It's that time again!

Today is the first day of the annual meeting of the American College of Rheumatology (ACR). Each year thousands of rheumatologists, researchers, nurses, therapists and others involved in caring for people who have any of the 100 or so arthritis-related conditions descend on a major city's convention center. This year, they're all in Boston. Unfortunately, this year, I'm not. I love being at the ACR conference amidst the collaborations, explanations of what's been learned and press conferences about key scientific or clinical studies. But this year, I'm a nursing mom needed more here at home. In my place, Arthritis Today's nutrition and fitness editor, Kenna Simmons, is on site in Boston gathering up loads of information for us to share with our readers.

Today, one of her e-mails sounded ominous, as she told me about Dr. Gurkipal Singh saying there was an "impending health disaster." Dr. Singh was describing a growing problem that he calls the "gastroprotection gap." With the number of people developing arthritis on the rise due to the aging of the baby boom generation, the use of nonsteroidal anti-inflammatory drugs (NSAIDs) has increased among older Americans. Older NSAIDs, such as aspirin, diclofenac, ibuprofen and naproxen, are known for causing gastrointestinal problems, such as ulcers. Beyond the pain of ulcers is the seriousness of the situation if they start to bleed – especially among the elderly. Bleeding ulcers can be fatal, so preventing them (and monitoring for them) is important. (Learn more about NSAIDs and side effects at www.arthritistoday.com. Click on Drug Guide.)

Protection against bleeding ulcers comes in the form of other medications, called proton pump inhibitors. These medications, such as Nexium, Prevacid and Prilosec, reduce the amount of acid in the stomach, whereas the traditional NSAIDs increase it. Dr. Singh's study shows that doctors had been getting really good at prescribing an acid reducer when they prescribed an NSAID – until the COX-2s came on the market. The COX-2s are a type of NSAID specifically designed to eliminate the gastrointestinal side effects. When the COX-2s Vioxx and Bextra were popular treatments, the rate of serious gastrointestinal complications was cut in half. But now that two of the three COX-2 drugs are no longer on the market (Celebrex still is available), and use of the COX-2s has declined, Dr. Singh found that the complication rate is jumping up again.

His study of Medicaid recipients in California shows that the percentage of people who receive medications to protect their stomachs while taking NSAIDs decreased from 35 percent to 14 percent in just one year (from 2004 to 2005). Ten years ago – before COX-2s were available and doctors had gastrointestinal complications top of mind – 79 percent of people were given stomach-protecting drugs. Since Vioxx and Bextra came off the market, gastrointestinal complications have gone up 21 percent. With the aging of the population, the increase in arthritis symptoms such as pain and swelling, and the return to using traditional NSAIDs again, Dr. Singh's study is a strong reminder for doctors to protect the stomachs of their patients when they hand out a prescription for an NSAID. And it's a call to action for patients to start questioning their doctors about the side effects of their arthritis treatments and how they can protect themselves. If both doctors and patients can take on that responsibility – and carry out their duties – I have hope that we'll avoid an impending health disaster.

Check back tomorrow to see what Kenna digs up in Beantown.

U-N-C

In my last post, my rheumatologist said it was OK for me to take the conservative treatment route until I cried Uncle. I'm more than half way to crying "Uncle." And I mean crying.

My horrible morning is now affecting my afternoon. As I was getting baby Katie ready for daycare this morning – she started this week – everything came to a head. The pain and stiffness has been wearing me down, being up at night to feed the baby has been wearing me down and having to part with my precious newborn has been eating at me all week. A minor argument with my husband over how exactly to prepare the bottles for daycare was the proverbial straw. A brief bout of shouting brought tears of frustration, anger and resentment that just kept flowing. Even now as I recall it, I'm tearing up. The pain makes it all worse – or is it the other way around?

Even as I was in the midst of a good cry this morning, my rational self was thinking, "This is just the pregnancy hormones shifting downward suddenly." But then I wondered if it could be the inflammation building. What came first this week? Did feeling down about having to put Katie in daycare at only 9 weeks of age increase my inflammation, which increased my pain? Or has the inflammation, which has been increasing since late in my pregnancy, finally trigger a bit of depression, which caused me to feel stressed out, overly tired and in pain? I study released last week suggests the latter explanation is most likely. German researchers say an increase of inflammation-causing cytokines can cause an imbalance in the brain that leads to a deficiency of serotonin and an increase in feelings of depression.

I could almost feel the bad chemicals flowing through my blood vessels as my stress level rose. I tried to calm down -- I didn't want to upset the baby. I continued getting her ready for daycare, with tears running down my face. She stared at me as if she knew something was wrong and then she smiled, like she wanted to cheer me up! I nursed her and she smiled. I changed her diaper and she smiled. She was completely carefree and happy, and I didn't want to screw that up.

I re-did my makeup and took Katie to daycare, trying to be my usually happy self, and it almost worked. Even though it's only day four at Katie's daycare, the caregiver seemed to sense that I had been upset this morning. I admitted to a certain level, but didn't go into how much the pain in my joints seemed to magnify the difficulty of leaving Katie for the day. Just yesterday, the same woman had commented on Katie's long fingers. I told her (as I stated in a previous blog entry) that Katie apparently had my grandmother's pretty, delicate hands, although I only saw her hands gnarled and curved because she had RA so bad. I didn't tell her I had it, too, or that I worried Katie someday would as well. Maybe I was too tired to get into a conversation about it or felt it was too soon in our new relationship to divulge such personal information. Looking back now, it was a great opportunity to educate and advocate, but I just wasn't in the frame of mine then.

I came back home and sat down at my desk. I read the news of the day. I made a note to check into the possibility of flu shots helping to reduce the risk of heart attacks, which occur more often and are more often fatal during cold and flu season. I tried to understand how overriding President Bush's veto of the State Children's Health Insurance Program could affect those of you out there on Medicare who need a 'breakthrough" medicine to treat your arthritis. I saw the irony in a new study that will be released tomorrow: the way brain cells communicate with each other may provide the ability or inability to cope with stress and depression. Depressed people showed a 40-percent increase in levels of a compound called BDNF, and researchers theorize that keeping BDNF from being released into a specific part of the brain could increase coping ability. I secretly hoped that today's meltdown was due to a temporary surge of BDNF and that my brain cells would get back to communicating well today. I did a task for a co-worker, though, and admitted I really needed a nap, a walk and a big cup of coffee. I tried to think but felt foggy and just stared at the piece I'm working on for a while. I drank the big cup of coffee. I took a 20-minute nap around noon. But still, my mind just doesn't seem to be working today. I apologize, as I'm trying to work on pieces for all of you to read in the magazine or on the Web site, but maybe tomorrow will be more productive. I'll go exercise later and try to clear the cobwebs. I'll try to get some extra sleep tonight. And I'll feel much better when I get to hold Katie again at the end of the day.

Til then, I'll just have to accept the fact that, being a human with a chronic condition, there will be good days and bad days, and that the bad days also are only 24 hours long. I'm well into those 24 hours, so things should be looking up soon.

Decisions, Decisions

Today's my first day back to work since having baby Katie, and my 7 a.m. rheumatologist appointment was a great way to start it off. As I sat in the waiting room nursing Katie, I was internally lamenting over the fact that when my appointment was over, I'd hand little Katie over to my husband for the day and get back to reading/writing/editing. Of course I instantly became used to holding her through the day, and, as any mom knows, it's immensely hard to cut back on that. That bond forms pretty darn quick and is amazingly strong. Any attempt to loosen that bond is made even more difficult by friends asking, "Do you HAVE to go back to work?" Financially, yes. (And then guilt sets in.) But when I overheard an older woman's plea to the receptionist at the rheumatologist's office this morning, I knew I had an important job to return to.

The woman's disability payments had been cut off suddenly, apparently due to a mix-up in paperwork. She was desperate, and I could tell by looking at her that she had been affected by RA for many years. She obviously had trouble maneuvering physically, and now I knew she was having trouble maneuvering through the healthcare system. My heart went out to her, especially when she had offered to hold Katie for me to make it easier for ME to fill out my paperwork! She was so sweet to me, but so spicy when it came to dealing with her current problem.

I internally cheered for her when I saw her massive folder of papers accumulated over decades of doctor visits. Every good patient should have one. And I smiled when the petite woman seemed 7-feet tall as she succinctly explained what had gone wrong and how it needed to be fixed. She was organized and assertive, just as we tell readers to be at their office visits. I don't know her outcome, but I have a good feeling she got what she needed and will be just fine.

I went in for my appointment -- my first since delivery -- and had an important talk with my doctor. This is where the tough decision comes in. I've been breastfeeding Katie almost exclusively, except for a daily bottle of formula to keep her used to it in anticipation of starting daycare next week. However, the doctor noted the swelling and tenderness in my fingers, wrist, feet and ankles. There's no denying it's there. I could go back on the DMARD now and stop nursing, or I can manage my arthritis conservatively and continue breastfeeding. My choice boils down to this: Prevent deterioriation of my joints and ease my pain, or give Katie the benefits of breast milk -- one of which may be reducing her future risk of developing chronic diseases. I opted for the conservative route, you'd think because maternal instinct is to take care of the baby before self. As it turns out, breastfeeding Katie may help me, too.

According to a 2004 study, women who have breastfed their babies for a lifetime total of more than 12 months (so a year for one baby or a total of 12 months among several children) have a reduced risk of developing RA. Well, that didn't hold for me. Among my three older children, I've breastfed for a total of about 48 months already -- 12 months or longer for each child. In digging deeper, though, I found a study from the University of California San Diego that shows women who have breastfed longer than 12 months have "significantly higher cortisol levels than women who breastfed for shorter durations or not at all." And that association was found to be stronger in women who had three or more children (phew!). Why is this good news? Because, as the researchers explained in the 2001 study, "increased cortisol and increased duration of breastfeeding may play protective roles in certain autoimmune diseases, such as RA." Apparently, cortisol – a hormone often associated with increased stress – may contribute to the beneficial effect of being a lactating mom.

So a lactating mom I am. And I'm also going to have to be a really good patient. That is, taking the conservative route takes work. As my rheumatologist said, I've got to stick to a routine, make sure I eat really well and regularly, take rest breaks, try to sleep well (even though it's disrupted with night feedings), keep my stress level down and get some exercise. The goal is to stave off a postpartum flare so I can stay off medication for now, all while protecting my joints from sustaining damage and keeping pain down so I can function as well as possible. It's not as easy as taking the medication, which gives me some confidence that my joints won't deteriorate and my pain will be minimal. With that confidence, doing all the good things simply makes me feel better. Right now, doing all the good things is how I will get by until, as the rheumatologist says, I cry Uncle.

Those nasty postpartum flares tend to happen most often between three and six months after delivery. I'm at two months now and truly hope being a good patient will get me through the coming months without a worsening of my RA, so I can be a good mom and worker, too.

Meet Katie! She's Not Perfect.

Here, my first baby, Steven, and what will be my last baby, Katie. He's a proud big brother, and I'm so proud of him for being so tender with her at what is such a tough age. He'll be 14 on his upcoming birthday. I know 14 years is quite a span for siblings; I never thought I'd have a child in my 40s. I do remember saying back when I was 16 or so and was dreaming with my girlfriends about our futures, that I'd want to have four kids. But, who really puts stock in those teenage whims? When my daughter Abby was born nearly 9 years ago, and I was 33, I thought that was the end of my childbearing years. After all, 15 months before Abby, I had given birth to our son Ryan. At 33, we had been blessed with three great, healthy kids. Why would we want to tempt fate? Our family felt complete – or so I thought.

I have to admit, now that a fourth child is here, she's filled a void I never really knew was there. I'm thrilled to have another baby, although I never thought I would. My husband and I never planned to have another one, partly because my doctor told me I was premenopausal and then that news was topped with the diagnoses of both autoimmune thyroid disease and rheumatoid arthritis. Baby Katie has proven to me that my body is powerful and resilient, even though it's affected by two chronic diseases. My body isn't perfect, but you know what? Either is my brand-new baby! Just a few weeks into her life, she's already afflicted with sensitive skin. She has eczema on her face. She has a few mood swings. She can't see more than a few inches in front of her yet. She can't hold anything, stand or walk. She's healthy, for sure, but she's not perfect. Yet she smiles. She trusts completely. She makes happy sounds. She oozes love. Even though she's brand new to this world, she's not perfect – and boy doesn't that take the pressure off of trying to get there! If newborn babies aren't perfect, why do we adults think we can achieve perfection? How stress-relieving it would be to realize that although we'll never be perfect, we are born with all we need for life.

Like I said in the last post, I've spent alot of the past 6 weeks just staring at Katie. And I've been thinking about how life starts, how it ends and how it is filled in the middle. At just six weeks old, Katie has already taught me an important life lesson: just relax, trust and be happy. And have confidence that your body will do what it needs to do, when it needs to do it. Hers will do what it needs to grow from here on out. Mine did what it needed to during pregnancy. That doesn't mean I won't try to continue to improve my body and health now that I won't ever be pregnant again. On the contrary! I've been given an amazing opportunity to regain faith in my body and I don't want to waste it. I want to put it to good use to keep my RA at bay. I'm fortunate to have lost more weight than I gained during pregnancy. Who knows whether that's from an increased metabolism or having to pay really close attention to my diet and activity? Regardless, I'm going to run with the positive change -- literally. My goal is to run again. Maybe it's a desire to run away from the RA that was mostly quiet during pregnancy, so it won't be able to catch up with me. The stiffness and soreness is increasing in my fingers, wrists, feet and ankles -- I won't let it take hold.

I'll certainly work up to running, slowly and wisely. I've been walking and doing some abdominal exercises since Katie was born, but this week I'll re-start working out with some weights. I'll keep you posted on my progress (and Katie's!), and will share tips and news I learn along the way. Feel free to post a comment and do the same! None of us are perfect, but we can make the most of our amazing opportunities to live, love, trust and be happy -- whether with our bodies, our relationships or our lot in life.

Rediscovery

Welcome back to the blog! I've been on a brief hiatus since giving birth to a little girl on August 10. Katie, our fourth child and second daughter, was born into a family who was completely ready and excited for her arrival, yet so completely overwhelmed by the miracle of it all. The photo I'm sharing here is of Katie's two older brothers and sister, as well as her Nana, seeing her for the first time. (Note my teenage son with cell phone in hand -- his baby sister's photo is now the wallpaper on his phone's screen. So much for his thinking it was no big deal I was pregnant again!)

So why haven't I blogged sooner? Well, besides the adjustment to having a new baby around -- sleep deprivation, seemingly constant nursing, diaper changes and squeezing in quick showers -- I have been spending time simply staring at my baby. First or fourth, it still amazes me, and always will.

I try to take in all her petite features -- burn the image of her rosebud lips, tiny nose and big blue eyes into my brain for future reminiscing. I listen intently to the sound of her breathing and capture the smell and softness of her skin and the full range of expressions she already has. While staring, I'm just amazed that although she's so small, she's entirely complete. I instantly noticed how long and slender her fingers were, how delicate and pretty her hands and nails looked. My mom tells me my grandmother -- the one who died of RA when I was a toddler -- also had beautiful, long fingers before RA took hold. Sadly, those beautiful fingers and hands ended up so gnarled and dysfunctional. I pray that Katie never has that fate.

Next post: baby pix!

Take care,
Donna

Hopeful and Positive

I am very close to delivering my fourth child – a baby girl who in all tests and ultrasounds has proved to be healthy and developing well. I am excited and not unaware of how very fortunate I am. I know autoimmune diseases can make conception and pregnancy challenging. I also know that being fearful of potentially negative outcomes can make pregnancy – and parenthood, for that matter – equally challenging.

I received a comment to one of my recent blog posts that said, "I truly do not comprehend why a woman would choose to give birth or raise children when she knows she has arthritis, a lifelong chronic disabling disease. It baffles me, and I wonder WHY as well as HOW one plans to physically be available for a baby, then a toddler, and then a youngster, etc."

Frankly, I was shocked at that one, and I'm sure many you will be, too. (I look forward to reading your comments!) The quick and simple answer to that comment is that I have hope and a positive attitude. Working here at the Arthritis Foundation, I hear about and see people who range from mildly affected to severely affected. I know what they go through and how they cope. I also know they never give up – and neither do I. To prepare each issue of Arthritis Today and write or edit each article, I continually read about the research going on in the field of arthritis. I know what's being studied, and I talk to those doing the studies. I know geneticists are very close to finding all of the genes involved in autoimmunity. I know tissue engineers are on track to growing cartilage for transplantation into bad joints. I know researchers keep finding markers of inflammation that can be potential targets for new medications. Because of all of that, I have hope that with continued research, treatment of arthritis will improve dramatically in coming years. I know that although it is lifelong and chronic, it does not have to be disabling.

I know treatment certainly has improved since my own grandmother was physically disabled back in the 60s. Being told to stay in bed to take pressure off her joints and being injected with gold didn't do much to help her RA improve. Her body weakened, and she died in her mid-50s with eroded joints and a damaged heart and lungs. When I'm in my mid-50s, I know for a fact I will be in much better health. Rheumatologists have learned alot since then, and I follow my rheumatologist's advice. I eat right. I exercise. I don't smoke. I drink alcohol, when not pregnant, in moderation – maybe one glass of red wine at night and maybe two on a weekend night with friends. I take my medications as directed. I make sleep a priority. I take time -- if only a few minutes when I get home from work or before I go to bed -- to relax. I have a great relationship with my husband, kids, mom, sister and extended family. I have supportive coworkers and friends. I have hobbies. I'm involved in my community. I enjoy life. And because of all that, I never questioned having kids or raising them. I have alot to offer society, and a chronic disease doesn't change that.

I think my three other children would say that I've always been available to them – both physically and emotionally. I had all three of them before being diagnosed with RA, but slowly and surely, the symptoms were making themselves known throughout the past decade. Still, I play ball with them; we walk, bike or swim together; my oldest son and I workout at the gym together, and my younger two can't wait until they're old enough to join us. We talk about anything and everything under the sun. We laugh – alot. We draw pictures, play cards and games, build with Legos or pretend with dolls. We watch movies, go miniature golfing, hike and camp. I help with homework and school projects. All three kids are involved in sports, and my husband coaches one of the teams. We're always at practices or games. Afterward, some nights we go home and cook together. Other nights, we run errands and get takeout. On weekends, we put on music and clean the house; during the week, the kids help out with chores after school so I can spend time with them all at night. My husband works from home full time, so he does the laundry. Our life is full and busy, but it works. We all make it work. And therefore, my having a chronic condition does not preclude both my husband and I from having a family and a full, happy life. I can't – and don't – imagine it any other way. And I truly believe that in life you get what you give. If I thought I could do nothing more than sit on the couch or take to my bed, I would be completely unhappy. If I get up, feel productive at work, contribute to society, engage in helping others and take care of my body, life gives alot back to me. Yes, I have a chronic disease, but I also am able to live. And that's the ultimate "why" and "how" for being available to my children, regardless of their age.

This fourth child coming in a matter of days or weeks will be delivered from my 41-year-old body that has been diagnosed with RA. I don't feel any different than I did when I delivered my last child 8 years ago. Actually, I feel better. Honestly. I feel stronger and healthier now. Perhaps it's because my diagnosis made me make my health a priority. When I got pregnant, my level of inflammation was down, I was exercising regularly, counting calories to keep my weight down and taking time to rest. Eight years ago, I knew my wrists hurt when I held my babies, but I was told I had tendinitis and that carpal tunnel syndrome was common in moms with young children who are constantly picking up kids or car seats. I knew my hips hurt, but was told it was because I held the kids on the same side and threw my back out of alignment. I knew my ankles hurt, but was told I sprained them. My doctor, although he knew my family history included RA, never tested me. I very well could have had RA back then, but didn't know it. So this time around, I'm ahead of the game. I know what I need to do now to keep the inflammation down. I'll go back on my DMARD after delivering the baby and nursing for a few weeks. I'll be coming back to work. I'll continue to be involved with my family, friends and community. I'll continue to take care of myself. And I'll still be happy and hopeful that I'll be controlling my arthritis. It will not control me or my decisions about how to live my life.

What Goes Around, Comes Around

I had a very interesting phone call with a recent college graduate yesterday. Jennifer, who currently works on writing grant proposals at the Rhode Island chapter of the Arthritis Foundation, is interested in pursuing medical writing and publishing as her career. The president of the R.I. chapter put her in touch with me to get some career advice. Like me, she majored in biology but decided she really enjoys writing about the science. She had questions and I loved sharing my thoughts -- we hit it off well, and her eagerness to explore the same career path I took reinvigorated me.

Her questions made me think about a few things I hadn't focused on in some time:
Did I enjoy my career? Definitely, yes -- love it and love being able to provide people with information they can use to improve their lives.

Any regrets? None, except for the ocassional twinge that maybe I should have gone for that M.D. degree years ago, if only to lend more credibility to what I write. If I had become a doctor, I likely would not have the time, thanks to managed care, to give the advice and information I can provide to people now – and doing that is what makes me happy.

Room for growth? It is what you make it.

Is the field growing? Yes and no – health and science writers are fading away from newspapers but showing up in droves on Web sites, blogs, podcasts and other new forms of media. Like with most careers, there will be job security in the future if you're good at what you do.

Must you be passionate about it? Most certainly. But that applies to any career, too. It makes no sense whatsoever to spend your life devoted to a career you don't truly love and feel passionate about. Otherwise, it's not a career, but just a job that feels like drudgery. No happiness there.

Why do I love it? Hmm. I thought back to something interesting I read years ago explaining the overlap and similarities between the scientific process and the process of researching an article and reporting on the findings. After having gone through scientific training herself, I was sure Jennifer would benefit from the analogy. Like a scientist, a medical journalist must make observations through reading, talking with editors, writers and scientists that lead to questions – the (a-ha moment). Then, a hypothesis is formed. A scientist will come up with questions to be answered through an experiment, whereas a medical journalist will come up with questions for interviews. After the experiment or interview, both the scientist and medical journalist will read through all the data collected and come up with a plan for either writing an article or asking more questions. With a bit of luck and lots of hard work, both the scientist and the medical journalist can get to the hoorah moment – a great study that leads to a Nobel prize or a great article that leads to a Pulitzer prize. The challenges in finding new angles within a slowly building base of scientific knowledge is what makes me love it. When I'm really into a subject, I lose track of time and that feels great. I get the same feeling when I play the flute or piano – getting lost in creating an article feels more like creating art than simply writing a story.

And that brings me around to the "What goes around, comes around" theme today. Twenty years ago I wrote a research paper on vitamin A and cancer. Back then, scientists saw great promise in the carotenoids of vitamin A – through foods like broccoli – being able to reduce the risk of several types of cancer. I remember sitting at a glass-topped table in my parents' home pouring over dozens of books and medical journals I took out of the library. This was back in the dark days before the Internet -- no PubMed, no Google searches, no RSS feeds! I was fully immersed in learning all I could about the topic and figuring out the puzzle. I enjoyed every minute of research, even though I didn't even notice the minutes or hours tick by. Once I got a handle on it all, writing the 20-some page paper flowed easily. Yes, writing about science was what I loved doing. I got an A on the paper and soon after got hired as a bona fide employee of a national health publishing company.

A few years into that job, I found myself writing about vitamin A again. This time, it was a corporate report on the benefits of vitamin A for children in Africa. The vitamin easily could prevent blindness and even death – if only the children in Africa weren't nutritionally deficient in vitamin A. Each year I created the annual report on the company's vitamin A intervention program.

Well, I hadn't thought about all that in years. But as I talked with Jennifer yesterday, I noticed a study printout sitting on my desk about vitamin A possibly being able to fight rheumatoid arthritis. Last week, researchers in California at the La Jolla Institute for Allergy & Immunology found that retinoic acid (derived from vitamin A) could control inflammation by keeping the immune system from attacking tissues. It worked in mice, anyway, and time will tell whether it works similarly in humans and could lead to new treatments for RA and related conditions such as psoriasis or colitis.

In either case, vitamin A research is in the news again. I've been following it for years and haven't tired of it in the least. It's fascinating to see what scientists know and how it evolves over time. Yes, it can be maddening to hear that one day something is helpful and another day to hear that it's harmful. But picking up on those apparent flip-flops means you're observing science (and journalism) as works in progress -- you're part of it all.

Hopefully Jennifer is excited to start tracking subjects that interest her now; over time a few will pop up as her favorites, and she'll find herself losing hours to delving deep into some topics. Speaking of vitamin A and spending hours of research time again ... be sure to look at what I found regarding vitamins in the upcoming Sept-Oct issue of Arthritis Today. In that issue will be our 2007 Vitamin Guide with background information on the vitamins and minerals your body needs, as well as whether research showing any benefit for arthritis and related conditions exists. If you can't wait until then, you'll find nutrition information on our new and improved Web site: www.arthritis.org/ArthritisToday.

Keep reading... I'll (happily) keep writing!

Stuck

It's been a few weeks now since I've had to start dealing with gestational diabetes along with RA, pregnancy and autoimmune thyroid disease, but you know what? There's always somebody who's worse off. Unfortunately, it's my next-door neighbor – a little 3-year-old girl named Rebecca.

The day my obstetrician said I'd have to start tracking my glucose levels and meet with a nutritionist to get started on the strict low-carb, low-sugar diet, little Rebecca was in the hospital unbeknownst to me. She had been at a regular check-up with her pediatrician when something clued her doctor in to a possible high glucose level. They tested her blood right there at the pediatrician's office and found her glucose level was in the astonishing range of 400. (Normal is between 80 and 100 or 120 two hours after a meal). Immediately, they sent Rebecca to the hospital.

Sure enough, Rebecca was diagnosed with type 1 diabetes, or juvenile diabetes – an autoimmune disease, just like my rheumatoid arthritis and thyroiditis. For the rest of her life, she'll be on medication. She's now suddenly at a high risk of kidney problems, blindness and future amputation. And, like me, she needs to get stuck four or more times a day to have her blood glucose level tested. I don't mind needles and I can handle getting shots or an IV line. I've done it before, and I'm a big girl now. I can handle pain. But after several weeks of testing my blood sugar four times a day, my fingertips are sore. They have little black dots where the blood has clotted recently. The skin is cracking where I've hit the same spot more than once too many times. It's uncomfortable, but I'm 41 and can deal with it.

My first thought, upon Rebecca's return home from the hospital and hearing about her diagnosis was, "How is her mom going to hold her down to prick her tiny fingers or give her a shot of insulin?" But guess what. Rebecca is as big and brave as I am. The second day she was home – after an excrutiatingly long day where she and her parents were educated about her condition and what it would take to manage it – she ran over to my husband and said, "Want to see me test my blood?"

Amazing. Even at three years old, she knew that she has to endure this to take good care of herself. She knows the medicine makes her feel better. And, when her blood sugar is too low, she knows that sometimes she has to have a snack – even if she doesn't want to stop playing to eat it. She's out riding her little bike and running around the yard every day, and her parents are out there doing it with her. Their lives have changed forever, too. Rebecca's mom has changed what she cooks, and they've become stringent about the times that they eat. It's probably been harder on the parents than on Rebecca, as they learn to gauge what foods have the best effect and how much to balance the insulin and food to keep her steady.

They're doing what needs to be done because it's crucially important to take necessary steps – just as anyone dealing with a chronic illness must. The disease, like RA, will never go away, and if good care isn't taken, the toll on health will be great. As I thought about the coincidence between the timing of both Rebecca and I having to deal with diabetes, albeit on greatly different levels, I also thought about the children with RA I met at last year's AJAO conference here in Atlanta. Like children with juvenile diabetes, those with juvenile arthritis often need to endure needles daily. And they do. Like Rebecca, they know it makes them feel better. They know it lets them function better, which means play better or be "normal" at school. They adapt quickly and generally take it in stride.

As my pregnancy winds down, this year's AJAO conference will be gearing up. In two weeks, kids, parents and volunteers will be descending upon Hershey, Pennsylvania (one of the best-smelling towns on Earth!). They'll share their stories, find solace in people like them who can understand what they endure every day, and they'll renew their hope for the future. (Learn more about the AJAO conference by going to www.arthritis.org.) Above all, they'll have fun – and function – thanks to the medications that make them feel better. It's tough work, but it's worth it.

I'll continue to stick myself, watch what I eat closely and make sure I get out and walk and swim. And I'll think of all the courageous kids I've met each time I do.