Juvenile skunk

Less than a foot away, thankfully outside the window, was a skunk. It was jet black with two wide, snow-white stripes along its back, and man, that tail! Black with the white stripes until it reached the last four or five inches at the tip, where it fanned out in a wild party spray of black, white and gray.

The skunk startled a little at the movement of the shade but continued its leisurely stroll along the walk and around the corner of the house. It seemed quite unconcerned. No wonder, though. Armed as they are with that noxious stink-bomb, not much worries skunks.

Western scrub jay

I don’t often see much wildlife here at Mom’s house, what with the busy road close by and the suburban neighborhood all around. It’s not like at my own house up the mountain, where any given morning might start with a raccoon or possum, a skunk or a deer, or even a coyote sighting, and nearly all mornings begin with our local gang of rowdy Stellar’s jays yelling up the sunrise from their perches in the tall pines.

Birds are rare around Mom’s place, too. I’ve seen all of one robin this spring, and no sparrows or finches whatever. Even the ubiquitous scrub jays that make the foothill live-oak glens their home are scarce.

This little dawn skunk was a gift. I hope I get to see it again.

For many years it worked hard every day, doing its part. It never complained. It stood up under the onslaught of Pez and jawbreakers and sour apple bubblegum. It masticated countless hamburgers and French fries, Cokes and chocolate milkshakes. It cracked ice and crunched up potato chips and Cheetos and worked over pepperoni pizza and burritos. Later there were steaks and Chicken Kiev and steamed vegetables and brown rice and tofu, but the good tooth never once complained.

But in its 55^th year, it developed a deep crack in its foundation. For quite a long time it said nothing. It just soldiered on, maintaining a stiff upper lip. The crack worsened, however, and finally one day the tooth broke. It died and abscessed. Its long life was over.

Yesterday, with the whole left side of my face swollen up balloon-like and startling, I went to an emergency dentist. He wasted no time pulling that good old tooth right out of my head. It was done in minutes and with a minimum of pain and trauma. Shuddering, I left my old tooth, sawed into pieces, in a sterile silver kidney pan in the clinic. There will be no funeral.

But its memory remains. The gap the old tooth left in my jaw is deep. It feels far larger than the tooth itself. I miss the little fellow. It was a dear and trustworthy friend. Once the tissues heal, I’ll be fine, but chewing will always be a little bit harder. A good memorial.

Farewell, my old friend. And thank you.

The term set a bell jingling in my mind, so I googled it.

Palindromic Rheumatism (PR) is a rare autoimmune disease. “The descriptor ‘palindromic’ is used based on its Greek root palindromos, which means ‘to come and to come again,’ which aptly describes this phenomenon,” states Dr. Gordon Lam in a paper he wrote about the disease for Johns Hopkins. “… palindromic rheumatism is an idiopathic, periodic arthritis characterized by multiple, transient, recurring episodes of mono [single joint]- or oligo-[up to four joints] arthritis associated with tissue swelling around the involved joints. Episodes last for a few hours or a few days and then spontaneously resolve. Between episodes, there are no residual effects.”

Bingo. I read Dr. Lam’s paper with growing recognition—and astonishment. His description of the disease, along with the story of one of the patients he’d diagnosed with PR, sounded incredibly familiar.

I was diagnosed with RA in 1987 after nearly a year of transitory, often disabling joint pain that came and went without warning and without, as far as I could tell, reason. The flares affected one joint at a time and could occur on either side of my body. They moved around. One day, it would be one of the knuckles on my left hand that was hot, swollen and so painful that I couldn’t bear to move it. The next day it would be my right knee, or my left great toe, or my right shoulder, or my left jaw or… or… or. You catch my drift. The flares started suddenly, lasted anywhere from two hours to four days, and ended just as abruptly. I never knew from one day to the next what to expect. Usually there would be a break—sometimes of up to two weeks, and the flares could vary in intensity.

The only continuous pain I experienced was on the bottoms of my feet. From the moment I got out of bed in the morning, my feet would feel as if I’d been standing on them all night long. They were sore and tender, and the first steps I took usually elicited groans of pain. Throughout the day, walking hurt, but standing for any length of time hurt even more. Still, I functioned, forcing myself to endure the pain and get on with my day, my professional work, and my life as a wife and mom.

When one of my joints flared, it would be exquisitely, excruciatingly painful. I could not move it nor bear much if any weight on it. Sometimes even the lightest pressure could be agonizing. For instance, if the flare was in one of the joints in my foot, I would have to hang it off the edge of the bed, uncovered, in order to rest or sleep at night. Even a sheet was too much. I often had to use a cane and, more than once, was prescribed crutches by my doctor for a week or two at a time.

I was a civilian married to a soldier and worked for the U.S. Army in Germany at the time, so my medical care was provided by the military. I was very lucky. My doctor, a young internal medicine specialist, believed me regarding the strange, awful pain I was experiencing and tested my blood for the rheumatoid factor first thing. There it was. He diagnosed me with rheumatoid arthritis and began treating me with NSAIDs, starting with high-dose aspirin.

Over the next five years I had blood test after blood test. Sometimes the Rf factor showed up, sometimes it didn’t. I learned that a diagnosis of RA required the satisfaction of several criteria: that the Rf factor show up in the blood; that there was symmetrical involvement of several different joints; and that flares would last for three weeks or more.

None of them ever really applied to me, as far as I could tell. My flares never occurred in the same joints on both sides of my body at the same time (re: flares in both knees or both wrists or both ankles at the same time). My flares didn’t last for weeks, but for hours or days, usually with short, flare-free periods that lasted a day or a week in between.

I also didn’t have any of the other criteria: I wasn’t unduly fatigued, I suffered no weight loss (darn!) and I never ran a low-grade fever or experienced any flu-like symptoms.

The exception was my near-continuous foot pain, which was symmetrical and long-lasting. But my doctor had no explanation for that.

It has always niggled at me that my symptoms didn’t exactly match the RA diagnostic criteria. But my doctor was the only expert I knew. He said I had rheumatoid arthritis. I believed him.

During those years, none of the NSAIDs or DMARDs—gold salts and plaquenil—ever worked to relieve my pain. The only drugs that did were narcotic pain relievers, and those were doled out with great caution, just 10 pills at a time. I was very frustrated and in a great deal of pain, and I missed a fair amount of work.

When we left Germany in 1992 and resettled in Washington state, I went to a new Army doctor. After a quick examination—I have no idea if he even looked at my medical records—he told me that my prior doctor had been wrong. I didn’t have rheumatoid arthritis, I had palindromic arthritis.

I was floored. What does that mean, I asked. He said that it meant that I had a type of arthritis that occurred in many different joints at different times, sort of a catch-all type of arthritis, and after all, there were many, many different types and they were all hard to diagnose. Anyway, since there was basically nothing they could do to relieve it, I’d just have to live with it. He didn’t offer any treatment or follow-up appointments. He was hostile and dismissive. And I was embarrassed to ask for narcotic pain relief, figuring he’d just think I was drug-seeking. He probably already did.

I left his clinic stunned… and after a while, absolutely furious. I was convinced that this new doctor had no real idea what I had and that he’d basically blown me off. Since the many different RA drugs I’d tried hadn’t had any effect on my RA (if that was even what I had!), I decided then and there that I’d never bother with another doctor, ever again, about my pain. I’d just, as the good doctor said, learn to live with it.

And that’s what I did for the next six years. Naproxen, the NSAID, was released as the over-the-counter pain reliever Aleve. I took it now and then. And by some stroke of luck, as time passed I had fewer and fewer flares. The pain gradually lessened in intensity. And finally, in 1999, the flares stopped entirely. I had achieved that fabled state, “remission.”

It lasted until 2005, when I developed two large, long, firm, mostly painless lumps beneath the skin along the outside of my right wrist. I consulted my PCP, who had no idea what they could be and who quickly referred me to an orthopedic surgeon. After X-raying my wrist, he asked if I’d ever had arthritis. I told him about my old struggle with “RA.” “Ah!” he said. “That explains it.” He said the lump was thickened, excess synovial fluid that had leaked out of the wrist joints and slowly hardened in place. Even though my RA was quiet, he explained, it was still in my body doing damage. If left alone, the lump would probably continue to grow and, eventually, impair the free movement of my wrist and hand. The other option would be to have it surgically removed. And he urged me to see my PCP again for a referral to a rheumatologist.

I had him remove the lump. Today I have a five-inch-long, flattened M-shaped scar that runs from the base of my palm up the outside of my wrist along my forearm. It healed without incident in about six weeks.

I was still angry and frustrated with doctors, however. I didn’t ask for that referral. I wanted nothing to do with rheumatology. I wasn’t having any flares or pain. Why bother?

It was in the years following the surgery that my hands began to swell and ache. And as that happened more and more often, and the pain slowly intensified, I finally broke down and went to a rheumatologist for treatment. I’d heard that new RA drugs had been developed. Maybe there would be something that worked, a wonder drug that would be worth the risk of the dangerous side effects.

My VA rheumy comfirmed my original doctor’s diagnosis of rheumatoid arthritis. He’s never once mentioned any other kind of arthritis to me. He treats my disease with a cocktail of DMARDs and tests my blood for the usual RA markers, including the Rf factor, which still shows up whenever he includes it in the tests. I’m not in remission anymore, but my disease activity is low.

As I’ve written here before, my old rheuma-dragon changed while we were in the Land of Remission. Instead of viciously sinking his long fangs into one joint at a time, he just chews and gnaws like a monster puppy at my knuckles and wrists—both hands at the same time. Once in a while he’ll give me a sharp nip in a knee or ankle, or he’ll sink his teeth into a shoulder for a while. The pain has only rarely been as intense as it was in the early years. Instead it’s mild to moderate and—a major difference—it’s constant. My hands always hurt. There is frequently some swelling around my knuckles, too. It’s like I’ve had a single, low-grade flare going on since about 2007.

I still don’t have fevers or mysteriously lose weight (darn it, again! If I have to have this disease, at least there might be one good thing about it!). I still don’t experience any flu-like symptoms. I do, however, become fatigued much more easily than I used to. It could be RA, but it could also be due to age—I’m 26 years older than I was when I was first diagnosed. And it could be from the hip bursitis my old rheuma-dragon brought with him when he woke from his long remission sleep. Some of the bursitis pain is a feeling of fatigued weakness in my hips.

So. What was my point about palindromic rheumatism?

As I read Dr. Lam’s paper on it this morning, it was like bells and whistles started going off in my head. I now believe that I probably did have palindromic rheumatism during those first, really bad five years. The Army doc I saw in Washington—the one that blew me off—was right, after all. I really wish he’d taken the time to explain to me how he came to that diagnosis, and I wish he’d had the patience, kindness and empathy to at least try to treat it, instead of telling me I just had to live with it. If he had, maybe I’d have gotten started on more effective treatments for it and for RA back in the early 90s.

Dr. Lam’s paper states that PR frequently precedes RA. It often goes into remission for a period of time and then reappears as full-blown RA. The Rf factor often shows up in blood tests in PR.

Finally, one of the puzzles about my RA is that I’ve had only very minor joint erosion over the years, mainly in my thumb knuckles. So many people with RA end up with terribly deformed, disabled joints.

It turns out that palindromic rheumatism never causes joint erosion. How about that!

I have an appointment with my VA rheumatologist later this month. I’m going to ask him about all this and see what he has to say. If I’m right, and I did have PR either alone or with my RA, questions I’ve had about my RA for years and years will finally be answered.

Over the last year or so I’ve experienced a noticeable change in my eyesight. At first, I chalked it up to the “normal” deterioration that most of us experience as we age—I am, after all, 56 years old, and I’ve needed prescription eyeglasses for the last 15 years or so. I have mild astigmatism and need some help reading close-up.

So, when I saw my rheumatologist a couple of months ago, I mentioned that I hadn’t received a notice for an eye appointment in more than a year. As I’m taking plaquenil, a rheumatoid arthritis drug that can cause, as a side effect, changes in the retina that can lead to blindness, he was surprised and concerned that I hadn’t been contacted. He put a flagged referral into the computer.

What are the changes? Vertical double vision is the one that has me worried. Less upsetting (and probably more normal) is that reading small print is nearly impossible now. Heh. Hand me a microwave dinner, tell me to read the cooking directions on the back, and I’ll have to go looking for my drugstore reading glasses first. Now, really, this is no big deal—lots of  boomers have this problem these days. My prescription glasses used to correct for it. Now they don’t.

The double vision is the scarier of the two.

I finally saw the ophthalmologist about a week ago. He checked for plaquenil-caused changes in my retinas. Holes, for instance. There were none, thank goodness. He dilated my eyes and studied them through the slitlamp. Everything looked good, he said. He had me read the eye chart, adjusted my eyeglass prescription a little and told me all was well.

“But what about the double vision?” I asked, trying not to sound plaintive.

“That’s most likely because of changes in the shape of the lens. It’s caused by aging,” he said. “Nothing to worry about.”

Right. I’m trying not to worry as I wait for my new glasses to arrive in the mail. Perhaps they’ll fix the problem. But if they don’t, what then? Do I just accept that my world now includes a ghost image slightly above and to the right of all the text I read? That all objects I see that are more than a foot away also have doubles?

My eyes also frequently feel gritty and itchy. Now, I have a grass allergy that’s most active in spring and fall, so red, burny eyes and I are old acquaintances, and that’s very likely the reason.

But for good or bad, I always look things up on the Intertubes.  Sjogren’s Syndrome, a common co-morbidity of RA, also causes abnormal dryness in the eyes, mouth and other mucous membranes. It makes the eyes  red and feel gritty and itchy.  Can it also cause double and/or blurred vision? I don’t have a dry mouth or nasal passages.

Being practical, I bought some allergy eye drops along with some that simply lubricate the eyes. I’ve been using them both each day, the latter as needed. They make my eyes feel better, for sure, but the double vision remains the same. Nevertheless, if I have Sjogren’s—or even just dry eyes for whatever reason—shouldn’t the ophthalmologist have noticed that? Surely he’s familiar with it?

I’ll be visiting my rheumatologist again in about four weeks. By then I’ll have my new glasses. If I’m still experiencing double vision and irritated eyes, I’m going to be a lot more vocal about it than I was last time. It probably has nothing to do with the plaquenil—a good thing—but it’s definitely affecting my daily life. It’s hard to drive (at night, especially) when the yellow line in the middle of the road doubles and floats.

Anyway. I know that some of you have Sjogren’s along with RA. Was your experience before your diagnosis anything like mine?

I’ll be upfront, here: I’ve always been seriously skeptical about homeopathic remedies. But I agreed to try LivRelief cream and review it because, well, as someone who’s lived with rheumatoid arthritis for close to a quarter century, I still dream of finding something—anything—that might relieve the pain this intractable autoimmune disease causes. Maybe, I thought, just maybe, LivRelief cream will be the one.

Since it came in the mail, I’ve used LivRelief cream several times on mild-to-moderately painful RA-inflamed joints in my hands, fingers and wrists. I’ve also used it at the base of my small toes on my left foot and on my right knee. Finally, I’ve tried the cream on both my hips. They ache frequently—and almost constantly—from RA’s co-morbid condition, trochanteric bursitis, and I figured why not?

That first time, I tried it on my hands and wrists. Within 10 minutes of using the recommended amount of cream—two short squirts from the pump-bottle—the sharp, twingy pain I was experiencing eased up. A couple of minutes later it was completely gone. As a nice bonus, the cream made my skin feel well-moisturized and silky-soft.

Whoa, thought I. This stuff works!

I was delighted—and genuinely surprised. I’ve tried and tossed out so many topical pain relievers over the years. Most of them had either capsicum (cayenne pepper) or menthol as the active ingredients in them. The menthol ones were pleasant but had no “relieving” effect on my pain. The ones with capsicum added the intense sensation of scorching, blistering skin to the already aching joints that lay just beneath it. I always ended up washing it off. Frantically.

So, discovering that LivRelief cream worked was wonderful.

Unfortunately, it only worked that one time. When I tried it again on my hands the next day, nothing but softened skin happened. LivRelief also had no effect on the small joints at the base of my toes, or on my knees. Finally, it did nothing for the bursitis pain in my hips.

Well, except for softening and moisturizing my skin.

Why did it seem to work that first time? I really don’t know. Maybe the pain in my hands would have gone away shortly, anyway. Rheuma is weird—the pain almost always comes and goes suddenly and without reason or warning. One time the flare will last three minutes, the next time, three-quarters of a day. Or maybe the gentle massage I gave my joints as I was rubbing the cream into my skin helped to relieve the pain.

Here’s what I know: the cream worked miraculously well once, but my wily old rheuma-dragon figured out how to overcome and disable the beneficial effect after that, no matter which joint or part of my body I used it on.

So, do I recommend that you try LivRelief cream on your achy, painful RA joints? The legendary hockey star Bobby Orr certainly does, stating on the website PRWeb that “LivRelief has improved my quality of life … I would recommend it to anyone suffering with pain.”

You can purchase the cream online in its 2 oz. pump bottle through Amazon for $27.86 or GNC for $29.99.

THE TRAMONTINA All Generations 10-inch Porcelain Enamel Nonstick Saute Pan has earned the Arthritis Foundation’s Ease-of-Use Commendation.

point out the pan’s pluses for people with diseases that attack the joints, making them stiff and painful. “Why not?” I thought.

When the pan arrived in the mail, I was impressed by its weight–and a bit worried. One of the biggest challenges I face when I cook is lifting hot, heavy pots and pans. I fear that the rheuma will make my grip suddenly dicey; I do not want to drop pans full of boiling or searing food.

I know I’m not alone in this.

But I do love to cook, and heavier, high quality cookware tends to stand up to frequent use and can last for years, even decades. A pan with a correctly made, heavy bottom conducts and distributes heat better, which allows the food to cook more evenly. This is a good thing, you know? It saves time. It means less stirring and less gripping of utensils in sore, twingy hands. And you don’t end up with some parts of the dish overcooked and some undercooked.

Still, maneuvering a heavy pan with arthritis-wracked hands can be truly daunting. But Tremontina planned for that. Instead of just the traditional, single long handle on the sauté pan, they’ve added a second, smaller one directly opposite the long one. I found that I could lift the full pan easily with both hands, dividing the weight evenly. It balances perfectly, regardless of the amount of food inside.

That is a big deal.

Here’s another really nice thing about the Tremontina sauté pan: it’s that smooth, Teflon© Platinum nonstick coating. You don’t really need any butter or oil to keep food from sticking to this pan, but if you do want to use some for flavor, a dab will do quite nicely. Watching your weight? This pan will make it a little easier.

And clean-up is simple. Just tip the pan and whatever remains inside will slide out smooth as a belly-down penguin on an ice-flow. Scrambled eggs, sautéed onions, reduction sauces and gravies–all come off the pan in a jiffy, without scrubbing, even if the food was accidentally overcooked and you expect it to be a real chore to clean the pan. I really appreciate this perc. Scrubbing can be downright painful.

You do need to season the pan before you use it the first time, but it’s a simple process that takes all of a minute. You should use wooden, plastic or silicone utensils to avoid scratching the non-stick surface. And to avoid damaging the pan, you must always cook on medium heat. No biggie, though: the pan conducts heat so quickly and evenly there’s no need to turn the burner up any higher.

The handles have comfy, ergonomic,  silicone-covered grips. You don’t need a pot-holder in each hand to avoid burning yourself. And the lid is made of clear tempered glass so you can see the food as it cooks. It also has a silicone-covered handle.

I’m trying not to gush. Really. But this is, honestly, about the best sauté pan I’ve ever used. There’s this, too: the Tremontina All Generations line of cookware has been given the Arthritis Foundation’s Ease-of-Use Commendation.

You can buy Tremontina cookware at Target, Wal-Mart, and online. The seven-piece set runs about $60, which dropped my jaw, it’s so amazingly inexpensive. It comes with a lifetime warranty. And finally, it’s made in the USA. (cue the patriotic music!)

If you’d like to take a better look at this great cookware and learn more about it, visit this website. And don’t forget to scroll down and watch the short CNN news video on the right-hand side. It explains how products like the Tremontina All Generations line of cookware are tested for use by people with diseases that cause joint pain and weakness.

Next time:  my review of the homeopathic pain-relief lotion, LivRelief.

I stand there, blinking at the pills. What do I take? My brain must be stiff too. Oh. Right. Take the ones from the daily pills thingy first. The morning RA drugs: sulfasalazine and plaquenil. They keep the rheuma-dragon drowsy and slow. There’s Ranitidine, to quell the nausea the plaquenil invariably causes. Then the rheuma supplements: calcium and Vitamin D for strong bones (cross your fingers) and a multi-vitamin. Finally, a teensy loratadine tablet for the year-round grass allergy that living in the valley with Mom has so rudely reawakened in me. (At my home up in the mountains I only took the allergy stuff now and then. Here with Mom, I either take it every day or live with constantly clogged sinuses and itchy, red, watery eyes. Bleh.)

I run a glass of cold water, snap open today’s pill compartment and shake the fistful of pills into my palm. I swallow them all at once, then force myself to gulp down the rest of the water. There. Now for the pain meds.

My rheumatologist told me again last month that the RA drugs are keeping my dragon quiet and sluggish. I have to believe him–he has Scientific Blood Test Results to back up his assessment. But I ache anyway. My rheuma-dragon may be much weaker than he was, but he’s still pushing hard against the bars of his medicated cage. Each push represents, to me, another throb of pain in my hands or my hips or both.

It may be only a shadow of what it once was, but it’s still pain. It dogs my existence. I gaze at the pill bottles. What to take?

There’s tramadol. It’s my favorite, a benign but fairly effective painkiller with no side-effects that I’ve noticed. Next to it is hydrocodone (Vicodin). It used to be my Number One pain med, an opiate I could count on to push the pain way back and send my mind floating sweetly away. But I didn’t dare take it if I had to drive or work or be responsible for anything, which naturally limited its usefulness.

Today, Vicodin is in definite second place. I’ve taken it for so many years, off and on, that my brain no longer reacts much to it. Its rarely any more effective than tramadol, and even the maximum dose doesn’t send me floating gently away from my misery anymore. My pain and I remain rooted firmly in reality.

This is the trap that narcotic painkillers set: to keep them working, over time you have to take higher and higher doses. Eventually, you’ll take a dose that will kill you. It’s the main reason doctors are so cautious about prescribing it, along with the fact that it easily makes the patient dependent on it.

I wonder, uneasily, what I’ll do if my dragon grows immune to the rheuma drugs and he wakes up? What will I do if my pain becomes huge again and the tramadol and Vicodin don’t work anymore? The thought itself makes me fearful. Memories of disabling pain flood my mind.

I push them away impatiently. Come on, Wren. Back to the here and now. We’ll deal with that when it happens. If it happens. Right now, though, your hips hurt. So, take some pain meds. Which should you take?

I refocus on the array of pill bottles in front of me.

Tramadol, Vicodin, and, finally, acetaminophen. You know that one: it’s Tylenol. I keep two strengths handy: extra strong (500 mgs per tablet) and arthritis-formula-strong (650 mgs per tablet). Alone, neither strength has any appreciable effect on even the sleeping dragon; I might as well pop a lemon drop and wish on a star. But they do boost the painkilling effect of the tramadol a little.

So, which is it to be this morning? Tramadol or Vicodin? Hmmmm. My mind does one of those odd little sideways slides: how about tramadol and Vicodin, it wheedles. And a couple of super-strong Tylenols, too? You know–the old one-two punch. That oughta shut the old dragon up for a while!

I actually consider it for a moment. But then I pull up short and tell myself not to be an eejit. Those two painkillers, taken together, could cause far more trouble than some bursitis pain. Both of them do their main work in the synapses of the brain, blocking different pain receptors, and each in their own way. Taken together, though, they could clash violently. They could cause my personal train to run right off the rails.

Visions of seizures and comas flood my imagination. Gods, no, I think.

Plus, I remind myself, taking that much Tylenol all at once (Vicodin combines 500 mgs per tablet in addition to the opiate) could do some serious damage to my liver. That poor, workhorse organ is already under stress, dealing with my RA meds as it does every day.

You don’t want to kill your liver, I mutter to myself, shuddering. Kill your liver and you die.

I decide to take the safest combination: the maximum dose of tramadol (two tablets) plus two extra-strength Tylenol tablets (1000 mgs total; 4,000 mgs per day, total). At this dose, I can take both pain meds three more times over the next 24 hours if I need to.

I usually do.

I take the painkillers with another full glass of water. And then I wait for the pain and stiffness to fade some. In an hour or so, I’ll be walking normally instead of stumping around like a miniature Frankenstein’s monster. The bursitis pain in my hips will still be there, but it will feel less intrusive, and the stiffness will mostly be gone. I’ll almost forget both–until I sit down for more than a few minutes and then need to get up. When I stand and move, the pain and stiffness will remind me yet again that I have an incurable autoimmune disease.

Both pain drugs will have mostly worn off in roughly three hours. I’ll start glancing at the clock, wishing I could take another dose. But I’ll have to wait six hours before I can, and by that time, the hip pain will once again be jostling for a place at the front of my mind.

Damn, I hate that.

All of what I’ve written about here took, maybe, a minute and a half in real time. Living with RA and its co-morbidities, such as hip bursitis, is a real, constant challenge. Even when the RA is “under control” there are symptoms of the disease that break through–and they’re just about impossible to ignore.

But I don’t want you to think I sit around every day whining and sniveling over my lot in life. I really don’t. Most of my days are just like anyone’s. I don’t work in an office anymore, but I do provide daily care for my elderly relatives. I plan and prepare meals, I shop for groceries, stop at the drugstore, run other errands as they come up. I take my mom and my uncle to appointments with their doctors and specialists and for blood and other tests. I spend, every now and then, hours and hours in the hospital emergency room with them, pacing or sitting on a hard metal chair. I take care of their pets, make their beds and carefully administer their medications.

And I try to make them happy. To make them laugh, often. I admit that it’s all a lot easier to handle with my rheuma-dragon dozing. I don’t know if I could do it if he were wide awake, snapping and breathing fire in my joints. So I get on with life, telling myself it’s only the dragon’s dreams that ache in my hipbones and twinge in my hands.

I’m grateful.

Lots of them are five-pointed like hands; back in late December they waved gayly at the breeze before dropping forty feet from the top of the skinny liquid-amber tree. Others are small, fat autumn teardrops from the ubiquitous, weed-like buckthorns, beloved trees of cedar waxwings, quick gray squirrels and women called Wren.

The fallen leaves have filled up a corner of Mom’s back garden, carpeting the ripply pavers.  Messy, she says. So messy! So I reach out with my late father’s old steel rake and drop the tines where the wooden fence meets the ground. The leaves, five-pointed or teardropped, roll up as I pull the rake back.

The scent of rain and earth and clean decay rises to my nose and makes me suddenly, sharply homesick. My eyes tear up. I blink. Shouldn’t I be over this loss? The home I miss is twenty years behind me and hundreds—even thousands—of miles away. It’s history. That old world, filled with rain, wind and fog and green is long-gone.

Three weeks ago it stormed gently for three days. There was a mild wind and some rare, sweet, soaking rain. The TV weatherpeople were breathless and excited, and there were SEVERE WEATHER ALERTS on the computer. Most of the leaves fell from the trees back then. But it’s been California-dry ever since, so the top layer of the leaves I’m raking is crisp and crunchy.  The older, underlayer leaves are wet and heavy with rain-memories.

I scrape up three big piles with the old wooden-handled rake. Then, with rubber gloves protecting my hands, I scoop all the leaves, wet and dry, into three black plastic bags. I put those into a tall, green plastic bin with wheels. A truck will soon come to empty it.

I was surprised to learn that our local garbage collection company won’t take the garden leaves for composting unless they’re first bagged in plastic. It seems odd to me. Even counter-intuitive. Do they hire people to empty all those leaf bags into the composter and then send the bags away for plastic recycling? Or do they just grind the plastic bags up along with the leaves?

Someday, maybe the Earth’s soil will be made mostly of plastic. What will grow then? Will the waxwings have buckthorn berries to feast on each autumn? Will there even be waxwings?

When it rains, will the air smell of plastic instead of home?

In about three hours I’m having a tooth pulled. I’ve never had that done before, but I’ve had nightmares about it for several years—actually, ever since the night the tooth actually broke. It’s a molar on the bottom right; I was crunching on an antacid tablet, and suddenly there was something foreign in my mouth that I couldn’t crunch. It was too hard. I took it out and… wow. Part of a tooth.

I was shocked. There was no pain. I went into the bathroom and peered into my mouth. Sure enough, there was no tooth surrounding the visible side of one of my bottom right molars. The old filling, done at least 40 years before, was still there, though, standing tough and alone.

I’d been laid off from work a month before. I had no dental insurance and my budget was already as tight as it could go. Screaming, actually. I didn’t have the spare hundreds I’d need for dental work, and all dental work, even the most routine, costs hundreds.

The broken tooth didn’t hurt. I could live with it. Once I found another job, I reasoned, and had medical and dental insurance again, I’d get it fixed.

I’m embarrassed to say that was several years ago. I never found another job. I was able to get medical care through the VA, as I’m a veteran, but they don’t provide dental care.

So I waited, hoping that the tooth would just endure.  And it did—until about two weeks ago.  The pain was minor, at first, but as the days passed it got worse and worse.  Finally, I broke down and went to a dentist.

Let me say here that I have a lifelong terror of dental work. It’s lame, I know, but along with the cost, it’s the reason I let that tooth go for so long. I’d break into a cold sweat every time I thought about getting that tooth fixed. I had long, lurid nightmares about it. I’d wake up gasping.

And now, well, the tooth is sick. There’s an abscess at the roots. It hurts like you-know-what. So, the day has come. I’ll get through it; millions do.

Wish me luck?

The creature ambushed my aunt on Christmas Eve. She’s still got the cough. Then it jumped my mom on New Year’s Eve and flattened her for a week, making her feel so awful she was barely able to get out of bed. Today marks her first decent day since then.

So, hoping to keep myself from catching it, I’ve been drinking lemon-lime Airborne three times a day. I figure the mega-doses of vitamins, in addition to the multivitamin tablet I swallow every morning, can’t really do me any harm and maybe, just maybe, they might keep the cold virus from setting up housekeeping in my respiratory system. I’ve been drinking lots of water and washing my hands frequently, too. I’ve been doing my best to get plenty of sleep. I’m staying nice and warm.

But I have a sinking feeling that it’s all for naught. This afternoon my throat feels sandpapery. My head feels like it’s packed tight with cotton batting. I can visualize my sinuses. My eyes feel hot. My voice is going squeaky. And I’m tired for no good reason.

Sigh. It got me.