Lately, I’ve been selling on eBay (which can be a terrific part-time job for arthritic folk…) and I’ve become addicted. In this house, anything that doesn’t move is in danger of being sold. Mementos, schmementos, is my motto…I want cash. On my latest closet raid, however, I was struck by a pang of sentimentality. There, in the corner—dust-covered and much ignored—was my old fencing equipment. It’s lunacy not to sell it—special-ordered foil with a pistol-handled grip, very nice fencing jacket, top-of-line mask, even the Valkyrie breast plates, all zipped up in a practically new carrying case. I could get a hundred bucks for it, easy…sold separately, maybe as much as $200.

And yet, I can’t bring myself to do it. Yes, I know that my fencing days are behind me—the quick, flicking motions of the wrist alone would kill me, not to mention the lunges—and yet, I have this irrational belief that if I sell my equipment, I’ll be jinxing myself. I can’t help feeling that if I give up on the idea of fencing, then I’ll never fence again…which leads to a whole Pandora’s box of fears that I’m really not up to facing.

Holding on to a fantasy isn’t always counter-productive, though. In this case, my admitted superstition about my fencing equipment is silly, illogical and maybe even childish, but it does serve a purpose. It gives me incentive to try to stay in shape (okay, sorta) on the off chance that medical technology catches up me. It’s not something I dwell upon, it doesn’t hurt anyone else and it gives me hope.

But some fantasies are harmful. Living with rheumatoid arthritis does, unfortunately, mean sacrifice. I doubt that there is anyone with RA who hasn’t had to give up something—and at times, it feels as if we’ve given up almost everything. Many of us lose our livelihoods, some of us lose important relationships and nearly all of us lose some measure of security, independence, and happiness. And, as devastating as it is to let go of something you love, holding on to an elusive dream can impede your progress towards acceptance…and without acceptance, you can never truly “live” with arthritis.

The Hobby
There are some truly inspiring arthritic folk out there. In Arthritis Today, I’ve read about mountain climbers, dancers, skiers, even runners—all people with rheumatoid arthritis. True, severity of symptoms varies wildly among us, and some people luck out on the right drug combination, but still…you can’t help but admire their determination.

And that kind of determination might make a difference in your abilities, as well. I will not be the one to tell you to give up football, hockey, rugby, ballet, or any other arthritis-unfriendly activity. Only you know what you can and can’t do. But sometimes pursuing an old hobby not only can lead to a serious (and possibly permanent) injury, it also leads to self-blame and anger…which can be just as harmful.

And letting go doesn’t have to mean giving up entirely…it just means modification. Suppose you used to love playing football on the weekends. Is it possible that you could play touch football? Or how about volunteering to coach a kid’s team? Maybe you can develop your writing abilities and submit an article to your favorite sports magazine. Become an entrepreneur and sell sports equipment, specializing in football. Be an avid booster for the local high school team. Just because you have to give up playing football doesn’t mean you have to give up football.

Now, let’s take ballet, which was another hobby I had B.A. (before arthritis). Even though you could not—throughout the entire history of dance—find a worse ballerina, I enjoyed ballet. I liked its discipline, its form, the way—as long as I avoided the mirrors—it made me feel graceful. Well, as I’ve mentioned before, I now have significant deformities in my feet—pirouettes are out of the question (as if I could pirouette before). But that doesn’t mean that I have to give up ballet! Maybe grand jetes aren’t going to happen, but I can still stretch at the barre and practice floor work. In this case, letting go means accommodation, not giving up.

The Relationship(s)
It has been estimated (and I always have to wonder at the crepe-hangers who come up with these statistics) that 80% of marriages in which one spouse becomes chronically ill, will fail. As much as I would love to believe Mark Twain’s credo—“There are lies, damn lies and statistics”—it’s hard not to find that figure discouraging. There are so many aspects to RA—physical, mental, financial—that can devastate a good marriage…and can finish off an already shaky marriage.

Now, if you’re like me, you probably scream every time some well-meaning writer suggests counseling. After medical bills and medications, who can afford a therapist? Okay, that’s true. But ask yourself this: can you afford a divorce? And, more importantly, can you afford the black depression that comes with a bad marriage…on top of RA, too? A neutral party can do a lot of soothe that destructive anger that I believe is inherent to RA…and he/she can also help you rationalize the very understandable resentment that your spouse may be feeling, as well. If you have lousy insurance/no insurance, try the local mental health center—they operate on a sliding fee scale. And if your partner won’t come with you…go anyway. It can only help.

RA affects other relationships, as well. Relationships with family and friends can become strained and even fractious. While you should make every effort to preserve your friendships, there are some people—the ones I call the Pathologically Healthy—who will never even make an effort to understand how your life has changed. They may ignore you, avoid you or even belittle you. There is a strange narcissism that runs in some people—if they are not experiencing pain/illness, then it is not possible that you are. If you cannot educate a person like this (and in my experience, you can’t), then you might need to let go of this friendship.

Family, on the other hand, is a different matter. You cannot divorce or break up with family…and you can’t choose them the way you can choose your friends. Since you’re stuck with them, try this: the Buddhist principle of Emotional Detachment. This is not the same as indifference; it is more like viewing someone from the wide end of a telescope and making them seem far away. Try telling yourself that—even though you love Uncle Al—nothing he says to you or about you really matters; you are the only one who knows the truth about yourself.

The Job
The reason that I saved this category for last is that many people identify themselves with their career. With men, especially, the loss of a job can be even more devastating that divorce. When your career is gone, so is your sense of security and independence. And, very often, when you develop rheumatoid arthritis, many of us have to let go of our jobs.

Or do you? Is there some other capacity in which you could still perform your job, even if only on a part-time basis? If, for example, you were a firefighter, perhaps there are still avenues for you to fight fires without the physical strain. Working as a dispatcher seems like a reasonable alternative…or maybe even arson investigation/inspection.

In some cases, arthritis could offer new opportunities. In my past life, I worked as an interpreter for the deaf. I liked it well enough, but it wasn’t really my passion. RA has forced me out of the profession—which was a terrible blow at first—but now I am doing what I love most: writing. (Now, if only I could make some money…)

If  RA has robbed you of your career, don’t automatically assume that disability is your only alternative. While disability is great for those of us who have not other choice, studies have shown that people on disability tend to worsen. I believe it’s the jinx factor: you are paid to be disabled, hence, you truly become disabled. Try to think of disability as a temporary solution and put your tax dollars to work by registering with the Department of Rehabilitative Services. Not only do they have a database of thousands of jobs available for folks with various limiting conditions (I’m not going to use the “D” word), they also know of grants and scholarships for people who need to learn new skills.

When Letting Go is not Giving Up

* When it leads to less pain—either physically, mentally or psychically
* When it leads to other opportunities
* When it ultimately leads to enrichment
* When it feels like a relief
* When, unfortunately, we have no other choice

I believe that the stages of grief—denial, anger, bargaining, depression and acceptance—aren’t truly “stages” at all, but rather cycles that we must endure and accept as part of the RA way of life. While we should strive to do all we can, be as involved as we can, be as “normal” as possible, there are times when we all—Christian, Jew, Muslim, Hindu, pagan and atheist—need to heed the wisdom of: “Let go…Let God”.

Why Exercise?
When you first discussed exercise with your health care provider, he or she probably did not spend a lot of time talking about the benefits of exercise. Throughout our lives we’ve heard that exercise is “good for you,” but if you’re living with arthritis, exercise is particularly important. Exercise has been shown to increase muscle strength, endurance and flexibility and reduce weight. It has also been shown to reduce joint pain and stiffness, and improve overall sense of well-being.

Types of Exercise
As you’ve likely discussed with your health care provider, there are three main types of exercise that benefit people living with arthritis. Range-of-motion exercises are designed to help with flexibility and joint movement. In range-of-motion exercises, you move your joint through its entire range. For example, this might include rotating your wrist 360 degrees. Range-of-motion exercises should be performed daily or every other day. Your doctor can demonstrate the correct movements. Strengthening exercises are designed to make your muscles stronger in order to support and protect your joints. Strengthening exercises are also done daily, but shouldn’t be done when symptoms are flaring. Strengthening exercises may include the use of small weights, or water exercises. Aerobic/Endurance exercises are done to help control weight and improve your overall health. These exercises are usually done three times a week, for 20 to 30 minutes at a time.

Hints for Maintaining Your Exercise Program
After you’ve worked with your doctor or physical therapist to design an appropriate exercise program, the most difficult part of all is taking what you’ve learned and applying it to your daily life. For most of us, this is easy to do for the first few weeks, but becomes more difficult as time goes on. Try the tips below to help stay on track.

* Start small. Don’t begin your exercise program expecting to work out like an Olympic athlete. While it’s good to start with enthusiasm, starting a program that is too advanced can lead to pain – and decrease your chances of maintaining the program.

* Stretch. Along the same lines, don’t jump into each exercise session at “full swing.” Give your muscles a chance to warm up by stretching and doing range-of-motion exercises.

* Make exercise part of your routine. Like brushing your teeth, taking your vitamins, or any of the things you do every day, exercise should be established as part of your daily program. Set aside time each day to complete your program. Don’t forget to allocate time for stretching and cooling down.

* Make exercise a priority. Too often we drop exercise from our list of “to do’s” when we get busy or tired. It’s difficult to make something a priority when most of the benefits are long-term rather than immediate, but if you make exercise a daily priority you’re guaranteed to see results in your overall health.

* Give yourself a break. “No pain, no gain” definitely does not apply to people living with arthritis. Sometimes, some joints will hurt more than others. If you find that a particular exercise causes pain or inflammation, talk with your doctor about adjusting your exercise program.

* Distract yourself! If you’ve been sticking with the same exercise routine for more than a few weeks, you may have begun to tire of its repetition. Look for distractions while you’re exercising. For example, range-of-motion exercises can easily be done in front of the TV while your favorite program is on.

* Make it a party! OK, “party” might be a bit of a stretch, but you can make exercise fun by doing it with other people. Check with your local Arthritis Foundation for classes in your area. Or invite a neighbor, friend, or your spouse to exercise with you, or even keep you company while you exercise.

Remember that these tips are provided to give you ideas. Experiment a little and find out what works best for you. If you can find a program that you enjoy and can stick to it, you’re sure to see long-term benefits in improved health.

Ayurveda: means “science of life.” This form of alternative therapy focuses on maintaining physical health and well-being so a person can pursue a greater spiritual development. The main emphasis is healthy living through a good diet, exercise, moderation and meditation. The practitioner is just an advisor. Each person must put the advice to use. The theory of this kind of therapy is centered at body energy. What the practitioners helps you achieve is a balance of energy within yourself and the forces around you. Most of the treatment has to do with your digestion and elimination systems. The idea is to purify the system by eliminating toxins, therefore restoring balance within the body.

Chinese Medicine: “Balancing Vital Energy.” This form of therapy also has to do with finding balance in the body. The Chinese describe it as the yin and yang energies. These two forces are often opposing, but need to be in balance for optimal health. The Chinese also believe in something called Qi, which loosely translated represents life itself. It is referred to as life flowing through our bodies. When the Qi is blocked somewhere in the body the person becomes sick and the practitioner must work with that person to unblock the Qi. To accomplish the unblocking and re-establish the balance between the yin and yang they prescribe acupuncture, acupressure and exercises called tai chi chuan and qi gong as well as other herbs and preparations.

Naturopathic Medicine: This form of therapy centers around the body healing itself by living a healthy lifestyle and giving the body what it needs to function properly. It focuses on the person and not the disease and also working with the patient to prevent disease. The doctor plays the part of a teacher, with the patient educating themselves on healthy habits. Some of the focus is on removing poisons and bad habits and encouraging things like exercise, positive attitudes and bringing balance into ones life. One of the key areas the practitioners focus on is nutrition. Modern naturopathic physicians study a variety of disciplines including, nutrition, manipulation, herbal medicine, hydrotherapy and counseling. This type of practitioner is not equipped to provide all the treatment you will need for arthritis. It is truly a complementary form of medicine; therefore you also will need a medical doctor to treat you as well.

Osteopathic Medicine: Today osteopathic doctors go through almost the identical education process as regular MDs. They can do surgery and write prescriptions and they can also specialize in other fields of medicine just as a regular MD. The big difference between a regular MD and an Osteopathic doctor is the Osteopathic doctor looks at the musculoskeletal system as the core of the problem. They feel that if they can help the patient get their bones and muscles in good working order that other problems will resolve themselves. They use manipulation of the entire bone structures of the body. Some other forms of therapy used include massage, relaxation, diet changes and also exercise.

Chiropractic: This form of alternative therapy is widely used. It is the third largest health-care profession. Millions of people each year seek the help of a chiropractor for the relief of back and neck pain. Many people find themselves going to a Chiropractor after an accident or injury. It is also a form of therapy that many people with musculoskeletal problems find relief from their discomfort. The focus of treatment is to realign the spine. Chiropractors feel if there are problems with the alignment of the spine (subluxation specifically) this causes pain and sometimes immobility and loss of function. By aligning the spine they feel the patient will benefit by a reduction in pain and an increase in overall mobility.

There are two different kinds of Chiropractors “straights” and “mixers.” Traditional or “straights” concentrate on just doing spinal manipulations. “Mixers” use several different approaches to treatment. Some include, electrical stimulation, ultrasound, herbal and vitamin therapies, and nutritional counseling. These practitioners may also have other certifications including massage therapy and physical therapy or work closely with practitioners that provide these complimentary services. “Mixers” use more of a comprehensive approach that involves more than just spinal manipulations. People with arthritis should use caution when seeking help from a chiropractor. Manipulating weak, diseased joints can cause more damage to the joint.

Mind-Body Connection: There are many therapies that are practiced by individuals for pain relief and stress reduction. Most people use these with other forms of conventional therapy. It has been well documented that negative emotions such as stress, depression and anxiety can increase symptoms and result in more pain and loss of function. The mind-body connection and how it can be used to help a person get control over symptoms and their life is an accepted form of therapy. This fact was proven a few decades ago when researchers used a placebo on a group of patients. In a controlled study some patients were given the real medicine and others were give a sugar pill or placebo. It was proven in several research studies that about 30 percent of the people in the studies responded the same whether they got the medication or the placebo. From this research they concluded that there was something to the mind, body connection and how a patients physical well-being was affected by their mental health. Because of these studies and others like them the whole field of mind-body therapy immerged. Some of the more common forms of mind-body therapies follow.

Biofeedback: This is a method where electronic monitors are used to teach the patients how to lower muscle tension and reduce pain. It is performed at a clinic initially and then as the patients become familiar with the process they can do it at home. Basically an electrical monitor is used to detect tension at a specific area of the body. The patient is lead through a series of relaxation exercises focusing on that area of the body to help relieve the tension. The monitor is used to help the patient or clinician detect a change in how the muscle is reacting to the relaxation techniques. This form of therapy takes concentrated work on the part of the patient. The results come over time as the patients become more in tune with their bodies and can focus on certain areas of the body. It also requires a place where the patient can go and not be interrupted and can feel safe.

Meditation: People who practice meditation find it helps relieve tension, pain, stress and depression. It is a form of therapy that develops an inner calmness when practiced regularly. Meditation is not a form of therapy that can be learned and applied overnight. It takes practice, focus and belief in the process. Usually the longer a person practices the more effective the outcome.

Hypnosis: There is self-hypnosis and being hypnotized by a professional. This form of therapy has been used for several conditions: weight reduction, smoking cessation, pain reduction and a number of other problems. The way it works is through different techniques that alter your consciousness and help you focus your attention. This is another form of therapy that you have to believe in or it will not work for you.

Other forms of mind-body therapy used are visualization, guided imagery, relaxation, deep breathing, progressive muscle relaxation, tai chi and yoga to name a few. In addition to the mind-body aspect of treating symptoms there are other specific forms of therapy that I want to mention.

Massage in its many different forms has shown to be beneficial in treating symptoms. When looking for a massage therapist you might want to educate yourself on the different techniques used in massage. These are a few of the more common types: reflexology, craniosacral, deep tissue, trigger point, myofascial release and acupressure. Each one of these techniques concentrates on a specific area of the body or amount of pressure used. This is one form of therapy that people either get good results or no results and it usually only takes one or two session to find out if it will benefit you. Educate yourself and find out what kind of training your therapist has before you schedule an appointment. The information you collect can mean the difference between helping you and causing more damage to your joints.

Other segments of alternative therapy are diet, supplements, herbs, teas and things like bee venom, magnets and copper bracelets. I am not going to elaborate on these forms of therapy because the benefits derived from them are controversial and lack scientific explanation. There are articles written about these forms of therapy if you have an interest and want to investigate them.

In closing one thing I would like to emphasize is that each person with arthritis needs to find his/her own unique remedies. Even though some 22 million people have osteoarthritis, each one of them needs to find the right treatment program for themselves. That program may include several different treatment modes, combining conventional with alternative. Just as each person is an individual, his or her approach to treating illness should also be tailored specifically for that individual.

Over the last 47 years of battling with rheumatoid arthritis I have used many different forms of therapy in my treatment program. One treatment plan will not last forever so we all must constantly be educating ourselves about new therapies whether they are conventional or alternative.