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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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.

 

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.

 

 

Ditching Shampoo, Tales of a Greasy Head

Michigan winters are especially cruel to 5th decade skin, so along with stocking our pantry and medicine cabinet, my winter prep routine includes stocking up on shower oil, body cream, sugar scrub in oil, and tea tree shampoo.  In a quest to retain dissipating moisture, I shampoo my hair every other day and can slip in a third pin-up day if I don’t have anywhere to go, but still, I fight dry scalp all winter.

Driven by this quest to keep the scales and itchy urges at bay, I decided to try cleansing conditioner in lieu of shampoo.  At one week in, doubt has taken root as I pin-up the hair I “washed” with cleansing conditioner yesterday, complete with a headband to keep the heavy greasy mass away from my face.

I wonder… is this yet another failed beauty experiment, the first of which took place early in the 2nd decade.  There is a sweet spot in the 3rd and 4th decades when our hair and skin is as healthy as it will ever be and the same products work for a long while.  Then the time to pay for our youth in the sun begins and hormones once again go wild, unsure if they are coming or going.   And again, the experiments begin, not as stupid as those of the teen years (I once steamed my face beet red), but more expensive.

The cleansing conditioner may work better on thicker, curly hair.  Frustrated with my greasy pin-up, I am now off to shampoo my hair, probably twice.  Maybe if I wear hats I can use up the rest of the bottle.

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.