Thanks, Alice. This is very clear. If you don't mind my thinking out loud...

In April, I started taking more Imuran. In May, I started noticing I had more energy. I spent it by taking the kids to the ocean once or twice a week all summer, because we love it so much--it was my number-one priority. I watched carefully to see if I could handle it, and I seemed to be doing fine. I noticed, in fact, that I was able to do things I would have ruled out before, like going on more than one errand at a time. I think I added more and more activities. In August, I went camping (just overnight!) and even walked to the lake from the campsite (a 20-minute hike through the woods).

In mid August I noticed symptoms creeping back up on me--heavy arms, etc. Towards the end of August I had a few episodes of weakness, like I had before I started getting better: an hour when I was too weak to walk.

So, the question is: did I just push myself too far? Or am I not taking enough Imuran? If I back off and "do a little less than I can" (boy oh boy, is that ever hard!), I see that I may end up with a pretty stable improvement. If I had contented myself with doing more, but not pushed myself to the limits, this summer, I may not have relapsed at all. Put like that, it seems like a very wise tactic. At the same time, if I experiment a bit by raising the dose of the Imuran, I think that can give me valuable information. If I don't get better, I can back off the Imuran, and concentrate on finding that sweet "a little less than I can" spot. If I do get better, that sweet spot may be a higher--high enough to let me get a job, for example. Is it possible that a higher dose could put me into remission, and then I could take less and retain the remission (at least for some time)?

What is really going to stick with me is what you said about my dreams (I sort of hate that word. I'm a practical person. I would rather talk about "plans" and "goals"...). You said that I don't have to give them up--just that I will carry them out in a different way. You said it doesn't have to be all or nothing. I'm trying to wrap my head around that. My plan was to be a teacher (either special ed, or maybe a middle-school teacher in a small school). I do not have the health to do those things right now. But I can explore other ways to teach that don't require a full schedule.

Thanks again for all your help.

Abby