Mature Skincare on a Budget

Firstly, I’m trying on this “mature” label… unsure of the fit… wondering if I can make it sound sassy in context… perhaps during the 6th decade as I tailor it to suit. Secondly and more on topic, I’ve searched for skin care to meet my basic needs since I was 13. While pimples have been elbowed out by fine lines and discoloration, a non harmful skin care routine remained my unicorn for over 36 years. Red, embarrassing, and painful reactions followed my use of many popular skin care lines sold in the U.S. Can you imagine the amount of $$$ I’ve wasted on products that landed in a waste bin after just a few uses? A few years ago I settled on Aveeno Ultra Calming foaming cleanser and moisturizer as the least harmful (yet still stripping), most affordable option, until my skin changed again, perhaps due to autoimmune issues, hormonal issues, age, or a combination of all those things and a couple that haven’t occurred to me. I tried everything from diet to dermatology and found corticosteroid cream the only effective treatment, which is when I began researching products again. I knew I reacted to chemicals and needed more natural ingredients in my skin care, AND I needed my face clean to avoid breakouts, AND I needed to retain and add moisture.

Red and Reactive, Dry Beyond Belief

Our universe finally smiled on my skin care quest in November 2017, and took pity on my worsening irritation and painful skin. I hate trying new skin care products, and once again I was justified.

When I stumbled upon Renee on her YouTube channel Gothamista

during a search for low Ph facial cleansers, I had a raw itchy reaction across my cheeks and forehead that lasted for 2 weeks following use of CeraVe Hydrating Facial Cleanser, which is lauded by 90% of users as the best thing since coconut oil and matcha tea. Renee’s minimalist style and my-sort-of-girlfriend demeanor made me watch a whole eight minute video about pH levels and 2-step cleansing. Add free and engaging skin care education, and I may be a loyal follower. To cross the moat of my cynicism, the products she recommended needed to pass a 30-day trial, but I was willing to take a risk based on reviews across multiple platforms.

I have hypersensitive combination skin, at times with extreme dryness/dehydration, which is dependant on weather and skin care products. Low pH cleansers were the next logical step for me, however as my CeraVe trial proved, ingredients also played a role. 7 is a neutral pH level, or the level of water/tears, and I wanted to trial a cleanser with a pH level of 5-5.5, between weak coffee and normal rainwater. Our skin’s pH is approximately 5 and the goal is not to disrupt our natural moisture production by cleansing with higher pH products.  Cleansers and toners with a pH between human blood (7.5 pH) and seawater (8 pH) stripped my skin, which in turn reacted with an overproduction of sebum. It was a perfect  skin care nightmare with few low pH products available in stores.

This low pH cleanser changed my skin and made me very happy: 

60 Days Using COSRX Cleanser with No Reaction

Toners with humectants played supporting roles

I went with a local seller of natural matcha green tea cleansing cream for 1st step removal of makeup and sebum, but not until I used the COSRX cleanser for more than 30 days because our skin cells turn over every 28 days and I wanted a true trial (I don’t wear makeup 5 days/wk). I also added moisturizing toners, a departure from the drying alcohol-based toners I grew up with and believed were necessary to oust that pesky sebum.

Moisturizing Toners that I pat on my skin with my fingers

I enjoy my skin care routine (finally!) and haven’t reacted to one product recommended by Renee at Gothamista, however I must warn you–skin care can be addicting.

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Not Today, Death

“Don’t cry. Stop crying,” she commanded, as I trapped my sobs and focused on her words. “Don’t cry. You have one heart, one body, one life. YOU have to fight for it. Stop crying.” The Infectious Disease Doctor seemed exasperated with me, as if my tears were drops of weakness that made me sicker. Briefly I thought my illness must seem measly to the towering Serbian blonde. In that moment I felt so small in my hospital bed. It was day 4 and despite innumerable tests, no bacteria had been found despite the appearance of my lungs on x-rays and a CT. “Maybe you aren’t finding anything because RA is doing this to me.” “You have fever and pneumonia, all signs of infection. This is what we are treating with antibiotic, ” she waved her hand at an IV bag hanging from one of the poles next to my bed. An oxygen machine ringed in pale blue gurgled and hissed in my left ear. The night before a child with big eyes stood at my bedside wearing a dress in the same shade. Intuition said I should keep that to myself.

When I created this blog 5 years ago I was 44, and fresh off losing a tough, unfair battle for my health and career. I’d been fighting since I was a kid, for myself and sometimes for those who I thought needed a champion, and I was spent. In hindsight, other people, especially those in power, not only preferred women who didn’t make waves, but rewarded them for not fighting. Maybe if I adopted a quieter, more graceful approach during the 5th decade, life would prove less bruising. In any case, I needed time to heal. What I didn’t know is that my fighting spirit would one day be the difference between life and death.

Lying in that hospital bed a few weeks ago, I feared going “…gently into that good night”, dying of pneumonia as the poet Dylan Thomas did, but after 5 years of curbing my fighting nature I was sorely out of shape. There are dreams I haven’t realized because I laid ambition aside, trips I haven’t taken, and works I haven’t written. Death takes who it can snatch away, especially if one cannot fight. Medical professionals are often champions when we are weak, their educated treatment hitting a bullseye and chasing away mortality. And then, there is luck and those who rage; “… rage against the dying of the light” – Dylan Thomas. One physician listened to my mumbles about rheumatoid arthritis as I was sliding near intubation, the ICU, and a large sucking mudhole next to my bed (According to a study published by the American College of Chest Physicians, every day a patient is delirious brings a 20 percent increased risk of prolonged hospitalization and a 10 percent increased risk of death). Once he consulted with my rheumatology office and hung a high dose bag of steroids, the mudhole disappeared. For me, rage didn’t look like the screaming, swing at the fences anger of my younger years. It looked liked grasping, holding on and repeating my assertion that RA affects the lungs, despite feeling small and weak. A reward for my tenacity is more time to write and dig my toes in the sand. Love is sweeter now, too.

My sixth decade begins in a couple of months, time enough to regain my strength, embrace my true passionate self, and resolve to live as loudly as I want. I understand now that I don’t have time to waste. Death is funny that way.

 

Owning Disease Shame – One Story

I began this post several times, always with a goal of seeking your understanding.  Feelings as words fall flat, so I will simply relay the story of when I started to sense that I was responsible for a disease diagnosis and could somehow control it, and will end with a recent encounter supporting that illusion.

I managed rheumatoid arthritis along with working full-time due to an open-minded and kindly opportunistic Residency Program Director, the only person at work I revealed a rheumatoid arthritis diagnosis to, at first.  During those first two years of RA, I excelled by working from home when I flared, sometimes as often as a couple of days a week during winter.  I spoke at national conferences, was elected to the board of a professional organization, and enjoyed the respect of my peers.  While I needed more rest, and at times the evening commute tortured my hands, I studied during off time and became one of the first in my field to earn a certification.  Biannual 360-degree reviews resulted in praise, pay increases, and even a bonus for the certification.  It would be remiss of me not to mention my diligent Chief Residents who made life easier, most of the time.  As challenging as it was, I had RA handled.

Then a new Program Director came on the scene, a new boss with a multitude of “better” ideas.  Within a month The Idea Guy notified Human Resources that I was ill.  He also sought big immediate changes during recruitment season, the busiest time of the year for competing medical residencies.  For 10 years I worked overtime during recruitment.  My new boss needed me on site  by 7:30a until at least 5p, yet I often stayed past 6p.  The RA flared and I started to limp and type painfully when I finally submitted a reasonable accommodation request under the Americans with Disabilities Act.  I mistakenly thought my past success validated my ability to perform; it was logical from my perch.  After my Rheumatologist’s recommendation and 2 months of diving into my medical records Human Resources determined that being on site was a job requirement, no work from home would be allowed forthwith.  All Residency Coordinators received new job descriptions requiring our signatures.  Within 8 weeks of the new Program Director’s arrival I was feverish with swollen joints and deep body aches I hadn’t felt before.  I tried harder as my new boss became more and more unhappy with my primary focus on recruitment.  He sought my apt attention for a minimum of 2 hours per day as he spoke and my task list grew.  Hiding my pain and frustration became impossible.  My Rheumatologist completed FMLA paperwork for intermittent leave and I asked if I could work at home on those days I could not make it in to the office for a full day.  Human Resources denied my request and began asking for re-certification of the FMLA paperwork every 30 days in spite of the physician’s certification that my disease was permanent.  It is allowable under the law and cost me $25 every month.

All of this happened between August 1 and December 10, the date I was diagnosed with Fibromyalgia.  I unabashedly wailed, “I CAN’T BE DISABLED!”.  Those few moments are indelibly etched on my heart and mind, both my hopelessness and the doctor’s compassion are a part of me now.  This was where my tenacity had landed me, with a prescription for an 11-week rehabilitation program and another for just a few Xanax to get me past the truth.  The story continues with a few months of me righteously (and pathetically) sacrificing my health trying to regain what I had lost.

You may think I am being vengeful 5 years later when I finally got up the gumption to reveal their behavior, but that’s not it.  For  purely selfish reasons and storage space I forgave a while back, but those days left behind a slime of shame that is reinforced with big and small hurts regularly.  The way to rid myself of shame is to own it, so here it is.  I cannot fully control Rheumatoid Arthritis or Fibromyaglia no matter how hard I try.

Waiting in the dentist’s chair last week I heard a conversation across the hall, the two women’s loud voices as clear as if they were in the room with me.  They began with a tirade against welfare, “except for those who really need it, of course”.  Then I heard, “But you know where they could really save some money?  If they actually looked deeper into these people collecting disability benefits.  At least half of them are faking and just sitting on their butts while we foot the bill.”  The other woman responded, “Yeah, I know.  They’re just lazy and don’t want to work.  I started working at 16…”.  I tuned out at that point.

 

5 Things Rheumatoid Disease Patients Wish You Knew

  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

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

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.

 

Dismantling Fear

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