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Josephine Ruiz, 72, is still worried about not being able to pay her heating bill, despite the mild January weather. So far this heating season, she is $250 behind on her energy bill. (MPR Photo/Lorna Benson)

An exceptionally mild January has eased the shock of high energy bills for many Minnesotans. And yet most will still shell out more money than ever this year to pay for heat. For people with limited incomes, that extra expense can quickly add up to an overwhelming debt.

Last October we introduced you to Josephine Ruiz, 72, who was worried that she wouldn't be able to keep up with her heating bill this winter. So she planned to get by with as little heat as possible by turning her thermostat way down and by using lots of blankets, a heating pad and her dog for warmth. We checked in with Ruiz recently to find out how her plan is going.

St. Paul, Minn. — Josephine Ruiz braces herself on the edge of an exam table in a small orthopedic clinic in downtown St. Paul. As she stands there, gazing out the window at the street below, her doctor, Jack Bert, stares intently at her hip bones and ask her where it hurts.

"Right here on the hip," says Ruiz. Dr. Bert replies that the pain appears to be in the sacroiliac joint. He pushes on the spot and Ruiz moans.

An x-ray confirms that Ruiz has a new area of arthritis. She has the disease in many other parts of her body, so this latest development is not really a surprise. But Ruiz believes that living in a cold house has made matters worse. Dr. Bert agrees.

"Oh, I'm sure it does. Cold weather will do that, absolutely," says Bert. That's why everybody goes to Arizona because it's dry, you know. They don't get swelling of their joints. It makes a huge difference."

Ruiz laughs and says, "Give me the dinero." Dr. Bert nods his head and says, "Yeah I know, dinero. Si."

Ruiz's fixed income is about $800 a month, and rent eats up most of that money. She does get federal heating assistance to help pay her energy bill, but it's not enough.

After heating assistance paid its portion of her December to January bill, Ruiz was left owing $258. That's despite her many heat-conserving strategies.

Ruiz sets her thermostat at 50-55 degrees. Sometimes she turns it down even lower, to around 45 degrees. She has a stack of six blankets to keep her warm. And she has her dog Pearl, who is happy to see Ruiz when she gets home from her doctor's appointment.

After giving Pearl a treat, Ruiz wanders into her chilly living room and stands for a bit. She says it's more comfortable to stand than sit.

There in the middle of the room, wrapped in a sweater, she reflects on her diagnosis and how her decisions might have made her arthritis worse.

"I didn't catch it in time," she says. "I waited too long. I should have kept the heat up there a little bit. At least 65. Then it would be good. So I haven't done that yet. I haven't done that yet. But I guess I'm going to have to start today."

By having the heat higher, Ruiz says she will have to cut back on items that aren't covered by her food stamps. Things like toilet paper, vitamins, soaps and detergents. She admits that probably won't result in enough savings to make up for her extra heating costs.

Her adult children try to help her out as much as they can by giving her rides to appointments, occasional meals and a cell phone to use. But she says her kids are also trying to help their oldest brother pay for expensive experimental cancer treatments.

Tears well up in Ruiz's eyes when she talks about her son's illness. She says his situation makes her financial problems seem insignificant. And she reminds herself of that every time she feels down.

"When you start worrying about things it adds to stress, and I have enough stress in my life," says Ruiz. "But you do. You have a tendency of going down that road, you know, where you're worrying about it. And you figure hey, you've got to stop -- sou gotta do with what you have and make due with the heating pad and the covers and the whole thing."

Her sense of humor intact, Ruiz points out that her heating pad stopped working recently. So maybe her electricity bill will go down a bit.

But in truth, she does worry, especially as her debt mounts.

"This is the first time that I've had the bill this high," says Ruiz. "So we'll see what happens. It's going to interesting."

Ruiz estimates that she will be at least $500 in debt by spring. She says can catch up on some of that bill over the summer. But she doubts she will be able to wipe it out before the next heating season begins.