Musings on life’s changes in my 40’s

In the rearview mirror of hindsight I wish I would have allowed my loved ones to make a big deal of my 40th birthday.  Black decorations, a cane with a horn, and a tombstone cake would have set the stage for humorous acceptance of the inevitable life changes coming my way.

Instead, I adopted the popular idea that by denying and fighting said changes I would age “gracefully”, which to me meant very slowly.  I quickly discovered that physiology and culture trump denial and that it is a damn expensive effort to not look 40.  My joy diminished as my ass started to fall and Continue reading

Liars – A Short Story

Glass hands

Never shoulda told her.  She said nothing bad would happen.  Out of all of them, Linny’s Mom is the only one ever asked about the marks on my hands, the only one ever brushed my hair out of my eyes to look at me.  She promised I’d be safe if I told her the truth.  Instead, I stood up and lowered my jeans right there in Linny’s kitchen and watched their surprise, then horror, as they took in the welts on my thighs.  Linny’s Mom cried, “Good Lord!”, and enveloped me in a warm cushy hug that felt just like I’d imagined.  I closed my eyes until she let me go and told me to pull up my pants.  Linny is so lucky, I thought for the millionth time.  My eyes followed her mom as she wiped mascara streaks off her cheeks with both hands, sniffed long and deeply, then picked up her phone.  Linny slid off her stool and softly took my hand in hers.  She shook a little, like I do when Mama’s boyfriend is in the room.  Probably never seen her Mom cry like that.  “Yes, this is Mara Kivich at 1335 Lafayette Street.  I need to talk to someone about a child who’s being abused’, Linny’s Mom said to who I guessed was the cops.  She turned her back to us then mumbled, “Uh-huh… no, bruises and welts from a belt, oh… ok.”

Cops never did anything when they came to our house.  Mama always said we were fine, it was just “a yelling match”.  Dave was usually gone by the time they got there, slamming out the door like somebody did something to him instead of the other way around.  The cops wrote down Mama’s stories in little notebooks they flipped closed with one hand.  She had slipped on a wet floor and ran into a cabinet door that hit her right under her eye or stumbled on our steep basement stairs while carrying a laundry basket.  The fingerprint bruises on her neck were never asked about or explained and they never asked me anything, either.  An officer often said something like, “We want to make sure you’re safe, Mrs. Batch.  Please give us a call if you need anything”, or “We’re here to help if you need us”, and gave Mama another of their cards.  Upstairs I rehearsed what I would have said if they asked and pressed my face against the window glass until each cruiser turned the corner.

A wide shaft of sunlight fell across the kitchen island and landed on our feet while Linny’s Mom listened to the cops and mumbled a word once in a while.  Not for the first time I stared at a Fruit Loops box on top of a giant silver refrigerator with Linny’s drawings, spelling tests, and pictures stuck to the front with magnets shaped like stars.  They never ran out of Fruit Loops and there were juice boxes and grapes that Linny could just take from the fridge whenever she wanted.  My gaze moved to the Cookie Monster cookie jar on the counter.  I wished we were still scooted up to the island dipping our cookie halves in milk after scraping sugary filling off them with our two front teeth.  My stomach flipped while a “you ruined it” chant taunted me.  I never shoulda told.  Linny’s Mom hung up the phone and looked at me, her sagging shoulders and wrinkled forehead said it before she opened her mouth.  “They are going to get in touch with your Mom this afternoon, Sweetie.  I’m..I’m sure they’ll get this all straightened out.”  Linny dropped my hand, and ran to her Mom, who folded her into her arms just as she had done with me ten minutes ago.  I felt alone, the same relentless chant circling in my head.  “I’m…uh”, I stammered and looked away from Linny and her Mom, “gonna go”.  “”You can stay for dinner, Cam”, Linny’s Mom said in a weird high voice, like nothing unusual had happened, like my Mom often sounded.   She let go of Linny, but Linny’s eyes stayed closed and her arms remained locked around her Mom’s waist.  “That’s ok.  I have to ask a day ahead of time”, I reminded her.  Her arms circled Linny again as she nodded.  “Thank you, Mrs. Kivich.  Bye, Linny”, I said and walked quickly down a hallway lined with smiling vacation photos and out the front door.  Tears welled in my eyes, but I would not cry.

For a couple of days after a whippin’ the rules were looser, but getting home more than 15 minutes late was chancy, so when Dave called “Cam get in here!” as I came through the door I thought I’d had it.  “You almost missed it!  Your boy is about to fight for the featherweight title.  Come ‘ere.”  He patted the couch cushion next to him.  I forgot about Linny and her Mom as I watched Conor McGregor hammer another wiry guy on the mat, relentless until the referee pulled him off.  “Daaaamn!”  Dave threw his arm around my shoulders and squeezed.  “You see that, little girl?  One punch!  Bam!  Dude’s on the mat and what does he do?  What does he do, Cam?”  “He keeps beating on him ‘til he wins!” I yelled and bounced my sore butt off the cushion as the new champ strutted around the octagon, an Irish flag held high between his bloody fists.  “Look at me”, Dave said.  I pulled my eyes away from the T.V. and tried to look in the black pools of his eyes. My smile faded.   “Don’t you ever let anybody think you’re weak, whatever you gotta do.  Your dude there,” he pointed toward the screen, “he just showed the world not to fuck with him.”  He took a drag off his cigarette, exhaled in my face, and laughed.  “You understand?”  No, not really.  I rarely understood Dave’s wisdom.  I understood anger though, and Conor McGregor exploded with fury in the ring.  I nodded my head.  “Yeah, I get it.  No mercy.”  Dave smiled and stubbed out his cigarette in a sparkling clean glass ash tray.  My mother washed them and sprayed air freshener around every night before going to bed.  You’d never even know a smoker lived here.

When Mom came home she didn’t seem any different, just said “Hi, Baby”, but nothing about the cops or Linny’s Mom.  Dave left for the bar after we ate goulash and watched the news.  Sometimes he came in my room kinda sniffling after he got back and woke me up to say he was sorry.  He said if I learned to behave he wouldn’t have to whip me, if I would just be good he wouldn’t have to be so hard on me.  I always told him I would be better, and tried to figure out how until I fell back asleep.

Linny wasn’t at the bus stop the next morning, so I sat in our seat by myself and played who-lives-in-that-house.  I liked it more when Linny and I went back and forth and made up stories about people in the big white house with peeling paint and pink roses growing up one side or the triangle-shaped yellow house with a huge golden dog stretched out in the driveway.  Linny was silly and our stories much funnier than the ones I made up by myself.  She walked into class and sat down just as the bell rang, but Linny wouldn’t look at me.  I wanted to whisper to her, but Mr. Malcolm did not play around and he’d take away my recess if he heard.  All morning long I stared at the back of her head.  “Cammie Batch”, the teacher said, “please use “intention” in a sentence”.  He seemed irritated.  I looked down at my desk and tried to remember what intention meant, but all I could think of was going to Linny’s house for Oreos after school.  Mr. Malcolm put his hands finger to finger in a steeple like he did when someone else took a while to answer, like he could wait all day.  Normally I was good at this, but today my words disappeared.  Finally, the recess bell rang.  “Cammie, come to my desk”, Mr. Malcolm said as I watched Linny’s head disappear into the hall with everyone else’s.  After Mr. Malcolm reviewed the word intention (it was nothing but a hope, really) and told me to pay better attention that afternoon, I raced down the hall and out the doors.  There she was, right outside the building.  “Oh good, you waited”, I said.  “Cause I have something to tell you”, she said and shuffled her feet, her arms crossed tightly.  “I can’t be friends with you anymore.  My Daddy and Mommy said so.”  She looked relieved.

5 Things Rheumatoid Disease Patients Wish You Knew

RD arthritis only one symptom
  1. A Rheumatoid Disease diagnosis leads to a double life. Thanks to new treatments, many of us have hours every day when we appear to participate in life just as you do.  There are also private hours spent soaking in Epsom salt baths, taking pain medications, going to doctor’s appointments and physical therapy, meditating, exercising, journaling, supporting one another online, wearing compression gloves and socks, applying cold and hot packs, applying menthol creams and patches, dipping our hands in hot paraffin, napping, taking hot showers, and wearing splints and braces, all to possibly have a few precious hours of normal, or as close to it as we can get.  Sometimes it works, and sometimes the disease rules our day and all we can do is rest and take comfort measures.  This aspect makes traditional employment challenging for Rheumatoid Disease patients, 60% of which are disabled within 10 years of diagnosis.
  1. Different than Osteo-Arthritis, Rheumatoid Disease is an auto-immune disorder that affects people of all ages, even children. Rheumatoid patients around the world advocate for “Rheumatoid Disease” to replace the term “Rheumatoid Arthritis” due to wide-spread misunderstanding.  Rheumatoid disease produces destructive molecules called fibroblasts that attack the protective lining around joints causing inflamed and shredded tendons, cartilage loss, and finally bone erosion.  That is the part you may be familiar with, but Rheumatoid Disease also causes:
    1. Costochondritis (painful swelling in the ribs)
    2. Uveitis (painful eye swelling, may cause vision loss)
    3. Pleurisy or interstitial lung disease
    4. Cervical subluxation and myelopathy (compression of the spinal cord)
    5. Kidney disease
    6. Atherosclerosis (heart disease), the leading cause of death in RD patients.

Educating health professionals about rheumatoid disease manifestations would facilitate early treatment of co-morbidities and delay disability.

  1. Even when symptoms appear controlled, Rheumatoid Disease marches on and adapts to treatment.  RD insidiously erodes cartilage and bone while patients feel perfectly fine, especially during the first 5 years.  Recent MRI studies confirm that even in clinical remission, there is inflammation around the joints, indicating a need for life-long treatment. The first RD medication I took stopped working after 4 years.  Currently, my rheumatoid antibodies are eleven times the norm after 3 years on an expensive biologic injectable.  Our super-immunity develops work-arounds to the medicine.  In the near future I will need to add a low-dose chemotherapy drug to suppress my immune response.  We will have to try other medications that may or may not slow the disease as my immune system keeps adjusting.  There are many RD Warriors who haven’t found a medication that works well enough, or who have run out of options.  One friend of mine injects herself every week for a 20% improvement in Lupus and RD symptoms.
  1. Rheumatoid Arthritis drug commercials exaggerate ability benefits and list a litany of risky side effects in a low monotone.  Actors appear in full remission without Prednisone moon-faces, but more than half of patients never achieve clinical remission for even a short period, and most medications help to a degree if at all.  Don’t get me wrong – I LOVE Enbrel because I can walk, fevers are less frequent, my pain is manageable, and I have little to no bone erosion.  While this miracle drug makes my life worth living, it doesn’t make running on a sandy beach or toting around a toddler on my hip possible.  More importantly, the medication doesn’t make working full-time possible because the disease is still active and unpredictable.  What it does make possible are life-threatening infections, which is why patients whose symptoms are fairly controlled often choose to risk joint erosion.  The risk-benefit ratio is tough to navigate, especially with the booming vitamin/supplement industry promising their own brand of remission.  Just like wrinkle cream promises, none are entirely accurate.
  1. We need you to help us spread the word. Rheumatoid Arthritis is one of the 6 most debilitating diseases in the world, yet the number of rheumatology research projects funded by the National Institutes of Health dropped by 52% from 2010 to 2014, while the number funded by private foundations fell by 29% over that period, according to data published by the Rheumatology Research Foundation (RRF).  A cure is on the horizon with new immuno-therapy breakthroughs, but funding is moving in the wrong direction.

Vitamin & Herbal Supplements

Digitalis

Here in the 5th decade health gets real.  This is typically the decade when our bodies cry out for more attention and we listen because we want to stay for the whole party.  Vitamin and herbal supplements advertise benefits especially attractive to people seeking good health, better memory, more energy, and heightened immunity.  In 2015, U.S. consumers will spend 21 billion on vitamin and herbal supplements with no proof of positive benefits.  Not that there is shortage of research; there is plenty.  Once manufactured and put on the shelf, the FDA monitors herbal supplements for consistency, quality, and unsafe ingredients.  However, recent investigations of supplements sold by GNC, Target, Walgreens, and Walmart were found to include very little to none of the herbal listed on the bottle.  Each brand of herbal supplement is a unique cocktail, each company with their own recipe of leaves or roots or both.  These manufacturers are like the kid that passed off oregano as marijuana in high school.  Some people swore they got a buzz, and some people experience benefits from supplements that claim to get rid of a virus faster, lift depression, or help memory.  Lemon water, a long walk in the sunshine, and brain teasers may be just as helpful, but not nearly as quick.  Still others experience how ginkgo biloba lowers sugar levels or how ginseng causes anxiety or headaches.  Working with emergency room staff I learned how important it is for physicians to know all the supplements a patient takes due to drug interactions.  Often supplements have unintended effects when they interact with a prescription drug.  If you take a blood thinner, taking ginkgo biloba or vitamin E can make your blood too thin.  I have a hyper immunity which attacks the synovial tissue around my joints and causes inflammation throughout my body including my organs and brain.  Echinacea, Vitamin C, and other supplements that strengthen immunity promote my disease and work against the prescription medicine I take.  I prefer gaining benefits from anti-inflammatory herbs, like turmeric or cayenne, by adding these spices to recipes.  Doctors recommend getting our vitamins and minerals through good dietary habits, which again, is more time-consuming than swallowing a pill or three.  Preparing food is mindful self-care.  Many of us claim organic food is “too expensive”, but if we add the cost of protein supplements to that of herbals and vitamins, Americans spend more on supplements than on organic food.

Recent research indicates no benefits for adults taking multivitamins, citing they may actually shorten our lives.  So why does the mega vitamin and herbal supplement industry thrive?  I think it takes time to accept new information that argues with long-held beliefs.  Cigarettes and cocaine were once thought to be advantageous to our health, in large part due to expert advertising.  In Shape and Men’s Health magazines supplement ads cuddle up to healthy recipes and ab exercise programs.  Seniors taking Centrum Silver multivitamin are fit and ride bikes with their active friends.  Vitamins are the fountain of youth, which may be why we don’t want to let them go.

Two studies published last month in the British Medical Journal found no evidence that calcium supplements improve health or decrease bone fractures.  This is huge news for every woman who believes taking a combination of calcium and vitamin D helps slow bone loss after menopause.  Sadly, increased calcium in our diets does not make any measurable difference in bone density, either.  The National Osteoporosis Foundation recommends exercise for building and maintaining bone density and preventing falls resulting in fractures.  Exercise is also a prescription for better sleep, improved creativity, depression, and anxiety.

Aging healthfully is an evolving science, yet a consistent practice of exercise and good nutrition is guaranteed to keep us at the party as long as possible.

 

 

 

 

Knowing Your Boobs Could Save Your Life

Breast Cancer Awareness

On Tuesday, the American Cancer Society published new Breast Cancer Screening guidelines reducing the recommended frequency of mammograms for women over 54 to every 2 years and increasing the age for a first mammogram to 45 for women with an average risk of breast cancer.  They also kicked the clinical breast exam to the curb.  How much can a physician know about my boobs and my “normal” by feeling them once a year?  Now me, I can touch them every day if I want, and I certainly see them during my daily ritual.   Early diagnosis is key to beating breast cancer and many are triggered by women who notice a change in the look or feel of their boobs.  Our breasts feel differently in each decade.  Natural changes occur, especially as we bear children and get older.  Tiny, swollen, lumpy, I know intimately the phases my boobs passed through to land happily at soft tissue.  I know what my skin looks like, where there are stretch marks from pregnancy, and the color of my areola, however I need to use the mirror more often with arms raised.  Rashes, dimpling, or swelling also occurs in the breast tissue on our sides, and is more likely to go unnoticed.Breast Exam

The American Cancer Society is careful in its language, stating a woman should have the choice at 40 to request a screening mammogram and become educated on mammography limitations.  Women at high risk (20-25% lifetime risk) should begin annual screenings at 30.  They recommend breast MRI in conjunction with mammography for women at high risk because the two detect different types of cancer, so if I found a lump or had other breast cancer symptoms such as skin or nipple changes, my plan is to request both.  False positives are more likely with breast MRI, but despite the American Cancer Society’s concern about causing me ” a lot of worry and anxiety”, I prefer an unnecessary biopsy with a huge slice of peace of mind to later-stage cancer.  And despite a statement that self exams do not show a clear benefit, I trust my judgement on this one and will continue to feel myself up in the mirror on a regular basis because self-love is a beautiful thing and the new guidelines for breast cancer screening are not definitive, but leave the responsibility with me.

 

Leave Joe Biden Alone

Vice President Joe Biden (R), puts his hand on his heart as he and granddaughter Natalie and stepmother Jill Biden look on before a funeral mass for former Delaware Attorney General Beau Biden, son of Vice President Biden, at St. Anthony of Padua Church in Wilmington, Delaware June 6, 2015. REUTERS/Bryan Woolston  - RTX1FETI

U.S. media and the Democratic Party are propelling Joe Biden toward a 2016 presidential bid that he does not want, but why?  Joe cusses when he doesn’t know the microphone is on, calls for wheelchair-bound Senator Chuck Graham to stand up and let the crowd see him, and extends condolences to the Irish Prime Minister on his mum’s death while she is alive and well.   Joe Biden is not smooth; he is genuine.  They will rip him to shreds, every gaffe in Joe’s past revisited by the G.O.P., who mistakenly admitted the Benghazi investigation was a political move to degrade Hilary Clinton’s support.  With Joe’s more than 40 years of public service, they are  likely collecting mud already.  He is a t.v. producer’s dream.

And how will he hold up after all he has endured?  In true Irish fashion, I imagine he will give his honest opinion, as he usually does, however when faced with stupidity he won’t hold back.  Joe’s colorful rhetoric is yet another potential distraction from the very real American concerns about costly education and healthcare, job creation, immigration, justice equality, environmental conservation, and gun-violence.  I voted for Joe in the 2008 presidential primary, eight long years ago.  In September Joe said in a speech that he was unsure if he had the emotional reserves for a campaign and told the Democratic National Committee that his “heart and soul are pretty banged up”.  I believe him.  Beau and Hunter, Joe’s sons, survived a car accident which killed his wife and baby girl in 1972.  While recuperating from broken bones that put him in a body cast, 4-year-old Beau often laid next to his brother Hunter who had a skull fracture and said, “Look at me, Hun.  I love you.”  Beau sat his dad down two months before he died from brain cancer this year and made Joe promise that he would be o.k.  Joe says Hunter, his wife Jill, and loving family and friends are supporting him and he has to get up every day or he would be letting them down; he’d be letting Beau down.  If Joe decides not to run for president, he is not letting America down, he is letting his heart mend, something only time and care can accomplish.

Dismantling Fear

Mona Lisa

Beyond survival, fear lurks not only in the dark corners, but also in the joyful moments, waiting for an invitation to withdraw serenity and instill anger and sadness.  Fear often wears a disguise of concern,  uses ego as a henchman, and usually surfaces as “what if?”.  What if I express an idea and people reject it/me?  What if I look stupid?  What if I fail or make a mistake (and look stupid)?  What if an accident or an illness takes away someone I love?  What if my health declines?  Thoughts run in gangs and possess a mob mentality.  I desire an upbeat, kind, and intelligent gang of thoughts to hang out with, but how do I control non-essential fear, the bully of my gang?

Fear lives in the amygdala, our base emotional center, where fear conditioning occurs and unconscious evolutionary memories are stored apart from complex reasoning in the cortex and higher learning in the hippocampus, .  The amygdala soaks up sensory input from our experiences and assigns emotional tags.  In similar situations we may feel threatened, fear triggered by a smell, a room, a voice, or an action.  Wired to react quickly to fear, I can easily damage relationships or sabotage my work by overreacting or withdrawing, two perfectly reasonable fear responses.

The amount of fear hiding out in my amygdala is understandable, thousands if not millions of memory bits collected long-ago during  times of abuse and rejection.  Understanding fear is a biological process, evolving with our experience, re-frames unreasonable fear responses as manageable.  Desensitization can minimize or even destroy unreasonable fears using exposure and relaxation exercises.  A rise in blood pressure and cortisol dumps dictate a two-pronged approach with relaxation at the center.  I am not addressing a phobia, but an imaginary fear, so I begin by imagining my worst fear.  Creating a list of fears aids in choosing the biggest, baddest and most destructive fear bully.

I can pick apart my fear of rejection, imagining a rejection letter, a negative blog comment, or an in-person query regarding what I do all day.  I can imagine “what if?” and write the story to its end, even if only in my thoughts.  Imploding from shame does not happen in real life, so I survive to write, live, and love another day.  Using diaphragmatic breathing and a memory of Lake Huron’s waves lapping the shore helps me release anxiety induced by my imaginings.  I also use exercise to reset my brain and confirm I am alive and safe, even if I do look stupid.  I’ll repeat my exposure and relaxation exercises until looking stupid or being rejected is unimportant and what may happen holds no power.

“Don’t give in to your fears. If you do, you won’t be able to talk to your heart.”
Paulo Coelho, The Alchemist