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.

 

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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.

 

Endometrial Ablation, An End to the Bloodbath

 

*Warning:  If discussions about menstruation and lady parts make you queasy, this post is not for you.

Since perimenopause set in eight years ago, I developed penis envy, not so much because I’d like one, but simply to eradicate several unpredictable and exquisitely painful periods per month.  Never prepared, no matter how many bloody tidal waves assailed my linens, my pants, my chairs, my life, I was taken off guard.   I am unaware of a more irritating interruption than a distinct gushing feeling in the middle of a meeting, especially when you are the one taking minutes.  Several times I prayed for a fire alarm.  When my red blood cell count fell to a level worthy of a gynecological consult, I felt relieved.  Dr. Burns, well into his 8th decade, said I seemed a good candidate for an endometrial ablation as long as fibroids did not lurk in my uterus.  Two tiny fibroids, one smack dab in the middle of my uterus and likely the painful trouble-maker, showed on ultrasound.  Fortunately, Dr. Burns has practiced for more than 40 years and was competent in more than one ablation procedure.  The simplest ablation procedure used a triangular mesh electrode that expanded in the uterus and delivered an electric current which cauterised and destroyed the uterine lining, and if needed, he had a back-up plan that used a roller-ball for the trouble-maker fibroid.

Elective surgery, while not typically as serious, entails risk and pain.  Infection is the scariest risk to me, likely due to a 3 month post-surgery infection following a previous gynecological mini-surgery.  I did not agree to an endometrial ablation sooner because of it.  Fear is a bitch, worthy of a post all its own.

Dr. Burns used the electrically charged mesh with success.  Prepping me with information, introductions, consent forms, and anesthesia took longer than the ablation, positively making me comfortable before asking Patrick to hurry up with the anesthesia in the operating theater.  Such a simple procedure to require such a dramatic environment, but…the risks.

My recovery nurse enjoyed my eyes-closed rendition of Gin and Juice and said I was her new favorite patient.  Apparently, I had my mind on my money.  Over the next few days I got to know the pain-killer norco as my uterus healed and I laid about on the couch drinking lots of liquids and eating toast.  So this is what it’s like in the 5th decade.  We endure procedures, therapy, and surgery to make life doable, and in this case, better than previous decades.  Little spots of blood every couple of months are all I have now.  Feminine hygiene companies are devastated by the decline in sales.

 

 

Birth Control Debate Attempts to Hit Men Where it Hurts

In a bid to show ‘em how it feels State Representative Yasmin Neal has proposed an amendment to Georgia’s anti-abortion law that would ban vasectomies unless necessary to prevent serious injury to a man’s organs or death.  Missouri State Representative Stacey Newman soon followed suit with a similar bill that also limits where a vasectomy can legally be performed to surgical centers and hospitals.  Both Representatives cited the fairness of legislating men’s bodies in the same fashion that predominantly male government bodies have attempted to legislate women’s reproductive health choices.

While women across the country are cheering for these bills, I see a couple of errors in this blatant strategy to encourage empathy in our male counterparts.  If you have not yet fully realized the inherent differences in women’s and men’s decision-making processes, I suggest Men are from Mars, Women are from Venus as a primer.  While many women are furious about recent debates over what a woman should be allowed to do with her body and affordable access to all birth control options, men will focus on one thing only- an attempt to mess with their genitals.  I call it “dick-sensitivity”.  When a man’s genitals become part of an equation, he loses the ability to think multidimensionally.  Last night I spoke briefly to my husband of writing a post on a proposed vasectomy ban.  He immediately covered his groin and started saying, “nanananana” to drown out my words.  Admittedly, I would greatly enjoy a video of the Georgia General Assembly when they debate Representative Neal’s proposed ban.  The looks on male lawmaker’s faces during such a conversation have great entertainment potential.

The second error in the bid to equally share government control over reproductive rights is thinking that men will fight for their right to a vasectomy.  Think about it.

On the heels of FDA recommendations that men be tested for underlying causes of erectile dysfunction, Virginia state Senator Janet Howell introduced a bill last month that would require a man to get a rectal exam and cardiac stress test before receiving a prescription for a drug such as Viagra.  Ohio state Senator Nina Turner has also proposed a similar bill stating that she is equally concerned with men’s health and believe they have the right to be fully informed of the risks associated with erectile dysfunction medications.

While I appreciate the clever maneuverings of our female politicians as entertaining, I am skeptical that such tactics will do more than add to explosively divisive rhetoric.  There are some things that need not be debated because they fall under our 4th amendment rights, and some things that are serious enough to fight head-on with a resounding “No!”  I would prefer female lawmaker’s efforts be strongly straight forward in their fight for women’s reproductive and healthcare rights.

Night sweating the bed

Jolting awake in the middle of the night sopping wet and chilled is an uncomfortably shameful situation that I thought was buried in my childhood.  I stopped peeing in the bed when I was six, so what the hell was this all about?  The hormonal changes during the fifth decade often cause flashbacks to my childhood, with night sweats at the top of the retro playlist.  Initially I was confused, not attributing my drenched t-shirts, pillows, and sheets to hot flashes because I was not hot, but wet and cold when I awoke.  The same friend that taught me how to use a
tampon 3 decades ago filled me in on the hot flashes that are termed “night sweats”, and occur when I am asleep.  I would be a bumbling idiot of a woman if not for my girlfriends and my Mom.

I did not make a doctor’s appointment to discuss this new development due to totally illogical embarrassment, perhaps a leftover from my peeing in the bed years.  I felt lucky that I was not “flashing” during the day, a perfect term for turning as red as a tomato and pouring sweat in front of witnesses that do not love you.  You may as well be wearing a sign that says, “Menopause, or close to it.  BEWARE!!!” in flashing
lights.  If I begin to have hot flashes that are anything like night sweats I will need to secure a towel to my belt so as not to leave a trail.  The closest I came to needing a towel was at a national conference where I was speaking.  Anxiety was clearly a trigger, and luckily I could run up to my room to change shirts periodically.  I woke every night that week cursing the luxurious down comforter that had lulled me to sleep.  Those few nights were the only times I woke up on fire because the flashes were prolonged.
When estrogen decreases, the hypothalamus steps up production of norepinephrine, a stress hormone that acts directly on the thermo-regulatory center of the brain.  Studies have shown that internal stress, an individual’s perception of life, and external stress
such as overwork and insufficient sleep, exacerbate hot flashes.

The altering effect of meditative relaxation and physical exercise on brain chemistry becomes more essential the further I journey into the 5th decade.  Between the mindfulness exercises that I learned at Mary Free Bed Pain Center and Belleruth Naparstek’s guided imagery exercises I can boost my DHEA (dehydroepiandrosterone) level and counter the increase of stress hormones.  I have focused on stress reduction techniques because anxiety is my most influential trigger for perimenopause symptoms.  The adrenal glands produce DHEA which can be promoted by “learning to think with your heart.”  It is similar to redirecting a toddler’s focus when they want something they cannot have.  Through practice I have learned to acknowledge what I feel anxious about, whether I have any control over the situation (usually not, hence the anxiety), and then refocus on something good in my life such as my family or a good memory.  It seems to put my life in a more balanced perspective and typically reminds me of what I deem important and what I do not.  One of the rewards of this practice is
witnessing the frustration of someone who is deliberately trying to provoke a stress response; it sort of freaks them out.  But, reduced night sweats and serenity must fall under the “living well” category in the common quote about revenge and are even better payoffs.  Other strategies to alleviate night sweats that have worked for me are: avoiding coffee after Noon, reducing alcohol consumption (drunk = guaranteed night sweats), eating fresh food and protein, and getting eight hours of sleep.  Interestingly, fasting and cleansing programs can weaken your adrenal system, which lowers hormone production.

I have discussed my night sweats and other perimenopause symptoms with my doctor who has offered to test  my hormone levels after I attempt to boost production with lifestyle changes.  He assures me that women today do not have to endure this decade in misery, and that in itself changes negative feelings that are woven into my understanding of hormonal changes during this time of life.  By paying attention (mindfullness) to what I consume and how I think I can lessen the impact of decreasing hormones, but it is comforting to know that my doc has a backup plan.  And comfort is the key.

 

Womanhood Ch-ch-ch-changes

The inconveniences of womanhood are enhanced in the 5th decade.  A few are familiar from a long time ago.  The hard painful cramping that accompanies my period reminds me of when I was 15 years old, yet now there is an end in sight.  Perhaps this is designed so that I will not miss it when menopause arrives, like the post-menopausal women who smile when they say, “I don’t have to deal with that anymore”.  Another similarity is that it always arrives at an inopportune moment, usually when I am wearing light-colored pants, busy, and away from home.  The difference is that it can arrive anytime, even if it was just here a few days ago.  Thanks to the excessive flow, I know how my Mom felt when she had to wash my sheets several times within a week.  I am stoic at this age however, and no longer believe that I may die from the pain as I did when I was a woman-child.  A few years ago I listened to an emergency room nurse chuckling as she talked about a young woman who rated her menstrual cramps as 10 on the 1-10 pain scale.  I felt sympahty for that girl because I remember feeling the same.

The drama queen of my younger years re-emerges the week before, but now I am embarrassed and guilty when I have acted like an out-of-control hormonal teenager.  If you read through a month of my blog postings, I bet you can pick out which week it
is.  I have tried taking birth control pills to regulate my crazy perimenopausal hormones, but they just made me more emotional, so I figure I will save the hormones for when I go truly mad.  In the meantime I try to be aware in order to control my emotional state and apologize often because being aware does not mean I am in control.

I was famous in my teens for my ability to pee quickly or more accurately for my penchant to pee in places that you should not, so I had to go quickly.  In a public bathroom with my daughter recently I could not help but notice that I was still peeing  while she had finished, washed her hands, and left.  It dawned on me that this is something else that has slowed down over the past few years.  Fortunately Cosmopolitan magazine schooled my teenage friends and me on the mechanics of Kegel exercises, although the reasons we learned them had nothing to do with avoiding incontinence later in life. Whatever my initial motivation was, I am a pro after 25 years of working those pelvic muscles.  Yet it still takes me a few minutes, so peeing on the side of the road is out of the question now.

I will save some of the other changes I am experiencing in my 40’s for other postings because some are so special they deserve their very own post.  It feels as though the past 30 years of being a woman have been sort of like boot camp for this – the most challenging decade yet.