In surfing around the internet, I came across a very interesting study on the link between the immune system and the brain.

We intuitively know that there must be a link:  we experience that we are whole selves, not parts.  But medicine seems to study disease by disease, not the interrelationships -- until now.

There are more and more studies that address how one thing affects another and, in this study, the scientists looked at how chronic inflammation (like in rheumatoid arthritis or heart disease) creates a depressive response.  The inflammation itself changes the chemistry in the brain.  This debunks the older idea that depression is a reaction to a disease, or even another form of poor coping with a chronic illness.

Instead, here we see that the disease of depression is the biochemical reaction to inflammation -- not a psychological failure or a maladaptive reaction to pain and limitation.

These studies were done on mice, and so there is a way to go before we can make definitive correlations to people, but I think there is something to pay attention to in this research.

Often our impression of depression is that it is a failure of will or a personal weakness -- not a serious illness with its own symptoms that go away when properly treated.

Classic signs of depression are feelings of hopelessness, sadness, and futility, along with sleeping problems, irritable moods and angry outbursts, lack of energy, and gaining or losing weight.  Recent statistics suggest that one in ten people have depression, and among those with RA newer studies put the incidence at twice that of the general population.

Depression is vastly under-treated because people feel embarrassed or ashamed.  In addition, many people don't want to be on yet another medication.  They "don't like taking drugs."

The tragic downside of this is that, when someone is treated for depression, it goes away.  They feel better.  They have more energy and the world seems like a friendlier and easier place to be.

What the inflammation research tells us is that, if you have RA (or another chronic illness with inflammation), the depression is a result of that disease.  It isn't your fault, and it can be treated.  You don't have to live with all those sad, angry, painful thoughts all the time.

To read the article, click here.

If you suspect you might be depressed, talk to your doctor and get an evaluation.  Don't be afraid of a brief course of anti-depressants.

You want to enjoy -- not just endure your life.

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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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Thanks for your responses to my last book review.  I am continuing the theme this week with another new book that came across my desk, The Empowered Patient by Dr. Julia A. Hallisy (Bold Spirit Press, 2009).

Dr. Hallisy had a very ill child.  Her daughter was diagnosed with bilateral retinoblastoma and she battled malignant tumors for over 10 years.  This heartbreaking history gave Hallisy and her husband an inside look at being a consumer in the American medical system.

It was not an encouraging picture.

As a result, Hallisy decided to write a book to share what she learned about the dangers of American medicine -- particularly inside hospitals -- and how consumers could become educated and take charge where it matters most.

Her message echoes what we teach (and preach!) on the CreakyJoints site -- that you have to be in charge of your healthcare.  But because of the errors and missteps that she observed, Hallisy takes our core message even further.

She has practical advice and has scouted out some of the places where medical errors can and do occur.  There is a chapter on infection -- of real importance to anyone with an autoimmune disease who has to be in the hospital.

Another chapter describes hospital protocol, including the designations of hospital personnel and what that title means.  Who knows the hierarchy of the hospital staff -- whether a surgical resident has more or less education and experience than a fellow or a third year resident?  She has a handy chart to help you navigate the "doctor chain of command."

She includes action steps to avoid medication errors, keep track of your own medical files and tests, and how to ask hard questions (and what those questions should be).

Two of her chapters deal with second opinions, and how to make a complaint and communicate about concerns.  Those are tricky issues, and there isn't a lot of how-to advice or encouragement to step into that sensitive terrain.

This author is candid, and she really delivers the "empowering" message of her title.

As we in the CreakyJoints community know, health care is a team sport.  (One of Seth's favorite sayings!)  It is the partner, friend or family member who helps to navigate these difficult places with the patient.

This book is written as much for those on your team as it is for the person with the illness. In fact, it seemed to me it was more important for the one who is not in the bed to read and absorb as much of this information as they can.  It may be too overwhelming to try to stand up for what you need from a horizontal position -- especially when you're in pain or recovering from anesthesia!

So get the book for the teammate, or better yet, read it together and make joint notes on what is most important for your situation.

I hope you never need this book -- but it is a great "just in case" resource.  And for those of us who are already dealing with a slew of medical concerns, Hallisy's advice may be just in time.

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