Disability Employee Awareness Month

"Invitation to Self-identify: During Disability Employment Awareness Month, I hope you will take a few minutes to report if you have a disability."

This was the title and first introductory sentence of an email I recently received from my employer. I am not sure why it bothered me and provoked such a visceral reaction from me. The topic of disclosure to my employers has been something that I have struggled with in the past. I have had some jobs where I have been very open about my JRA and other jobs where I felt it was unnecessary to ever mention it. At my current job, I have told my supervisor and some co-workers and even though I am certainly not hiding it from anyone, I am also not shouting about it at the top of my lungs. All of this is ironic, considering that I work in healthcare as an occupational therapist and work with kids with many different disabilities every day. You would think that I would feel more open and honest about discussing my JRA, but honestly it is something that I always initially struggle with revealing. 

I am often afraid to disclose my JRA at work because I do not want to be treated differently than any of the other employees. Although I know it is illegal to discriminate against people because of their disability, it is hard to not be worried about this. On the other hand sharing the impact my JRA has on my everyday life, may help if I have to ask for reduced hours or work accommodations. I continually struggle between these two thoughts.

I think one of the reasons this particular email caught me off guard is that it forced me to define whether or not I consider myself "disabled." The email from my employer defined disability as:

You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition.

They then listed a variety of disabilities such as cerebral palsy, diabetes, multiple sclerosis, PTSD and Bipolar Disorder. Rheumatoid Arthritis was not listed. Typically on a day to day basis I do not consider my JRA as causing me to have a disability. I work over 40 hours a week and my JRA does not impact my ability to perform my job. However, I am usually exhausted after working and would not be able to keep up with my physically and emotionally demanding profession if I didn't have my supportive husband. I also have to constantly juggle medical appointments in order to not miss too many work hours. Just managing my JRA on a daily basis requires extra effort and sacrifices so I am able to perform my job without any accommodations or concessions. 

I am still undecided about whether or not I am going to "declare my disability" to my employer on their human resource website. Identifying myself as disabled will not change how I perform my job, nor will it automatically provide me with any job accommodations. In essence it will not change anything for my benefit. Instead, I believe there are other ways to improve awareness about disabilities in the workforce that will be more beneficial than just declaring it on website.

Epic Pharmacy Fail

I recently discovered that my local pharmacy had been giving me the pediatric dose of Enbrel for the past 6 months! Yup. You read that right. Since January I have been receiving half the amount of medicine that I was suppose to be taking. I only discovered this mistake because I recently switched insurances and was requesting new prescriptions for my new insurance plan. My rheumatologist called me to clarify that I was actually taking the 25 mg "dosing kit," which is very rarely offered anymore, instead Enbrel typically comes in pre-filled syringes or auto-injectors. She was completely shocked about this dosing error, as her prescriptions had all been correct. Therefore, somehow my pharmacy had been giving me the wrong dose, month after month as I refilled it.

Now don't get me wrong. I actually really like my pharmacy. In fact, I found it very hard to call them and complain about this error, but I needed to make sure it wouldn't happen again. The pharmacist was literally speechless and didn't know what to say to me. I have used my local town pharmacy my entire life and even after moving away, I still traveled back home to continue using this pharmacy. It is a small family business and they know my whole medial history which has helped decrease many stresses and hassles over the past 28 years. I have been willing to pay a little extra money, instead of using mail order, to know that my prescriptions are handled correctly, will be ready on time and there are no surprises. Unfortunately, my trust was recently shattered. 

I know how lucky I am that even on half the intended Enbrel dosage, I still have felt OK. I know it could have been a whole lot worse. I am optimistic that now that I am on the correct adult dosage, I should continue to feel even better. Moving forward, I will most certainly check all of my prescriptions more thoroughly! 

The Stages of Hiking with JRA

On Wednesday I went on 7 mile hike. It was a very flat and level hike with little elevation. It was also on well kept, wide trails with few roots or rocks to navigate over.  No problem! I thought. Hiking 7 miles in the woods is something I do not decide to do frequently and as a result I am still recovering. However, throughout this hike, I realized I went through many emotional stages...

The Stages of Hiking with JRA

1. Excitement: I feel great! 3.5 miles each way, no problem. Let's do this! 
2. Wonderment: Nature is beautiful! Look at these trees, birds, the rushing river!
3. Motivation: Already one mile down. This is easy! 
4. Trepidation: My right knee is starting to ache...oh no, not even half way.
5. Reenergized: Sign says 1.8 miles to go! That's nothing!
6. Denial: Both knees and ankles are throbbing, but I must keep walking.
7. Anger: Why is this so hard, it's only 3.5 miles. 
8. Hope: Only .4 miles to go!
9. Fear:  As the path narrows and becomes filled with rocks and roots, I have fear with every step that my knees will give out and I will go tumbling into the river. 
10. Focus: I have to focus on every step I take, all of my effort and energy goes into making each step, no more nature, no more wonderment...
11. Relief: I made it to the top! Hooray! Must Sit Immediately. 
12. Anxiety: I know I have to complete this whole journey again to get home. 
13. Resilience: I have done this once, I can do it again...(and my legs are numb at this point, so it hurts less)
14. Pain: Once again, every step causes throbbing, stabbing and pain in both knees, ankles and my back.
15. Despair: Will this trail ever end...
16. Optimism: I see the bridge at the end of the trail, I can hear cars on the road, we are close!
17. Thankful: Although my body fought me, it did not fail me and I succeeded.
18. Fulfilled: I conquered the trail, conquered my JRA and completed my goal! (Now time for a well-deserved ice cream and bath!)

"So I have JRA..."

I recently booked a weekend away in October for my one year wedding anniversary! It's a strange feeling where it seems like just yesterday I was walking down that aisle, but at the same time it feels like we have been married for ages already. This milestone has caused me to reflect on how fortunate I was to find a supportive, caring and understanding partner when I was just seventeen years old.

Prior to meeting my husband, I dated on and off but struggled to find someone who understood the balance of helping me when I needed it, but not pitying me all the time. Some boyfriends went too far in helping me and made me feel like I was incapable of doing anything without assistance, while others seemed to be in denial that I had any limitations at all. Thankfully, my husband seemed "to get it" from the beginning. I still remember the day I told him I had JRA. We were kayaking together with a bunch a friends and were momentarily alone from the rest of the group. I had been wanting to tell him for a while, I wanted him to know before Junior Prom of course! I remember feeling so anxious about this disclosure and how he would react. I nervously said, "So I have JRA.." "Ok" He said. "Do you know what that means?" I responded. "Yeah" he said. And that was about the extent of our conversation! Granted we were only in high school and I am not sure either of us knew what that meant for our future together, but I was relieved that my JRA was a "non-issue" in our relationship. Now of course, having JRA has caused us to face some unique challenges together and our marriage has only just begun, but it has never stopped us from having the life we imagined 10 years ago as teenagers. However, I know that I am fortunate in finding my husband and this is not always the case.

As a result this post is dedicated to all the husbands, wives, friends, sisters, brothers, parents and caregivers who have supported those of us with JRA. Who have pushed us to complete our goals despite our limitations. Who have not accepted having JRA as an excuse for overcoming any challenge or obstacle that may lie in our paths. Who have rubbed our sore knees, massaged our swollen wrists and administered our injectable medications. Who have laughed with us, cried with us and carried us. We thank you...

Juvenile Arthritis Awareness Month: Part 2- Being a college student with JRA

Transitioning to college can be challenging enough. However, having JRA during college adds many more challenges. There are many factors to consider when choosing the right college to attend such as is it a small campus or large campus with shuttles, is there a responsive disability center, are the dorms and buildings accessible and is it close to doctors and health services.

My friends carrying me while
simultaneously tying my shoes!

I attended Boston University for many of these reasons. It was a flat campus, close to all of my doctors and had very accessible buildings. Although, BU had a large campus there were many shuttles and public transportation options to help me maneuver the campus. Despite all of this, college can still be challenging. As a result of the stress of living in a new environment, not-stellar eating habits, late nights studying and much, much more walking, I battled continuous flares, 3 surgeries and constant treatment changes during college. 

However, I made it through with not one, but two degrees (a BS and a MS in occupational therapy) and I learned some tips along the way.

1. Pick the right college for you: As I mentioned BU was a huge campus, however, it worked for me because it had public transportation as well as school transportation options to help with my mobility. Some people may opt for a smaller campus where you only have one building to walk to. 
2. Make the connection with the school's disability service right away: BU had a lot of disability services to offer, but there were lots of steps to take to get anything done and it was often frustrating and time consuming. I learned how to advocate for myself better during this period. A smaller school may not have a disability office but you may be able to talk directly with your professors about accommodations. 
3. PACE yourself: This was one of the most important aspects of managing my JRA at college but also one of the hardest things to do. As a college student, you don't want to miss out on any experience but I often end up paying for busy weekends, with days not wanting to leave my bed.
4. Adapt and Accommodate: If you are like me and can't pace yourself, learn ways to still enjoy all of your college experiences but with accommodations. For example, my friends would often walk over 2 miles to attend parties (in order to save precious subway money), however I knew if I spent my energy walking, I'd have no energy left to party. I frequently took the subway, cabs or school shuttles to meet them in order to save my energy for the night. I also used a wheelchair (while on spring break in Disney) because I knew there was no way I would be able to keep up and saved my energy to enjoy my vacation.

   

   In Disney on spring break, a wheelchair
   was necessary to pace myself 

5. Don't be afraid to say no: By the time I was an upperclassman, I learned that I would rather have friends to my apartment (even if I had to bribe them with wine and food), so I could have a comfortable place to sit all night long but still be with my friends.
6. Be open and honest to your friends: My friends were wonderful and tried to accommodate and help me as much as possible.  They would even carry me if I was desperate! I was always honest to them when I was really hurting and they learned a lot about JRA as well.
7. Don't be afraid to ask for help: One of the best ways I relieved stress and decreased my joint pain was to take baths. However, wanting to take a bath in my apartment meant cleaning the tub. After a long day of classes, that was the last thing I had the energy for. Luckily, I had an amazing roommate and friend and on one particularly achy day, I asked her to clean the tub for me and she did! 
8. Sometimes it sucks: My last point is somewhat hard to read, however, there were definitely nights when I felt left out, was flaring badly in pain, lonely or just felt bummed that I had JRA while in college. It's ok to have nights where you binge watch Sex and The City (eek, I feel old now) and some of your friends may even enjoy the excuse to stay in on a Friday night and join you. However, all experiences (whether they are good or bad) help define who you are as a person and who you become. 

College with JRA can be hard, but it doesn't have to be impossible. I loved my college experience, even though my it was one of the hardest times to manage my JRA. I learned a lot about myself as a person, I learned how to manage my JRA better and I learned how to totally disregard everything and just be a college student. JRA be damned! Whatever your experience ends up being, make sure to make the most of it.

My all time favorite Patriot player, Teddy Bruschi, was doing a
book signing, 1 week after I had knee surgery. The line was over an hour
long, but I brought my crutches to wait to meet him! 

Juvenile Arthritis Awareness Month: Part 1- Being a kid with JRA

July is Juvenile Arthritis Awareness Month! Instead of listing facts and statistics about the disease, I've decided to write each week about what it meant for me to grow up with JRA and delve a little more into my experiences with this disease.

Swinging with swollen knees
at five years old

I was diagnosed with JRA at 13 months old and do not know a life that has not been impacted by this disease. My childhood was filled with therapist visits, doctors appointments, pool therapy and frequent medication changes. I wore bi-valved casts on both my legs, every night when sleeping, to prevent my knees from contracting in a flexed position. Twenty-seven years ago they did not have colorful casting plaster and we would decorate my leg splints with stickers. I remember when they finally offered colors and I would always get red and green splints around Christmas time! I also often wore resting wrist splints to prevent contractures in my wrists. As a result I was unable to independently remove my leg splints in the middle of the night and would wobble with splints on, perfecting the mummy walk, to make it to the bathroom. Despite these measures, I would still wake up sore and achy with morning stiffness and I took frequent baths before school, in order to loosen up my joints and make the school day more manageable.

Being a pirate for Halloween to make
use of having to wear an eye patch.

Further complicating my childhood, I had cataract extraction surgery at 5 and 6 years old as a result of persistent Uveitis inflammation, and this resulting in requiring my mother to put in my contact lenses at 5 years old. This made sleep overs and play dates somewhat challenging. However, my mother would always sneak in and help me remove my contact lenses and then come back the next morning to put them back in, being as inconspicuous as possible, so I could still enjoy those slumber party experiences. My parents were always adaptive and creative, making the best out of lousy situations. One of my cataract surgeries occurred around Halloween and I had to wear an eye guard for protection for about a month. In order to still allow me to participate in trick or treating, I was a Pirate that year!

As a result of my many therapy appointments, I did end up missing out on some childhood experiences due to scheduling issues and physical limitations, however I was able to try many unique adaptive activities such as horseback riding, karate and adaptive skiing. Adaptive skiing bNew England Disabled Sports Program and I will most certainly talk about this again in the future. Life as a child with JRA can be challenging. A child's life should be filled with play and fun and not doctors appointments and needles. However, I have met some of the bravest, most courageous children with JRA who are able to always find the joy and laughter in their lives despite the challenges JRA throws at them.
ecame a huge part of my life as my family and I headed up to New Hampshire every weekend to be able to participate in a family activity together. We all became actively involved in the

If you know someone or have a personal story of your life as a child with JRA, email me allgrownupwithjra@gmail.com to be featured on my blog this month.

Fitbit Fitness Time

I have written previously about my impulsivity and constantly changing exercise kicks and phases. I have a new fitness phase to discuss! I recently purchased a Fitbit after a week long vacation of doing nothing but eating too much and lying on the beach. I researched all the newest activity and heart rate trackers. I knew I did not want to spend more than $200.00 and I wanted it to look subtle enough that I could wear it to work and not have it stand out.

After researching over 5 different trackers (Garmin, Polar, and Basis Peak), I narrowed it down to the Fitbit Charge HR and the Jawbone UP3. The Fitbit was $150.00 and the Jawbone UP3 was $180.00. They were very similar in features including tracking steps, calories, sleep and with wireless apps and syncing capabilities. The big differences were that the Fitbit tracked your heart rate continuously and the Jawbone only tracked your resting heart rate (see the websites for more descriptions on how the heart rate tracking works). Also, the Jawbone had better sleep tracking (your REM, light sleep and awake cycles), but was more expensive and did not have any external display.

So far I have enjoyed wearing the Fitbit Charge. It has definitely made me more aware of the amount of exercise I was getting daily, and it was not nearly as much as I thought! The Fitbit suggests a goal of 10,000 steps a day which is recommended by American Heart Association. I have only achieved over 10,000 steps twice and they have been days where I have been very active, walking over 4.5 miles and am usually very achy and sore the next day. I decreased my step goal to 7500 steps a day and am averaging 5 to 6 thousand a day, meeting my goal of 7500, two to three times a week. It has definitely pushed me to take that extra 30 minute walk on my lunch break, walk up that extra flight of stairs or park farther away at the grocery store. Hopefully it will continue to keep me motivated. Fitbit fitness time!

Rheumatoid Arthritis and Vaccines

I recently got a new job in a hospital setting and as a result all of my immunizations had to be checked to make sure I was not susceptible to any infectious diseases. As a child, I was vaccinated by my pediatrician with the Hep B series, MMR and all the other childhood vaccinations. I have always been vigilant about receiving my yearly flu shots and occasional pneumococcal vaccinations as well. As a person with an autoimmune disease, who is also on immunosuppressant medications (Enbrel),  I have always been on time with my vaccinations and very careful about washing my hands or my contact with people with infections.

So needless to say, I was surprised when I was found to be susceptible to Hepatitis B and Rubella. As I mentioned, whenever you work in hospitals, you need to demonstrate immunity to Hepatitis B in case you have contact with a patient who may carry it. In 2011, I worked in a long-term acute care setting and was found to be susceptible to Hepatitis B. After conversations with my rheumatologist, I received a Hep B booster (one shot) and never really throughout about it again. Until recently..

I was again found susceptible to Hepatitis B in January, only 4 years after my original booster. After more conversations, it was concluded that once again there is not a lot of research about people on immunosuppressant medications and their antibody response to vaccinations. It is thought that the immunosuppressant treatment (biologic medications, chemotherapy, etc.) may decrease their bodies ability to effectively make antibodies to protect themselves from infection from the diseases. Furthermore, even if their body is able to make the appropriate antibodies, the level of protective antibodies may decline quicker than their non-immunosuppressed peer, thus resulting in more frequent need for additional vaccination boosters. (Medscape, 2001)

Fortunately, Hepatitis B is not a live vaccine and only carries part of the disease thus weakening side effects or chance of infection, (vaccine types) and is therefore safe for people on immunosuppressant therapies. So I am once again completing the series of shots in hope to boost my immune response.

However, two weeks later, my test for Rubella (or German Measles) came back "Equivocal" or inconclusive. Meaning they were unable to determine if I had protection or not from this disease. Now I was starting to be worried. Why was my body losing all of it's immunity! After discussing with my rheumatologist again, we decided it may be time to see an infectious disease specialist for further advice. The MMR vaccine (which I had received as an infant) is a live vaccine, which mean it contains much more of the active virus than a inactivated vaccination. Live vaccines do not make healthy people sick or cause any diseases such as Autism (a post for another day!) However, people with weaker immune systems may demonstrate more symptoms or illnesses.

So, receiving the Rubella vaccine would mean not taking my Enbrel for up to a month! This was not something, I wanted to do unless absolutely necessary. At my next medical appointment, I asked to have my immunity to Rubella re-checked, since the initial test was not clear. None of my health professionals had mentioned this even as an option, but I wanted to make absolutely sure it was negative before pursuing more specialists. And it came back positive this time! Fortunately, this means I did not have to stop my Enbrel or see another specialist, for now...

I wanted to share this story because I'm sure some of you have had similar experiences! There definitely needs to be more research on vaccinations and their effect in people with autoimmune diseases. Especially now that some people are choosing to not vaccinate their children, thus exposing many people to potential infections, outbreaks and serious illnesses.

Arthritis National Research Article

I recently had the pleasure of spending a weekend with my adorable 3 month old nephew. Many of my cousins, friends and co-workers have also just had babies or are pregnant. Of course all of the cuteness around me has led me to think about my future baby plans as well. Unfortunately, family planning for a woman with JRA can be more complicated then the typical woman. Many medications need to be stopped 6 months to one year in advance and there are few medical treatment options that have been researched to be safe during pregnancy. Some women experience a remission (or decrease in symptoms) of their RA during pregnancy while others do not.

There have been many times in my life where I have heard that there is not enough research on treatments or long-term effects of JRA or Uveitis. As a child with JRA,  my family often had to balance the risks of unknown medication side effects with improved quality of life and decreased joint damage. There is still not enough research about effective Uveitis treatments. However, I find the lack of research about JRA during pregnancy the most unsettling. JRA affects over 300,000 children, the majority of these young girls. These girls are going to eventually be "All Grown Up" one day soon and will need to make difficult decisions about their medical treatment and decision to have a family with limited research to help guide them.

As a result of this, I chose to be interviewed and share my experience, thoughts and concerns with the Arthritis National Research Foundation (ANRF). You can read my article here, Cure Arthritis Article. The ANRF's mission is to provide initial research funding to scientists with new ideas to cure Arthritis and related autoimmune disease. I hope that sharing my experience will raise awareness and lead to research in this area to help others make informed decisions about their future.

Follow me on the Twitter!

I have finally joined the twitter! Follow me @grownupwithJRA. There has been a fantastic #chroniclife movement on twitter and although I am late to the game, I thought I would start my new twitter account by tweeting every time my JRA affects my life for the rest of the day/night. The #chroniclife movement is about promoting awareness about how chronic, invisible illnesses affect people's lives so frequently throughout their daily lives. 

Follow @grownupwithJRA

Seventeen Stitches to the Sunshine State

At around 11:30 AM on Saturday morning, about 6 hours before I needed to be at the airport to catch a plane for a much needed week vacation in the Florida sun, I was washing dishes in the sink. This particular morning I was washing a rather large, glass salad bowl. As I turned the glass bowl over to wipe it dry, it slipped and fell into the drying rack, shattering into many large and small pieces. One such piece sliced directly into the palm of my left hand. As soon as I felt the sharp, stinging burn of the cut and saw the gaping wound in my left hand, I knew I was in trouble and immediately went to "The Bad Place." I grabbed paper towels and applied pressure without investigating it much further and immediately called for help. As I waited for my father and husband to come pick me up, I tried to distract myself from the pain by catching up on my fellow RA bloggers, just hoping that I wouldn't pass out alone in my apartment. 

An hour later I had arrived at the ER, was checked in and was waiting for the Physician Assistant to examine my injured hand. Every nurse and technician who entered, greeted me by saying "I heard you did a good job on your hand." Fortunately, like most things in life, it could have been a lot worse! Apparently, if you have to slice your hand, I picked the best spot to do it. I missed any arteries or tendons and was still able to move and feel all my fingers. Seventeen stitches and 10cc of lidocaine later, I was stitched up and discharged. With amazingly 3 hours to go before our plane for Florida departed.

My hand is by no means healed. The cut wraps around from the side of my hand to the bottom corner of my palm. It is black and blue all over and numb around the wound. Currently it looks like a shark took a bite out of my hand and that may be the story I tell to my forever curious pediatric patients when I can return to work. However, I was still able to make my flight to Florida and lying on a beach is nice place to build skin cells!

New Blogger Alert

I would like to share a new blogger.  Anna, just launched her blog, Six Hips and Counting, last week and it is already fabulous. I met Anna many years ago when we both attended a camp for children with Juvenile Rheumatoid Arthritis in Vermont, Camp Dartmouth-Hitchcock. Her mantra of being "Stronger Than RA" is inspiring to us all!

Please check it out!

My Quest for the Perfect Yoga Studio: Part One

I am a beginning level Yoga student. No, I am more like a "fair weather yoga sports fan." I have tried a variety of yoga classes including classes at a gym, classes in a yoga studio, classes watching a DVD and classes by private instructors. It always starts out really well and then a variety of things happen... Either the class progresses too quickly and I can't keep up with the poses, I push myself too hard and end up straining myself, the class is too slow and not challenging enough, or I have a difficult time modifying the poses to accommodate my range of motion limitations and there is not enough individual attention to assist me.

However, I have become "fluffy" over the long, hard winter and most definitely need to get back into an exercise routine. Watching the snow pile up as I dunked mint oreos in hot coca probably did not help my physique. I decided I need to do something before bathing suit season commences. I researched yoga classes in the area and picked the closet one to try first. I emailed the instructor and asked how vigorous the class is and if it would be appropriate for knees with decreased range of motion. The instructor promptly responded and reported that the class is very gentle and most of the students have injuries they are healing from. I thought "Perfect!"

I did enjoy the class and the teacher was very nice and receptive. She made sure to check in with me to see if I needed any modifications. However, the class was very gentle and felt more like stretching and mediation. I also was the youngest person by at least 15 years. I am very accustomed to being the youngest person at the eye doctors, the youngest person in the Arthritis clinic and the youngest person with a aarp card, however, I was hoping I wouldn't be the youngest person in the yoga class. Although, I think this class will be a nice meditation and relaxation class, I am going to keep searching to find the right class.

Tomorrow is yoga studio #2 of the week...

Marathon Monday

Patriots day in Boston has always been about much more then the anniversary of The Battle of Lexington and Concord. It is of course Marathon Monday as well. As a child, my family and I would often go into Boston to cheer on the runners. For a few years, a close family friend ran the marathon in my honor of me as part of the Joints In Motion training program for the Arthritis Foundation. We often brought my wheelchair as a portable "chair" and to decrease my fatigue, so I could watch and cheer the runners for hours without getting tired. I remember one year, when our friend provided me with his medal and I wore it proudly as we walked through the crowds.

Later on, I attended college on the Marathon Route and for many college students, Marathon Monday is the greatest excuse to party. It always falls on a long weekend, is the start of spring and is towards the end of the semester. We would make t-shirts and signs to cheer on the runners, wake up early and start cheering! This tradition often involved many alcoholic beverages, which would only lead to cheering louder.I remember one year counting how many high fives I received from runners, I think it was over a 100 before I lost count.

Most recently "grown up" life obligations have gotten in the way of me attending Marathon Monday traditionally as I have in the past. However, during the year of the bombing I had just returned early from work and was about to turn on the television coverage when I received a call from my parents. They were near the finish line and wanted to know what the news was saying about the explosions. I feel very fortunate that no one I knew was injured by the bombings, but I will never forget that day and the events of the week that followed. Boston will never be the same as a result.

I feel that even before the Marathon bombings, this day always had a way to inspire people, bring strangers together and make the tight knit community of Boston feel that much closer. I always love watching the television footage, not just to see the elite runners race, but to learn about the many personal obstacles and triumphs people overcome to meet their goal and run the marathon.

This year I was touched by the woman's wheelchair race winner, Tatyana McFadden. Born with Spina Bifida, she lived in a Russian orphanage too poor to afford a wheelchair until she was 6 years old and was adopted by a state worker. Since then, she has become a world class paralympic athlete. This year she rode in honor of the Martin Richard Foundation, honoring the youngest victim of the bombings. During the award ceremony she gave her winners gold crown to the Richard Family.

Tatyana's is just one of the many stories of people running the Boston Marathon that inspires me and everyone else to not give up on their dreams. Boston will always be my home. Being a Bostonian is about more than the geographical location of where you live, it's about the spirit and passion of the people in this city. A fiercely passionate, close community of forever loyal people that will make me always proud to be a Bostonian.

Boston Strong.

Running through Springtime

Spring has finally sprung! After breaking the record for the snowiest winter ever, I was pretty sure it would never happen. With the warmer weather, longer days and the melting of all the snow, it instills a positive, hopeful energy in all Bostonians. We made it through the winter and came out on the other side. The grass may not actually be greener yet...but it will be soon! There are people every where running along the Charles River, biking through the city and enjoying the start of Spring.

There have been times in my life where I have felt well enough to join those enthusiastic runners along the Charles River. My type of "running" typically involves jogging for about a minute and then walking for five minutes. During my best feeling days, I could keep this up for 3 miles and generally not feel any different the next day. Unfortunately, as I deal with a medication change, this is not one of those periods. I recently went for brief walk along a hilly road way in New Hampshire and felt the after effects for 3 days. My knees were achy, swollen and painful and I spent the following day icing them in my office inbetween patients. Now, every time I see one of these runners, it reminds me of the limitations my JRA puts on my daily activities and sometimes that is harder to deal with then the physical pain.

I have tried many fitness routines in my life besides jogging such as yoga, personal training, TRX, skiing, water aerobics and home DVD workouts. I have always struggled with finding something that fits into my schedule, is safe and healthy for my body and that I am motivated to stick with. I have yet to find my perfect exercise routine and will continue to try new avenues until I do. However, although I am excited and optimistic to embrace Spring and all that it has to offer, I can't help feel a twinge of jealousy when I see the newly energetic runners sprint by...

What Is Occupational Therapy?

April is National Occupational Therapy Month! I have been an Occupational Therapist for about 4 years, working mostly with pediatric populations in a variety of settings. Even before I choose a career as an Occupational Therapist, I had worked with many in my life as a result of my JRA. I had early intervention up to I was three years old to work on my overall development and hand strength. Early Intervention is a program where therapists visit families in their own homes to work together with the family until the child is age 3 to provide support, education and therapy. I then received frequent out patient occupational therapy to increase my hand strength, work on my fine motor skills and create splints to increase range of motion and decrease pain. I received occasional OT in the schools as well as accommodations to allow me to access the curriculum more effectively. In my adult life, I still occasionally visit OT's when my needs are outside of what I can provide myself.

But what does an Occupational Therapist do? OT's help people across the lifespan participate in the things they want and need to do through the therapeutic use of everyday activities or occupations. As an adult, occupations can include daily life skills such as dressing, feeding, caring for children and daily life activities. As a child occupations include playing, learning, developing, socially engaging with peers and participating in school. OT's can work in hospitals, homes, schools, private clinics or community settings.

I have always enjoyed working with children in their homes, schools, clinic, and community settings. I work with children with Autism to help them maintain focus better to increase their learning, to increase their tolerance of sensory input to help them participate more at birthday parties and community outings. I work with children to improve their hand strength to help them dress themselves more independently and improve their handwriting. I help children improve their core strength so they can sit at tables without slouching or fidgeting. The best part of what I do is almost all of my treatment with children is centered around play. It is what makes my job challenging, fun and rewarding.

I am creating a new page on this blog with some occupational therapy tips and resources for children. My hope is to update this page and occasionally write blog posts regarding OT as well.

Happy OT Month!

My AARP Membership

I remember the first time The American Association of Retired People sent me a personalized membership card. I was 16. I remember thinking "Why, do they think I'm old?" Oh yes, I have Arthritis. Initially, I was slightly offended. It's enough that I am usually the youngest in my rhuematologist office and always the youngest at the glaucoma specialist office, but now they think I'm old enough to join the AARP! However, each year a new AARP card would arrive in the mail. I often thought about trying to join, they do offer great discounts and the membership often comes with a free rolling travel cooler. SCORE!

As humorous as this clerical error often is, it is still a reminder of the stigma that Arthritis is an "old person's disease." There are many organizations and people trying to raise awareness that Kids Get Arthritis Too , but there is still a long way to go. On the other hand, Arthritis does in fact often make me feel like I am old enough for the AARP and often I can relate to their aches and pains more than I can relate to my peers running frequent 5k's. I wake up stiff, achy and sore. My knees creak and hurt as I walk down stairs. I have used a wheelchair in my past. I have already had two cataract surgeries and I have ongoing glaucoma eye disease. I have used reading glasses since I was 15 years old.

So here I am living with the body of an AARP member but navigating life as a late 20 year old. This desire to want to live out my youth carefree and energetically, but still navigate the challenges of my Arthritis will consistently be something I struggle with. Fortunately, I no longer desire to stay up to 3 am, eat macaroni and cheese for every meal, or spend 4 hours standing in bars only to walk miles home, as I once did in college, and my body thanks me for it. However, I am also no where near ready to sign up for an AARP membership. I have a lot more "youth" to enjoy, regardless of what my Arthritis or the Association of Retired People think about it!

Disclaimer: I have nothing against the AARP and their organization. I will join as soon as I turn 50 and can't wait to go to the movies for 5.00 or get a free donut at Dunkin Donuts. Just not yet!

The Eye Ultrasound (and other strange medical tests)

This morning I had a follow-up eye doctors appointment. I have been seeing a retina specialist for about two years to follow a cyst in my right eye. Initially the discovery of this eye cyst was very unnerving because they were unsure of it's origin or pathology.  However, it seems that somehow the cyst is in the perfect place, between all the important eye structures and my glaucoma tube shunt implant. And as long as it remains there, happily not bothering anyone, no one seems overly concerned anymore. As a result, every 6 months I visit this specialist and have two eye tests done, photographs of the inner parts of my eye and an eye ultrasound. When I first heard I needed an ultrasound, I thought "wait, how does examining my stomach tell you anything about my eye?" There are indeed a ton of different types of ultrasounds and ways to use ultrasounds. Physical and occupational therapist often use ultrasounds to provide deep heat to joints, muscles and tissues. An eye ultrasound is not a painful test but it continues to be one of the strangest sensations I experience. I am by no means uncomfortable with eye drops or touching my eyes. I have worn contact lenses since 5 years old, used eye drops since before then and have had four eye surgeries. However, this test is still very strange! First, they use numbing eye drops to make your eyes more comfortable. Then they use an ultrasound stylus with ultrasound gel on it and rub it all over your eyeball, taking pictures in certain spots. It feels as awkward as it sounds. There is cool gel being rubbed onto and all over your eyeball, your vision is blurry and sometimes you enjoy the pleasant experience of cool ultrasound gel running down your cheek. Fortunately, the test is over quickly and you can move on to more pleasant tests..

My second least favorite medical test is the visual field eye exam. As a result of my glaucoma I need this test every 6 months to make sure that my visual field (the amount you can see in the periphery when your eye is focused on a point centrally) is stable. For this test you close one eye and place your head inside a giant circular bubble. These bubbles remind me of the chairs Will Smith sits in during
Men In Black. Then they flash small bright dots in various directions inside this bubble and you click a pen every time you see a dot of light. Testing each eye can take up to 5 minutes but it often feels a lot longer. I once made the horrible mistake of scheduling one of these tests the day after St. Patrick's Day while I was in college. I had gone out the night before and was not feeling myself the next morning (read: extremely hungover). This may have been the worst possible test to take hungover as every flashing light made me feel nauseous, my eyes were tired and dry and I am sure I missed seeing many lights that day. I will never make that mistake again.

Facing Forward Feature on From This Point Forward

Check out my interview on Mariah's blog, From This Point Forward. She is posting a series called Facing Forward. Facing Forward is a series that shares the lives of people living with arthritis and other invisible illnesses. The goal of the series is to see how we are similar and how we are different – and to remind us to keep moving forward because we aren’t alone!  Her blog is a fabulous resource for anyone living with Rheumatoid Arthritis, espeically if you are thinking about starting a family. Her honest, hopeful and candid posts about her path to pregnancy and parenthood are inspiring to us all!

Read more here!!!

The White Lie

"Did you hurt your knee?"

If you live with JRA you have inevitably heard this question and have been faced with the dilemma of telling the complicated whole truth or just a white lie. As a child in middle school, the occasional mean 6th grader would ask "why do you walk funny?" I would just ignore them because explaining the truth would take far too long to sustain a 12 year old's attention span. However, the comments and questions don't stop as you graduate high school.

Recently, my right knee has been slightly stiffer than usual, causing me to occasionally limp. As I was walking into work a co-worker, who I barely know by name, asked if I had hurt my knee. He was probably just trying to be nice, initiate some casual conversation and voice his concern. However, I barely know his first name and I only see him once a week for a few hours in passing. I decided it would be much easier to tell a white lie. "Oh, I hurt it skiing." Then delve into the complicated past of my JRA. He responded, "Oh yeah, I've had some knee injuries." We connected over our mutual "injuries" and the conversation moved on.

Sometimes I feel guilty about telling these white lies, but I know it will save the inevitable follow-up questions. "Oh, you're too young for that." Or my favorite. "My dogs has Arthritis too." Yes, that's exactly the same thing... Occasionally, I will take the opportunity to educate people about JRA to help build awareness and advocacy, but some times you just want to to get through the day without having to explain your life story to everyone you meet. Sometimes you just want to be able to blend in without the questions. Sometimes telling a little white lie is what it takes.

Adventures in Puppy Parenthood

This week started off like any other, lying in bed mentally and physically preparing for another week of work, wishing for one more day off, but then Sunday night our puppy got sick. The poor little guy got sick to his stomach 5 times before throwing up blood, prompting our panicked visit to the doggy ER at 6.00 AM. I'll spare you the gory details but basically after many tests, expensive vet bills and a week of sleepless nights, he
is on the mend. It was determined he may have a bacterial infection (probably from Dog Daycare) and was put on antibiotics.

However, being a first time pet owner, I was unprepared for how emotional this whole experience would be. We felt helpless being unable to determine what was wrong with him and what we needed to do to help him get better. He just stared at us with his puppy dog eyes and it broke our heart. We felt like we were over reacting taking him to the vet twice and calling them many more times, but immediately went to "the bad place" about what could happen if he was really, really sick. We were investigating his daily bathroom breaks like forensic investigators, looking for anything abnormal. It was an emotionally and physically exhausting week. I was beginning to worry about how we will ever survive the ups/downs up "baby parenthood," if "puppy parenthood" had us so thrown.

Sometimes I feel like a crazy person for loving my puppy like he's my child. I recently read a study from researchers at Mass General Hospital that woman really do love their dogs the same way they love babies.

In the study, researchers from Massachusetts General Hospital explored the neuroanatomical similarities between the human-pet bond and the maternal-child bond. To run the study, they had women look at photos of their own babies and dogs. They then looked at other dogs and babies that weren’t their own.

The researchers found that, “there was a common network of brain regions involved in emotion, reward, affiliation, visual processing and social cognition when mothers viewed images of both their child and dog.”

They also discovered that the animals they didn’t know didn’t trigger the same brain regions. They concluded that dog owners really do love their dogs like they’re their babies. (http://www.ryot.org/science-says-humans-love-dogs-like-their-babies/840873)

So maybe I'm not crazy. The reason this experience was so trying, was because that emotional connection could be real. His cute little puppy dog face makes it all worth it!

Hello, I'm late, I'm late, I'm late

"I'm late, I'm late for a very important date.
No time to say hello, good-bye, I'm late, I'm late, I'm late
I'm late and when I wave, I lose the time I save.
My fuzzy ears and whiskers took me too much time to shave.
I run and then I hop, hop, hop, I wish that I could fly.
There's danger if I dare to stop and here's a reason why:
I'm over-due, I'm in a rabbit stew. Can't even say good-bye,
Hello, I'm late, I'm late, I'm late."

- Alice and Wonderland

Punctuality has never been my strong suit. I am always running late. I'd like to blame my mother (sorry, mom!) who was also always running late, but at this point in my life I think I only have myself to blame. However, I don't want to be late all the time and have tried many strategies including setting my watch and car clock 10 minutes fast, and setting 3 different alarms to ensure I get up in time. Somehow though, I still end up being late.

A typical morning for me proceeds as follows:

• Alarm goes off at 7.20 - I really need to be up at 7.30 but I give myself 10 minutes to slowly wake up) 
• I actually get up at 7.45 - after snoozing the alarm 2 times and then lying in bed searching social media for 15 minutes
• Now I am running behind. Cue the hectic rush period. I usually only need 15 minutes for make-up and dressing (as I shower at night) and then about 15 minutes to make lunch and get ready for work. 
• Bringing me to 8.15 which is when I should leave the house to be at work by 8.30 - barring absolutely no traffic or red lights...
• Somehow I always forget to do something such as letting the dog out, doing a few dishes, or the time it takes to defrost the car and that brings me to 8.30
• Now I am running late...

As you can see I am fully aware of what I need to do. Set my alarm to 6.45 or 7.00 or prepare some of these tasks the night before, but it won't happen. When I try to set my alarm to 7.00, I just end up snoozing it to 7.30, rationalizing that I am exhausted and I still have 30 minutes to get up and then the cycle continues..

I went to the google machine before writing this post and determined that people who are chronically late actually have certain personalities. Diana DeLonzor wrote a book called, "Never Be Late Again: 7 cures for the Punctually Challenged" She classified seven different personality types of people who are chronically late. Most people have a combination of the seven types. 

1. The Deadliner: These people enjoy the rush. They either crave stimulation or rushing is a way of distracting them from boredom. They are unable to accomplish tasks without a looming deadline. 
2. The Rationalizer: These people have difficulty owning up to their responsibility and blame external factors such as traffic, kids or busy schedules. 
3. The Indulger: They have difficulty with self-motivation. The tend to procrastinate and lack self-discipline.
4. The Producer: These people try to get as much done in as little time as possible. They underestimate the amount of time it takes to complete tasks. They don't like to waste time and time their arrivals to the minute. 
5. The Rebel: They feel the need to break rules, compete for power, resist authority and attempt to be unique.
6. The Absent-minded Professor: These people are easily distracted, they have difficulty staying focused on the task at hand.  
7. The Evader: These people have lower self-esteem and need to control their environments as a result to decrease their anxiety.

I can relate to the feelings of "The Deadliner," I am not going to jump out of bed at 6.30 if I know I still have 2 hours before work; "The Absent-minded Professor," I am often heading out the door before remembering to turn the heat down, or grab my lunch bag; "The Producer," I illogically believe that I can straighten my hair, finish the dishes, pack my bags and take care of the dog in 20 minutes; and "The Rationalizer" traffic is always bad (no but seriously!). So what do I do? How do you stay on time? What are some of your tricks?

This article offers a few recommendations including:

• reevaluating how long your routines "actually" take - straightening my hair alone takes 20 minutes!
• remembering why it's important to be on time - I have time to eat my yogurt before seeing my patients, and it's more professional
• learning to enjoy doing nothing with your time - This one I don't need much practice with...
• being able to stop budgeting your time to the minute - My alarm is set to 7.20, I should just make it 7 am
• adding "buffer" time for the unexpected - Like being stuck behind a snow plow and school bus
• re-scheduling your day knowing you will not be able to get it all done - The dishes can wait and I probably don't need to make the bed when i'm already 10 minutes late..

I am going to try a few of these suggestions and see how it goes! But for now I have to run, because I am running late...

The Lack of Spontaneity

I have always been a planner and organizer. Crossing items out on a to do list is gratifying and rewarding. I live by my google calenders and have post-it notes everywhere. However, it's hard to tell how much of this is my personality and how much of this has been a product of my JRA. Keeping track of at least 6 different specialists, from different hospitals with different clinic days, requires a good organizational system. Remembering when to take pills each day and eye drops as frequently as every four hours, requires consistent and successful planning.

However, I feel like I have missed out on the ability to be spontaneous throughout my life. I had contact lenses at five years old due to my Uveitis and as a result any overnight school trips or friend slumber parties required more planning than my peers. My mother would often drive to my friends house, remove my contact lenses and then come back the next morning to put them in (being as inconspicuous as possible) so I could still experience those childhood memories. Even as I entered college and I was independent in all my healthcare needs, my life still lacked the spontaneity that my friends enjoyed. I could never "crash" on a friends couch  and walk home the next day (not that I ever wanted to!). If there was ever a chance I wouldn't be coming home that night, I would "plan" to be spontaneous and pack the smallest bag possible with back up contact lens solution, glasses and eye drops. I often carried a Marry Poppins type purse filled with re-wetting eye drops, purel, spare contact lenses, contact cases, contact solutions, advil, icy hot and medications.

Still to this day, I often wish I could just fall asleep on the couch and wake up the next morning but I have a nightly routine of 6 eye drops that need to be applied a few minutes apart. I call this nightly ritual "the process" and it has just become a part my normal routine. Even though the days of spontaneously crashing on friends couches are over, I still long for the ability to have a little more carefree impulsiveness in my life...

The Light Sleeper

I have always loved sleeping. I was excellent at it. If sleeping was an Olympic sport, I could easily medal without trying. I would sleep till 11 or 12 without difficulty and more importantly I would sleep through anything! I could sleep through fire alarms, hurricanes, thunderstorms etc. However, recently that has changed and for the past 6 months or so I haven't been sleeping as well. I lie in bed and toss and turn trying to stop my mind for thinking. Thinking about what I have to do tomorrow (dishes, laundry, vacuum, bills) or what I did today (difficult treatment session, evaluations to be written, conversations with friends). In fact last night as I was lying in bed trying to fall asleep, I found myself thinking about writing this post about not falling asleep because I can't stop thinking!! What a vicious cycle I have found myself in! Hopefully writing this post tonight will help clear these thoughts.

Furthermore, I have somehow become a light sleeper. I hear that this can happen as you age. (Old joints, old sleeping habits?) Or maybe this is in a woman's genetics to prepare us to be on the alert to protect and care for our children (or in my case my puppy). I hear every pop of the radiator, every shifting and pawing my puppy makes, every footstep from my upstairs neighbor, every sigh and snore from my husband. It doesn't help that my husband can still sleep through anything and is never bothered by these sounds, (I guess one of us has to be rested!). I have gotten into the bad habit of falling asleep with the T.V on, but it helps drown out the noise and distract my mind. I have thought about noise machines but can't decide on which one to purchase. When I broke my wrist last year, I occasionally took ZzQuill because I was uncomfortable and when I become desperate that still seems to help. However, I don't want to rely on more medication. What to do?! What are some of your sleep aids?

This is a basketball player. I want this bed. 

Before writing this post, I looked at some of the fatigue related posts of my fellow RA bloggers. As you would expect it is a very common topic for people with Arthritis. Having Arthritis itself can cause fatigue, the medications can cause fatigue and inflammation can cause fatigue. Occasionally I find it hard to get comfortable in bed, my knees lock and I can't stretch out enough or my elbow contracts and it pains to move it (I dream of an enormous California kind bed and a room big enough to put it in!).

Stress is another major factor that influences sleep. It is not a coincidence that my sleep greatly declined the month before my wedding. So much so that I began to talk in my sleep! Waking up my husband by asking unintelligible random questions! Two weeks ago I asked him, "What's the plan, babe?" at four in the morning. I'm pretty sure his plan was to sleep and I was already planning something in my subconscious.

Hopefully, I will figure out soon what is causing the decline in my ability to become a gold medal sleeper and return to the Olympic podium once again...

My Safety Net

I can not remember a time in my life where I have not taken a handful of pills every morning and every night. The type of pill, the amount of pills and the frequency I took them changed often, but I always took pills. I have never been one of those people who needed to set reminders to take their medicine, or needed those weekly dosing containers, because it was just part of my daily routine. However, recently I stopped the majority of my oral medications and am only using a subcutaneous injection, Enbrel, and occasional nutritional supplements (those don't count as pills in my mind!).

When I first made this change, I was cautiously optimistic and excited that my disease is under such well control that I was able to make this change in the first place. However, all day long, on that first morning without pills, I felt like I had forgotten something important to do. I also felt strangely vulnerable and exposed. For my entire life, taking medications every day has been my safety net, my reassurance that if my joints were sore today the medication would being working soon and help me feel better. Although most of the medications have unknown and scary side effects, I still feel like they are almost a part of me. They have helped my joints move, my swelling decrease and allow me to live life the way I would like. Without this safety net I feel like I am preparing to jump off a bridge without knowing if there is net below to catch me. However, this time the change is my choice and that makes living on "the edge" a little easier..

Pets and Arthritis

Confession: This post may just be an excuse to post many pictures of my puppy, who will turn 1 year old this Saturday. So I'll get one photo out of the way now. I didn't grow up with a dog for many reasons, and as a child I was actually terrified of dogs and would cry if they barked at me. It wasn't until I began dating my husband, whose family always had dogs, did I begin to grow fond of them. My husband and I finally got a puppy last May after many months of planning. We chose a Rat Terrier because his family has three Rat Terriers and we were very familiar with the breed. As a rookie dog owner, I wanted a breed that I was comfortable with and had an idea of what they would be like. We also liked their size, growing to about 20-30 pounds, not too small but also small enough for our apartment living. He is the best!

So I started to think about how having a dog has changed my life so far this year and I came up with some positives and negatives.

Positives: 

• He makes me smile and laugh
• He provides unconditional love
• It requires me to be active by needing to walk him, exercise him and play with him
• I am never lonely
• I have someone to vent to besides my husband (this is true! I totally talk to my puppy like he can understand every word I say)
• It provides me with the responsibility to care for something else

Negatives:

• It is expensive to provide food, vet bills, dog walkers, etc. 
• As a young puppy he didn't sleep well, there were lots of early mornings and sleepless nights
• House breaking a puppy can cause many carpet stains!
• He always has energy-sometimes he has lots of energy when I don't!

So I did some research about if my thoughts about dogs are consistent with experts opinions about whether dogs (or cats) are beneficial for people with chronic illnesses. After weeding out the many results about dogs with Arthritis, which is one of the most annoying responses when you tell someone you have Arthritis, "Oh, my dog has that!" Nope. not the same. I found one research study from 2012 on the effect dogs had in a waiting room in a outpatient chronic pain patient. The researchers used certified therapy dogs and they recorded the pain levels and mood of the patients and family members when the dogs were present, and when they were not. They determined that 23% of the subjects demonstrated a significant difference of a 2 point decrease in their pain level or increased mood than those subjects who did not have the dogs in the waiting room. You can read more about the study here, Animal-Assisted Therapy at an Outpatient Pain Management Clinic. Other research has shown that having dogs around can decrease heart and blood pressure, slow breathing rates, decrease stress hormones like cortisol, increase endorphins and boost immune systems. So what are you waiting for?!

There are factors to think about before going out and getting a dog tomorrow, especially if you have RA. Here is a great article that discusses some things to consider before buying a dog. A smaller dog breed may be easier to care for, lift and walk but may also have more energy then a larger dog. There are lots of adult and senior dogs at shelters, who are already trained and may have less energy then a puppy. So if a dog does seem like it may be right for you. Good luck and much love to the puppies! Oh and Happy Birthday Turner!

The Body Mechanics of Shoveling Snow

Don't get me wrong, I actually love winter. I love skiing, my birthday is in the winter, I love how pretty, peaceful and quiet it is after a snowfall and the first snowfall of the season still makes me giddy like a child. However, currently I feel like this cartoon. We are expected to receive 10-20 more inches by Tuesday morning, on top of the 2 feet we received last weekend, after the 3 feet we got the weekend before that. It seems like Mother Nature has decided New England is the new Antarctica and even Minnesota would be warm and balmy compared to this. I have been fortunate enough that I have done very little shoveling. We have had plows and my husband is very diligent with his snow removal. However, I know everyone is not so lucky. As a result I am going to try to offer some advice on the proper way to shovel without killing your back. 


Body Mechanics is the study of muscle movements to aid in lifting, pulling and postural corrections in the most efficient way in order to prevent injury and increase endurance for tasks. There are few general principles for correct body mechanics,

1. Remain close to the object 
2. Use short lever arms for better control & efficiency (with less strain)-Don't use a shovel with a 10 foot long handle!
3. Maintain your center of gravity close to the object’s center of gravity
4. Widen your base of support and position your feet according to the direction of movement you will use to perform the activity  
5. Use the largest & strongest muscles of your arms, legs and trunk  
6. Avoid twisting your body when you lift  
7. When possible, push, pull, roll, or slide an object rather than lifting

So how does this apply to shoveling. Here are some important tips. Always face the snow you are shoveling. Bend at your hips, not your back, and lift with your leg muscles keeping your back straight. Position one hand on the shovel close to the blade and the other hand at the handle to provide stability. Do not twist or throw the snow, instead pivot your whole body when dumping the snow.Whenever possible, push the snow to one side rather than lifting it. Although these techniques may make your shoveling job take a little longer, it will save your back and hopefully hours of back pain afterwards!

There are also many of ergonomic shovels on the market. Make sure you do your research first to see what kind of shovel is right for you. Some shovels have a bent handle which makes it easier to scoop snow, there are also shovels designed to push the snow, and I even saw one shovel that has a mechanism that automatically releases the snow. Hopefully some of these tips will help save your backs and hopefully spring will be around the corner. Although it may take till the summer for all this snow to melt!