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!

Hypochondriasis, a side effect of lifelong JRA or a result of "The Burden of Knowledge?"

JRA has many mysterious and overlapping symptoms. However, figuring out if your symptoms are related to your JRA, or just typical human being symptoms can be challenging. Having to decipher this puzzle of symptoms your entire life can lead you to become a hypochondriac.

I haven't always been a hypochondriac. I can imagine that my parents were pretty on top of any swollen joint, cough, cold, pain or symptom when I was child. When my knees were swollen we'd go see my doctor and usually determine my JRA was flaring and try a new medicine. When my eyes got blurry we would see my eye doctor and determine that my uveitis was flaring or during one scary weekend, determine my glaucoma was uncontrolled, leading to emergency eye surgery. When I was feverish and weak one day, I visited my PCP and learned that I had the flu. Recently I had SI joint pain, I thought it was from a fitness injury (that's what I get for getting in shape) but as it turns out there is inflammation around my SI joints, caused by who knows what. So you can see, typically in the past when I have had a gut feeling something was wrong, it usually was.

Compounding this precedence is my tendency to go to "the bad place," very quickly. I'm not sure if this is an Italian trait or just me being dramatic. But basically it works something like this... My puppy was lethargic and had a swollen stomach one night, and I went from thinking he had a stomach ache, to a bowel obstruction to a rare fatal dog disease called "Bloat" where their stomach twists in on itself. This happens frequently throughout my life; my husband doesn't answer his phone in an hour = he's been kidnapped or is passed out on the floor in a coma, I have stomach pain= I have an ulcer or appendicitis, I have an ingrown toe nail= my toe is going to get infected and cause total body sepsis. You get the point.

I was recently watching the T.V show Scrubs and it was an episode where the attending doctor, Dr. Cox (a very brash, frank, no BS kind of guy) had a baby and was over reacting about a cough. The pediatrician said to him that he has "The Burden of Knowledge," meaning he knows too much based on his profession and unless he "gets a handle on it" it will torture him. I feel like this is part of my problem. I have had too many personal experiences involving pain or illness leading to actual infection, inflammation or complication that I will forever be sticken with "The Burden of Knowledge."

However, I know I need to get a handle on this for the sake of any future children. With my developmental and clinical experiences as a pediatric occupational therapist, as well as my personal experiences with JRA, together with my husband's education as a nurse and nurse practitioner...our future children will stand no chance. Every developmental milestone they don't reach on time, or symptom that could result in a myriad of illness, I will go to "the bad place." So how do you rid your memory of a life of symptoms and years of studying and clinical experiences? I am not sure, but I am going to try to find out how...

Appointments before sunrise

I am not a morning person. I use to easily sleep till eleven as a child and college student. You would not want to talk to me during breakfast before high school and I still need my coffee before I can smile each morning. Therefore having to wake up at 5.30 am this morning to make it to my 6.40 MRI appointment and 7.45 eye appointment was not enjoyable. However, scheduling these appointments so early was my idea, in order to make two appointments back to back and still be at work before my first patient arrived. So I rolled out of bed before the sun rose and started the expected 30-45 minute ride to the hospitals in my city. However, some of you may have heard of the recent weather we have been having...

On the right is a picture of the current streets in my city and the left is my actual backyard. Needless to say traffic was not good and I was 20 minutes late. Luckily, they saw me right away and I made it to the MRI successfully (I'm investigating SI joint pain) and then my eye appointment on time (read about my JRA background and eye disease here). As I was negotiating downtown traffic in the snow, parking in one garage, walking in between two different hospitals, knowing exactly where I needed to go, I thought that my JRA has indeed taught me some valuable skills. I know many peers who will not drive into "the city" because it overwhelms them, or who would have taken the whole day off for these appointments. I feel fortunate that I have never been nervous to drive in the city (as soon as I got my license I drove to my own appointments) and that I can negotiate hospitals and appointments before I have even finished my morning coffee. So I was off to work for my 10 hour day. Today definitely felt like two days in one, but tomorrow is another day and more importantly a day I can sleep till 11!

Go Patriots!

I love Sunday mornings. There is nothing better than bacon, eggs, pancakes and coffee. I love Sunday morning acoustic radio programs and more coffee. I always feel simultaneously more relaxed and productive on Sundays. And to make today an even better Sunday morning...

bleacherreport.com

It's the Superbowl! I love football season and I love my Patriots. I used to name my stuffed animals after Patriots players ("Teddy" Bruschi) and I once waited in line for over an hour (on crutches post knee surgery) to meet Bruschi. 

The Patriots have been through a lot this year and they will be better for it! 

My whole family is ready for the superbowl! Including my puppy.

Go PATRIOTS!

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