Thank you, veterans, for your love for your country and your fellow Americans. Today is yours. We’re so proud and so deeply grateful for your sacrifices.

Today, so far I’ve: 1) jammed my little toe on that sneaky, hard maple dresser in the guest room in the darkest of the wee hours; 2) lost my footing on those wicked stairs down into the garage; and 3) had my forehead whacked by the edge of the evil washing machine lid.

I think I may have broken the toe. It’s quite sore, swollen and a blue around the base. But there’s nothing you can do about a broken toe. You can’t put a cast on it. And my little toe is so little I don’t think taping it to the uninjured toe next to it would do much good. So I’ve been icing it and trying to keep my weight off it when I walk. It makes for an interesting gait.

I was taking some recycling stuff to the bin in the garage. There are five steps down. Somehow, I mis-stepped on the second one, started to fall, grabbed the two-by-four banister and managed to stay on my feet as I slid/hopped down the other three steps to the floor. I twisted my back and my left hand is yelling at me for the unexpectedly heavy use. Lesson? Pay more attention on staircases.

There’s a sore, throbby knot just above my right eyebrow. That evil washer lid fell forward out of the blue just as I was leaning down and reaching into the tub for a single wet sock, one I’d missed while loading the drier. OWW!

It’s only 1:30 in the afternoon. I’m almost afraid to move—and there’s nearly a whole day and evening ahead, hours and hours during which I might unexpectedly add more mishaps to the running list. And my middle name has always, always been Grace.

And it’s Halloween.

Listen, Halloween spirits: We have treats to hand out liberally when the time comes tonight, so please, no more tricks? Take it easy on me.

Now, I think I’ll go make myself a cup of decaf. I promise to be extra careful with the boiling water.

Last night,  for my birthday, Mr Wren took me out to dinner at a favorite restaurant. Afterward, rather than point the car toward home he drove it in the opposite direction. He refused to say where we were going. He just smiled mysteriously.

Eventually, we arrived at the Three Stages at Folsom Lake College in Folsom—and my sweet man produced two tickets for world-class Cape Breton Celtic fiddler Natalie MacMaster’s one-night-only, sold-out performance.

Oh, what a huge surprise! I absolutely love Celtic music. I love the jigs, the reels, the laments and the aires. I love the jaunty, foot-tapping liveliness of the beat and the whimsical, whirling complexity of the tunes. A live performance of Celtic music is guaranteed to burst with wild energy, a here-and-now, pull-out-the-stops, gleeful celebration of life, laughter and camaraderie. And MacMaster, a native of Cape Breton, Nova Scotia, is one of the best Celtic fiddlers in the world.

She and her band were absolutely brilliant. So was her six-year-old daughter Mary Francis, who played an amazingly complex reel on a miniature fiddle. And when she was done, that talented little girl joined her mama in a lively step-dance. MacMaster grinned, fiddled and danced all at the same time!

The evening was such an unexpected and thoughtful gift from Mr Wren. He gave me happy music and a happy memory for my 56^th birthday.

Curious about Natalie MacMaster? Watch and listen to her here.

Late this afternoon I went to the pharmacy to pick up a prescription for my mom, who isn’t feeling very well right now.  As I left the store and crossed the vast parking lot to my car, I suddenly heard, over the noise of cars and traffic …

Red-winged blackbirds. Singing. Trilling, filling the air with their songs.

I stopped next to my car, shopping bag with mom’s pills in my hand, and just listened, entranced. I’ve always loved birds and loved listening to birdsong, but I can’t really identify many of them. Was that a robin? A meadowlark? A flicker? A wren?

But I know the song of the redwinged blackbird by heart.

Many years ago I was canoeing around a pond at dusk while Mr Wren fished for crappie and bass from the shore. We were way out in the countryside, surrounded by low mountains, vast stretches of wildland and a few small farms, and it was very quiet.  I dipped the oar into the still water as softly as I could, not wanting to break the sweet silence even with the sound of a splash as I glided along. I was waiting for the muskrat I’d seen duck under the surface of the pond to reappear.

And then, to my right, a bird trilled. It was close. I looked, and there, in a thick stand of cattails was perched a red-winged blackbird, his bright scarlet and yellow shoulder caps glowing against his jet black feathers. He trilled again, his beak opened wide, his bright inky eye on me. I stopped rowing and sat still, watching. Listening. I was absolutely entranced. There was nothing in the world but me and that blackbird.

He flew off after a while. I didn’t hear him again. But that moment has remained utterly clear in my memory, one of those moments filed under “precious.”

And now, today, in one of the uglier places one can be in the world—a big asphalt parking lot in front of a ubiquitous grocery store—I was being regaled with not just a redwing song, but an entire redwing chorus. It sounded like there were dozens of them. A flock of blackbirds, every one of them singing the end of the day.

I looked for the birds. There were parking lot trees dotted here and there, but I could see no blackbirds in any of them. None sitting on the lightposts, either. In the end, I gave it up. The air was full of song, but the singers were invisible. I drove back to mom’s house, smiling like a goof and feeling like I’d been given a very special gift.

I’m grateful for it. I’ve been homesick lately, wishing for my own home in the mountains, where I wake up to birdsong instead of traffic noise every morning, and where I’m surrounded by a forest of evergreens, whispering in the breeze. Hearing those blackbirds singing today was like a cool balm to my soul. And I’m grateful, too, that autumn has finally arrived with her cooler days and nights and beautiful colored leaves. I’ve had more rheuma pain lately, no doubt because of the changing barometer, but with redwing blackbirds to listen to, I don’t mind.

Click here to listen to a redwing blackbird sing. Scroll down a bit to find the recordings of the various calls and songs.

I went to live in Germany in the fall of 1986, just seven months after the ill-fated nuclear reactor in Chernobyl, Ukraine, USSR melted down and spread deadly radiation across the region and high into the atmosphere, where jet-stream winds wafted it over much of Europe.

But no. It probably had nothing to do with my RA because first, there’s no proof that radiation can trigger RA, and second, Germany measured only harmless, trace amounts of radioactive fallout as a result of the Chernobyl nuclear accident, and third, after seven months even that tiny bit of radioactivity was, for all intents and purposes, gone.

Right. I scratched Chernobyl off my list of possible reasons for my RA a long time ago.

Still, if you’re anything like me, you sometimes wonder what triggered your RA (or any other autoimmune disease, for that matter). While it’s not terribly rare, RA isn’t nearly as common as, say, osteoarthritis, the “wear-and-tear” variety of arthritis that most people develop, to varying degrees, as they age.

I was thinking about it all again last night. Why? Well, yesterday was a pretty good day, rheuma-dragon-wise. In fact, he hadn’t made an appearance all day. Only the hip bursitis bothered me, and even that had turned itself down to merely annoying background noise. It was sorta nice, you know?

Yes, I know you do.

So. There I was last evening, reading a news story on my laptop and enjoying a lovely after-dinner cup of coffee. I was working the laptop’s scrolling keys with my right hand. My lefthand was wrapped loosely around the warm coffee cup, which rested on the arm of the chair I was sitting in. I lifted the cup to take a swallow …

… and a breathtaking stab of pain flashed across the back of my hand and through my knuckles. My delicate metacarpals screamed with outrage and my knucklebones started an angry, insulted throbbing. I put the cup down fast and massaged my suddenly painful hand, frowning. WTF? That coffee cup hardly weighed anything!

“What happened?!” Mom asked from the sofa, startled.”What’s wrong?”

“It’s just my RA,” I sighed. “No big deal.”

And that was the truth. It wasn’t a big deal, except that lifting a coffee cup doesn’t usually hurt like a you-know-what. Once again, the rheuma-dragon had totally ambushed me.

As my hand twinged and throbbed I thought about it all again. Scary Chernobyl, while it sounded good as a reason for my RA, was out. I let my mind wander back to our arrival in the Old Country. It was Autumn. It was cold—far colder than we’d anticipated, so within two days of arriving, we’d had to run out and buy much heavier winter coats than we’d brought with us from the mild West coast of the U.S. We also bought ourselves some serious hats, scarves and gloves.

Our second weekend in Germany, my husband’s Air Force unit sponsored a Halloween hayride for off-duty personnel and their families at a German farm. My six-year-old daughter had never been on a hayride before, and the whole outing sounded like fun. Our German hosts were planning to serve grilled brats, pommes frites (French fries) and hot apple cider. I was excited.

Everything went great until it was time for the hayride. Drawn by a gigantic draft horse, the hay wagon was a huge affair made of rusted metal. It sat high off the ground, too; the lowest rail was about chest-high on me. There were no steps or any other obvious way to get in. My husband boosted himself up and over the rail, into the wagon. I handed Cary up to him, and then, hoping I wouldn’t make a fool of myself, I jumped and hoisted myself up.

Maybe I overdid it a little. With my waist at the top rail, my legs swung beneath the wagon bed. I hit my right shin, hard, against something sharp. The pain was excruciating; if you’ve ever barked your shinbone, even lightly, you can imagine it. But I didn’t cry out. I was too conscious of all the strangers around me; I was embarrassed. So I just climbed the rest of the way into the wagon and sat down on a hay bale next to my daughter and husband, forcing a smile and wondering if my shoe was filling with blood. I didn’t tell them I’d hurt myself.

My injured shin burned and throbbed for the rest of the afternoon, but no bloodstain ever showed up on my gray wool trousers (or in my shoe. So dramatic!). After we got home that evening, I closed myself into the bathroom, hiked up my trouser leg and looked, finally, at the damage.

There was a small hole in my shin about the size of the fingernail on my index finger. I’d worn pantyhose under my trousers for warmth; the nylon was stuck to it. I soaked it free, gently, and put some antibacterial salve and a adhesive bandage on it. The wound stung and burned, and my shin was tender for a few days, but I didn’t worry about it further. I didn’t see a doctor.

Fortunately, it didn’t get infected. Over time, the wound healed, leaving a shallow dent in my shinbone beneath the skin.  A couple of months later the first symptoms of rheumatoid arthritis started.

Could that shinbone injury have triggered an overactive immune response? Maybe. Last night I googled this question: “Can an injury trigger rheumatoid arthritis?” I didn’t expect much, so it was a surprise when pages of information showed up. One of the first five was this one:

http://rheumatology.oxfordjournals.org/content/40/3/262.full

Titled “A case–control study examining the role of physical trauma in the onset of rheumatoid arthritis” in Rheumatology, the official journal of the British Society for Rheumatology, the authors of this paper believe that yes, physical trauma, such as an injury like I got that day on the hayride, can trigger the onset of RA.

Read it—it’s an interesting study.  There’s no way of knowing, so many years later, whether my injured shinbone started it all or not, but the possibility is there. Does it make any difference?

Only in that I can, if I want to, call that long-ago day out at a German farm the probable reason I contracted severe rheumatoid arthritis when I was only 31 years old. There’s a certain comfort in being able to blame that rusty old German hay wagon for the debilitating disease that’s shaped so much of my life since, and that continues to shape each day, like it or not.

The big difference now is that the RA pain—after that first, savage bite—generally subsides to an annoying but bearable, twinging throb. Gone are the horrific, tortuous flares that lasted for days before fading as quickly as they’d started. Gone are the days when I limped on the right foot, then three days later limped on the left, no doubt making my co-workers think I was faking it. Gone are the times when walking at all required gathering all my courage.

And gone, thank goodness, is the awful, creeping, bewildered terror that accompanied each flare. Not knowing is awful. But now, thanks to the Internet and many good online blogger friends, I’m educated about RA and–just as important–I know I’m not alone. And I finally have a weapon—an Arava, sulfasalazine, and plaquenil bomb— that works just well enough to blunt my rheuma-dragon’s fangs.

For that I can thank medical research and studies like the one I cited above. Maybe one day they’ll come up with a cure.

Crrrrack! Bam! KaaaBOOM BOOM BOOM boom kaabam boom …bamboom… boom…

Silence.

I lay awake in the dark, eyes wide, heart beating wildly as my mind reeled, trying to make sense of the stunning, fantabulous racket that had just jerked me so rudely out of a sound sleep. I blinked. There’s a busy road, one of just two main thoroughfares that traverse this densely populated foothill community from north to south. It runs just a hundred yards or so behind Mom’s condo. Traffic moves fast. You can hear cars whizzing by even during the darkest hours of the night.

Had there just been a horrific accident? Should I get up? Look out the window, try to see past the back yard fence and through the screen of trees t? Were there a couple of cars—at least!—laying crushed, mangled and upside-down out there? People hurt? Could anyone have survived such a catastrophic, violent collision?

I tested my sleep-stiffened hips and legs, gingerly preparing to sit up and go to the window when there was a startling flash of blue-white light. Almost at the same moment came the explosion, another otherworldly crashing, ear-splitting cacophony of booms, as if giants were rolling house-sized boulders instead of bowling balls down the road just outside my window.

And suddenly, I knew. It was thunder.

Thunder.  Now I remembered the weather guy on the evening news talking about thunderstorms possibly moving through the area overnight. No big deal, really, except for the threat of random wildfires caused by lightning strikes.

So the ear-splitting noise that had torn me so suddenly out of my sleep was nothing more fearsome than the concussion of sound caused by bolts of lightning.

Still. Thunderstorms are fairly rare in California at any time of year, but even more so in the summer. Along with their rarity, for some reason the storms have always been some distance from wherever I happened to be. For me, thunderstorms were nothing but rain, lightning flashes and thunder that was merely a soft rumble in the background.

Well, this was no quiet rumble. It sounded like the storm was hovering 10 feet or so above the roof.

As I laid there awake, I became aware of the RA and bursitis pain in my hips, hands and, oddly, ankles. It was relatively mild pain, a naggy throb that sort of waxed and waned along with the roiled air pressure accompanying the storm. At one point I could feel the pressure building up suddenly inside my right ankle, so intensely that I thought, a little wildly, it’s going to explode! A few seconds later the pressure eased back and it returned to that irritating little throb.

I considered getting up to take some tramadol, but a glance at the alarm clock on the nightstand reminded me that not enough time had passed since the dose I’d taken just before getting into bed. It had been about four hours, long enough for the drug to have mostly worn off, but I needed to wait for at least six hours to take any more.

I sighed, shifted and turned onto my side, cuddling down deeper into my pillow and blanket. The storm seemed to be moving along. There were no more flashes and thunderclaps. I drifted off, hoping vaguely that I’d just sleep on through the pain until morning, and that there would be no more storms to wake me up.

There weren’t. I slept.

Today, with the weather still very unstable and the big low pressure area stalled in place over northern California, I’m one big ache. It took more than an hour for the overnight stiffness in my joints, particularly my hips, knees and ankles, to ease. And while I’m certainly not moving like a nicely oiled machine, I could probably beat the tin man in a race to the liveoak trees down the street as long as I hid his oilcan.

The low pressure and unstable weather is supposed to move out later today. I’m anticipating some additional discomfort as the air pressure rises, but once it stabilizes I expect most of the pain to dissipate along with it. I’m never without some level of pain these days—so different from how the rheuma dragon used to attack me, when the intermittent flares were huge and intense and always disabling, and almost always lasted several days at a time before suddenly disappearing without warning or explanation—but I’ve learned over time to cope. Even given the intractable hip bursitis I live with now along with the rheumatoid arthritis, it could all be so much worse. I’m deeply grateful for the RA drugs  I have now that keep it under control. And grateful for tramadol and, occasionally, the stronger painkillers that allow me to keep on keeping on.

Autumn is on its way, and after that (if we’re very lucky; cross your fingers?) the western rainy season should begin. Bring on the thunderstorms. I can take it.

… finally. Relief from the cat-bite infection, which turned into cellulitis around the bites and along my shinbone to the ankle. Blessed relief from the 100-degree-plus, week-and-a-half-long heat wave (today it barely topped 80 degrees). Relief from repeated runs to the VA medical center for emergency care, from the hospital stay, and from follow-up appointments. Relief from IV needles, blood draws for tests and cultures, and blood pressure cuffs.

And, best of all, relief from worry.

Today, the infection is but a tiny glimmer of its former bad ‘ol self. The punctures have completely scabbed over and are drying up, and the angry redness under and around them, while still present, shrinks smaller and smaller each day. There is absolutely no pain any longer, even when I press down near the wounds or along my shinbone. The huge needle-caused bruises on my inner arms are fading slowly. And instead of feeling like my get-up-and-go got up and went, I feel normal. Not trembly. Not low. Normal.

As Martha Stewart used to say, “this is a Good Thing.”

Of course, my RA hands and bursitis hips are back to their normal, too, which is stiff and twingy and achy. Hey, no prob. I can take it. But I still think it’s amazing how the body can abandon its usual joint-and-bursae-bullying to wage war in earnest against a real enemy. I’m thankful that it does, too.

And I’ve learned another thing about fighting off a serious infection while being 55 years old and immuno-suppressed: don’t think you can just hop up and resume your normal routine after three days in a hospital bed connected to IV antibiotics. It’ll take you another week to recover from such feather-headed foolheartiness.

I’m going to try shopping and cooking for my aunt and uncle again tomorrow. I think I’ve rested and healed long enough this time.

…the entire weekend, which I spent in the hospital when the cat-bite infection went south on me. I went to the ER on Friday afternoon because the bites looked like they might be getting worse, expecting nothing more than a stronger antibiotic prescription. Instead, they put me in the hospital for a round of stronger IV antibiotics and so they could keep a close eye on the infected bites. I came home today, armed with more oral antibiotics.  The condition of the bites  is back to about how they were at this time last week. I’ll write more when I’ve got a little more time, gang; probably tomorrow night. Right now it’s getting late and I’m due at my aunt and uncle’s house early tomorrow morning …

Here’s a puzzle:  Since being bitten by Mouse-the-cat a week ago, I’ve had very little RA or bursitis pain.

Could it be because my attention has been more focused on the bite wounds? You know—this immediate pain is more noticeable than that other, older and more routine pain?

Like that old joke: “Aw, you’ve got a headache? Here, let me bash your hand with a hammer. You’ll forget all about your head!”

Or could it be that my body’s immune system has been so busy fighting the infected bites that it hasn’t had antibodies to spare for its constant, erroneous attack on my joints? And if my body isn’t attacking my joints and making them become inflamed and painful, maybe those busy antibodies aren’t attacking my hip bursae either?

I have no idea if either situation, or both, could be possible. But it’s not the first time that some immediate, temporary pain has pushed my RA pain out of the way for a while. I’m not alone in this, either—I’ve read several other RA bloggers who’ve mentioned this phenomenon.

Whatever it is, it’s real, odd and fascinating. Any thoughts on this out there? I’d love to hear them.

My clownish little friend Mouse turns into a very fang-y mountain lion when she’s scared…

Whew! Whadda week!

In my previous post, I wrote in a sort of brief, tongue-in-cheek style about how I managed to get bitten by my cat-friend, Mouse, on Thursday night last.  She was terrified when it happened; in retrospect, I shouldn’t have tried to untangle her back feet from the thin purse straps that had gotten wrapped around them. But honestly, it all happened so fast! I was bitten and bloody before I knew it.

That was almost a week ago. Here’s an update:

First off, I’m doing just fine. But just as it was a couple of years ago, when I was bitten by my dear old dog, I have serious reason to be grateful to the VA medical system. I’ve no doubt at all that my life would have been at risk without them.

Because I’m taking disease modifying anti-rheumatic drugs, or DMARDs, for my rheumatoid arthritis, my immune system is somewhat compromised. These drugs suppress and inhibit the body’s normal biological defenses in an attempt to keep them from mistakenly attacking and destroying its own joint tissues. But those defensive antibodies also protect the body from foreign bacteria and viruses. By taking DMARDs, I’ve made myself more prone to infection and have a harder time fighting it off than most people do.  It’s the trade-off that so many of us who have autoimmune arthritis choose to make to avoid awful pain and disability.

So, being infection-prone, I made a beeline for the local VA medical center for emergency care. I arrived at the ED just before midnight. Once I was called back to an exam cubby, a nurse thoroughly cleaned the many puncture wounds Mouse had inflicted on me. Some were on my left hand over the large knuckles. The rest were on my right leg, about halfway down my calf. All of them were angry, raw, ugly and beginning to swell. And they hurt about as much as you might expect such wounds to hurt; to me, the pain was about a four on the pain scale—unpleasant but bearable.

The nurse drew vials of blood for analysis and cultures and sent them to the lab. Finally, after looking the wounds over, the ED doctor prescribed oral antibiotics and told me to come back on Sunday for a progress check. I took the first dose of antibiotics when I got home.

By late afternoon the following day, it was clear that rather than healing, the wounds were getting worse. Both my hand and my calf had become grossly swollen. Both were also becoming increasingly tender and now were quite painful. Walking on the injured leg hurt enough to make me limp; dropping my injured hand below my heart made it throb angrily. It appeared that the cat bites had become badly infected. But since I was taking antibiotics, I decided to wait before running back to the ED.

By the evening, the wounds were so much worse that I decided that making the 30-mile trip to the ED would be prudent. Sure, the doc might tell me that all my symptoms were normal, not to worry and send me packing. But I figured it was better to be safe than sorry.

The ED was surprisingly quiet for a Friday night (I’d expected a packed waiting room and a long, long wait). But after only a few minutes, I was called back and they got started. I was having my temperature and blood pressure taken when one of the docs wandered by. “Whoa,” he said, stopping dead in his tracks, his eyes on my arm. “Look at those streaks!”

Sure enough, in the ER’s bright lights, several ominous red streaks were clearly visible running from my hand up to just above my elbow. In the much dimmer light at Mom’s house, none of us—Mom, me or my sister, who’s here visiting from New Mexico—had seen them. Their significance was dire. Not only were the wounds on my hand infected—it was traveling. Without much more aggressive treatment, my wounds could start to gangrene. I could lose my arm and/or my leg to amputation. The infection could become systemic. I could die.

The doctor wasted no time. Within a few minutes I was hooked up to an intravenous drip containing a much stronger antibiotic. When it was gone and the nurse removed the IV, he drew a thick black line with a Sharpie along the border of the hot, red, tightly swollen area that now surrounded the puncture wounds on my knuckles. He drew a second black line around the wounds on my leg, too (although there were no red streaks coming from them, yet).

“If the redness expands past those lines, I want you to drop everything and come

This is how the leg wounds looked on Tuesday, the last day I had IV antibiotics. It looks gross, but it’s much, much better than it was on Saturday…

right back here,” he said, the seriousness of the situation clear in his voice. “Don’t delay. Even if it doesn’t, I want you back again tomorrow for another infusion.”

I agreed to do as he said—and that’s what I did every day until Monday, when that day’s ED doc decided that day’s infusion would be the last. The streaks on my arm had disappeared, the heat and swelling in my hand and my calf had gone, and the wounds were healing nicely. The pain was mostly gone, too, except for some tenderness immediately around the punctures. He changed the oral antibiotics I’d been taking to a stronger variety and told me I didn’t need to come back unless things went south again on me—in which case I should run, not walk, back to the ED.

Yesterday, I saw my primary care doctor, who had called me Monday afternoon, wanting to see the wounds. She gave me a thumbs-up and told me to be sure to finish the oral antibiotics.

No problem, doc.

My hand as of Tuesday. Nice, eh? What a difference from a few days ago.

And that brings me to today. The wounds on my hand are now just small scabs. They look like I scuffed my knuckles. The leg wounds still look a bit scary, but they’re also healing well. I’m doing great.

If there’s a moral to this story, it’s this: If your pet is in a terrified frenzy, don’t get anywhere near those teeth and claws. She will bite you, even if she’s normally the gentlest kitty in the world. When they’re scared, animals react defensively to protect themselves, and they do it indiscriminately.

I’ve learned my lesson, I think.