About a month ago, my left ring finger started swelling badly at the first knuckle [the one where your finger connects to your palm]. Quickly, the swelling moved up toward the second joint, making it impossible to remove my wedding and engagement rings. I started taking significant quantities of Advil, hoping it would jolt my finger back into submission the way it did my knee last year. [More on that below.]

I did recently manage to get my engagement ring off, but apparently, my finger so disliked that that I haven’t been able to budge the wedding ring since [and the wedding ring is even a tiny bit bigger]. A couple of mornings this week, I’ve awakened to a finger so swollen that my ring is really painful. So this is not a good situation.

Reluctantly, I’ve finally admitted I need to get back to my rheumatologist. When I say reluctant, I’m serious — last year I lived through a month-long episode where I could barely walk, convincing myself [apparently correctly, as it turned out] that the problem with my knee a. did not require the steroids my primary care provider prescribed and b. was related to residual damage from my several-year bout of active RA, instead of being a “flare” — what you call it when the disease is active. Because going to the rheumatologist means you might actually be sick, you know? And nothing good comes of being sick with RA.

So at any rate, I struck out right away this morning when I found out that my rheumatologist’s practice has disbanded in the past few years. I Googled him to no avail [some advice, medical industry? SEO. You need this so badly. Data mining/spam/SEO content farms have totally sucked up all your Google juice. It wouldn't be hard to claim it, but you seem to be asleep to this basic marketing principle.], and then I sought recommendations for another rheumatologist on Facebook.

Within 2 hours, I had several good personal recommendations, so I tried one, at the Vanderbilt Medical Group. They pull up “my file” [how?? haven't been there -- apparently I've seen SOME Vanderbilt doctor], but when they see I don’t have an active relationship with one of their doctors, they tell me I have to go to primary care first. But then I notice on their web page — there’s my missing doctor! He’s joined the Vanderbilt practice! But he’s at the Cool Springs office instead of in town. So I say, hey, Dr. Douglas is my doctor, but can’t I see someone at the hospital office instead?

Well, no. It takes a voice mail and a message back [they were all very nice and very prompt], but because it’s been more than 3 years since I’ve seen Dr. Douglas, they don’t have my records [they're not electronic]; only he does. So I have to go there, see him, and get him to refer me back to someone at the hospital.

That’s dumb, but fine. So I call his office in Cool Springs. And again, I get nice people, but no help. Even worse, they tell me I can’t even see Dr. Douglas, because it’s been more than 3 years. Have to go to a PCP first. The first guy explains the 3-year policy. And I said, I totally get it, but who can help me make an exception to your policy? Because Dr. Douglas is my doctor. And it seems awfully silly to waste time and money seeing a primary care provider who is not an RA expert when I already know I need an RA expert. So he has the nurse call me.

Here’s the annoying part: The nurse explains that it is not a Vanderbilt policy that I need to see primary care first — it’s an insurance rule. [I'll get to how stupid this is in a minute....] Now, why didn’t the FIRST Vanderbilt person I spoke to, 4 phone calls ago, explain that? So I said, ah, while that is dumb, I get it. It’s a gate we have to go through for the insurance company to pay for my doctor visit. Yes. So if my primary care provider will refer me without seeing me, then we’re good? Yes.

Right now I have a call in to my primary care practice to see if this is possible. Something tells me it’s going to be illegal or insurance fraud for them to do this…what do you think?

The upshot is, it’s going to cost me not just the extra time [hello!! trying to make sure I keep my finger here!!] but also oh, say, an extra $100. I have high-deductible insurance with no copays, because I own a small business and that’s pretty affordable as far as insurance goes. But the catch is, when you go to the doctor, you pay every penny, until you hit your deductible. So, to see my PCP just to get the referral will cost me the price of an office visit…and then I’ll get to pay the whole amount of whatever it costs to see my rheumatologist, too. Because, like I said — I’m healthy, so I’ve probably just hit my deductible 4-5 times in my life.

So let’s recap:
I am so healthy that I can’t go see a rheumatologist. But I’m so sick that I don’t qualify for individual insurance. That’s right…I got turned down for individual insurance a couple of years ago when we were contemplating going that route. A few years of epilepsy and RA make you pretty damn uninsurable…but apparently, not qualified to go to the doctor.

In my whole life, I’ve just never been that hung up on what other people think. [OK, no need to shout, "Obviously!" from the peanut gallery.] I try not to take myself too seriously and I don’t take you all that seriously, either. I’m more comfortable in jeans and a t-shirt than almost anything else. Every once in a while, I think to put on some makeup. At 37, I have a rapidly growing amount of gray hair and it’s not occurred to me to color it. You get the point.

So about 5 years ago, I started developing rosacea. Well, that’s not really true. I think I’ve been developing it since about when I was born. I’m very fair and freckled and I’ve always blushed easily. I blush when I’m NOT embarrassed or drinking, a fact I find quite annoying, never mind when I am. So, given what I was just saying earlier, you’d think the fact that my face gets red…and can sometimes stay red much of the day…wouldn’t be a big deal for me, emotionally.

But it’s here that I met my limits. I have given up trying to evaluate the roots of this vanity: Is it that I’ve always been complimented on my skin, so that I developed some pride in it, as if I had anything to do with what kind of skin I have? Or is it that it’s changed the way I see myself? Well, regardless.

Here’s the kicker: I was so worried about what would happen to my skin while I was pregnant, since I wouldn’t be using the topical medicine that really seemed to have helped [though not eliminated] the rosacea. Yet my skin just got better and better. And then I realized: Pregnant. Practically no alcohol for 8 months. [Baby arrived early.]

Alcohol is a known trigger for rosacea, but so are lots of other things. I’d never been able to conclusively identify anything beyond alcohol that really set mine off, and now I’m thinking, maybe that IS the only significant trigger I have.

Back to the vanity part: I’m seriously considering not drinking anymore, just so my skin will stay like this. I’m not a big drinker anyway–unless there’s a big party or family event, I’m unlikely to have more than a couple of glasses with dinner, a couple of nights a week. But apparently that was enough to really screw up my skin.

Vanity number 2: I’ve never been really, terribly overweight, but I haven’t been skinny in years. Until I was about 30, I was definitely skinny. My metabolism downshifted dramatically around 25, before I ever got pregnant the first time, but I exercised enough and ate just well enough that I still wore a size 4 or 6, back before they super-sized all the women’s clothes sizes. [Seriously? That was marketing genius.]

For my 30th birthday present from the universe, I developed rheumatoid arthritis. Put an immediate and final halt to my running career. I’m incredibly fortunate; my RA has been in remission for 3 or 4 years now, with just mild lasting damage to my knees, which frankly, could have as much to do with the gymnastics, cheerleading and running I did for years.

But let me clue you in about what happens when you suddenly stop exercising at the age of 30: You won’t be wearing a size 4 anymore. Once my RA was under control and in remission, I tried any number of times to get back in my exercise routine. I ran into issue after issue: Child care. [I was a single mom to 1 and then 2 kids for about 7 years total.] Regular work schedule. Volunteer commitments.

I think the real issue is that I’ve never found anything I loved as much as running, though. I was never a distance girl, but the runner’s high is a real thing and it will drive you out the door when it’s too cold, too wet and too hot to even think about sitting on the porch, never mind pounding the pavement. Can you tell I crave it to this day?

Still, I wasn’t horribly overweight. My cholesterol was fine. I was in reasonable shape for someone who exercised just sporadically. And I was fine with myself. For several years.

And then I got pregnant. And from the split-second I started to show [at about 6 weeks, to my mind], I was ready to be skinny again. I have no idea why being pregnant triggered that in me. I didn’t just want to not be pregnant and back to my old self; I wanted to be back to my old old self, skinny.

A month after the baby arrived, I’m almost back at my old, pre-baby self. And I haven’t really worked at it yet. But the weight loss and changes to my body have slowed down a lot, and it’s obvious that getting back to my old old self will take some work. I am about to embark on a quest to find something I can like to do, if not love as much as running.