It’s been a bit hectic around here lately, which is why I haven’t posted anything to RheumaBlog for more than a week.

At 5:00 a.m. a week ago today, Mom woke me out of a sound sleep to ask me to go downstairs and get her sciatica pain medicine.

“Aw,” I said, “sure I will. Is your hip really bad?” I was a little surprised, as she’s been doing great, sciatica-wise, for quite a while, now.

“No … my chest hurts pretty bad,” she said. Now that I was awake–though I hadn’t turned a light on, yet–the weakness of her voice registered in my sleepy brain. So did the fact that she was gasping for breath.

“Mom? Your chest hurts? How long has it been like that?” I took her arm and walked her back into her bedroom.

“Oh,” she gasped, “I guess since around 1.”

I found the lamp on the nightstand and turned it on. “You’ve been having chest pains for four hours? Mom, why didn’t you wake me??” I was aghast.

“I thought it would go away,” she said. With the light on, I could see that her color wasn’t good. She looked small, frail and very, very frightened.

I called an ambulance.

***

Mom wasn’t having and didn’t have a heart attack. It turned out that she was once again experiencing bradycardia, a condition in which the heart beats much more slowly than it should. Where a normal heart rate is in the 60 beat-per-minute range, when they measured it in the hospital emergency department, Mom’s had dropped to 29 bpm. That was why her chest felt tight, heavy and painful. It was what was causing her to gasp for oxygen. It was even why she’d waited so long to wake me–her brain was sluggish, foggy. She could barely think, let alone make vital decisions. That she was finally able to–and find the strength to get out of bed and make her way to the guest room, where I was snoozing blithely away like a hibernating bear–is nothing short of a miracle.

I could have wakened at my normal 6:30 a.m., got up and made coffee, fed the cats, got the newspaper off the driveway, performed morning ablutions and only then, when the fact that she still wasn’t up (which would be unusual, as she rarely sleeps past 7 a.m.), would I have discovered the danger she was in. In fact, it would have probably been too late.

***

In the ED, the doctors got her heart rate up to the low-to-mid-40s. Her chest pain disappeared and, with an oxygen lead in her nostrils, she started breathing more easily. The diagnosis of a second-degree heart block–a condition that affects the electrical charge in the heart that causes it to beat–was made by the on-call cardiologist. Because she was fighting off an existing bladder infection, he admitted her to the ICU and put her on IV antibiotics, hoping to knock it out quickly. The plan was to fit her with an internal pacemaker the following morning.

The device, he explained, would stimulate her heart to beat faster anytime it dropped below 60 bpm.

She still had the bladder infection the next morning, but the cardiologist didn’t want to wait any longer. They placed the pacer. Two hours later she was wide awake, smiling, bright-eyed and a little bewildered at all the hullabaloo. She felt great, except her upper left chest and shoulder were pretty sore from the minor surgery.

Phew.

A few hours later I picked my sister up at the airport. She’d decided to come (she lives in New Mexico) for the obvious reasons–but also to give me some moral support and a chance to rest, bless her heart. Mom was released from the hospital on Saturday afternoon.

She’s doing incredibly well. Her mind is more clear, more sharp, than it’s been in a year, at least. At 80, even a minor surgery takes a little time to recover from, but she feels well. The docs told her to take it easy for two weeks, and she’s behaving herself nicely, taking their instructions to heart. And while she’s still on antibiotics for that persistent bladder infection, the immediate danger she was in is gone.

My sister flew back to Santa Fe on Tuesday afternoon. I spent the day yesterday at my aunt and uncle’s house, as usual, and am doing the same today. Mom is feeling really good.

And me? Same ol’, same ol’. Hips and hands are achy, but nothing I don’t get along with every day anyway. I haven’t had the wherewithal (or energy) to get to the gym since all this started, but I hope to re-start the regimen within another day or so.

And I tell myself: All will be well, and all will be well …

Update: It appears that mom’s very stubborn bladder infection has taken a turn for the worse. She ran out of steam mid-morning and has been in bed since. As you might imagine, she’s severely bummed. And me? I’m working hard at cheerful and upbeat. Sigh …

We’re off to see her PCP in a few minutes.

Back in October I got a laser pen, one of those things bright young lieutenants use to point out strategic spots on enemy-territory wall maps to the four-star generals they’re briefing. Presumably, they used a laser pen like mine to point out Tora Bora just before the president butted in and changed the mission so the bad guys got away.

Laser pens. Cool technology. Reminds me of The Jetsons. Weren’t they fun? I loved the flying cars and the robot housekeeper. Astro was a hoot…

Right. Laser pen. Mine is just for the cats. They chase the little, bright red dot it makes like it’s a yummy mouse.

At least, that was the idea. When I tried it, Kitty and Emma gave half-hearted chase a few times, then stopped. The disdainful looks they gave me just before they stalked off clearly said “what, you think we’re stupid?”

So I put the laser pen down on the table  next to the recliner and went on with my life.

Fast-forward to a week ago. It was one of those days when my hips were so sore that walking was the kind of challenge that requires careful planning beforehand. I was flopped in the recliner, bored, trying not to think about my achy parts when my gaze fell on the laser pen. Hmmm. Maybe Mouse would like to chase the Light. Maybe she wouldn’t be insulted like those little snobs. Maybe she’d enjoy it for what it was: an excuse to play like a kitten.

Mouse loved it. Pretty soon she was tearing around, chasing the Light for all she was worth, obviously having a ball. Kitty and Emma watched, interested, their heads turning as the Light went this way then that, Mouse hot on the trail.

Suddenly Kitty–black, tail-less, lithe as a panther–leapt into the fray. Mouse backed off (Kitty is the alpha cat) and let her take over. It was beautiful, the way she stalked and pounced, turning on a hair, never taking her eyes off the Light. Emma joined in, far less competent but game (since Kitty was). Mouse, who’s in the omega spot, being the newest member of the little pack, backed off and tended to her grooming, content.

We played Chase the Light for about 20 minutes, until pressing the tiny button on the pen made my fingers and hand hurt too much. (Sheesh, ya know??) And since then we’ve played the game frequently. Kitty, in particular, seems to have forgotten that she thought it was Stupid at first.

In fact, as I write this, Kitty is meatloafed, facing me on the floor a couple of feet away. She’s perfectly still and staring at me, willing me to pick up the laser pen and make The Light appear so she can hunt. Understand: Kitty is and always has been standoffish. She prefers not to be petted. She feels lap-curling-up-in is for the rabble. She makes demands: “You! Open that door! I wish to explore The Porch.” To amuse herself, she opens kitchen cabinets and dresser drawers and doesn’t bother closing them. If she had opposable thumbs she’d be terrifying.

Until the lowly Mouse showed her the benefits of Catch the Light, I might as well not have existed in Kitty’s world.

Heh. Now I am the Holder of the Pen and Maker of the Light. She’s always within a couple of feet of me when I’m in the recliner. Sometimes she hops up onto the table, sits up tall like one of those Egyptian cat statues, and gazes at me with her dangerous amber eyes. She transmits urgency. “The Light. Pick up the Light. Make it Appear! Do it now, servant! Don’t forget I have claws like tiny curved scimitars …”

I’ve created a monster.

The pain was slightly to the right of the middle of my chest. It felt as if there was something with a dull point poking me there with each breath I took. I was 28 years old.

Strangely, it would come and go. One day it would hurt as I woke up in the morning and continue until I fell asleep that night. The next, it would be gone. Sometimes the pain stayed for several days before disappearing, only to reappear a week or more later.

The pain wasn’t debilitating. I coped with it. Sometimes it intensified with each breath, easing as I exhaled. Sometimes it stabbed when I moved. Still, in the back of my mind was a vague fear that there was something wrong with my heart, even though the pain wasn’t on the left, but just right of center.

I hadn’t injured myself. I hadn’t been ill with a respiratory bug that could leave me with a pain (something I’d never had happen, but when you can’t explain something, your mind goes there). I hadn’t lifted anything heavier than my three-year-old daughter, and she was light as a feather, a tiny child, smaller than other children of her age.

After several months of this on-again, off-again pain, I finally made an appointment with a doctor. I’d been out of the Air Force for about two years; I’d only recently landed a full-time job that included health insurance.  A friend at work had recommended him.

He listened to my complaint and examined me. He had one of the nurses do an EKG, just in case my heart was causing the pain. The result was completely normal. Since I hadn’t hurt myself, he seemed almost as mystified as I was. In the end, he said that it was possible that the cartilage that connects the ribs to the sternum at the middle of the chest might still be forming; it does, apparently, grow until we’re in our early 30s. Or, it could be a tiny spur of cartilage rubbing the muscle tissue there, causing irritation and inflammation. It could even be stress-induced, he said, after inquiring about my daily life. As a single mom with a small child, stress was a normal part of my day.

Still, the doctor felt that whatever the pain was, it would go away in time. He told me to take Tylenol for it when it hurt, but not to worry about my heart. And if it got worse, I should come back to see him again.

I went away relieved that I wasn’t in danger of dying suddenly, but perplexed about the ambiguous diagnosis. I did what the doctor recommended, though, and took Tylenol. And indeed, in time, the pain in my chest disappeared. It has never come back.

Three years later, I was re-married, living and working in Northern Germany.  After suffering agonizing, on-again, off-again pain in a variety of joints over several months, I was diagnosed with rheumatoid arthritis.

It wasn’t until recently that I connected that old pain in my chest to my RA. During an appointment, my rheumatologist was talking about how RA also attacks, along with the joints, the body’s soft tissue—and that includes, he said, the cartilage and ligaments. He said my RA was the culprit behind my hip bursitis. Not only were the bursae inflamed in both hips, but the long ligaments (the ilio-tibial bands) connecting each hip to each knee were inflamed, as well.

Now, I already knew that RA attacked “soft tissues” as well as joints, but I’d only thought of tissues like the heart, the eyes and the other vital organs. But RA also attacked the ligaments? And cartilage? Wow. (Actually, if I think about it, RA attacks the ligaments and cartilage–soft tissues–in the joints, as well…)

A couple of weeks later, something piqued my memory of that long-ago mystery pain in my chest. Cartilage! RA affects cartilage! Suddenly, all the puzzle pieces fell into place: That sharp poke I felt  nearly 30 years ago could have been a manifestation of rheumatoid arthritis symptoms in my body. I had it even then, though it wouldn’t become freely active for a few more years.

Yesterday, my mom reminded me that when I was a junior in high school, I complained once about my right heel hurting. It was so bad I could barely put my weight on it. The doctor didn’t know what was causing it—the usual culprits didn’t apply and x-rays didn’t show anything unusual—so he had me take a painkiller and put me on crutches for a week. The heel pain gradually went away.

Oddly, I had forgotten all about that. I still can’t dredge up a concrete memory of it, though I do vaguely recall stumping through the halls at school on crutches, trying to move fast enough to make my class on time. Could it be? Was that heel pain actually an early RA flare, too?

There might be other childhood pains I suffered that have slipped through the sieve of memory. I do remember, rather clearly, the chronic leg-aches that came on at night when I was a child and a young teen; they hurt so bad they’d make me cry. Mom and Dad said they were “growing pains.” They always went away after an aspirin and a couple of hours. Dad used to wrap the affected leg in his old blue terrycloth bathrobe, a garment that acquired almost magical healing qualities over the years.

Was that rheuma, too? I don’t know. But it is nice when some of these old, personal mysteries are finally solved.

—

Note: Upon googling “chest cartilage pain” several articles about a condition called “costochondritis” came up. This is a rather common inflammation of the chest cartilage that connects the ribs to the breastbone–and it sounds exactly like what I had. The cause is unknown, but it does tend to go away on its own. I can’t recall my doctor from way back then mentioning it as a diagnosis; he really did seem completely baffled. I’ll have to ask my rheumatologist if RA can cause costochondritis as a co-morbid condition… hmmm …

My body seems to have settled into a one-day-up, one-day-down pattern—which, while not perfect, is a lot better than the all-days-down sinkhole I was in last week.

After the initial hour or so of creaky, ouchful stiffness I wake up with every morning smoothed out, I was actually feeling pretty darned good Monday morning, so I went to the gym. I figured I’d do a lighter workout than I was doing before The Flare, just to give my hip bursae and joints a chance to get used to the idea again.

Once started on the recumbent bike, though, my hips and knees and ankles were fine with the work. In fact, stretching and using the muscles felt really good. Later, as I got started on the weight machines, I told myself that taking it easy was okay, that there was no need to overdo and plenty of reasons not to.

And again, my body felt great with the usual amount of weight resistance. My one concession was that on the machines that work the thigh muscles, I did just one set of 20 reps rather than two. (Wouldn’t you know that, vanity-wise, my hips and thighs are the part of me that need the tightening and toning effects of exercise the most?? Grrrr…)

Mike stopped by to razz me gently over my prolonged absence. I explained why I missed those days and discovered (as I’d suspected) that he was confusing rheumatoid arthritis for osteoarthritis. So I told him how RA is an auto immune, systemic condition that involves any and all joints in the body, among other things, as opposed to OA, which is usually the result of normal wear and tear in the joints. I told him about the crushing fatigue that can come with RA, too. And I told him that as much as I want to exercise daily for my overall health, there are simply going to be times when I just can’t. It’s not a failure of willpower that’ll keep me away.

So we talked a little about whether modifying my workouts might help. Since the regular routine doesn’t seem to hurt me while I’m doing it, I decided I’d continue, paying close attention, of course, to my pain levels following the workout. I had a physical therapy appointment coming up on Tuesday, too, so I told Mike I planned to ask the therapist about my workout and whether I was shooting myself in the hip (bursitis) by doing it. And if I was, I planned to ask about alternatives.

That’s how we left it.

And wouldn’t you know it? On Monday evening I got a call from the VA to tell me my PT appointment the next morning had been cancelled. Apparently, the therapist they’d assigned me was out sick.

So. I’m back to waiting for a new PT appointment date. And, for now, I’m doing my usual workout at the gym. C’est la vie.

Update: Just got a call from the VA. My physical therapy appointment has been rescheduled for tomorrow! I don’t have to wait another month, like the last time they cancelled it!

That’s how I feel today after waking to a fourth day of a severe bursitis flare coupled with RA joint aches and twinges all over my body.

On Tuesday, I went to the gym early in the morning, then spent the day at my aunt and uncle’s place, grocery shopping and cooking meals. Got back to mom’s around 6 p.m. and threw together a light dinner for both of us. I’m always tired in the evenings after doing this, but on Tuesday night, I was truly exhausted. My hips ached and my hands were twingy, but that’s de rigueur. Usual. Nothing new.

But on Wednesday morning I woke up wiped out. I hurt, literally, everywhere. Now, I’ve read in other RA blogs about whole-body flares. And I was very glad that I’d never experienced such a thing. Having a single large joint flared badly is hard enough—a knee, a shoulder, a great toe, my jaw—but I couldn’t even begin to imagine having joints all over me flared all at the same time.

Well, I can imagine it now.

I can’t quite believe I’m saying this, but even hurting all over like I was, I was lucky. None of my aggravated, throbbing joints flared to the point of immobilizing me. On Wednesday, I experienced a kind of flare that I’ve never had before, but I was still able to move around and take care of myself, even though I limped and winced and whined under my breath the whole time. Fortunately, it was a good day for Mom. She got to mama-hen me for a change, which we both enjoyed.

Along with Wednesday’s weird pain came another RA symptom I’ve had little experience with: fatigue. While I hadn’t slept very well the night before, it surprised me. I’ve always been able to function reasonably well in spite of limited sleep. (I think back to the long months of insomnia I went through as my rheumatologist slowwwwwly increased the dosage of the drowsy-making anti-depressant drug he’d prescribed for me as a sleep aid before it finally worked.) But this fatigue went far beyond the kind that follows simple sleeplessness. On Wednesday I felt like I’d climbed a 9,000-foot mountain to the summit overnight. I had the energy of a nearly depleted smart-phone battery.

I’d told myself when I first got up that once the morning dose of thank-the-gods-I-have-them pain-pills kicked in, I’d decide whether to go to the gym. I felt like roadkill, but I really didn’t want to skip my workout. It had been making me feel so good! But by 10 a.m., with the pain med’s effects peaking, I knew I couldn’t peddle the bike for 20 minutes or do a circuit on the weight machines. I doubted that I could even make it out to my car, as knackered, achy and foggy as I was. Glumly, I gave myself a day off from the gym. I dragged my sorry, aching arse back upstairs and into my bed.

I slept like the dead for five hours.

When I woke, I was still in the jaws of that whole-body RA and bursitis flare, but the intensity was down a bit. That killer fatigue was mostly gone, leaving in its place a more familiar sensation of weariness. I spent what was left of the day resting, sticking mostly to the recliner. I read several more chapters of “The Tiger’s Wife.” I surfed the Intertubes for a while, reading blogs, commenting here and there, and surfing the news of the day. I watched reruns of Mom’s favorite crime shows on TV with her. And I went to bed early. I needed to be back at my aunt and uncle’s house Thursday morning no matter how rotten I felt. They were depending on me.

I was still weary, my hips achy and my hands twinging, when I got up. But overall, I was feeling much improved. I skipped the gym again, though, not wanting to rock the boat. I did everything I needed to do, but I did it slowly and mindfully, and did no more than was necessary. The day passed slowly. I came home that evening exhausted again. Cooked and ate dinner with Mom, and crashed in the recliner.

Yesterday was almost a carbon copy of Wednesday. The main difference? I didn’t have that crushing fatigue on top of the all-over flare, thank goodness. And once again I skipped my workout at the gym. I simply couldn’t face it. Walking further than to the kitchen and back felt beyond my capabilities.

And now it’s today. I slept fairly well, but I’m still stuck in that flare. The overall pain level is moderate, which is an improvement, but once again I’m whupped, energy-wise. I feel like my body might tolerate a workout—maybe a half-workout instead of a full one—but even though it’s almost noon, I haven’t been able to force myself out the door.

And this is my rock and hard place. I hate that I don’t have the willpower to go the gym, which is only five minutes away. And frankly, I’m embarrassed. Mike the fitness guy will be there. He’ll know I haven’t worked out in several days. I know, rationally, that what he thinks doesn’t matter, that I need to listen to my body. I know that pushing myself to work out when my joints are flaring can only injure me and put me out of commission even longer. I’d certainly rather not aggravate the trochanter bursae in my stupid hips, as that pain, too, can be devastating. Still, I’m embarrassed. I don’t want to be yet another middle-aged, overweight, flabby woman with no willpower in his eyes—or my own. If I stay away from the gym yet another day—one during which I’m feeling better than I have all week, even if I’m fatigued and sore—it’ll be even harder to go tomorrow, as I’ll be even more ashamed of myself. And yet … and yet. I don’t want to make myself hurt more.

There’s still plenty of Saturday left. I may go, I may not. It’s almost time for another pain pill. Maybe once it’s working well, I’ll do it. A half-session. A half-hour. Wish me luck.

It’s raining, it’s pouring,

the old man is snoring.

He went to bed,

and bumped his head,

and couldn’t get up

in the morning.

This silly song from my childhood played in my head as I woke up this morning and saw the gray skies through my rain-spattered bedroom window.  I’d have been up dancing to it, except my stupid hips hurt too much.

I knew I shouldn’t have bragged about feeling so good, so pain-free, in that last blog post. I did jinx myself. When am I going to learn to listen to my intuition? When it starts yelling, it usually has a really good reason. Sigh.

I took Mom and my aunt to the local Indian casino for lunch yesterday (there’s a great buffet there). After we ate, we wandered around the massive building, looking for a couple of penny slot machines so they could sacrifice some money to the gambling gods. My hip joints felt odd. Not painful, but loose, as if the ball joints could slip out of their cups and dislocate at any moment. I put the sensation down to my workout the day before and ignored it.

When we left the casino a half-hour later, a low, steely gray cloud cover had replaced the sunny blue sky and fluffy white clouds we’d started the day with. Mom and Aunt expressed dismay and instantly felt cold and shivery (though it was still in the mid-60s). I turned the car’s heater on for them. I was pleased. We really need the rain and, as I’ve mentioned before, I enjoy it. Let it rain, I thought.

But when we got home and I was getting out of the car, I felt like I’d rusted into position. My hips and knees creaked and whimpered as I stood up. By the time I got into the house, my knees were okay but hips had started that naggy, low aching I’ve become so accustomed to. I’ve just got to accept that nothing is going to actually cure this trochanteric bursitis. It’s chronic. The inflammation and pain it causes might ease up and even seem to go away when I’m working out and the barometer is steady, but as soon as the air pressure rises or falls, my hips will protest just like my RA joints always have.

When I went to bed last night, I discovered that once again I couldn’t lay on one hip or the other for more than a few minutes before the aching intensified enough to make me groan. If I lay on my back, the pain in both hips intensified. Fortunately, the sleep aid I’ve been taking worked to allow me to drift off, but even with it the pain woke me frequently through the night as I rolled from one hip to the other.

A week from tomorrow I’ve got an ultrasound therapy session scheduled. I was hoping that I wouldn’t even need it, thanks to resistance training. That hope has been dashed, so I’ll hold out hoping for the ultrasound to make a difference. If it doesn’t, and the workouts don’t, either, I’ll have to make a decision: Live with this chronic hip pain for the rest of my life, or let a surgeon remove both of the offending bursae.

It’s not a decision I have to make this minute, thank goodness. Instead, I need to get myself moving, exchange my pajamas for workout clothes and skadoodle for the gym. I’ve not tried working out while my hips ached before, and my bloody hands are twingy, too. Today’s session should be … interesting.

UPDATE: This morning’s workout went just fine. During the first 20 minutes of the session, on the recumbent bike, my fatigue-burn in my legs quickly overpowered the bursitis ache in my hips. Once done with that and using the weight machines, I was able to use my hands when they were necessary without any trouble. I left the gym glowing profusely (glowing being the ladylike word for sweating like a pig), went home and took a warm shower, ate a healthy lunch and now, I’m resting. My hips ache, but you know what? I’m proud of myself for working out successfully anyway. There was a time when I’d have rationalized my way out it. What’s different now? I have a better understanding of why I’m exercising. It has little to do with how I look and everything to do with having strong muscles, hard bones and a strong heart.

As you know if you’ve read my last couple of posts, I’ve finally started resistance weight training. I say “finally” because it’s something I’ve been thinking about doing for a long, long time.

I’m almost afraid to say it for fear of jinxing myself, but this daily hour of sustained exercise is having an effect on my RA and hip bursitis. I’ll whisper: my pain level for both has dropped way, way down there in the last couple of days. One or two on the scale of zero-to-10 down there. And not only that. The hip bursitis pain that has dogged me so furiously and continuously over the last year and a half only bothers me at that low level for a few minutes each day, usually in the evenings.

I realize that it’s long been known that appropriate exercise can help in the day-to-day management of rheumatoid arthritis pain. I just never had that result, until now. Perhaps I was doing the wrong sort of exercise. Perhaps I wasn’t doing enough. But here’s the surprise: The exercise I’m getting now is working for me–and I can’t describe to you how relieved and pleased it makes me.

Because using a gym and the resistance machines costs money, and my finances are stretched nearly to their limits, I’ve been looking for good ways to exercise at home should I be unable to afford the gym in the days ahead. Today I ran across the Rheumatoid Arthritis link on WebMD. While I was perusing it, I clicked the link to RA exercise–and found this excellent slideshow.

Isometric wrist stretch

All the exercises shown in the slideshow are gentle and can contribute greatly to muscle strength and flexibility. I don’t know about you, but even before I had RA my body was decidedly non-limber. Since I’ve had RA, it’s even more tight and un-flexible. One of the benefits I’ve already noticed from my gym workouts is a less stiffness upon moving after sitting down for a while. And this morning, after a good seven hours of uninterrupted sleep, I got out of bed and walked–not stumped, gimped or shuffled–out of my bedroom and down the stairs for that first, lovely cup of coffee.

Incredible.

I know from experience that no-one can make us exercise. It’s something we have to decide for ourselves to do. Nevertheless, I encourage you to give it a try. If going to a gym is out of the question, perhaps the exercises shown in the WebMD RA link can work for you.

I’m adding them to my daily routine, starting tonight. My willpower is strongest in the morning, so that’s when I go to the gym. But I’ve found myself wanting to do something in the evening, too. Something that I can do at home that doesn’t require special equipment and that won’t necessarily wear me out, just increases my overall strength and flexibility. These exercises are perfect for that.

Here’s wishing you all a restful and happy weekend.

Killer.

That’s my new name for Mike, the fitness trainer at the gym.

Yes, the gym. My gym. That sounds so weird to me: My gym. Why? Because I have never really been into exercise, particularly since passing my 45^th birthday and facing the grim fact that cute little gym/workout clothes won’t work out on my unfit, queen-size body. So it’s sort of … odd. My gym.

But back to Killer. I mean, Mike. I’ve gone to the gym each day (except Saturday) since last Tuesday and have become, to my mild surprise, an expert at setting the recumbent bike to my legs and entering the program I want to pedal. Or is that spin? I spend 20 minutes on that thing, legs pumping out Level 2, keeping my heart rate around 135, and then move on to the weight machines. I can change the weights and seat settings on each of those, too. What’s cool: I’m now lifting twice as much weight as I was the first three days, and doing twice as many reps.

I’m doing this because Killer wants me to hurt. Not a lot, mind you, but he wants me to hurt a little doing the exercises. He wants me to walk out tired but strong, and within a day or so of doing all those exercises, feel each and every muscle in my body, the “good” hurt, as he calls it. Not too much. Just enough to know you worked out.

And until today, he wasn’t successful.  My muscles didn’t really hurt. I’d walk into the gym and he’d say, with a grin, “How’re you feeling?” And I’d say “Just fine” and he’d get this quizzical look on his face, a sort of surprise mixed with disbelief. I certainly don’t look like I’m in any sort of shape. I don’t look very strong.  But I was telling him the truth.

Yeah, I was surprised, too. In the past when I’ve started exercising suddenly, I paid for it with sore muscles a couple of days later. But riding the bike and working out on the machines wasn’t causing me any discomfort.

So what happened today? Why call “Mike” “Killer?”

Well, I’ll tell you. Tp my surprise, my legs started burning right away on the recumbent  bike this morning. I kept on, working through it, but was very relieved when the beeper said my twenty minutes were over. I trudged… yes, trudged—to the weight machine area and started my 20-repetition set, one for each machine.  Mike wandered over, studied me for a moment and gave me some tips on form as I was working my shoulders. When I finished, he suggested that I rest for 30 seconds and then try another 20.

He didn’t actually say “dare ya,” but I heard it anyway. “Sure,” I said. Now, I’d increased the amount of weight I was lifting way back on Sunday, and even that hadn’t really strained me. I started the next 20. Got to 10 and… um… ow. There’s that burny feeling again. Oh, well. Just 10 more… um… five more. Jeezly crow! I managed the last five but it was close.

Of course, I wasn’t going to let it show. I moved to the next machine. Mike gave me that gently wicked grin of his. “Do two sets of 20 on this one, too. Oh, hey. You know what? Just do two sets on all of them.”

So I did.

When I finished and was dragging myself over to the cubby where I’d stowed my purse, he called me over to a tall, steel frame thingy. He hung handgrips off a pulley connected to weights. “Time to add some new ones,” he said. “We gotta make you hurt.” He showed me how to pull the handgrips down to my hips, lifting the weights as I pulled. He showed me how the down, up, down, up should go and let the handgrips rise back to their original position well above my head.

“It’s all yours,” he grinned.

I looked at the dangling hand grips, reached up, grabbed them and pulled down, expecting serious resistance. But no, it was easy. I did five or six.

“How’s that?” Mike asked.

“Fine,” I said, my confidence flooding back. Down, up, down up. “Easy.”

“Let’s add a little more weight, then.”

Again, he didn’t say “dare ya.” But I heard it. So I let him add 10 more pounds to make a total of 30. By repetition No . 9 I wanted to crumble, but I didn’t. I kept on … and on … and finally I made it through the taffy-like down-up-down-up seconds to 20 reps. The last five I moaned through, but I did it.

Killer had the grace not to suggest a second set. Trying to remain dignified as my muscles trembled and with stumbly feet, I made it to my car and sort of flopped myself into it. Lifting my hands to the steering wheel worked muscles in my arms and shoulders I didn’t know I had. It took far more effort than I usually put into it. I drove back to mom’s place, braved the stairs to the bathroom and took a hot shower.

As I ate my breakast yogurt and toast and sipped my coffee, I marveled at how tired I felt. It took a week, but the gym finally got to me.

By three this afternoon, while preparing dinner for my aunt and uncle at their house, I started hurting. Not from RA. Not bursitis. No, it was that crazy, fine muscle pain you get from pushing your muscles to do a lot more than they’re accustomed to for longer than a few moments. I was hurting all over.

It’s late now. My body is still yelling at me. I feel weak as a kitten tonight but oddly good, too. There’s a part of me that’s groaning over my self-inflicted pain, and a much bigger part whooping over the fact that I can do this sort of exercise without triggering a bad flare of RA or hip bursitis. That’s not to say that it won’t ever happen. But until it does (if it does), I’ll just keep on counting to 20. Twice. And I’ll keep on doing it every day except Sunday. It’s worth it for the sake of my joints and my bones and my overall health, after all.

“Killer” will be pleased.

When I was sixteen, all zits and teen-aged angst, the one person who understood and comforted me better than anyone else was Hector.

When I was 25 and pregnant with my daughter, Annie was always around to make me laugh.

In Germany, when I was 33, my friend Max was the one who made me giggle. He also forced me to walk and move in spite of terribly painful rheumatoid arthritis flares, but always snuggled with me afterwards, soothing my pain and frustration and touching my heart with his kisses and devotion.

Back in the States again, when I was 40, Logan warmed my aching fingers and kissed them gently. Pib comforted me when my hips hurt, and when I was 53 years old, Finny cuddled me and, like Max, pressed me to walk and move when I didn’t really want to.  Like the others, Finny also made me chortle.

Who were these people? They were dogs and cats, of course. Hector was a brindle Boston terrier with a certain expertise regarding adolescent girls.  When the inevitable teenage traumas hit, Hec  was right there to demonstrate his deep understanding and loyal

Not Hector, but much like him

solidarity with me and Bobby Sherman time and time again). He frequently tipped his head back, rounded his lips and sang along with me as I played music on my little organ-piano, particularly inspired when I hit flats and sharps at the same time.  How we laughed, Hector and I! And man, could that little guy play a wicked game of backyard tetherball. If Hector had a vice (other than occasional nose-hair-curling attacks of flatulence), it was streaking out the front door to find another dog—always a much, much larger dog than himself—to pick a fight with. By the time we tracked him down, he usually had his unfortunate victim cowed or even running for its life, tail tucked tight. Hector strutted his stuff all the way home in spite of being scolded, a big, goofy Boston terrier grin on his face. He was obviously not in the least bit sorry for being naughty.

Annie was a miniature smooth-haired Dachshund, barely 14 inches long from the tip of her delicate nose to the end of her little tail. We joked that while she might be a little too big for a hot dog bun, she’d fit perfectly into a hoagie. One of my dearest memories of her is of when, one evening when I was sitting on the sofa watching TV, she climbed up onto my very pregnant, very round belly and stretched herself out across the top of it for a little nap. Suddenly the baby kicked, hard, raising Annie’s hind end about an inch before dropping it back. Annie gazed at her bottom, her little brow wrinkling, and then up at me. She had such a quizzical look on her face I busted out laughing. She just sighed, put her head back down on her teensy front feet, and went back to sleep.

Not Max, either, but very close.

Max was a standard wire-haired Dachshund (born as he was in Germany, I’m sure he spoke Deutsch far better than I did, even though he was a dog). We lived in a third-floor flat, so it was necessary that we take him outdoors for a walk two or three times each day and a couple of times each evening. My  husband and I took turns when we were both home at the same time, and he usually took my turns for me when I had a bad flare going. Even so, there were many, many times when I limped slowly along behind my little dog, willing him to just get on with it, please? my teeth gritted against the pain. Sometimes I counted cadence under my breath (HUP-two-three-four!)\. I even sang childhood songs (The ants go marching one by one, hurrah, hurrah) in time with my steps, distracting my panicky mind from the awful pain. When we climbed all the way back up the stairs to our flat, Max snuggled up next to me on the sofa, transferring his warmth and yes, his love, to me. I’m convinced that he knew; that he wanted to comfort me in any way he could. And he did.

Logan was much larger, an unexpectedly gorgeous cross between a border

Logan in 2007

collie and a Queensland healer. He had long, thick russet fur—fur so luxurious the full length of my fingers would disappear in it. It was incredibly soft and warm, and it felt so good on my flared knuckles. Strange and a bit addled from puppyhood, Logan was nonetheless tender and devoted to me and the other members of the family. He always sat patiently as I warmed my fingers in his fur, soothing the dreadful aching. Often, when I took my hand away, he’d turn around and nudge at it with his nose until I let him kiss the affected fingers, his tongue soft and infinitely gentle. This from a dog who, from the time he was about eight months old, was so dangerously aggressive with strangers we had to keep him locked away from visitors throughout his long life. Logan was the most difficult dog-friend  I ever had, but I loved him completely.

PIB (Puss in Boots) was a tuxedo cat. He spent the first eight years of his life as an indoor/outdoor cat, always friendly and affectionate but, like many cats, very independent and frequently standoffish. Though he’d been neutered, he still guarded our property as his own territory and defended it

PIB, snoozing.

fiercely against other feline intruders. Finally, his over-inflated sense of duty just about killed him. After much home nursing and veterinary expense, PIB recovered after a long battle against a terribly infected, abscessed wound in his belly, presumably the result of scrapping with someone who had much larger teeth than his own. The result: when he healed, PIB became an indoor cat.

Though he perceived his confinement as an undignified insult at first, eventually PIB decided that his new life of leisure was pretty darned comfy after all. When I was laid off from my job and began spending great swaths of time at home in the daytime, PIB became my 24-hour-a-day companion. Where once he’d enduredthe indignity of being held and petted as part of his job as family cat/property guard, now he sought it out, spending a great deal of time on my lap, purring when he wasn’t actually snoring. He didn’t mind if I slipped my hands under him for the deep warmth his little body radiated. And when I got hip bursitis, he made it a habit to meatloaf on my hips at night, once again sharing his magical cat-warmth. As time passed

Sweet Nessie.

we became closer and closer, PIB and I. I brought him over to live at my mom’s house with us once it was clear she shouldn’t live alone anymore. And when PIB died at 15 years old last fall, I simply crumbled with grief. That sweet old cat was my brother.

These wonderful animals—and all the others: Jake, Petey, Mugs I and Mugs II the boxers; Albert the Boston terrier; Winston the English bulldog; Spinner

Mugs II near the end of his life.

Finny and Shadow.

the Siamese cat; Alex and Merlin the marmalade tabbies; sweet Nessie the Doberman mix; Finny McCool the Scottie/Schnauzer (Schnottie?); Shadow the Labrador retriever; and now, Mouse the Maine Coon cat—each gave or still gives me love and devotion, laughter, comfort, my Beloved Friends and Companions. Brothers and sisters, even. As Adrienne, the writer of the blog You Don’t Look Sick wrote yesterday, “Dogs are so intuitive.  My doggies know when I am ill and won’t leave my side.  When I am in bed sick, they don’t even want to leave me to go eat.” Adrienne gets it. She obviously has some dear animal friends, herself.

Dogs surely are intuitive and deeply empathetic. Cats are, too. I can’t imagine my life without the selfless, unconditional love, sweetness and joy my companion animals have given me. It would be a barren, much less joyful life without them, I think. My hope is that I’ve fully returned that same generousness of spirit to them as I’ve cared for them, gave them a warm, comfortable home and even gave each of them a comfortable bed (usually mine). I’ve done my

Mouse the Cat

best to freely give them back all the love and comfort they’ve given me to me.

Big, fluffy Mouse is becoming more and more comfortable with me and her new home as the days pass. She’s goofy, sweet and heartbreakingly affectionate—just exactly what I hoped she’d be like when I adopted her two weekends ago. My achy fingers sink to the palm into her thick fur, and she likes it. She purrs and rumbles and bumps her head into my hand, reminding me of my old buddy PIB and bringing tears to my eyes.

He, Max, Logan and Hector would be proud.

Twenty minutes on the recumbent bike, pedaling, pedaling and pedaling as I watched, on a flatscreen TV set high up on the wall, a mindless but beautiful couple blather on about Demi Moore and her mystery illness.  I moved on to the weight machines, set up in a circuit. Mike, the middle-aged fitness trainer, showed me how to use them and then encouraged me through 20 repetitions on each one.

“Tomorrow,” he said, “we’ll do this all over again, but work on breathing, too.”

I nodded, pleased with myself for having done all that sudden exercise without weeping.

“Have a nice evening. Eat carefully,” he said. “Drink a ton of water. Get a good night’s sleep and I’ll see you tomorrow.”

And with that, I completed my first workout at a gym about a mile from mom’s place.  It’s something I’ve been mulling over (instead of just doing) for way too long. This last year or so of caring for my mom—coupled with RA and hip bursitis pain—has left me fatter and much less fit than I was. So yesterday I finally gathered up all my courage and walked my blumphy self through the gym’s doors, where I asked Mike the trainer if he could help me, a 55-year-old, post-menopausal woman with rheumatoid arthritis, hip bursitis and osteoporosis, get fit.

Yes, he said, he probably could, as long as I was willing to do my part. I asked what it would cost, and to my surprise, discovered that I could just afford it.

Until the bursitis attacked a couple of summers ago, I walked for exercise, usually two or three miles three times a week. But when I went to physical therapy for the bursitis, I was told to walk only short distances or I’d make it worse.

I didn’t argue. I couldn’t even grocery shop without my hips aching, the joints feeling as if they were coming loose. Still can’t, most days.

So here I’ve been, living with and caretaking my mom, who loves cookies and candy and ice cream and, for most of the last year, who’s been ill and housebound. It wasn’t long before my willpower, never terrific to begin with, gave out and I was enjoying those sweet, carby things with her. My weight ballooned, and in February I got scared and went back on a serious diet, dropping 30 pounds over six months in spite of getting no exercise to speak of.

Then Halloween arrived. There was candy. Then Thanksgiving got here, filled with cookies, pies and cakes. In between were restaurant meals and fast food. And then there was Christmas. More candy. More cookies and pies and mashed potatoes and gravy and stuffing and dinner rolls…

Throughout January I told myself to stop eating crap—my clothes were getting really tight again. I told myself, but I didn’t stop. Mom bought bags of cookies; I helped her eat them. And then I had my rheumatology appointment. The nurse weighed me. I was shocked and appalled: I’d put all those hard lost pounds back on. No wonder nothing fit me comfortably anymore.

I went to the gym again today. It was a little harder—my muscles were a bit tired from yesterday—and this time, I broke a sweat. Mike told me to expect to be very sore tomorrow. “So when you come in, we’ll see what you can do. The plan is for the bike again, the machines, and then, if you can, the elliptical.”

Wow. The elliptical. I’ve never used one of those before. I hear they’re… awesome.

I’m looking forward to making exercise each day into a habit. I need to. I simply can’t afford to get heavier and put more stress on my joints. I need to build and maintain stronger muscles to support my joints, too. And now that I’ve been diagnosed with osteoporosis, it’s vital that I do weight-bearing exercise to build up all the bone strength I can manage. Rheumatoid arthritis is hard enough when I’m at my fighting weight and fairly fit. If I’m obese and weak, I’m setting myself up for more pain and disability. And chances are, I’ll end up breaking bones doing normal everyday things like standing  up.

And frankly, setting my will on exercise is something I need to do for my self-image and my self-confidence. When I’m heavy and weak I feel unattractive and lumpy. But when I’m eating good, nutritious foods and moving my body, I feel better. I’m more positive. I have more energy, even when I hurt. I can smile easier and more often.

It’s not a walk in the park, this exercise thing. I’ve got to go to the gym early tomorrow morning, before heading over to my aunt and uncle’s place for the day. That means I need to push myself away from my laptop and get myself to bed. At the moment, losing those 30 pounds—and then, 20 more—again seems impossibly daunting. But I know I can do it, probably by June and maybe sooner, since I’m exercising this time.

Who knows? Maybe I’ll kill off the bursitis while I’m at it.