Avoiding Holiday Flare

Flare — dramatic worsening of RA symptoms — seems to occur at the worst possible times. That’s because triggers include stress and overwork.  We have two weeks until Thanksgiving, so unless our goal is to flare badly and miss out on all the festivities, a bit of advance planning is needed. Don’t wait until the last minute; start the work now.

Menu Planning

Write out your menu.  A few years ago, I realized that our menu was way more food than what we really needed.  I have no idea why it took me so long to recognize that we were serving two full feasts. My pared-down menu requires about half the work. Nobody feels deprived (that’s why there are still rolls on the menu) and it’s way less work to clean up.  Do whatever works for your situation.


Next list all the ingredients that will be needed to prepare your menu.  This should eliminate running out of ingredients and needing to make an emergency run to the store.  Here is my list; you’ll generate your own based on your specific menu.

Click to enlarge

Click to enlarge

Make things easy for next year!  Type your list and save it in your computer; you’ll be able to find it next year. You can even slip a holiday notebook onto your cookbook shelves so that the same menu and grocery list can be used every Thanksgiving (and Christmas, if you’re like me).

Check this required-ingredient list against your pantry to determine what you need to get at the grocery store. Don’t wait until next week.  Now is a good time to take care of getting your menu planned and your grocery list made.  Obviously you won’t want to buy vegetables this soon, but everything else can be done now.  Spreading out the work a little-bit-at-a-time helps to minimize RA flares.

Menu Prep

Delegate!  Just because you’re hosting an event does not mean you have to provide all the food and do all the work.  My mom is diabetic, so she is in charge of bringing the cranberry relish that she loves and wants instead of my cranberry sauce.  The person who’s celiac is in charge of the GF dinner rolls so that she knows they are safe for her to eat.  Another person is asked to bring drinks.  Green salad is another thing that’s easy to delegate.

Copy your menu, then work out a schedule of when those things should be prepared.  Mine is provided below as an example.  How much can be done in advance? The turkey needs to be roasted on Thanksgiving day, but almost everything else can be done ahead.



Everyone’s standards of cleanliness are different. Mine are generally, “clean enough to be healthy; messy enough to be happy,” so I do a little extra right before the holidays. No matter what your personal standards are, if you try to clean your entire house the day before company comes, you’re going to flare and miss out on the fun of having people over.  Spread the work out over the next two weeks so that everything gets done without you wearing yourself out. I do a scaled-down spring-cleaning in the fall to get ready for holiday company.


Getting it All Done

Choosing a couple jobs a day makes all the cleaning and meal prep realistic instead of flare-inducing.  Make yourself a little calendar and spread the jobs out over the weeks leading up to Thanksgiving.  Here’s my plan:


Click to enlarge

This lets me do just a few jobs each day so that I’m not too tired, and it gets things done Thursday morning with minimal effort. I’m able to sit and visit with family and friends instead of rushing around, stressed about getting everything done.

Serving the Meal

Gone are the days of multiple serving dishes so that both tables are set completely.  Gone are the days of taking forever to fill everyone’s glasses.  Gone are the days of taking two hours to clean up after dinner.  Life is so much easier now!  I serve Thanksgiving dinner buffet-style.  The plates go in a pile on the counter. People get their own drinks. The food is arranged so that everyone can walk through the kitchen to fill their plates, then head to a table to sit and eat.  The table isn’t too crowded; there isn’t a side-board set up to hold the salad and dressings that won’t fit on the table.  Cleanup goes much faster with half the serving dishes.  It’s much less work this way and everyone still enjoys a nice meal together.

Thanksgiving, like the rest of life with RA, goes much more smoothly when we learn to pace ourselves.

When the Doctor is Running Late

Recently I’ve seen a number of complaints about doctors running late.  There’s even a cartoon showing the (im)patient handing the receptionist a bill for excess time spent in the waiting room.  I have to admit that I used to feel that way. If I made an appointment for a specific time, I expected the doctor to see me at that time.  No excuses.

The more experience I have as a patient, though, I believe that’s the wrong approach. I don’t want a doctor who schedules patients in carefully allocated appointment slots and watches the clock, kicking people out when their time is up.  Sometimes things happen.

When one of my children was an infant, we went in for a routine check-up and the doctor noticed a strange lump.  A clock watcher could have said, “Your time is up. You need to make a new appointment — preferably soon — about that lump.”  He didn’t.  He called in a colleague to take a look and they consulted some of their medical reference books.  The consulting doctor then resumed her schedule (running behind), while my daughter’s doctor made some phone calls, then ushered me into his office to use his phone and make an urgent appointment to see a specialist at Children’s Hospital.  It seemed like a whirlwind to me, but took about an hour.  That hour he spent on my child was an hour that he was scheduled to see someone else’s child.  He spent the rest of the day behind schedule, but not due to lack of respect for people’s time. Rather, due to caring about the health of a patient.

I think we need to adjust our thinking.  What if we viewed medical appointments like airline flights?  We would show up early without complaining.  The airline industry has to check everyone in just like the doctor’s office does.  While doctor’s offices don’t need to x-rayed our luggage, they do need to verify insurance coverage and document receipt of copays.  The airline wants people there at least an hour before the flight; we should be happy that medical appointments only need us there 15 minutes early!

Last week’s newscast showed footage at a jam-packed airport where flights had been delayed.  Nobody was ranting and raving about having their schedule thrown off. It was inconvenient, but nobody was demanding a refund or billing the airlines for their time lost.  Everyone knows when we buy our tickets that the airline will try to depart the airport on time, but that things sometimes come up to cause delays.  People just make the best of the situation.  We need the same mindset when we need medical care.  Doctors try to keep to the schedule, but sometimes there are delays.  We just need to make the best of it.

What are our options?

  • Asking for the first appointment in the morning can help.  In theory, there have been fewer chances for things to go wrong with the schedule if you’re the first patient of the day.  Note, however, that if your doctor rounds on patients in the hospital before opening the clinic, that the first appointment in the clinic is not the first patient of the day, so the doctor could still be late.
  • Asking for the first appointment after lunch allows for catch-up time to counteract any delays in the morning’s schedule.
  • Taking the last appointment of the day almost guarantees that the doctor will be running behind.
  • Doctors are swamped in December, with people trying to fit in everything they can before the end of the year.
  • Doctors tend to have much more space in their schedules in January (because charges are applied to your insurance deductible, which means that appointments in January are out-of-pocket).
  • Leave yourself a cushion.  If your appointment is for 10:00, don’t have somewhere else you must be by 11:00.  Expect that the doctor might be running late and allow time.
  • If you’ve allowed a cushion, but not enough, be polite. Once I was scheduled to teach a class at 1:00. I couldn’t be late.  My doctor’s appointment was at 11:00 and I knew the office closed for lunch, so I thought I had plenty of time.  Unfortunately, the doctor was so far behind that he worked through lunch.  I explained that I would need to reschedule since at that point I couldn’t get a sub to teach my class. I wasn’t mad, but couldn’t stay. Rescheduling might not be ideal, but getting one patient out the door helps the doctor be a little less behind, and gets patients where they need to be next.  When you reschedule, take a first-appointment of the day to reduce the odds having a repeat experience.
  • Friday after Thanksgiving is a shopping day and nobody wants to be at the doctor’s office.  I can’t speak for every doctor in every year in every city, but my limited experience shows the years that I’ve checked my doctors, this is a great day to get an appointment. The doctor will be running on time, and even has extra time.
  • Avoid Mondays.  Everyone who has issues arise over the weekend phones the doctor and tries to get in on Monday. It’s a zoo. Avoid the pharmacy on Mondays, too (same reason).  Likewise, on Fridays people try to squeeze in to see the doctor before the weekend.  Specific offices might have variances in their schedules, but in general, people claim that Wednesdays are best.  If this matters to you, ask the staff in your doctor’s office to see which days they believe run most smoothly.

Scheduling a medical appointment isn’t the same as taking a class at a specific time, nor is it like meeting someone for lunch.  It’s more like scheduling an airline flight — the appointment time is a hopeful estimate of when the doctor will be able to see you.  We can make our lives a lot easier if we recognize that delays are inevitable and plan accordingly.

Edit to add: Mondays.

PT Resources

When you have RA, a physical therapist should be part of your treatment team.  It’s important to strengthen the muscles around joints so that the joints will work more smoothly.

Unfortunately, many PTs are most interested in sports injuries.  They merely tolerate older patients with their age-related needs, and know next to nothing about the various types of arthritis caused by an overly-energetic immune system.  Fortunately, the exercises to strengthen any given muscle group are very similar regardless of the need for rehab.  Nonetheless, it doesn’t hurt to look around for a PT who either knows about RA, PsA, AS, etc., or who is interested in learning.  If you find a PT who is bored stiff and consequently has eyes wandering around the room instead of watching to make sure patients do their exercises properly, run the other direction!  You want someone who will ensure that you’re using proper technique.

I was lucky enough to find a physical therapist who had worked near a rheumatology clinic and knew tons of tips to help people with RA.  Little things like:

  • It matters which way you turn the doorknob. When you open doors, turn the knob toward your thumb, not toward your pinkie (which is backwards from the way I naturally turn doorknobs).
  • When shopping, protect your fingers.  Always get a cart on wheels.  Those small baskets are handy when you’re only buying a few items, but they can accelerate joint damage in fingers.

Most PTs will provide a handout to help you remember your exercises.  Save them in a notebook so that you’ll be able to refer back to them in the future.

If you want to try the Dr. Google method (which is rarely a good idea), consider

Schedule time in your busy do to make sure your muscles will do their jobs, to keep you as active as possible while taking a minimum number of pills :)