"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.

To send Dr. Laurie your thoughts:

• add a comment below
• or e-mail her by clicking here
  
  

The video on STILL'S Disease featured on the site this week raises a host of difficult questions and concerns.

This column is addressed to parents who are navigating the complicated terrain of caring for a sick child, although those of you who are caretakers may also find something that speaks to you.

Before Diagnosis

Persistence matters.  Follow up on tests, uncertainties and symptoms.  You are the best judge of what your child needs – seek advice and don't be afraid to keep asking questions.

Listen to your gut.  I have seen medical people (with all the best intentions) try to calm someone down, and miss what matters.  If you are concerned or worried, find someone who will listen.

Be informed – study, join discussion groups, read, read, read, and search for similar symptoms and situations.

Build Your Team

You are in charge.  I say this to adult patients, and it is just as true when you are advocating for your child.  You have to take responsibility for managing the medical care.

Talk to your doctor.  If s/he isn't responsive to you, move on.  You need a doc who is part of the team and who listens and works well with your family.  I know:  It's an overwhelming and scary time, which is why you need the doctor -- and the doctor's staff -- to be with you, NOT resisting you.

Nurses matter.  Your pharmacist is part of your team.  Your religious leader, and any other grownups who can help you sort through options, and make serious choices are part of your new tribe.

Keep track of records.  Don't expect the medical establishment to take care of this.  Keep copies of X-rays, test results, prescriptions for yourself.  Start a journal and take good dated notes.  Keep track of symptoms, and side effects.  Your record is part of the team.

This is a time to call in your markers.  Even if you're not a person who depends on others, get over it.  You need them.  You need friends who bring over meals, who run errands, do research, and who listen.  Your neighbors, your family, your dog.  They are all part of the great embracing team of support.  But you need to invite and allow them in.  Don't be a martyr.  There isn't time.

Communication

This can be hard, but your child needs the truth.  Not knowing is scarier than being trusted with the real story.  But you don't have to tell them everything.  Start small.  Let them know you are there for them.  Tell your child that lots of people are on their side and figuring out how to make them better.

Allow feelings.  Yours and theirs.  This may take practice.  Sometimes when someone we love is sick, it seems overwhelming to admit to fear, or sadness, or being so vulnerable.  But if we practice saying things out loud, that takes away some of the power.

I know a child who was so frightened by the grim faces, and the sound of her mother crying at night that she was sure she was dying.  It was a relief to be told that she had a disease, and that it could be treated and that her mother was sad because her daughter had to suffer.  The little girl could deal with that, and was able to say how she felt.  In the cleared air, there was a brightened mood.

You are the model.  If you shut down, no one will feel safe to express anger or worry or even joy.  If you have trouble doing this, find someone to talk to about it -- a therapist, a priest or rabbi, a wise friend.  Your habits and moods set the tone for the family.  Practice good ones.

Don't assume how everyone else is.  Ask.  Listen.  Receive.

Time Out

This is one of my constant themes:  When you are doing the hard work of caring for someone you love, you need a break.  You must take a break.

The airlines have it right when they tell us, "in the case of oxygen failure, when the little masks drop, put your own mask on before you try to help anyone else!"  You can't be on this mission unless you are taking care of your own physical, emotional and mental health.

Talk to your friends, read a novel, get a massage, take a walk, go out to eat with your partner ... You know what stokes you -- what music, beauty, food, dance, or play helps you remember to breathe.

Stay close to your spiritual center -- mediate, pray.  Avoid people who can't help themselves and bring up scenarios that worry you or make you feel like you're not doing enough.  You are.  You are enough.   You are doing enough.

Trust that your child is getting through this, with all your help and energy and love.

Breathe.

Now you have rekindled the stamina and the heart to do what you need to do.

To send Dr. Laurie your thoughts:

• add a comment below
• or e-mail her by clicking here

A client of mine isn't doing so well. I'm watching her cope with a new round of doctor visits, tests, questions ... and fears. She is on the merry-go-round of one visit leading to three new appointments with different physicians -- each one working to diagnose and treat her many symptoms.

There is something different in her approach though, and it is making me think.

She seems to be doing most of the work.

She is taking each opinion, each "recommendation," and she and her partner are sifting through the data, doing some research, and choosing what seems best to pursue as a healing option.

In the not-so-distant past, she -- and many of my other patients -- would have relied on a doctor to choose a path.

He (and The Doctor was almost always a He) made the decisions, and was The Omniscient Healer. We looked up to our doctors. We relied on their experience and wisdom -- and hopefully on their caring concern.

The landscape of medicine has changed with lightspeed ... and many of us are still catching up. We only have minutes with our physician. We are given options -- not decisions. And there is an often unspoken expectation that we are the ones in charge.

That's the good news -- and the difficult news, isn't it? We have to adjust to this new way of doing things at a time when we feel most in need of someone to lean on, someone who will take care of us and make it all better. But we also know that this is unrealistic -- a fairy tale that never quite fits the situation.

Our work is to help ourselves grow up a little into this responsibility and develop some ways to adjust and use our new power most effectively for our own healing.

I'm watching my clients and here is what I've learned:

The good news is, if we're in charge, we get to decide.

OK. The doc may recommend certain surgeries, or a certain course of medication. But once we do some research -- and ask around -- then we choose. You and your body are the best judge of what works for you. You're in charge -- and you know what works best for you.

• Speak up.
• Speak out.
• Tell the truth.
• And be The Boss.

It's empowering and it is what will make you feel better.

Get an advocate.

Don't try to keep track of everything or make decisions by yourself. Again, this is good news -- partners make us stronger. They help us feel better.

If it isn't a family member, take a friend. If you don't think you have a friend that close, then get to work to make sure there are some people in your life you can count on. This is a two-way street and it is part of healing.

Write everything down.

Get copies of tests, records, whatever. Doctors will make mistakes. You need your own written stuff.

Keep track.

Nobody else is. This means a written list of every medication and herbal thing you are doing. Make sure every doctor, every assistant, and every pharmacist sees it. Every time. Don't assume they "know" -- even if they have seen your list, they have often forgotten.

Have second opinions.  Use alternative modalities.  Use research.

The internet is wonderful ... and awful. Go to reputable sites, and double-check what you learn. Reach out to other patients, nurses, and support groups. Be informed. Then practice making decisions.

This is a new way of being for most of us. It steers us in the direction of responsibility -- instead of feeling passive or victimized.

Once you begin to practice this, it's heady, intoxicating, and, yes, sometimes a little scary. But being a grown-up is always more scary ... and more fun -- because you get to set the course. You get to decide how late to stay up, what to have in the fridge, and how to spend your money.

Should your health care be in any one else's control?

It's your body. Your side effects. Your pain. Your healing. Your life.

I'm rooting for you.

To send Dr. Laurie your thoughts:

• add a comment below
• or e-mail her by clicking here