Ornamental cherry tree

Spring snuck into the northern California foothills about three weeks ago. (Yes. It was only February, probably the coldest, harshest month of winter in the rest of the Northern Hemisphere.) It was 68 degrees out and sunny. Today, everywhere you look there are ornamental fruit trees in full bloom—glorious, rounded clouds of pink or white—and there are daffodils showing off their sunny yellow faces in lawns and gardens everywhere. Here and there, tucked into quiet corners and unexpected spots, there are tiny crocuses in a rainbow of pastels. And many of the deciduous trees have already put on their fine, yellow-green sheaths of perfect, unfurling new leaves.

Spring is pretty, I’ll give it that.

Western redbud in bloom.

Manzanita blooms.

On the mostly-still-wild, chaparral-covered hillsides that surround and permeate this foothill community, the redbud shrubs and the manzanitas are fixing to bloom. Soon, the redbuds will be dressed in showy suits of startling, smile-inducing purply-pink; the tough manzanitas will be covered in tiny, pinkish-white blooms that look like upside-down faerie cups. It’s the only time of the year (in my humble opinion) that this tinder-dry chaparral comes close to pretty.

The squirrels are playing tag in the live-oaks and yesterday, I heard birds singing—something I haven’t heard since leaving my mountain home 18 months or so ago.

So. Accept it, Wren. Spring is extra-early this year—and that means an extra-extra-early summer heating up, with malevolent glee, in the wings. But just as I wrapped my head around that fact, this region’s version of winter decided to make a brief comeback.

The first rainstorm arrives tomorrow, followed by two or three more throughout the coming week. Rain! Wind! Sorta-cold temperatures! Yay!!

Like the rest of the country, we’ve had a strangely mild, scary-dry winter season. Except for higher up in the mountains, winters in this part of California are always mild, though, so this wasn’t really a surprise. Still, in a normal rainy season (which starts in late December and lasts, usually, until mid-March) we usually get a decent (read minimal, barely enough) amount of rainfall. The temperature becomes cool in the daytime and cold overnight. Winter here often means frost in the mornings. While parkas and heavy wool overcoats overdo it to the extreme, the northern California valley/foothill winter is perfect for sweaters, cardigans and trench coats (with liners for the cold-blooded). An umbrella is occasionally handy, but not vital.

This winter it’s been almost uniformly warmish. Daytime temps have rarely gone below 55 degrees. There’s been so little rain that the snowpack in the mountains, which the entire state depends upon for water, are at 40 percent of normal. We’ve needed no warm clothing this year. (Except for my mother, who emerged from the womb chilly and hollering for a sweater. She bundles up anytime the temperature drops under 75 degrees Fahrenheit. Indoors, with the thermostat on the heat pump set to a thrifty 68, she dresses in several layers and wraps up in an electrically heated throw whenever she sits down. In contrast, since moving down to the valley foothills to live with her, I wear T-shirts and jeans, no socks, and keep a sturdy Japanese hand-fan near at all times. We are very different. Sometimes I wonder if I’m actually related.)

Last night, the local weatherguy warned us of these imminent, incoming,

Rain settles in over valley in northern California (or, as southern Californians might say, "NoCal").

wonderfully winter-ish storms. He could hardly hide his glee. You can’t blame him: imagine how truly boring it would be to be a meteorologist in California, where the forecast for all but a few weeks of the year is for sunshine, clear skies, mild temperatures and a steady barometer reading on the high end? Where even fluffy white cumulous clouds rarely make an appearance? Where a windy day rates a Severe Weather Warning?

Well, I didn’t need Dandy Dave to tell me the weather was changing. I’d already been aching furiously all day. Both hands were screeching at me. And my bursitis hips were much worse than usual. Sheesh. Who needs a TV weather prognosticator when your own body acts as your personal Early Warning System?

The Storms are approaching with molasses-like slowness. The first, as I write this, is just now touching the far, northwest corner of the state, roughly 350 miles from here. The actual rainfall is expected to be fairly light and won’t start until sometime tomorrow. But ahead of the storm is some cloudiness—a bit of that is here already, tempering the brightness of the sun, and it’s 10-degrees cooler than yesterday. A light, fresh breeze is whispering. (Wind, my mother would call it. She’d call it a gale but won’t because she knows I’d laugh at her.)

And the point of this post? I felt like writing but didn’t have anything much new to write about. Why not the weather? Why not write about the promise of rain—a weather phenomena I love, personally, but that we’re also in desperate need of if we want to flush toilets or water flower beds once summer arrives in, like, April. My mental health needs this weather. I’ve missed two winters at

A Stellar's jay checks out the snow-covered persimmons after a late December snow at my home in the Sierras.

home, now—and anyone who has read this blog for long knows how I love the snow, my woodstove and hot, homemade soup.

In other news, Mom’s pacer incision is healing nicely. She’s still tiring easily, but the cardiologist told us to expect that until she recovers completely from the surgery and her body gets used to the pacemaker. Her mysterious, phantom bladder infection symptoms and general malaise have totally gone. Her appetite is improving—this morning, she’s already had a sweet roll, two slices of toast with butter, two chicken legs and she just wandered back upstairs with a couple of cookies to eat with her coffee. Her usually diet between early morning and noon consists of a cup of coffee and a sweet roll.

Big difference, and a positive one. She’s doing well.

And me? I’m waiting for those storms.

The good news: Mom’s bladder infection hasn’t heated up again. In fact, the infection is totally gone.

The bad news: The doc had no idea what caused her symptoms yesterday. No idea why she spent most of the day feeling so bloody rotten.

The good news: She’s feeling pretty good again this morning. Up with the sun and ahead of me, she fed the cats (well, she fed Mouse, who is always ravenous and not even a little finicky about her food as long as she gets a generous bowlful), got her newspaper, made herself some raisin toast, made coffee and took it all back upstairs to enjoy it. Mom loves having her first cup of coffee each morning in bed while she peruses the paper. The crackly, random sound of newspaper pages turning in the still, coffee-scented morning air is one I’ve heard for as long as I can remember, going way back to babyhood. I’ve alwaysd associate it with safety, warmth and serenity. Makes me want to pour a bowl of Captain Crunch and turn on cartoons.

The bad news: I woke up with deep, fundamental, aching pain in both hip joints and down the outsides of my thighs. My first lucid thoughts involved glum acceptance of the pain and the mundane hope for the temporary, partial relief associated with swallowing a dose of pain medication.

Here’s a question: Do narcotic analgesics make you feel high while they chase your pain off to the far edge of town? They used to have that effect on me, but that was years ago. I no longer experience that floating, grin-worthy “high.” There’s no associated euphoria. Today narcotic pain pills merely move the pain back several yards so I can get on with things a little more easily.

Of course, that’s no small accomplishment. I’m deeply grateful for the relief from pain they offer, even if it’s not as dramatic and enjoyable as it used to be. But sometimes I do miss that sweet, gentle high. It was the only good thing about a bad flare.

I left Mom’s doctor’s office yesterday evening dissatisfied, still worried about her and more than a little baffled. Like most Americans, I’ve been conditioned to expect immediate results when I seek medical care for myself or my loved ones. I expect a solid diagnosis and medications or procedures that will make the problem go away, hopefully forever. And that’s in spite of knowing—first-hand, thanks to 25 years of rheumatoid arthritis—that modern medicine, as miraculous as it can be, doesn’t always have answers and an instant cure.

So this morning, while I’m pleased that Mom is feeling better again, I’m also a little bit blue. Her pacer-stimulated heart and resulting well-oxygenated brain haven’t improved her memory or cleared up her frequent confusion—at least, not so far. And it may never do so. I have to admit I was hoping it might, because as long as she remains forgetful and scattered, I can’t go home. I can’t leave her alone for more than 12 hours at a time.

And while I’m so glad I can be here to care for her, chase away her loneliness and keep her safe, I do miss my own home. I miss Mr Wren and my daughter and her fiance’. I miss my dog, Finny McCool. I long for my gardens, the sharp, chill mountain air, the sea-sound the breeze makes rustling in the tall pines, the morning songbirds and raucous cries of the Stellar’s jays, the quick little wrens in the hedgerow and the graceful Japanese maple outside the kitchen window. I miss the quiet. I miss the colors …

For now, my home remains just out of reach, except for short visits.

Of course we’ve talked about other options. But Mom won’t move up to my house or to my sister’s house in New Mexico. Both locations are far too cold for her; she’d be miserable. And anyway, her townhouse has lost so much of its value in the crashed economy that she’d have to pay more to sell it than she’d get back from the sale—assuming it would sell at all. An assisted-living situation would probably work well for her, but such places are stunningly expensive—and she refuses to consider it right now, anyway, since she feels she’s perfectly capable of living on her own. (heh) And frankly, she’s too bright, too healthy and too independent to justify the horrible, living burial of a nursing home.

And there’s the fact that I’m able to stay here with her. She needs me. She’s my mom.

I’ll be fine. This blue funk will pass. The pain pill is starting to work, so I’m thinking about running some errands, going for an hour to the gym, and maybe even going to spend half a day at my aunt and uncle’s house, rustling up a couple of weekend meals for them. As long as Mom still feels okay, I can go out for a while without worry.

I’m thinking the change of scenery, even if it’s temporary, will do me a lot of good.

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.