Tag Archives: menopause

Walking the Talk

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BVF ben downhill

The Journey and the Struggle

18 months ago I wrote about my plan for maximizing menopause preparedness.  As with so many missions, this one has experienced both successes and failures.  Since January 2016, I have grooved my exercise routine in the most awesome way.  I am all over the TRX, doing Spiderman push-ups, incline presses, pistols and more.  I get my cardio intervals and I’m foam rolling.  I feel stronger now than at any time since high school, and I’m proud of this accomplishment.

*sigh*

The eating, on the other hand, continues to be a challenge.  Earlier this year a patient looked at me without expression, and stated bluntly that I had gained 8.7 pounds since the last time he saw me.  Right after that’s kind of inappropriate, I thought, well, he’s right, I have been gaining weight.  Last March I wrote about weight loss strategy, thinking mainly about my exercise habit formation.  Sadly, my own weight has gone opposite to the desired direction, despite an honest attempt at adherence to my own advice.  Evidence suggests that weight loss really is about 80% diet and 20% exercise.  But sometimes you can only focus on one thing at a time.

Back in 2008, when I finished nursing, I thought, I can get my body back!  I knew I was not going to exercise, and I had no energy to police my food choices.  But I also knew I was eating too much, so I decided to just cut my portions in half.  It felt easy, decisive, and empowering.  I lost 25 pounds in 9 months, and got down to my wedding weight.  But eventually I acknowledged that though I was thin, I was squishy.  So I connected with my trainer in 2014, the primary goal being to get moving without injuring myself.  Right now I’m up 17# since my nadir in 2009, though I’m much more fit than the last time I lived at this weight.

Talking the Walk

I’ve always had a love-love relationship with food, and it shows in my weight/habitus.  I notice also that my own state of mind and body has influenced the advice I offer to patients.  Before I exercised regularly I spoke to patients a lot more about diet; now it’s more balanced.  One patient brought it up recently.  He asked, “What about the doctors who smoke, or the obese ones, how can they advise anybody about healthy habits?”  I’ve thought a lot about it, so I was ready to answer.  To me, there are three main options, all of which I have tried.

Disclaim.  We doctors can rely on our authority to tell people what to do to get healthier.  They notice our fat rolls, or smell cigarette smoke on us.  They see the dark circles under our eyes and surmise that we don’t sleep enough.  Maybe they can tell we don’t exercise.  But we admonish them to eat less and move more.  We say (subconsciously) to ourselves, “Do what I say, not what I do.”

Avoid.  Rather than give lifestyle advice at all, we can focus on prescriptions and referrals.  We feel we have no place instructing patients to eat more leaves, go to the gym, or quit smoking, when we don’t even do so ourselves.  So we don’t even bother, feeling like hypocrites.

I think both of these responses are rooted in shame and perfectionism.  And I think we should not fault physicians for choosing them—that would be meta-shaming–never helpful.  These are normal, human responses to our professional training and expectations.  Physicians have long held positions of authority and expertise.  Until very recently, our relationships with patients were mostly paternalistic.  But with burgeoning access to information, a culture evolving (rightly) toward patient autonomy, and physicians experiencing historically high levels of burnout and suicide, we cannot afford to burden ourselves with the illusion that we must be perfect in order to be credible.

Connect.  I think the healthiest response, for both patients and physicians, is for us doctors to acknowledge our own struggles; to empathize with the difficulty, the conflict, and the utter disappointment of not being able to control our actions and choices as we would like.  I think patients don’t expect us to be perfect.  But they do want us to be human and relatable.  I often find myself saying, “I know that feeling,” or, “Yep, that’s my weakness, too,” or, “Oh, and what about x-y-z?  That’s my problem!”  Only once has a patient said to me, “Shame on you!”  He was a perfectionist himself; I didn’t take it personally.

I stress eat. I eat when I’m bored.  I eat late at night, and I love sugar, starch, salt, and fat.  The struggle is real, and I know it all too well.  So when I ask you, “What small changes can you commit to in the next month?” believe me, I’m asking myself also.  And if you tell me something that has worked for you, I’ll probably try it.  I still think my ‘4 A’s of goal setting’ apply: Assessable, Actionable, Attainable, and Accountable.  I just haven’t found my 4A formula for eating yet.  But lately I have taken a more lighthearted approach to healthy eating trials.  Nothing is life or death, and I know iterative changes are best.  If one thing doesn’t work, hopefully I can learn something and move on to the next.  No dessert on weekdays.  Vegetarian on days I work.  No eating after 8pm.  No starch at dinner…  Meh, none of it seems to stick yet.  Even my cut-it-in-half strategy doesn’t appeal to me these days.  It’s so frustrating!  And it’s also okay, because I know I’m doing my best, just like my patients are.  We can all just take it a little more lightly, one step at a time.

So by the time menopause actually hits, I’m confident that I will be prepared to meet it, with grace and maybe a little irreverence.  I’m learning to judge myself (and thus others) a little more gently.  I’m learning to love my body, whatever shape it’s in.  After all, it’s the only one I’ll have this time around, and I need to maintain it for the long haul.  Turns out, my patients have been my best companions and consultants on the journey.

 

 

 

 

Setting Intentions For 2016

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Happy New Year, Friends! Was 2015 not a wild ride?  However you experienced it, we can safely call the past year eventful, if nothing else.  The violence and the tenderness, the destruction and the connections—how can we hold it all at once?  I used to think myself an optimist, but now I often wonder if the world will actually end in my lifetime—whether we humans will obliterate one another in a rapid succession of escalating violence, or somehow see the light and work harder toward mutual understanding.  Nature will go on, though, with or without us.  I’m still an optimist, then—for the Earth, not necessarily for people…

This year I realized my body’s inevitable march toward menopause, a stark and sudden awareness. It came to me sometime in the spring, and I felt a keen jolt of motivation to prepare.   After 13 years of practice, I recognize two characteristics of women who suffer the least through this dramatic hormonal transition.

First, they accept it. They have made peace with this phase of life, letting go their reproductive years and embracing their elder position in our human tribal order.  They see menopause as a rite of experience and advancement, rather than a loss.  They move with confidence through this segment of life, and make the best of whatever happens.

Second, these women almost always have well-established habits of good health long before their hormone levels start dropping. Nutrition and physical activity come to mind first, but the practice of  ‘being at peace’ must also be included among the ‘habits.’  They have, whether innate or learned, effective mechanisms for overcoming adversity and maintaining balance—physical, mental, emotional, and relational—they are resilient.  I aspire to be like them.

So, until such time as humanity actually annihilates itself, I pledge to persist on the journey toward my best self. The more I read and share with contemplative friends, teachers, students, patients and others, the more I see how we make our lives out of small, daily choices.  As such, I propose below my intentions for the coming year.  I will fail, over and again, I know.  But as Ben Zander would say, these are not expectations to live up to.  They are possibilities to live into.

 

Choose to Train

I started working with Melissa, my trainer, in January of 2014. It was slow going that first year, with only a vague goal of exercising for its own sake, because I knew I ‘should.’  Now, my pursuit of fitness has much more meaning.  I have a finite amount of time to get in the best possible shape before ‘The Change.’  It’s an exhilarating challenge now.  How fit could this body get?  Every week since July, except for one, I have managed to exercise at least three times.  I set this goal on January 1, 2014, and it’s only since my Menopause Epiphany that I have truly owned it.  I think of myself as an athlete again, training for the ultimate marathon of living well in old age, by getting off my butt and moving, each and every day.

 

Choose to Fuel

*sigh*

I need to manage better what I put in my mouth. Eating is one of the hardest things for me to control.  I know exactly how much my patients struggle to include more vegetables, avoid sugar and starches, and eat less overall, because I fight the same battle every day.  After my daughter was born, at age 35, I successfully lost 25 pounds in nine months by simply cutting my portions in half, getting down to my wedding weight.  I had neither the time nor the interest to exercise, nor the energy to police my food choices.  Though I have kept the weight off for the most part, 7 years later I find myself wondering if I’m pre-diabetic.  I see every day how insidiously a persons’ glucose metabolism changes, and it’s ever clearer to me that ‘trying to eat healthy’ is not enough.  I need to set goals for eating, just like for exercise.  Is it food, or is it junk?  If it’s junk, is it at least junk that I really, really enjoy?  Will it be worth the cost to my body after eating it?  Does it align with my highest goals for health and a sustainable ecosystem?  Will it help me age well?  A body in training needs appropriate fuel.  The training piece feels established by now.  In 2016 I will strive to discern and allocate my energy resources better.

 

Choose Curiosity

It always amazes me, and scares me a little, how easily I slip into assumptions and negative storytelling about the people around me. I play old scripts in my head about other people’s intentions, based on my own fears and insecurities.  These thought patterns reinforce themselves over time, creating perceptive realities that are hard to distinguish from objective truths.  This phenomenon is well-described in psychology research, and contributes to misunderstanding at least, disconnection and isolation at worst.  My heroes Rosamund Stone Zander, Brené Brown, and Elizabeth Gilbert, all propose curiosity as the core antidote to assumptions, judgment, and alienation.  First, I can get curious about my emotions, whenever I feel triggered or agitated. What am I feeling? Where did it come from?  Then I can ask myself, “What story am I telling about this person, and what assumptions do I make about their thinking or perspective?”  If I can get this far, I’m already doing pretty well, and on a good day, I can take the next step, asking, “What other story can I tell, one that could cause me to suffer less?”  Last, I can always engage the other person from a place of vulnerability.  I can ask questions, confess my inner stories, and clarify what’s happening between us.  I’ve been practicing this for the past year, too, and it is hard.  But I’m getting better at it, and the results are well worth the effort.  Mutual understanding and deeper connections are only the beginning.  Curiosity may well be the best approach to world peace.

 

Choose My Family, My Tribe

We are each born into a family, for better or worse. And throughout a lifetime, we can also choose our connections, both inside and outside of our genetics.  I wrote recently about my friend Yakini.  My son had been to her daycare for months, and morning drop-offs were happy and smooth.  Then we went on vacation for a week, and when we came back, he was suddenly distraught every time I left him.  Immediately, Yakini knew what to do.  “We need to come to your home for a meal,” she said, as if it were the most obvious thing in the world.  “He needs to know that we are part of your family, that we will take care of him the same as you,” she continued.  Of course, it was a no-brainer.  We had to validate the sacred contract, as she called it.  Her whole family came over with their guitar.  We ate, we sang, we bonded.  After that the boy was happier than ever to see them every morning.  We had officially claimed Yakini’s family as our own.

My family of origin has its complexities. Culture, generation, and sibling rivalry have all contributed to my repeating scripts and stories.  I have learned with age that these patterns can and do change, and it serves all of us to hold space for the evolution.  I can practice curiosity, allow myself to be vulnerable, and choose deeper connections to the people I might otherwise take for granted or let drift away.  My siblings and I have also chosen our spouses.  We need also, then, to acknowledge each of their families of origin, their patterns, scripts, and stories.  I feel very lucky that my husband and my brothers-in-law all seem to accept our family’s quirks and dysfunctions—I can certainly learn from their example.

Lastly, in 2016, I intend to continue nurturing my ties to my tribe. These are the other family members I have chosen over the years, my friends.  They come from all stages and places of my life, and all offer unique perspective.  They accept my imbalances and love me anyway, and always challenge me to live in my integrity.  They hold me up on my quest for self-actualization.  They invite me to do the same for them, and together I honestly believe we make the world better.

2015 comes to a jumbled end for me, full of intensity, volume, texture, and possibility. I’m grateful for this blogging platform to explore and share ideas.  Thank you for reading to the end of this, I think my longest post yet.  I look forward to more growth and exploration in the coming year.  Nothing matters more than our relationships, first with ourselves and then with one another.  Let us cultivate connections that promote peace, love, and harmony, this year and beyond.