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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Every morning when I turn on my computer and boot up my e-mail, a lovely post appears from a fiery woman named Danielle LaPorte.  Her blog is titled White Hot Truth and I never know what will show up -- a song, a quote, a poem, a musing.

Today it was a simple question written in large script across the page:

What are you tolerating?

Isn't that a great question?

We tolerate so many things, letting them accumulate on the edges -- and sometimes even in the center of our lives.  Unanswered letters, cluttered desks and drawers, cars that need to be fixed, freezers that overflow so we can't get one more thing in them.  All of these are irritating tolerations that distract us a hundred times a day.

Then there are the larger, more insidious tolerations.  We tolerate thoughts that eat up our precious energy:  "I can't, it doesn't matter, it's not worth the effort."

We allow ourselves to tolerate relationships that don't support our growth, less-than-ideal self-care, and work that is dead-end.

We rationalize this -- but we let so many things stay in place because we're ... what?  You fill in the blank.

We don't put forth the effort to make a change.

I learned a long time ago that our tolerations actively sap our energy.  For every undone project and every jam-packed clutter zone, we pay a price.  A tiny bit of energy drains out.  If you are tolerating lots of things, your energy deficit may be larger than your energy credit.

When you live with a chronic illness, this is an expensive way to go.  You need your energy, your initiative, your sense of power and control.

You can take that energy back.  It is a simple process.

Start eliminating those tolerations.

I suggest people begin with a list.  Don't worry about how many items there are -- or how minor they seem.  Every one counts.  Write them all down.

Look for the easiest ones to eliminate.

Decide what you can do today and tomorrow.  Do two or three.  Then pick five to cross off by next week.

I once worked with someone who needed new glasses and hadn't taken the time to go to the eye doctor.  She also was out of checks, and got behind on bills, and her daughter was toddling around in shoes that were too small.  Then there were minor things like a car inspection, and a hall closet where you couldn't hang up anything because it was full of coats no one was wearing.  She had a longer list, but this was where she decided to start.

Three weeks into the project, she was feeling stronger and happier and more in charge.  She even felt that her arthritis was improved.

I think it had a lot to do with not feeling so overwhelmed and stuck.

What are you tolerating?  What will you do about that today?  This week?

When you get rid of them, I promise you will feel better -- in lots of ways!

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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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