A colleague of mine had a serious operation last month.  She has had rheumatoid arthritis (RA) for over 30 years, and lived through some severe flares that kept her bed-bound.

The result of some of these flares has been a crippling of her hands, and in particular her right hand. The deterioration -- that so many of you know so well -- has continued.  She has had more and more trouble using that hand to write, to drive, to open doors and jars, and to hold a cup of coffee.

For some time now she has been considering hand surgery to replace her knuckles.  This would unbend and unfreeze her hand, but the surgery is lengthy and potentially very painful.  The fear of the pain and being even more incapacitated kept stopping her.

Who wants to voluntarily sign up for pain, a hospital stay, and an uncertain outcome?  What if -- after all the trouble -- it didn't even make that much difference?  What if there were more pain?

She was full of doubt and indecision.  She talked about it for several years, and kept finding reasons to put it off.  The bottom line:  she was scared.

Last month, she did it.

The full results aren't clear yet, but the intermediate results are stunning.  She can move fingers that haven't been in motion in 20 years.  It makes her cry to experience the change and the possibilities that are now here for her.

It makes me cry, too, and it makes me wonder how it is that so often we don't make the moves that would change our lives because we're scared.

Courage.  The word comes from cour or heart.  Some of the work of living our lives in the biggest and strongest way we can means living from our hearts -- letting that energy move us forward.  Trusting our heart energy to carry us through those stuck places and those frightening valleys.

On a news show last week I saw another example.  A town in the Midwest had been the site of a deep mine.  It turns out the metal they were mining was toxic when large quantities of it were exposed to the air, and there were hills of sludge and waste piles all around the town.  It was declared a disaster area, and everyone was asked to move out of the town.  The government paid to relocate them, and slowly all of the businesses closed. The Post Office left.  There were no more grocery stores.  The schools and churches were empty.

The story focused on a woman who had lived in this town her entire life.  She was born there, married there, and had her children there.  She was being interviewed because she refused to leave.  She couldn't imagine living anywhere else.  She couldn't let go.

Wow.  The visual was her house -- surrounded by these mountains of toxic gravel -- and she was rocking on her front porch, staying put in a ghost town.

What a metaphor for the way we sometimes live.  We can't imagine the next place -- we are afraid of what it will take for us to get there.  So we stay put.  Talking about how hard it is.

If that feels like you today, go into your heart.  See where your courage is -- to take one step in the direction you need to go.

It may not be as dramatic as having your knuckles replaced, or moving to a new town.  It may be deciding that it is necessary for you to start some exercise, or take a class because you really are thinking about training for a different job.  It may be investigating some new treatments or starting your own blog.

Whatever it is, breathe into your heart and let your courage unfold.

Then set forth.

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"Emotional Wellness Helps RA" is the title of a recent post on PsychCentral that caught my eye:

http://psychcentral.com/news/2009/08/05/emotional-wellness-helps-ra/7550.html

The incidence of depression among people with RA is twice that of the general population.  An additional study found that when spouses and partners of those with RA are depressed it correlates with a poorer prognosis for the person with RA.

Being emotionally healthy is essential for those who have RA and for their family -- it can alter the course of the disease and supports better pain control.

So how do you become "emotionally healthy"?

What the studies look at is depression -- that feeling of hopelessness, powerlessness and the sense that things will never change.  Other symptoms of depression can be persistent anger, sleeplessness (or always wanting to sleep), or an overall grey feeling -- nothing seems good or worth looking forward to.

These feelings can creep up and subtly worsen over time.  Early intervention is the best way to stave off a more serious bout of depression.

Yet most people don't treat depression.  They hope it will just go away.  They don't want to be whiners, or feel "weak."  Many folks also don't want to take more pills or feel like they have another disease, so they just try to ignore those downbeat thoughts.  They try to "act" cheerful or okay.

The bad news is that this strategy doesn't work.  And depression is wily and tenacious once it takes hold.

Dealing with it early is the most effective approach.  Here are a few ways to start if you find yourself regularly feeling blue or blah:

Talk to Somebody

Find a neutral, supportive person who can listen.  It is best to rely on someone who knows something about depression -- a religious leader, or a medical support person like a nurse or therapist.  Many communities have free or low-cost clinics that can be a great place of help and hope.

Talking to a professional can help you put your concerns in the hands of someone who is an expert in these matters.  You will get lots of good advice and perspective.

Physical Movement

This is free, easy, and one of the most researched tools to combat depression.  I didn't say exercise because that can connote a huge program that feels too overwhelming before you even begin.  What helps is just getting your body in motion.  A short walk every day.  Moving some parts of your body -- stretching, breathing, whatever you can do.

The more often you get your self moving each day, the more it helps.

Humor

OK, you don't find very much funny.  But laughing out loud or a good chuckle lifts your spirits and shifts your brain chemistry.  What tickles each of our funny bones is very individual, so you may have to experiment.  Is it a silly spot on YouTube?  An old movie like When Harry Met Sally?  Jokes from the Reader's Digest?  Jon Stewart?

Give yourself the prescription of two funny contacts a day.

Create Community

Who is in your tribe?  Pain and depression lead to isolation, which makes pain and depression worse.  Where are your friends?  To whom do you talk?  Facebook friends and chat rooms are a good place to begin, but be willing to move on to real-time relationships.  Invite someone for coffee.  Go out for breakfast after church or temple.

I know, you don't feel like doing this.  It's hard.  I get it.  Your cave feels safe.  But you need to get into the world and be around people.  Set a goal.  One outreach in two days.  Then you can build from there.

One of my favorite blogs is The Happiness Project by Gretchen Rubin.  The other day she had this great line:  "The absence of feeling bad isn't enough to make you feel good -- you must strive to find sources of feeling good."

As always, you are in charge, and your sources of feeling good are particular to you.  Remember it is an active process -- not a passive one.  Follow the practice of identifying what these sources of feeling good are.  You have to be willing to act on what you know and feel.

Depression is tough -- but I know you can take the first step towards healing.

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It's the time of year when we're thinking about vacations.

Maybe you are anticipating going away, or perhaps you've already gone.  Some of us are just dreaming about it.

Vacations are essential for everybody -- and particularly for those who have a chronic and painful condition.  The break in routine, the exploration of new sights, the creation of memories and relaxation all contribute to a healthier mind and attitude and body.

Yet we often put that need aside.  "I can't afford to get away!"  That's our usual excuse.

Whether we can't afford the money or the time or the energy, we give up and put vacations on the back burner in our mind.

The reality is that we don't need to go away for a week or even physically leave our homes in order to get some of the best benefits of a vacation.  We can create "mini-retreats" or even brief mental vacations that can offer us some of the best nourishment of a time away.

To do that, there are a few pointers.

"Set the table."

By that, I mean, put aside a little time and prepare for your mental break the way you would for any trip.  Think of where you'd like to go.  And it works especially well if you choose somewhere you've been and loved.  Using your memory and imagination, recall specific details of the place -- smells, sounds, the slant of the light, what you are wearing ... make it detail rich.

Last year my daughter and I took a brief trip to San Francisco for her high school graduation present.  It was one of the best trips of my life -- and I will never be able to repeat it.  So, I have thousands of delicious details tucked away in my mind so I can take that trip again any time I want!

Put lots of wonderful things on the table.

It's a vacation, remember!  So you get to eat, and put your toes in the water, and feel the sun, and listen to the birds and the wind in the trees -- whatever pleases you.

To ramp up your relaxation, use all your senses.  Eat something, listen to certain music, put out a scent.  Have a raspberry, sniff a rose, hold a beach shell.  The more you stimulate your senses, the more you will relax.  Look at pictures that remind you of how happy a time you had and are having again!

Spend as much -- or as little -- time as you please.

You will get the benefits very quickly.  Your pulse will slow, your mind will unclench, you may be breathing a little more easily, and for sure you will find yourself smiling.

That's what happy feels like.  You don't need to do this for very long.  The effects will last for a while.  When you need another break, do it again.

The best effects happen if we practice vacationing regularly -- every day, or twice a day.
You give yourself a big sunshiny happy vitamin.

That's a break we can all afford and it offers a rich payoff.

Bon voyage!

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