Mental agility and RA

          I am really zeroing in on the number three these days as I am about to embark on three surgeries in three consecutive months starting in April.  

    The first two will correct cataracts in both eyes, courtesy of the long term use of prednisone.  Turns out that even low dose usage (I currently take only 4mg per day - and have been for about 4 years) can impact the development of cataracts.  

     Having said that, I am in my late fifties (58) and they are not unheard of at that age irregardless of other diseases.  In reading about cataracts I have discovered that there is some valid research that supports the notion that not wearing appropriate sunglasses can hasten the development of cataracts, particularly as Earth's ozone layer shrinks.  So now I tell my sons to wear their sunglasses all the time!  

     Of course anytime I have to have a procedure I tend to study it to the point of absurdity...that comes from years of managing a chronic disease. I suspect that many of my RA friends out there do the same thing...just sayin...no judgement, just stating the facts.  The point is that I will come out of this with an implanted lens in place of the "cataract" lens and I will no longer need glasses for distance!!! That's right - after nearly 50 years of wearing corrective lenses I will be able to see the alarm clock from across the room in the middle of the night! Yippee!  The trade-off is that I will now need "cheaters" for reading most likely. I had hoped to get the implant that corrects for all distances but alas I was not a good candidate for that as I have Sjogrens  Syndrome and that combined with an astigmatism tossed me from the pool of folks likely to have success with it.  No worries though.  I am happy to be getting better vision back.  
     There are some signs of cataracts that those of us with RA and users of corticosteriods need to be aware of.  Without a doubt the worst symptom was the discomfort and distorted vision while driving at night into oncoming traffic.  

     For me this picture comes close but it was even more pronounced than this. Some folks see a blur, some halo's, but I saw a splintering/glare effect that was really horrible.  I live in a rural state where we primarily drive on two lane roads so oncoming traffic is the norm and that means that anytime I was out past dark driving I had to cope with compromised vision.  This symptom was the key reason I am getting the surgery.

     Another slow building but persistent symptom is the lack of clarity and sharpness with colors.  Clearly this is not pleasant and although it does not effect your actual ability to see, the truth is, that over time it really impacts your enjoyment of life.

     Additionally, having "clouds" or "fog" appear within your line of vision is another and often first sign of cataracts.  This photo shows it directly in the middle but in my case this is off to the side in both eyes and not quite this large an area...thanks goodness!

     Lastly, for me anyway, is the problem of looking into any type of light head on and having it literally block out whatever is in front of it.  The best example I can give is if you are talking to someone who is standing directly in front of a window and light is coming in..you can barely see the person's face and it is almost painful.
     So, all in all, getting this simple corrective surgery done will be quite a blessing indeed and I am actually looking forward to it!  I will blog again post surgery to update you on how the procedure goes, what, if any, RA medication adjustments I need to make before the surgery, etc.
     The third and by far most complicated surgery is the foot reconstruction I am having done in June, first on the right foot and later in the year, the left one. 

     I, like many of my fellow RA sufferers, have seriously compromised foot mechanics.  Not only from years of RA, but also from having lousy feet to begin with!  In fact, when the orthopedic surgeon looked at my xrays he was pleasantly surprised by the almost total lack of joint erosion, which was welcome news to me as well.  We both concurred that this was a real endorsement of the treatment and medication choices that I and my RA Support team have made over these last 15+ years.   That was the really good news....

     Then we got down to business about what this would actually involve and I quickly realized that this is a major challenge I am undertaking.  For me that instantly translated into 1) ask every question you can possible think of that needs answered 2) plan ahead for all contingencies 3) panic 4) now calm down 5) call everyone who is willing to listen to you talk about this and finally 6) reflect on how this will be a successful and positive step you are taking (pun intended) with good outcomes.

     I will have to tell you that despite being an upbeat person who usually is unafraid to take on a challenge no matter the size, this really did overwhelm me initially.  When I think back on it I think it was because I was naive about the aftermath and recovery more than anything else.  I did know what the procedure would involve (will share that in a future post) but I did not truly understand the limitations on my mobility short term (if you consider 8 weeks of no driving short term!) nor did I understand how long the recovery will be until I am able to resume normal activity.

     The point of this is that when you are dealing with RA and all of the challenges and "opportunities"  (AKA obstacles) associated with it, you have to keep in mind that flexibility, not physically but mentally :)  is absolutely critical to successfully managing chronic diseases like RA.  Don't misunderstand me, I had my moment(s) of self-pity and crying and still do.  That is an important outlet and quite healthy in my opinion.  What I am referring to is being "agile" mentally.

     If you can achieve the skill of adapting to rather sudden changes and/or unexpected barriers or obstacles it will serve you well in handling the day to day challenges of RA in all its glory!  Being resilient is a huge asset in dealing with RA and a wonderful tool/trait to add to our RA toolbox.  I have learned to refine this over the years and feel it is perhaps my greatest achievement in dealing with RA.  I encourage anyone with a chronic disease to explore strategies to enhance resiliency and mental agility.  

     I have no doubt that my belief that I can defy the odds like the flying cow pictured above is largely responsible for the successful and positive way I have managed RA for 15+ years and...I know it will get me through these next challenging months.  I will keep you posted.  

Nan  

chicken or the egg?

     Believe it or not this perennial question actually has applicability when it comes to RA, especially as it relates to pain and depression.  At first blush you may think that it is an obvious answer.  You may think, well of course, pain is first and depression follows.  Let me be clear that I am not talking about the day to day pain associated with RA that we all deal with.  Clearly when the disease takes  hold, pain is one of the leading symptoms and it occurs, in my opinion, before depression enters the landscape.
     That said, I recently read an intriguing article on the Mayo Clinic website by Dr. Daniel Hall-Flavin in which he explores this question and discusses if there is a link between pain and depression.  Here is the link to the article and I would recommend you check it out.
http://www.mayoclinic.com/health/pain-and-depression/AN01449 

In it Dr. Hall-Flavin really gets into the way these two issues can be "married" if you will (my term not his).  He relates how pain and depression can be a viscous cycle that can really spiral out of control if not kept in check.

     The result is that pain worsens depression and likewise depression intensifies pain.  According to the article, depression can often manifest first in the form of headache or back pain for instance.  And in fact, he stated that in some cases it may be the first and only sign of depression.  
     By contrast, pain can lead to lack of sleep, stress, emotional and mood problems.  One side effect of pain that I found particularly profound and common with RA is low self esteem over time that can come from work, financial and other personal issues that can arise from unending and disabling pain.  These are all elements of depression and yet we often overlook this in our drive to control the physical elements of RA.  

    So we need to attack this from a two pronged perspective that examines and treats both issues concurrently and perhaps even with the same treatment. For example, anti-depressants can help both pain and depression because of shared chemical messengers in the brain.  Psychological counseling can be effective in treating both chronic pain and depression.  Stress reduction techniques, physical activity, meditation or guided imagry, and journaling have also proven effective. 

     It may seem like there are just too many options and that can become overwhelming when trying to sort through the various treatments which can lead to a tendency to do nothing.  That personal paralysis needs to be addressed and resolved.  When I hit that barrier I find that turning to someone I trust from my RA Support Team helps me to get through that and move forward.  

     Knowing that there are people out there that you can trust to listen, advise, assist and care is, in itself, uplifting.  Sharing your choices, talking about the dilemma of pain and depression can go a long way in helping you to sort through the many options for treatment.  
     So, in the end the question of which came first the "chicken or the egg" "pain or depression" becomes far less important than understanding and addressing the link, once again adding to our strategies for managing RA.
Nan