calmed listening to bird song, a sprinkler in the distance, feeling the warmth of sunlight on my face.  More often than not, mediation consists of bringing the mind back to focus, and thinking-not thinking about the pain of the crossed ankles and stiff fingers folded at my knees.  I’m a meditative work in process.
What works in your rheum?

RA: Master of Wisdom & Tomfoolery (#RABlog Week)

Several decades in, I thought I had life figured out.  Rheumatoid Arthritis has a way of screeeching perceptions to a halt, like a phonograph needle dragged across a vinyl record.

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A great master of wisdom (and tomfoolery), RA has taught me 5 things:

Patience:  The greatest lesson of Rheumatoid Arthritis is patience.  You must be patient through the worst days, the worst hours, and tough through the worst moments.  You must be patient with your emotions and allow yourself to grieve, but don’t forget to move on.  You must be patient when your pain is less, but then the tomfoolery of autoimmune exhaustion suddenly hits.  You must be patient with your family when they try to help too much, or the times they forget.  You must be patient with the general public, who can in fact be very general.  You must be patient with your doctors, nurses, technicians and staff.  Reserve your impatience for automated phone calls (i.e., free cruise to the Bahamas!).
Creativity:  Perhaps the greatest pain relief I have found is creativity.  I sit down to write, play with graphics, push paint around (poorly), or get lost in the meditative art of nature photography and I lose most perception of pain.  The minute I complete a creative pursuit, the pain seeps back into all corners, new tissues, and my psyche.  The real act of creativity will be to train my mind to live in creative distraction.  And I’ll happily take some NIH research dollars toward that effort.
Laughter:   Ah, that cliche.  Yet laughter truly is the best medicine.  There are are physiological benefits to laughter:  it raises the endorphins, relieves stress, relaxes muscles and eases pain. But the real benefit is the pure joy of life.  Our home is filled with laughter through even the worst of times.  The running joke is that we need to set up a Snort Jar:  mom pitches in $1 every time the tall chronic kid makes her snort with laughter.  I’d be wealthy in every way.
Forget the Impossible:  When RA struck me overnight, I was immediately aware of the simple things I could not do.  My perception was that I needed help with many simple tasks. This despite having raised a child with JSpA autoimmune arthritis since age seven.  There are few times she has distinctly needed physical help, and in such case it’s been to simply reach out and offer a literal hand up.  Sometimes that’s all we need, or we need to prioritize differently in a given day.  When your body fails, it is so easy to focus on the cannot.  I am still training my mind to simply do at my pace, and damn the results.
Friendship:  The physical and psychological realities of Rheumatoid Arthritis and any chronic condition hit hard.  A very difficult lesson is that old friends who are mostly healthy simply will not understand.  They may attempt to empathize, but bail when you mention a little thing like: I’m starting chemotherapy.  Silence often follows.  What I’ve had to learn is that there are different friendships for different aspects of life.  New friends in the chronic life community are my immediate source of comfort, solace, laughter, and most of all understanding.  Old friends remind me of who I was, and who I will continue to be if I allow myself.

Dear Otto(immune) #RABlogWeek

Here I am, mid-week.  And here you are, my unbidden companion.  Once again you have dictated the course of my days, my hours, and my energy.  I’ve had the best intentions.  You see, it’s the first annual RA Blog week, hosted by a delightful fellow named Rick Phillips who shares his writing at RA Diabetes.
I missed the first couple of blog topics this week, including the topic of energy.  Ironically it was this balance of energy that kept me from clicking the keyboard.  I awoke early Monday morning with ideas and goals flooding my mind.  This alone tells me that Enbrel has begun to work. Overall motion has improved, though pain levels remain the same.  Otto, you are still making your presence known in my hands, though the fingers will now straighten.  If you’d ease up on the jaw, the wrists, shoulders, ribs, hips, ankles, and toes, I’ll take you someplace nice. Realistically you’ve learned that I’ll take you anyway, because life is one big adventure.  Fresh air, architecture, history, and the sparkle of autumn light beckon.
Though the goals and motivations were there, Monday was a giant struggle.  To achieve that huge garage clean-up and gather donations for charity, require multiple talks with you.   Determination and pit stops carried me through this task that had been on my Tew Dew list for weeks (and a list is more fun when titled Tew Dew).  By the end of the day, I could barely walk and the heating pad beckoned.  Still, I forced the body to remain in motion and threw together a quick, healthy home-cooked meal.
Maintaining energy to prepare healthy food is vital not just for Otto and me, but also for my son. Before I developed Rheumatoid Arthritis, my young adult son became ill with Dilated Cardiomyopathy and Ehlers-Danlos Type 1.  Good nutrition has been a significant part of his health gains in the last four years.  As I always remind him, I need the motion, while his heart needs the rest.  And I’ve got a guy with Smiling Brown Eyes who loves my kitchen creations and we do so much for each other.

Tuesday passed as Tuesday’s will in any life, and especially in the chronic life.  Run here, run there, drop the truck at the mechanic, take chronic kitty to the vet, fight with unresponsive websites, then spend an hour on the phone with Enbrel and the mail-order pharmacy.  And complete all of this before the appointed Enbrel Hour.  Do that quick injection because there’s no time to be wimpy or squeamish.  Outwit the men at a game of Catan, take pup for a walk under the stars, and finally settle the Enbrel-hungover self into bed.  And will sleep to be mine. Otto, you won that game.

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The game that you will not win is the game of adventure and the pure joy of life.  I’m an old soul with a young play list, and I have places to go.  Otto, you carry a lot of baggage, so pack it — we are going places.  We’ll rest along the way and feel the cool autumn mist rise from a wandering trail.  We will savor the sights and texture, view old stone walls and fresh green leaves, hear the footsteps of generations.  Otto, pack your bags.
Love,
Jody

Same As It Ever Was: Chronic Pain

You may ask yourself…well, how did I get here?
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And you may ask yourself…how do I work this?

As a rheumatology patient, you know when you arrived.  If you’re lucky, you know where you are diagnostically.  With so many cross-over symptoms and comorbidities, the specific diagnosis is often less important than:  How do I work this??
 
Since the overnight onset of Rheumatoid Arthritis, figuring out how to work the problem has been foremost.  I approach any challenge in life with a calm bit of strength — though admittedly after a freak-out of variable duration.  My logical mind thought through how this changes my day to day life, my future plans, and how it affects my family and those who depend on me.  I needed to mentally set an approach for the long-term.  
What I am finding more difficult is how to cope in the short-term. The week, the 24 hours, the minutes of impatience with myself, with disease, and impatience then directed toward the world. Each moment in the rheum is one of “same as it ever was.”  Pain levels increase, or ease, stiffness varies, the clumsy hands and bumbling feet and ankles can be counted upon.  On days that I feel fairly zippy, fatigue or weakness can appear suddenly like a deep pothole on this rheum highway.
Into the silent water
Another day begins — at sunrise, or at the pain witching hour, and I again ask myself:  how did I get here?  In the worst moments I’ve learned to put myself into the silent water.  Float just above the surface in a warm bit of ocean.  Warm water laps and repeatedly curls softly against my cheek, providing a counterpoint to the insistence of pain.  Pain may not recede with the tide, but I’m in a better place and I feel the warm sand.

Same as it ever was…Same as it ever was…Same as it ever was…
Same as it ever was…Same as it ever was…Same as it ever was…
Save as it ever was…Same as it ever was…
 
This is each day as a rheumatology patient.  We have to remember this is our life.  What we cannot change, we have to work around, over and through.  Yield for rest when we must, but don’t forget to  follow that squiggly road sign.  Explore new ideas and new places literally or figuratively.  Instead of letting autoimmune disease dictate my every action, I’d rather ask:
 
Where does that highway lead to?
 
 
Once In A Lifetime” from the album Remain in Light, written by David Byrne,
Brian Eno,Chris Frantz, Jerry Harrison, and Tina Weymouth.

Cue The B-Movie, working title Rheumatoid Arthritis

Cue the dramatic music!  DUN-DUN-DUHNNNN!!!  Patients with autoimmune arthritis are living a drama straight out of a B-movie. Replete with villains, rivals for our attention, weapons, and passionate communication.  We live for those moments in the sunset.  The days we feel strong, and well.  We have those cliffhanger moments, but have to be the heroine of our own film, whispering…I can do this. I can do this.  Repeat until you’ve earned an Oscar.
Arthritis treatment is seldom singular, 
most often we’re prescribed The Big Combo.
Chemotherapy drugs & injecting ourselves is a chance we take.  
A chance at a better life.
(spoken rapid-fire, on a shadowy street corner)
We stab, poke, wrap, immobilize….
because this villain we fight is not of this Earth!
“It was a cool day and very clear.  You could see a long way — 
but not as far as Velma had gone.”
– Raymond Chandler, Farewell, My Lovely
 
A strong dame, Velma nipped the pain with a snap of her compact.

Yogagraphy – The Art of Meditative Photography

I crept about the flowers and prairie grasses, seeking the beauty of morning light and sun angles, and had a realization.  Not only is nature photography utterly meditative for me, it requires careful, measured movements, stretches and positions that I wouldn’t normally attempt.  From this day forward, I shall practice the art of Yogagraphy.  

 

Sipping a cup of French Roast, I hear the morning song of Cardinals, Chickadees, and Doves.  Sunlight tops the towering oaks, so I trade slippers for a scrappy pair of Birkenstocks and wrap my crooked hands around my Canon camera.   Adjust the tripod, and step into the butterfly garden beneath the Crepe Myrtle, which is raining tiny, sparkling dew drops.  Maneuver just so to catch the magnificent backlight illuminating oranges, purples, and greens.   Adjust the tripod legs higher, no lower, then let the front leg dip.  Fussy ankles and toes forget to protest.   Crane the neck and dip the shoulders to find a bit of magic in the lens.  

 

As I meander, capturing the texture and structure of nature, I feel very little pain.  Creativity does that for me.  Since the onset of Rheumatoid Arthritis over two years ago, I find that complete absorption in a project nearly erases pain.  As soon as I stop the creative project, I am fully aware of the pain that is present.  Quite a powerful lesson.  Live in creativity, or train the mind to function in this way.

 

Creativity is different for each of us, as are physical abilities in the face of Rheumatoid Disease.  Each of us has some form of creative spirit, and I do not mean artistic ability.  What activity captivates you and makes you lose track of time?  Or lose track of pain levels?  
 
Yogagraphy provides my greatest moments of peace and pain relief.  I am distracted by Nature.