April (Snow) Showers Bring May Flowers

Snow storm on April 19th

I'm going to be honest: I have complained about the weather a LOT this year.  January wasn't bad, February was about on par with average, and I began to gear up for spring come March.  You know the whole "in like a lion, out like a lamb" thing?  Well, I'd say forget March -- even April was in like a lion...and out like a bear!  From temperatures that kept getting colder instead of warmer, to late season snow storms, I was not happy.  I kept wondering if April snow showers would still bring May flowers.  Lo and behold, as soon as May hit, somebody flipped the switch on the weather and we jumped from winter straight into summer!  We have now had a full week of what I would call the perfect weather: high in the mid-high 70s, mostly sunny, light breeze that is neither cool nor warm.  Perfect.  And my plants have loved it (and so have I!!).  After all of April's precipitation and all of the sunshine in the past week, my spring flowers and trees are in full bloom!  Here are a few of my favorites...

I planted my "early spring" vegetables late due to the still frozen ground, so there's not much to show yet there.  I have seedlings started indoors, and my tomatoes are doing the best they've ever done!  Most likely because I actually did some research this year and am trying to follow the rules for proper seed starting.  I'm hoping it's going to be a good garden year.  I even have a plan for the deer.  I have fashioned some netting out of tulle fabric that I plan to drape over any vulnerable plants if the deer find their way to my garden again this year.  They've already been digging up bulbs in my front yard!

Once I have something more interesting to show, I'll give the full vegetable garden update!

Bending the LAWs

I've been struggling with decreased mobility, stiffness and some pain with use in my LAWs (Little Arthritic Wrists) for some time now.  Even though they are not so inflamed and painful from rheumatoid disease as they once were, I'm suffering the results of the damage done.  At my last visit to the rheumatologist, my doctor suggesting that I try physical therapy to try to regain some functionality and range of motion in my wrists.  Even though there is already damage done, I want to get the most out of whatever my wrists have left to offer.  To be honest, I was a little bit skeptical about physical therapy because it felt like when I tried to bend my wrist the joint would simply get stuck, since there's not much room for my joints to move anymore.  Of course, that didn't keep me from being optimistic and telling my physical therapist that I wanted to be able to do a push up again!

I started physical therapy for my wrists last week, and have now been to four sessions.  I am actually pretty amazed at what we've been able to accomplish so far.  She measured how far my wrists could bend in all four directions on my first visit there.  Now, bear in mind that my first appointment was at 7:45am, so my joints hadn't had much of a chance to get moving and loosen up for the day.  However, looking at the measurements from that day versus just yesterday, there are already some big improvements -- particularly in my flexion and extension.  As an example, I think both wrists were originally in the 35-40 degree range for extension, and they've since increased to 55-60!  I've been doing stretches and exercises at home to get my joints moving, maximize the range of motion and gain strength in my wrist muscles.  When I'm at PT, my therapist will work on mobilizing each individual wrist joint.  I'll tell you what -- my wrists feel great right after she's done!  

Functionally, I'm not sure I've gained a lot yet, but my wrists do move more easily in all directions, with less pain.  The only thing I have to be careful of is not pushing myself too far.  My personality is such that I want to do the BEST that I can and see just how far I can bend my LAWs or just how much weight they can bear, etc.  But, pushing things too far will just trigger the inflammation to come back and reverse some of the progress that's been made.  So, I will do my best to keep up my range of motion and strength exercises without pushing myself to the point of pain.  I'm going down to one PT session per week now -- for who knows how many weeks.  I may not be able to do a real push-up when I'm done, but I feel pretty confident that I'll be able to do a wall push-up soon.  If I do, I'll send proof.  Wish me luck!

An Upbeat Update

I had my latest rheumatology appointment last week. Overall, I would say that the appointment went very well.  I told my doctor that I had been feeling well, but that my wrists continued to be stiff, sometimes sore, weak and definitely had a very limited range of motion -- though they are far better than they were a year ago, and holding steady.  He noted some slight warmth/swelling in my right wrist, which I'm not sure I would have detected.  He ordered some new x-rays for my hands and wrists, which I was able to get done right there and then discuss with him.  I had the x-rays taken, then went back to my room and waited for the doctor to return.  

I finally decided I should request a copy of my x-rays from the doctor's office.
This is one of three from last week: wrists have some damage, but fingers still look pretty good!

The x-ray images were sent to his laptop, which he pulled up and showed to me, knowing that I was interested in seeing them.  He actually took the time to explain what he saw in the x-rays -- definitely joint space narrowing, some erosions, and other irregularities -- and he pulled up some images of healthy wrists so I could see the difference.  Then, we looked up my x-rays from last time -- in December 2011 -- and compared them to now.  There was not a huge difference, which relieved me.  Plus, I was glad to see that the bones were not fused, which had been my fear.  However, my doctor made clear that he was "not happy" about the way my wrists looked.  There was a rueful tone as we discussed the damage that had been done, with no way to reverse it.  If only I had come in sooner, perhaps we might have made some treatment changes sooner and prevented some of the damage.  Hard to say, but I will let that be a lesson to myself to call my doctor when I do have even a moderate flare that lasts longer than a week or two -- especially when I have been feeling well and have ~6 months between appointments.  The Humira is still working well, so I'm staying the course for now. AND my rheumatologist ended up referring me to a physical therapist to work on increasing my range of motion in my wrists.  More on that later.

Battery powered heated slippers! They are amazing.

I did end up showing my rheumatologist the bruises on my toes and explained that they had appeared in conjunction with Raynaud's phenomenon.  He did not give a name to them, but did say that it looked like the blood vessels had burst from the Raynaud's.  He didn't seem overly concerned about it, but said we could consider putting me on Norvasc next winter.  The only issue is that I have a pretty low normal blood pressure -- so I'm not sure I want to be on something that will lower it.  I'll see what happens next year.  At least I have an amazing husband who found and bought me heated slippers!!

Lastly, my doctor ordered some blood work to check my Sed Rate, among other things.  Everything came back normal -- and my Sed Rate was a 9!! That's the lowest I have had to date!  Here's an updated look at my track record:

Click chart to view full size

I really appreciated the time my doctor spent with me on this visit and his willingness to help me get a better understanding of my own condition.  I left feeling very positive (1) that the disease was holding steady and (2) that I have a doctor who values me as a partner in my own care.

The Impression that I Get

I have my next appointment with my rheumatologist on Tuesday.  It's hard to believe that it has already been six months since I was last there.  And that I've had very minimal pain or symptoms in the past six months.  I have to say, I am glad I decided to make the switch to Humira last winter.  And, perhaps I'm thankful for the Plaquenil, as well.  In preparation for my appointment, I've been trying to think through any questions I have or discussion points I want to touch on with my doctor.

I was reading through RA Warrior's posts about foot involvement in RA recently, and it got me thinking: I need to talk about my feet.  My feet were one of the first things affected by RA (so discounting foot joints in formal joint counts continues to baffle me) and have consistently remained my largest problem area outside of my hands.  Amazingly, since my switch to Humira, my feet have felt fantastic.  I cannot recall a single day in the past YEAR that I actually had foot pain.  Maybe a few days where they felt stiff, but they've even felt surprisingly good on our new hardwood floors (although, yes, I am wearing slippers almost constantly now). I'd better knock on wood and hope my feet don't start revolting tomorrow.  At any rate, I was thinking my feet may be a pretty good barometer of my progress.  Not only has the pain gone away for an extended period of time, the nodule I've had on my big toe for a number of years has also shrunk significantly. 

Despite the fact that I don't have any RA symptoms to show and that doctors tend to ignore the feet anyways, I do need to show my rheumatologist the bruises that are still on my toes -- that have appeared in conjunction with Raynaud's attacks.  We'll see if he thinks it's chilblains and if he has any suggestions.  They do seem to be getting better as it gets (slightly) warmer.

Beyond the feet, I do need to talk to my doctor about my wrists, as well.  If I don't take Naproxen for a while, they will begin to act up.  While they feel miles better than they did last year and they don't always appear to have active inflammation, they still only bend about 30-45 degrees and they will hurt if I put too much weight or pressure on them.  I think I will be getting new x-rays on this visit, and I need to request copies of my old ones, as well.  I'm curious to know if he can tell from the x-ray if I do have permanent damage and how things may have changed since my last x-rays a year and a half ago.  Undoubtedly, if there is damage, some of it occurred between November 2011 (when I got the x-rays) and March 2012 -- the period during which I had my worst symptoms.  I seriously doubt much has changed over the past year. There will be no way to tell for sure...but that's the impression that I get :)

Have you ever been close to tragedy
Or been close to folks who have?
Have you ever felt a pain so powerful
So heavy you collapse?

...

Have you ever had the odds stacked up so high
You need a strength most don't possess?
Or has it ever come down to do or die
You've got to rise above the rest?

...

No? Well...
I never had to knock on wood
But I know someone who has
Which makes me wonder if I could
It makes me wonder if 
I never had to knock on wood
And I'm glad I haven't yet
Because I'm sure it isn't good
That's the impression that I get.

Chicken Tortilla Soup

It is now mid-April -- well into spring.  Yet, all week we have dealt with cold 30-40 degree weather and rain.  It's been dreary, to say the least, and I've been more than a bit cranky as I wonder aloud why spring has not yet arrived.  I was trying to decide what to make for dinner on Thursday night, and by the time I got home from work I had determined that it had to be soup.  A nice warm bowl of delicious, hearty soup would surely warm my spirit on a cold April day.  I had some chicken in the refrigerator that I had to use up or freeze, so I decided I'd make something with that.  I had this vague idea of making "Chicken Tortilla" soup, but I didn't really know what that entailed -- and since this was a last-minute meal, I had not gone shopping for any special ingredients.  I decided to peruse AllRecipes.com for some general direction, then raid my pantry to see what I could throw together.  This was the result.

Ingredients:

- 3 boneless, skinless chicken breasts, cubed
- 1 can of black beans
- 1 can of enchilada sauce
- 1 small onion, diced
- 8oz salsa*
- Chicken broth
- Seasonings to taste: salt, pepper, chili powder, cumin, paprika
- 1 Tbsp. olive oil

Directions:
Heat oil in a skillet over medium heat, and add chicken and spices to taste.  Cook until chicken is no longer pink in the center.  Add chicken to a stock pot, along with beans, enchilada sauce, salsa, and onion.  Add enough broth to make it soupy -- use your own discretion.  I ended up adding a little bit of flour, too, to thicken it up.  Season with additional spices, if desired.  Serve topped with shredded cheese and tortilla chips.

*For the salsa, I used some homemade salsa that I had leftover from a couple of weeks ago.  A friend gave me this recipe -- it is SO easy and SO good!!

I thought it turned out great, especially for a "see what's in the pantry and try to make something of it" sort of meal.  The cheese and tortilla chips are a must, in my opinion :)  I think I'll be making this one again -- it was very simple and quick to make!  To make it even easier, just get a rotisserie chicken, shred that, and add some extra seasoning when you make the soup.

RA Won't Get the Best of Me

This post is part of a blog carnival, prompted by RAWarrior.com -- with the subject of the carnival being, "how do you keep the disease from taking over?" Click here to read all of the entries!

We all need to have an armory, well stocked
with things that help us fight this disease --
including things that protect against RA taking
over our lives and getting the best of us.
Yes, silliness is in my arsenal.

We know that rheumatoid arthritis attacks each person differently, and the severity and impacts of the disease can vary widely between patients.  I feel very fortunate that while my disease is moderately aggressive, it has so far been very treatable and has responded well to the treatments I've tried.  As a result, most of the time, RA hasn't severely impacted my day to day living.  On the other hand, even with well-controlled RA, there are flare ups and periods of time with more active disease, there is joint damage that has occurred, and there are days that the disease threatens to steal away part of my life and part of my joy.

As I type this, I am home sick, lying in bed.  I've never dealt well with being sick (I'm the kid who would pout and cry whenever my mom made me stay home sick from school), and I finally realized why: admitting I'm sick and deciding to stay in bed makes me feel like I've lost a battle, I've been defeated, the sickness has won.  I know that's silly, and it's important to rest when your body needs it, but it remains an internal struggle.  Imagine the struggle I faced when I was diagnosed at age 19 with rheumatoid arthritis: every day it felt like I had lost a battle.  Coming to terms with living with a chronic illness was a long process.  At first, I was devastated.  Over the years, I've learned to accept things for what they are, but when the days of despair creep up (as they always do from time to time), I've found a few things I can do to help keep my spirits up and keep the disease from taking over and getting the best of me.  I've already discussed my thoughts on "managing my rheumatoid disease" -- there are obvious things we can do to be proactive about getting proper care and treatment and to take good care of ourselves -- but when the disease threatens to take over anyways, here are some things I've found to help.


Focus on Faith
I've said it before and I'll say it again: my faith in God is what keeps me going each and every day.  Learning how to rely on God's strength instead of my own and focusing on His faithfulness helps me to get through the tough days.  Knowing that God can work good things even out of the bad helps me to keep a a proper perspective.  If I focus my attention on my disease and dwell on my symptoms, on pain, on the unknowns of my future -- it quickly leads to a downward spiral.  But, when I focus my attention on God, and his love and promises, it fills me with hope and leaves no room for worry, fear or despair.

"Therefore, since we are surrounded by such a great cloud of witnesses, let us throw off everything that hinders and the sin that so easily entangles. And let us run with perseverance the race marked out for us,  fixing our eyes on Jesus, the pioneer and perfecter of faith. For the joy set before him he endured the cross, scorning its shame, and sat down at the right hand of the throne of God. Consider him who endured such opposition from sinners, so that you will not grow weary and lose heart." -- Hebrews 12:1-3


Do What You Can and Accept Help
Another thing that helps me to keep RA from getting the best of me, is continuing to do what I can.  This will look different for each person affected by the disease, and obviously you need to be careful not to overuse flaring joints -- but focusing on what I CAN do instead of what I CAN'T do can help me to feel better.  I can't do push-ups anymore or anything that requires more than a 30-degree bend in my wrist, but I still CAN do most of my yoga DVD -- and I CAN modify things so that they work for me.  

I call this one of my "Conquering RA" pictures -- backpacking
on Isle Royale was a life dream that I was able to realize
despite RA!

I've learned that some of my activities have limits, but have also learned to adapt and to ask for help when I need it.  And to rest when needed, as it will help me feel better in the long run (okay - so, maybe I'm still learning how to do this one!).  I finally learned to take a prednisone burst if I know I'm going to be doing an intensive activity -- like backpacking -- and when I'm feeling well enough to do those activities, I need to take advantage and DO them!  Cooking in the kitchen has become a greater challenge with my bad wrists, but I've been known to knead bread dough with my forearms if it comes to it, and have learned to ask my husband for help with lids and heavy things, rather than hurting myself trying it on my own.  In the end, I feel a greater sense of accomplishment and less frustration when I simply ask for help with the parts that I know I won't be able to do -- then I can focus my efforts on the parts I can do and can actually enjoy the process.


Delight in Life's Simple Joys
Finally, one of the best things I can do is to take delight in the simple things in life that bring me joy and happiness.  A chronic disease can steal a lot of things from you, but you don't have to let it get the best of you.  Spending time with loved ones and taking the time to enjoy the things you love can make a world of difference.

"I simply remember my favorite things, and then I don't feel so bad"

These are a few of my favorite things...

Laughing. Humor always makes things better for me. A funny joke...or even a silly pun; I'm easily amused.  Inside jokes are even better :)

The smell of the outdoors on a fresh spring day -- or on a crisp fall day

Playing games -- cards or board games -- with family and friends

Watching things grow in my garden

Animals -- either watching them in nature or playing with a pet (or playing with chipmunks in the wild!)

Napping in a hammock

Sitting around a campfire

Reading on the beach

A bouquet of fresh cut flowers

Simply spending time in good conversation with loved ones

Spinach Stuffed Chicken Breasts

I couldn't remember what I had planned to make for dinner tonight.  I thought about it briefly while I was at work, but by the time I got home, I still had no idea what I had meant to make or what I was going to do.  I just went grocery shopping yesterday, so I figured it couldn't be that hard to come up with something.  As I started running through the foods in my fridge, I came up with an idea that I've been wanting to try for a while now: stuffed chicken breasts.  I didn't really know what I wanted to stuff them with, however, but I was thinking maybe spinach.  I looked up several recipes on AllRecipes.com and gleaned some helpful insights, but none of them were exactly what I was looking for.  So, I made up my own dish.  I will do my best to recount the recipe and measurements, though I didn't actually measure anything.

Ingredients:

- 2 boneless, skinless chicken breasts
- 1 cup fresh spinach leaves
- 1 Tbsp olive oil
- 1/3 cup feta cheese
- 1/3 cup shredded mozzarella cheese
- 3 Tbsp. sour cream
- 1-2 cloves of garlic, minced
- 2 slices of prosciutto
- seasonings to taste

Directions:

Pound out chicken breasts to flatten (I don't have a good meat tenderizer or mallet, so mine weren't all that thin, and it still worked).  Put spinach and olive oil in a food processor and pulse until spinach is finely chopped.  Add cheeses, sour cream and garlic and process until well combined.  Spoon spinach mixture onto the middle of each chicken breast, then roll up both sides and secure with a toothpick in the middle.  Wrap a piece of prosciutto around each chicken breast and secure with additional toothpicks, if necessary.  Bake chicken at 350-375 degrees for about an hour.

It really was not that difficult to make.  It would've been quick and easy (besides the hour wait while it bakes) if I had already had my chicken thawed when I got home!  I ended up putting some red skin potatoes and onions in the oven at the same time as the chicken.  I figured they'd both be done about the same time and it would make an easy side dish!

For a made up recipe, I thought this turned out pretty well -- plus, the presentation is great!