Sun finally shows up after long absence

It’s an absolutely beautiful day here on the shoulders of the Northern California Sierra mountains.

Unlike yesterday, and last week, and the week before, and the week before that and

The Chinese lantern tree, really just a sapling still, is blooming for the first time this year.

– well, you catch my drift – the sun is out, there are no clouds, and by 10 o’clock this morning I’d opened every window in the house to let in the still-cool-but-rapidly-warming fresh air.

A walk outside with Finny filled my nose with the scent of lush greenery and, delightfully, flowers. The garden beds around the house are bursting with growth and blossoms, the earth beneath them moist from weeks of on-again, off-again rainshowers and, most recently, thunderstorms. The heather, some butter-colored daylilies, the roses andazaleas, the Chinese lantern tree and even our two Japanese maples are in bloom, along with many others that only Mr Wren, the master gardener, knows the names of.

We have two pairs of black-headed grosbeaks visiting our sunflower-seed feeders (one hanging outside the kitchen window, the other outside my den window) and, I’m guessing, nesting nearby. Both genders sing, which is a bit unusual, but fortunately they share a pretty song. And the tiny Bewick’s wrens that have made our garden their home for many years now fill the early morning and dusk hours with their exquisite singing. This sunshine must feel so good to them.

I watched a little nuthatch work sunflower seeds through openings in the bottom of

It's not a great photo, but here are one of the pairs of black-headed grosbeaks, chowing down as the sun sets. The male is on the left side of the feeder, and the female on the right. With them are a couple of house finches. Usually, the grosbeaks chase them off, so it was nice to see them sharing for a change.

the kitchen window feeder this morning; he did the job clinging upside-down, as nuthatches are wont to do. Once he had a seed in his narrow beak, he fluttered up to a wooden crosspiece on the arbor, where he went about cracking it. Nuthatches are primarily insect-eaters, so they have a short, very thin, pointy beak, perfect for sticking into cracks and hidey-holes. To eat the sunflower seed, though, this little fellow had to peck at the hard outer shell furiously until it broke. It took a number of tries, but he did it, and after eating the tender seed, he zipped back down to the feeder – and his gravity-defying position – for another. I was enthralled.

Although I’m a cool-weather person (and the rare Californian) who enjoys rain, I have to admit I’ve been getting pretty tired of it lately. We’ve had very few sunshiney days this spring. So few, in fact, that our raised beds haven’t yet been built and our vegetable gardens, which I was so looking forward to, haven’t been planted. And it’s been downright cold; yesterday I built yet another late-season fire in the woodstove to warm the house up. The last time I can remember doing that in May was in 1998, the first spring we lived in this house and, yes, another El Nino year.

Only Mr Wren knows the real name of these, but I call them "butter lilies." Fits, doesn't it?

If it stays clear and sunny, we’ll get busy on the gardens again, finally, but it means that my tomatoes, eggplants and beans (all my favorites) will produce very late in the season. Last year was also an odd growing season with lots of cool, overcast days. By the time my roma tomatoes finally started ripening, it was mid-fall and the weather was turning chilly. The plants ended up dying, still loaded with unripened, green fruit.

So while it’s had an iffy start, I hope this summer will be more normal, with plenty of bright, warm days. Even then, though, I’ll be lucky if my tomatoes ripen before autumn arrives.

Today’s sun and fresh air was so nice, I got all jazzed up and cleaned the house, reaching up to the ceilings with my broom to sweep down all those cobwebs I couldn’t see before in the gray gloom. I vacuumed and dusted and mopped and window-washed, singing along to Simon & Garfunkle’s Greatest Hits on my iTouch. It was fun – I haven’t really listened to that album in years, but I knew all the words to all the songs.  I guess I’m showing my age.

When I went up to the mailbox around noon, there was an envelope in it from the veterinarian. I opened it – and found a sympathy card for Logan’s passing, signed by the vet, her techs and the office staff, each with a short note of condolence. I was so surprised and touched, I started blubbering.

Finally, I stepped on the scale this morning and was pleased to see that I’ve dropped a couple more pounds. This was a triumph! I’ve been stuck at 170 for several weeks in spite of being very careful of what I eat, so I was getting a little frustrated. It’s funny, though. Even though I was stuck, my clothes were still getting a looser and my waist (I have a waist again!) a bit more defined. I can’t tell you how much that pleases me. It makes the effort – the daily mindfulness – so worthwhile. I’ve got a ways to go before I’ll need smaller clothing sizes again, but that’s all right. It’s just nice to know that I’m getting there. I’m really going to enjoy being slim, and as I resume walking and some resistance exercise, being more strong and fit, too.

Have a lovely Sunday, everyone.

bravehearts

Kris’s post, Inventory, on her wonderful blog Letters from the Breach, got me thinking last night.

This is a good thing. I like to think, but I don’t do it often enough. Or, at least, not with enough conscious effort and careful consideration.

In Inventory, Kris wrote about the things she used to be able to do before she was diagnosed with arthritis – things she can’t do now without difficulty, or at all. She talks about grieving the “old me,” and how listing her losses has helped her to accept the changes in her life and move on.

This struck me as very wise. Kris is doing this very early in her experience with arthritis (she’s been diagnosed for just about half a year, and her doctors still aren’t sure if it’s rheumatoid or psoriatic arthritis; both types cause awful joint pain, fatigue and disability). I’ve had RA for more than 22 years, but I’ve never really thought hard about what I’ve lost to it.

This could be because even in the beginning, I simply adapted my activities so that I could continue to get on with things. It never occurred to me to do otherwise. Honestly. No one told me about the crushing fatigue that so often goes hand-in-hand with RA; I thought I was wiped out because I was so busy! Or because I was so busy and I was hurting. I made the connection between constant, debilitating pain and being tired, but that was it.

My day started with a hot shower, often taken while shifting from foot to foot because the soles of my feet were so sore it hurt to put my full weight on them, even after sleeping all night. I’d get myself dressed, my hair done and my make-up on. I had one pair of old, black patent leather pumps with low heels that became my go-to shoes for just about everything. I’d get my small daughter, Cary, ready for school, giving her breakfast, making her a lunch to take with her, helping her gather up her schoolbooks and get everything into her backpack, and then whisking us both out the door for the day. Cary would walk to the Department of Defense elementary school two blocks away, and most days I’d walk to the bus stop to catch a German city bus for the American Army post 8 miles away. And oh –I almost forgot. We had a wire-haired dachshund, Max. He needed his walkies every morning, rain or shine, whether I was hurting or not. Before we left for the day, I’d walk him around the block, usually limping behind him on the leash and cussing my flared toe or ankle or knee with each step.

Some of my work days were spent at my desk in the office, writing, making phone calls, writing some more. Other days my job required that I go out to interview people and take photos. I was a writer-editor for the U.S. Army Public Affairs Office in Northern Germany. We wrote and published the post newspaper, and it was a big area to cover. There were many days when I did my job while limping badly from a flared ankle, or while coping with a shoulder that was so painful I couldn’t lift my arm. I took notes with fingers that screamed with pain as I held the pen and wrote – and then had to try to decipher my own hen-scratchings later on. I went out to the field with the soldiers, interviewing and writing about them as they trained for war, blowing up Claymore mines and “shooting” at each other with electronic guns. I took photos of them, hoping that they’d turn out well in spite of my awkward, painful hands.

In short, I adapted to the attacks of my rheuma-dragon. Of course, there were days when I was in far too much pain to adapt to anything, and I’d have to call in sick. I hated doing it. But I was very fortunate: my supervisor and my co-workers were extraordinarily understanding. They saw me frequently walking with a cane, or limping, or holding my right arm against my chest as I tried not to move my shoulder – and working in spite of it. Kind people. Good people. And in return for their compassion I made sure that I always got my work done, well and on deadline. Whatever it took.

This wasn’t heroism or bravery. It was no more than what anyone with RA does. We do what we can, we live as best as we can, and we fill in the blanks as we go.

I wonder, really, what I couldn’t do because of RA. I have to think hard about it. It could be that I’m blanking out the bad times, too, but I don’t think so.

There were a few times when I had to bow out of taking long bike rides on weekends with my friends. We all loved riding along the dyke that ran the length of the northern coast of Germany: the North Sea on one side, the green farmland and coastal plains on the other; the thatch-roofed houses and farmyards; the little villages that sparkled on a sunny day. Still, it was always hellaciously windy and usually cold. Sometimes I just couldn’t face it, or one of my joints was flared badly enough that peddling the bike or holding onto the handlebars would be impossible.

And there were times when long walks were off the schedule, too. I loved walking to the big city park that was a quarter-mile from my flat. It was filled with trees and paths; one could easily use up a day just wandering around it. But some days my feet or a knee or a hip was just too painful. So I stayed home. Rested. Did what I could do instead.

What I remember about those years are the things I did in spite of RA. I can only shake my head at myself – I’m not sure I’d have the same gumption, or the same courage today. Of course, I’m a lot older. My energy levels are different than they were when I was in my early 30s and still invincible. And perhaps I’m wiser, too. I’ve learned my limitations better. Or … dare I say it? I know more now about my disease and it’s effects, and that knowledge alone can dampen my spirit.

Would I take on long days on foot to explore the ancient parts of ancient cities now, if I had a flare going in my foot or knee? I did back then; I didn’t want to miss out on the experience, and if I had to do it limping, then so be it. I remember clearly walking and walking, each step painful (and being hyper-aware of it) but also soaking up the sights, the history, the thrill of being able to put my hand on the wall of a cathedral just like some other woman did, 800 years ago; to feel the cold roughness of the stone as I marveled at the dedication, skill and sheer hardheadedness it must have taken to cut that stone to fit in with all the others, to raise its tonnage even a few feet, and all to form the wall of a magnificent building that I wouldn’t even be allowed to enter if I was very poor.

I skied the Alps – while I was flaring – because I wanted to have that experience. Those ski trips form some of my fondest memories of my time overseas – they’re simply unique to me, and unrepeatable. I gimped my way across the dead-zone between West and East Germany in the months after the Wall fell. It was a very wide swath of cleared land where nothing grew, in which the soil had been salted with land mines. I walked across it with an eye on the old, empty guard tower just a short distance away, knowing that just a year prior, my presence there would have caused an East German soldier to fix his rifle sites on me – and perhaps shoot me dead. I limped, leaning on my cane, and soaked up the somber history of the consequences of war and conquest.

I visited farmer’s markets, the city zoo, shopped the city stores, attended the seasonal festivals, got on and off the crowded city busses (often forced to stand, hanging on to a hand-loop for the entire ride), and I walked. Here and there, there and here. I took my daughter to soccer practice and went to games that took place in the cold rain, and humped the family laundry four long flights down to the basement laundry room and back up at least once a week. I carried heavy grocery bags up those stairs to our flat from the car. I did it all while being in sometimes awful pain, pain that could make me cry, pain that made me take the stairs so slowly that sometimes I wondered if I’d ever reach the top. I did it, though.

After returning to the U.S., I went hiking and fishing high in the mountains while flared with RA. I once took an unexpected whitewater rafting trip while covering a story for my newspaper – while my ankle was flared, then went to a friend’s home and cooked up a mess of crappie for a big fish dinner under the stars.

So I empathize entirely with Kris’s determination not only to list and mourn the things she can no longer do (or do as well), but also to make herself aware of how she’s grown and changed because of them. And I know (because this is how we’re made, us humans) that one day she’ll look back and realize that it’s not so much what she’s lost to RA, but what she’s gained. It’s not all physical. A very great deal of it is mental. We’re tough as nails, even if we look like we’re not.

We’re all Bravehearts; all of us doing everything we can do to live our lives with joy – and astonishing accomplishment.

wren’s er adventures, part 2

I left off in the first part of this account of my visits to the ER after being bitten by my dog, Logan, with me and the stunningly handsome Dr. Melody once again sitting face-to-face over an old-fashioned typing table, my swollen, mangled hand between us. I’d been babbling  …

Setting: VA ER, Monday morning: Dr. Melody is looking at my hand again. “Let’s get this cleaned up,” he says, and the med student squeezes back into the tiny room, carrying a rolled up blue cloth. I’ll be honest: I’m not looking forward to this. I’ve seen ER. I know he’s going to pick up a syringe full of something that will numb my hand (thank the gods!) and inject it before he starts slicing and scraping, but I also know that the injections themselves won’t be a picnic. I swallow.

The student unrolls the blue cloth and lays it out. Yep. It’s full of neatly arranged and coldly glittering scalpels and forceps and syringes, oh my. “The lidocaine will burn a little,” he says, picking up a syringe with calm purpose. “It works fast, though.” He looks into my eyes as the student swabs my hand with more Betadine. “Ready?”

“Ready,” I croak. I pride myself on being tough and stoic, and to be honest, I’m really curious about what he’s going to do with my hand. But as he lowers the needle toward the ragged wound, I discover I can’t watch. “A little prick, here,” he says. I feel it. Hey, that’s not so bad! I can handle – and then the back of my hand catches fire. It’s like he just put a blowtorch to the flesh and bones to the left of the wound. I catch my breath, hold it. There’s another prick – amazing that I can feel it, considering the conflagration next to it. More flames. I can feel the blood draining from my face, but I sit as quietly as I can, not moving my hand. Breathe, I think to myself. Breath in, breath out. Breath in … Of course I want to yank my hand away and find a vat of ice water to plunge it into, but I don’t. “Holy hell,” I whisper. “That really burns.” “I’m sorry,” Dr. Melody says. I risk a glance. He’s put on some funny, thick glasses with black rims and what look like big, faceted crystals built into the lenses at the bottom, and he’s totally focused on what he’s doing with that needle. He’s still handsome anyway. I note that the student has very pretty, red-gold hair, scraped neatly into a bun at the nape of her neck, and I wonder what time she got up this morning and how long she’s been on her feet. The pain is huge. The flesh of my hand must be crackling, blackening in the blue-hot fire Dr. Melody is causing with that needle of his. I can’t look at it.

It hurt when Logan bit me. But it was so sudden, and I was so shocked, and so focused on the blood spurting out of my hand as I ran for the kitchen sink that the pain seemed almost secondary.  This is different. This is right here, right now, and my stomach flutters and rolls. There are more tiny pricks, more outrageously intense burning. “You all right?” Dr. Melody asks. “I know it hurts, and I’m really sorry. I’m almost done.” His voice is quiet; I can tell he means every word. He doesn’t like this part any more than I do.

“I’m OK,” I say. It’s the truth. The fires are dying down fast, leaving no feeling at all in their wake. I can look, now. How exceedingly strange. My hand is Betadine orange and looks just like it did before he started, the gaping wound deep, ugly and crimson, but not charred black and smoking like I expected. He sets the syringe aside. “How’s it feel?” he asks, looking across at me again.

“Wow. I can’t … I can’t feel anything.” And that’s true. The bone deep, pulsing ache, the strange coldness, the sharp twinges of pain I’d felt when I tried to flex my fingers, the horrific burning of the lidocaine, they’re all gone. Miracle.

He grins at me and my heart melts again. He could slice my fingers off, one by one, and I wouldn’t bat an eyelash. Quickly, he and the student put blue paper drapes over my hand, leaving a square open around the wound. I can’t see it very well; I expect they both know that and have arranged the folds the way they have on purpose. It wouldn’t do to have their patient faint dead away when he starts cutting. He picks up a sparkling silver scalpel and gets to work. “Feel that?” he asks me calmly. “Nope,” I say.

A new doctor sticks his head in the door, then sidles in sideways. “Hi!” he says with a big smile for me. “I’m Dr. W. I’m a hand surgeon.” Ah. This is the surgeon who’s in charge of Dr. Melody and his student. The big-wig. The top gun. He’s a little older than I am, a heavy-set, tall, balding man with a kind face who obviously smiles frequently. You can tell by the crinkles around his eyes. I greet him, feeling a bit overwhelmed now. The tiny room is packed to the walls with me and doctors.  “Your dog bit you?” he asks me, and then shifts his gaze to the work Dr. Melody is doing on my hand.

“Yeah,” I say. “That’s the pits,” he commiserates, and then starts talking to Dr. Melody about tendons and ligament involvement.  He leans over and looks closely. “Get that bit of gristle,” he says. Gristle. They’re talking about the inside of my hand, I think calmly. Some gristle that got ripped loose. There’s a part of me that wants to scream and run.

“How’re you doing?” It’s Dr. Melody again, those cool brown eyes on my face. He’s sharp, that one. “Fine,” I say. He nods and continues whatever he’s doing behind those drapes. “I’ll just trim the edges of the wound,” he says, “so it can heal up more cleanly and with less of a scar. It will scar,” he says, and looks at me again. “That’s all right,” I say. “I sorta expected that.”

He sits back, and Dr. W takes a close look with his own funny glasses on. “Nice,” he says. Is there another wound?”

“In the palm,” says Dr. Melody. He takes away the drapes and turns my hand over. “It’s not as ragged, but it’s deep. And also infected.”

They decide he needs to do some clean-up on that one, as well. Oh, joy, more fire-needles. And it begins all over again. But this time, I just close my eyes. I know what to expect. It burns like a you-know-what for 30 seconds, I bite back my cries of misery, and then it stops. Just like that. More drapes are applied. Dr. Melody sets to work, scalpel in navy-blue-gloved hand. This one doesn’t take very long. The wound is in the meat of my palm, just beneath my first two fingers. It’s less ragged than the one on the back of my hand. More gristle is sliced away. The two doctors discuss the wounds, both of them concerned about the infection. Dr. Melody is quietly pushing a long, thin ribbon of cloth deep into them. I’m watching, now. It’s rather cool – I should be screaming and hysterical with pain, but I can’t feel a thing. Amazing how deep he stuffs that ribbon into them, and with how much force. “These are wicks. They’ll allow the infection to drain. It’s best to leave the wounds open,” Dr. Melody says. “If we stitch them closed, there’s more chance that the bacteria will grow and multiply inside, because there’s no place else for it to go. The wicks give it a way out of your body.”

I just nod. I know they know what they’re talking about, and I’m just educated enough to know how dangerous infections can be. Given that I’m taking rheuma drugs that impair and slow my overactive autoimmune system, I’m also aware that my body isn’t very good at fighting infections off. I’ll go along with whatever they say.

The discussion turns to which antibiotics to use, and – to my surprise – whether or not I should be admitted to the hospital to receive them intravenously. Dr. W goes back and forth on this, weighing the options. He’s concerned about the infection because if it gets away from us, I could be in serious trouble. At the same time, though, he doesn’t want to make me have to live in the hospital for days if it’s not absolutely necessary. Finally, he says, “We’ll send you home today. But I want to see you again tomorrow morning, first thing.” I agree I’ll be back at the crack of dawn, promise-cross-my-heart. He gives me another lovely smile, wishes me luck, tells me I did just great, and disappears.

Dr. Melody explains how I should do my home care: three soaks a day in Betadine-infused water, and then I should use the pair of forceps and scissors he’s giving me to scrape and pick out any greenish-white goo that appears in the wounds. That done, I should take some of that ribbon and poke it into the wounds again, deep as I can, before covering in all back up. I tell him I will, my stomach fluttering a bit at the thought. But I can do this, I know.

He puts gauze pads over both wounds and wraps them, and my hand, lightly in a soft, cotton-like material. Then he makes a splint from a thick plank of white, reinforced, plastery stuff, dips it in warm water, and shapes it to my palm and forearm, leaving my sausage fingers free as the plaster hardens. All that gets wrapped in more soft cotton stuff, and then finally, a thick pressure bandage from palm to elbow, holding it all in place. It’s oddly warm and comfortable.

“Come back right away if you notice any red streaks moving up your hand toward your heart,” he says, “or if it becomes more painful than it is now. Good luck.”

I thank him and the med student for their kindness, compassion and excellent care. And they’re off to help someone else. An ER nurse appears and equips me with all the supplies I’ll need to care for the wounds at home, along with a bottle of fat, inch-long antibiotic pills And now I’m off too, my arm and hand looking like a short baseball bat with fingers. I’ve escaped being hospitalized, at least for now.

Setting: VA Orthopedics Clinic, Tuesdsay, 7 a.m.: The first day of home care has gone fairly well, at least up to each cleaning of the green goo out of the wounds and replacing the soiled wicks. That, I’ve discovered, hurts like the blazes. Cary offered to help me (she has a strong stomach; must have got it from me) but I found I preferred to do it myself, left-handed, because at least I could stop when the pain got too intense. I was a little concerned because, brave as I tried to be, I couldn’t stuff that wicking material into the wounds as deep as Dr. Melody had gotten them. Just plain couldn’t. The pain would overwhelm me and leave me sweating with butterflies in my stomach. The wounds, while they looked a little better to me, were still pretty nasty 18 hours later. My hand and fingers remained vastly swollen and dark, with wide patches of even darker red around the wounds themselves. Very sore, too, but thankfully, no red streaks headed up my arm toward my heart.

Mr. Wren settles down in the waiting room while I tell the receptionist that I’m here without an appointment, but that Dr. W has instructed me to come in early, before he goes to surgery. She’s pleasant, a little confused, and goes back into the clinic to check. When she returns, she smiles and tells me to sit down, and that Dr. W will be with me shortly.

He appears smiling in the doorway a couple of minutes later, beckons me back, and invites Mr Wren to come back, too. We go into his office and he unwraps my hand. Looks at it closely for a while. “It does look a little better,” Dr. W says, “but this wound on the top – I think I’d better see if I can get some of that stuff out of there for you. Hang on.” He goes into a side room, rummages around and comes back with a basin, Betadine and sterile water. “Soak it for a while for me,” he says, preparing the basin. “That’ll loosen and soften everything up. I’ll be back soon.” I lower my hand once again into the cold orange water, trying not to think of needles, lidocaine and scalpels.

Thirty minutes later, he’s back, carrying the dreaded, rolled blue cloth, which I now know is filled with the sharp instruments of his trade. He asks a passing nurse to bring some lidocaine and a syringe; she returns with astonishing swiftness and gives them to him. “I know you don’t like this,” he says kindly, “but it really is necessary.” “I know,” I say, resigned. “Let’s just do it.” He injects the numbing medication into the area around the wound on the back of my hand. It burns like fire, just like the first time. I hiss and Mr Wren shifts uncomfortably on his chair, then takes my free hand. I grip his, hard. “I’m so sorry,” Dr. W says. “Need me to stop for a moment, let you catch your breath?”

I look at him, touched. “No, go ahead and finish,” I say. “It’s not that bad.” Already, I can feel the stuff working as the fires quench themselves and numbness replaces them. He nods and injects a couple more spots. They burn, but not as much as the first two did. The lidocaine must be making the other areas a little less sensitive.

Dr. W (I can’t help but wonder where the magnificent Dr. Melody has hidden himself) puts on his own pair of crystal eyeglasses, takes up a scalpel and carefully slices, picks away the thick greenish scrim from around the edges of the wound, then digs out the jelly-like greenish stuff that has pooled in the wound’s hollow, malignant and crawling with bacteria. He explains what he’s doing, what I should be looking for when I do this myself, and how he wants the wound to look each time when I’m done – clean, glistening pink and scarlet, and with no extra gunk lurking inside.

“Surgery,”he says conversationally as he works, “is really nothing more than plumbing.” “Really?” I ask. “I’ve always thought of surgery as removing diseased or injured organs, or cleaning and stitching things that are injured back together.”

“That’s it, exactly. But everything in your body needs a way to get rid of toxins. So it’s a little like plumbing, too. We go in and clean everything up, patch things, and provide drainage so it can all heal.” He shoves the wicking material deep into the wound, back up under the skin. Once again, I feel nothing, but it’s surreal, because I know for a fact that it should hurt wildly. Mr Wren shifts in his chair again, but he keeps my free hand, rubbing the back of it gently. “Infection has to have a place to go,” continues Dr. W. “If we let it, it will go further into the body, so we try to give it another option – the wicks draining to the outside. Think of them like a highway right out of town.”

He doesn’t re-clean the palm-wound. “That one looks pretty good,” he says. I’m oddly proud of that. It is smaller than the other one, though, and it has a cleaner edge, more like a traditional puncture. It’s also not as close to my bones. I can get the gook out easier and the wicking into it deeper than I can the other one.

He mentions the low temperature I still have. “I’m still considering admitting you,” he says, turning to his computer to pull up my records and test results. “I’m concerned about your impaired autoimmune status.” He finds the results of the blood test, but nothing has come back on the culture. “That takes a few days,” he tells me. “But overall, your blood is good, considering.” For a moment he’s silent, looking from my hand, to me, to the screen, his wheels turning. “Keep taking the Augmentin,” he says finally. “Don’t miss a dose, please. Go on home, and just keep doing your home care like you have been. You’re doing just fine with it. Come back again and see me early Thursday morning, unless the wounds get worse. If that happens, or you see red streaks, go straight to the ER. Don’t waste any time.” I assure him I won’t. He wraps everything back up and sends me on my way.

Setting: VA Orthopedic Clinic, Thursday, 8 a.m.: The clinic is already stuffed with vets waiting for exams, follow-ups, and procedures. I have to wait an hour this time, but I don’t really mind. I’ve nowhere else to go. When I finally get in to see him, Dr. W is pleased with the healing procress, even though my hand is still swollen, sore and dark.

I tell him that I’m worried that I’m not getting the wounds cleaned out well enough; it seems like each time I do the wound care, they’re a little smaller, a little tighter, and I can get even less gunk out of them or wicking into them. That gunk worries me. My temperature continues to hover between 99 and 100. And while the wounds aren’t very painful (at least, not between cleanings), my right wrist has decided to flare with rheuma and is very sore.

“I was afraid that might happen,” Dr. W. says. “Keeping it immobilized doesn’t do a thing for RA. You need to be able to move it. So we’ll get rid of the splint now.” He looks for the blood culture results. They still haven’t come back, but he seems unconcerned. “No need to admit you,” he says. “You’re doing well.” He tells me to keep on with the home care – and if I can’t get the wicking into the wounds, don’t worry about it now. Unless they suddenly get worse, I don’t need to come back at all. He thinks I’m out of the woods. And finally, there’s no need for him to clean them any deeper than I’m managing on my own. I’m glad, as I was afraid he’d want to slice them open again to drain more gunk, and I wasn’t looking forward to the fires.

That appointment was two weeks ago today. My hand continues to heal. It’s still a little bit darker than my left hand, and it’s still slightly swollen. But both wounds are closed, with only a small amount of redness around them, and while they’re a bit tender and sensitive to pressure, and my first and middle fingers twinge a tiny bit when I bend them, they don’t actively hurt. The fever is long gone. I’m well, once again coping only with the “normal” rheuma pain that I have in my hands.

You know, we’ve all read a lot about Veteran’s Administration hospitals over the last several years, and a lot of the news hasn’t been very good. Until recently, government funding was low and some VA hospitals were simply unable to cope with the massive numbers of vets that needed them, particularly those which were caring for so many young, grievously hurt soldiers from the wars in Iraq and Afghanistan.

But that’s changing. The VA medical center I go to for my medical care is always busy, its clinics crowded, and while I haven’t seen them myself, I imagine that the hospital and surgery wards are full, too. Yet these doctors and nurses, medical students and surgeons, physical therapists, clerks and receptionists are all doing the very best they can under difficult conditions. I’ve received nothing but excellent care – and I appreciate it more than I can say.

If I hadn’t been a veteran (with an old, service related disability, and thus qualified for VA health care), I’d have had to have all this fantastic, competent medical care for my dog bite done through the local civilian hospital ER. I’m unemployed at the moment and cannot afford private health insurance; my income is precarious and there would have been no way I could begin to pay the medical bills that would have soon hit my mailbox. Mr Wren and I would be scrambling right now not to lose our home and everything we have. We’d have to declare bankruptcy. And all of it would have been because of a sudden, unexpected dog bite that went septic.

If that’s not an argument for health care reform, and someday, perhaps, universal health care for all Americans, I don’t know what is. My taxes and yours are used to keep the Veteran’s Administration medical centers open for the men and women who have served their country in its military services, regardless of whether they served during wartime (I never did). Those taxes pay the salaries of medical professionals like Dr. Melody and Dr. O, and Dr. W, and Nurse John. They work long hours and give their time and their expertise to vets of all services, races, genders and ages, many of whom are often non-compliant, grouchy and very, very ill or disabled. And yet these dedicated medical professionals do it with a smile and with more compassion than I’ve ever encountered before, even when I was able to go to civilian doctors when I had health care insurance through my job.

Thank you all for supporting your country’s veterans. At least one of them is deeply grateful – and I know I’m not alone.

Stress and pain

Interesting how one kind of pain can “cancel out” another.

In the weeks since the dog bite, I’ve had only very light rheuma pain in my hands, and none in any other joints. And Terry, who writes the blog, “Dual Sports Life,” writes today about his recent relaxing vacation in the sun and how his pain disappeared until he went back to work a couple of days ago. When things like this happen, I wonder (a bit uncomfortably) if my rheuma pain really is in my head.

Of course, I know it’s not. There are real, measurable, physical proofs of the existence of rheumatoid arthritis. The inflammation we all experience in our joints is a reality. It does cause stiffness. It does cause fatigue. It is, frequently, very painful. Even agonizing. When I went to a rheumatologist two years ago for help, there was no question after he examined me and got the blood test results back that I have rheumatoid arthritis.

But I also know that stress absolutely can make rheuma worse. When I was diagnosed 22-plus years ago, I was living in a foreign country, had a demanding job (that I loved), was raising my small daughter 3,000 miles away from my old support system of close friends and family, and was only recently married to a man I discovered was an alcoholic. Thinking back, I don’t recall feeling terribly stressed (at least, not all the time; there were many good times mixed in with the bad). The timing of my RA onset was probably just coincidence; I loved living and working overseas. Nevertheless, the disease was far more painful and disabling then than it is now. And after I returned to the U.S., ended the destructive relationship, and found my way back into daily American life here close to family and friends, my rheuma pain gradually eased over a period of years – and then stopped altogether without drugs.

Was stress causing my symptoms?

According to Marikje Vroomen-Durning, RN and Cynthia Hayes, MD in a short article in Everydayhealth.com,

“(R) esearch shows that stress may play a role in the actual inflammation that causes pain, inflammation in RA is partly caused by molecules called cytokines. While cytokines can be released for a variety of reasons, stress also releases them. If you’re stressed and are releasing more cytokines, you probably will develop more inflammation. This may result in more pain.”

So perhaps stress contributed to the intensity of the RA symptoms I experienced back then. But it didn’t cause them. RA itself did that.

My dog-bitten right hand is almost completely healed. There’s very little discomfort left in it, which is a blessing. But it’s also been a blessing that, while my right hand was infected and pain-full, my rheuma-dragon didn’t pile on with more pain and stiffness in that hand or elsewhere in my body. Well, let me qualify that. It did once, briefly, when it flared in my right wrist a few days after the initial bite. That, however, was likely because that wrist was being held immobile by a  splint and wrappings. Once I took them off my hand, the rheuma flare eased.

The pain and temporary disability from the dog bite was, simply, a different kind of pain than I’m used to. Puncture wounds are sharp, stingy things, and the emotional toll involved in the decision to euthanize my beloved old dog was heavy. Yet given all that stress, shouldn’t my RA have flared, big-time?

Well, it didn’t. And it’s only been the last couple of days that my hands have started feeling achy and twingy again with unmistakable rheuma pain.

“Aw, you’ve got a headache? Hold still. I’ll kick you in the knee and you’ll forget all about your head.” That’s an old joke, but maybe there’s some truth in it.

Starting a new week

Posts will be light for a few more days; my sister will be in town until Wednesday, so I’ll be spending most of my free time visiting with her and my Mom. We had a good weekend. The drive down to Santa Nella was a breeze on Saturday (which surprised me) and, while visiting Dad’s marker has always been a somber event in the past, this time we laughed a lot. My Mom brought some beautiful peach-colored roses to leave; Dad absolutely loved them when he was alive. He must have had 15 mature rose bushes in his garden, and he brought the blooms in nearly every day for Mom during the summer. There were always vases full of them in the house. Saturday was a good day, not so crushingly sad. We’ve turned a corner, I think.

In other news, the weather here is still just plain freaky. It’s barely 40 degrees this morning, and the forecast is for a high temp of 54 today. The sky is gray. More rain is coming tomorrow (with snow in the mountains at the higher elevations) and it’s supposed to continue through Friday, along with temps in the mid-50s. It’s more like early March than late May, and I’m beginning to wonder if we’ll be able to have much of a garden this season, as we haven’t been able to plant yet. To be honest, I don’t really mind the coolness, but even I’m starting to stare in disbelief at the sky as I wrap up in my sweater and pull warm socks onto my feet. What very odd weather we’re having!

The dogbite wounds have nearly healed completely. They’re still sensitive to touch, but each day brings less discomfort. I took the last antibiotic horse-pill on Thursday last week, and I’m feeling good. I’m back on my rheuma meds. And the rheuma symptoms have been mercifully faint, just a light ache in my hands now and then.

Finally, while I miss my dear ol’ Logan, Finny has stepped into the breach to make me laugh and carry me through. That wee dog is a born clown and over-the-top affectionate. I’m very lucky. So, once my sis is winging her way back to New Mexico, I’ll start walking again. Carefully. Shorter distances, and with attention to how my hips react to the exercise. I’m looking forward to it, and I know Fin is too.

Hope this finds everyone feeling good and enjoying the gifts of the day. You’re all in my thoughts.

Sunday words

Terra Incognita

When I walked in the yard

Before sunrise,

I made my way among patches of dew —

Those constellations on the darkened grass.

The webs drifted like anenomes,

And I thought of lifting them

As if they were skeins of brilliant yarn

That I could give to my mother

Who’d keep them

Until we knew what to make.

I pictured a shirt —

How I’d pull it over my head

And vanish in the sudden light.

— Stephen Kuusisto

Only Bread, Only Light

Off for a long weekend

I probably won’t be posting for the next couple of days; I picked my sister up at the airport yesterday. She flew in from Albuquerque and will be here for several days, staying with my Mom. So I’m getting ready to zoom down the mountain again to spend the weekend with them. Today will be spent shopping (my sister loves to shop). And tomorrow we’ll head south to Monterey to visit Dad’s grave. Tomorrow marks the fifth anniversary of his passing.

Throughout my life, he never spoke much about the time he served in the Marines,

Dad at 17, a proud Marine. He dropped out of high school to join up, but went on to get his degree in accounting with the GI Bill after the Korean War.

much of it during the Korean War. Yet when he was dying, it was in that military cemetery he wanted his remains interred, rather than in one closer to home. After he passed, we found a short biography he’d written. In it, he described some of the places he went and the things he did and saw during his time in Korea. It was a new story to us. Though he was proud to be a Marine, Dad had always shrugged off his service, saying that he’d spent most of his time in the rear, doing office work. But in his bio he wrote about the places he went and the battles he took part in, and about the young men he knew who’d been killed or maimed in combat. It was a revelation. His bio brought home to us how much that gentle, genial, humble man’s service meant to him. We honored his wishes.

The cemetery is a nearly five-hour drive (on freeways crowded with hurtling semis) from Mom’s house, which makes it really difficult (read “impossible) for her to get down there on her own. She’s 78 now

Dad and me in 1957, San Francisco, CA

and is a very nervous driver. So Jami and I, along with my Dad’s younger sister, will make the trip with her, as we do each year. Mom and Dad were, from the moment they met in San Francisco in the ’50s, very much in love with each other, and that never changed during their 49 years of marriage.

My hand has nearly healed, though it’s still a bit swollen. The wound on the back is puffy and sore-ish, but it’s closing up slowly but surely. The one in my palm has closed completely. Amazing how quickly the body repairs itself after injury, isn’t it? I don’t even need the band-aids; the wounds don’t look scary anymore, so there’s not even any need to hide them.

I hope this finds all of you, my friends, feeling well and getting ready for a relaxing and rejuvenating weekend. Enjoy the gifts it brings.