Life in the Slow Lane

I am rowing a boat along a river.  The river is flowing down a slope and I am headed uphill, against the current; it is very hard work.  This image came into my mind in the middle of a busy day selling real estate.  It returned to me later when an endocrinologist asked what it felt like to be hypothyroid.  That doctor was the one who finally got my thyroid situation under control after almost fifty years.

The thyroid is a butterfly-shaped gland at the base of the neck.  It releases hormones that control metabolism.  When it releases too little (hypo) symptoms like fatigue, weight gain, constipation, depression, and sensitivity to cold may appear; with too much (hyper) there may be sweating, weight loss, heart palpitations, and anxiety.  Thyroid conditions behave differently in different individuals so they can be frustrating to treat, both for doctor and patient.

When I was in high school I started noticing that it had become almost impossible for me to lose weight.  At a younger age I could take off ten pounds in a few weeks; now, even if I ate 1000 calories a day, the weight stayed on.  Something was wrong, I thought.  A neighbor of ours who was a surgeon did a blood test and discovered that I was hypothyroid.  Little white pills were prescribed and I took them every day.  I didn’t feel any different; I didn’t lose weight; and nobody followed through with further tests so eventually I quit taking them.

During an extremely stressful period in my early thirties I developed an eyelid retraction (stare) so that my left eye was wider open than the right.  Since this can be a symptom of hyperthyroidism, I was given a radioactive iodine uptake test to examine the functioning of my thyroid gland.  The results were inconclusive and, after several months, the eyelid retraction mostly went away.

After a few years my life settled down and I acquired a regular family doctor.  When blood tests again indicated hypothyroidism, she got to work trying to fix the problem.  I took pills of various colors; the levels went up and back down again, often up in summer and back down in winter.  Eventually she concluded either that I was not taking the pills as prescribed or that there was something else wrong and sent me to a specialist.

From the endocrinologist, Dr. Melissa Cavaghan, I learned a number of things.  One is that you shouldn’t take your thyroid medication at the same time of day when you take calcium because the supplement can affect the medication.  Another is that levels of thyroid medication need to be adjusted in tiny increments so you don’t get the kind of swinging back and forth that I experienced.  For some people, including me, it is important to use the same type of thyroid medication because generics don’t always work the same as the brand name product.  Also, in recent years medical science had changed its opinion about treating hypothyroidism, calling for intervention at levels that were previously considered normal.  Probably my hypothyroidism has been under-treated all my life.  In any case, I now take light blue and dark blue pills on alternate days, which produces an acceptable result on the blood test and makes everybody happy.

Why I Do This

A friend asked me why I devote so much time and energy to staying in shape.  “What is your goal?” he asked.  Perhaps he thought I was planning to live forever, but that’s not the reason.  Like all good pragmatists, I have my Living Will signed and notarized and my Health Care Representative selected.  As I watch myself getting older, I have two main objectives: to remain independent for as long as possible and to avoid pain.  Being in good shape after the age of sixty is a luxury; eating what Michael Pollan calls “real food, not too much of it” and working out are the price I pay for that luxury.

Stilbestrol and Me

My parents were married in June of 1942.  The following year a male child was born and died shortly afterward; he was a “blue baby” with a congenital heart defect.  Ironically, it was only two years later at Johns Hopkins that surgeon Alfred Blalock and his laboratory assistant Vivien Thomas performed the first surgery to correct one type of “blue baby syndrome,” a story told in the film, “Something the Lord Made.” http://www.imdb.com/title/tt0386792/

Shortly after that, my father went to Europe, where he served as a chaplain for the remainder of the Second World War.  He returned to the US in 1945 and my mother became pregnant in September.  Having lost her first child, she was especially concerned for my safety so when a highly esteemed ob/gyn suggested she take a new medication that was supposed to prevent miscarriage, she did it.  She gave birth to a healthy daughter on June 11, 1946.

In the early 1970’s I started reading about diethylstilbestrol  (DES), a synthetic estrogen that was given to pregnant women from the 1940’s on, but was now found to increase the incidence of a rare cancer in women prenatally exposed to the drug.  I asked my mother if she had taken DES and she told me she had taken “lots of it.”  Two points were especially galling about the situation.  It was an example of misdiagnosis:  DES was supposed to treat miscarriage but the problem was not with my mother; my would-have-been brother had a heart defect.  It also showed blind over-confidence in a drug that had not been sufficiently tested; my mother and others like her were unwitting guinea pigs and so were their daughters.  DES was later shown to be of no use in preventing miscarriage but to have a number of adverse effects on DES daughters and sons and possibly on the third generation as well.

The next step was to find out whether I had cancer.  The recommended test was something called a colposcopy and at that time only one doctor in the Boston area performed them.  My mother and I paid him a visit.  Before examining me, Dr. R assured us that I couldn’t possibly be a DES daughter because I was too old; my mother must be mistaken.  The test proved otherwise, however, and I was told that I had a “pre-cancerous condition” caused by DES. 

For a while I worried about this.  The number of women who got a DES-related cancer was small but what if I turned out to be one of them? I also tried to participate in a lawsuit against Abbott Laboratories, one of the manufacturers of the drug.  My claim was disallowed – I no longer remember why.  The next several years brought a series of problems related to my reproductive system, culminating in a hysterectomy in 1978 at the age of 32.  Did DES cause my infertility? We’ll never know.  It may have resulted from my hypothyroidism or my very stressful professional and personal life.  My smoking habit probably didn’t help either.  The good news is that I never got cancer and, almost forty years later, I’m very healthy.   I do get regular physicals just to be on the safe side.

Dr. Gustafson, I am grateful to you for bringing me into this world but, when it came to stilbestrol, I wish you had left well enough alone.

The Family Hero

Our handyman was standing in our upstairs hallway talking on his cell phone.  He had been interrupted in the middle of a job he was doing for us to answer a call from his sister, something about financing on the family farm.  The call went on and on.  “What’s she calling him for,” I wondered grumpily.  Then it clicked.  “Family Hero,” I thought.

The Family Hero is a child, sometimes, but not always, the eldest, whom the parents designate as a special helper.  This individual may be chosen because he or she is particularly mature or simply because the parents feel they need the extra help.  For a child, it can be flattering to be selected for this important role; it defines your place in the family and enhances your self-esteem.  My handyman said, “I like being the Family Hero.”  It may also create a closer bond with the parents.  Family Heroes often help to care for their siblings or participate in the parents’ discussions and plans, almost like another adult.    

There are some down sides to this situation, however.  Giving too much responsibility to one child may discourage initiative on the part of the others.  If the Family Hero is always there to help, why should anyone else bother? For the Heroic child, a sense of obligation to family may limit other lifetime options.  She or he may be uncertain about career choices; when you already have a job there is less incentive to look for another.   Whenever there is a family crisis the Family Hero is expected to be on the scene; if this means leaving a job, a spouse, or children, those others will just have to get by on their own; family comes first.   In many situations the Family Hero may not actually be able to do anything, but his or her presence is felt to be reassuring.

 In childhood, the parents tended to forget that the Family Hero was still a child who deserved nurturing and protection.  In adulthood, they think of him or her as still being part of their family and not as an independent person with a separate life.  Even after the parents are gone, adult siblings may continue to treat the Hero as a surrogate parent who can be expected to provide moral and financial support when they are needed.  Then there is old age:  after everyone else’s needs have been met, who is there to take care of the Family Hero?
  

The financial problems with our handyman’s family farm were resolved; the job at our house was completed.  Life went on – until the next phone call.

Foam Rollers: Help for Sore Muscles

One of the more discouraging parts of clothes shopping used to be looking in the mirror at my back and seeing the rolls of flesh around the band and straps of my bra.   People tend to exercise the parts of the body they see every day in the mirror; this means that back muscles are often neglected.  Trainers Anne Tierney and Steve Sierra first pointed out that my “posterior chain” needed work, so I starting focusing more on my back and shoulders.  For this part of the body, some of the best exercises are the old fashioned ones:  push-ups (on your knees if you can’t do a regular one) and pull-ups.  I still can’t do a real pull-up but I have a device like a large rubber band that lets me do an assisted one.

Anne also suggested that I start using a foam roller, a styrofoam cylinder that can be rolled under the body.   The most helpful discussion I’ve found on foam rollers is “FoamRoller Exercises for Easing Tight Muscles” by Elizabeth Quinn.  Here is a summary statement from that article.  “The foam roller not only stretches muscles and tendons but it also breaks down soft tissue adhesions and scar tissue. By using your own body weight and a cylindrical foam roller you can perform a self-massage or myofascial release, break up trigger points, and soothe tight fascia while increasing blood flow and circulation to the soft tissues.”  On any day when I do a workout I spend some time in the evening stretching and using a foam roller.  If I do that, I avoid the muscle soreness that can interfere with my sleep and bother me the next day.  Using a foam roller was uncomfortable for me at first because some areas, like the inner and outer thigh, were very sensitive, but with continued used use the soreness gradually diminished

An interesting thing happened after I started using the foam roller.  I noticed it one time when we went to Italy.  Italian people have many wonderful ideas and a few bad ones.  One of the bad ones is that hard beds are healthy for the back.  In Italy it is virtually impossible to find a bed that is not rock-hard.  I normally sleep on my back and, when I slept on one of these beds, would wake up in excruciating pain.  This was not arthritis but pain in the soft tissue, more like muscle soreness, and it would gradually dissipate during the day.  We made a trip to Italy at some point after I started using the foam roller and I had little or no trouble with the hard beds.  Perhaps there had been soft tissue adhesions and scar tissue that the roller broke down; perhaps it simply improved the circulation in my back.  Either way, I appreciate the change.   The rolls of flesh around my bra are pretty much gone too, possibly a combination of working the back muscles more and using the roller.

Update 9/12/2014:
It's always good to learn that there is scientific support for something I'm doing already, as in this article in the Wall Street Journal, "Can Foam Rollers Help Relieve Muscle Pain?" "Foam-roller therapy at home, often called self-myofascial release, has been shown in several small recent studies to improve range of motion in the knee and hip, and to ease muscle soreness after exercise." According to an article published in The Journal of Sport Rehabilitation, using a roller increases the effectiveness of stretching.

The Truth About Spot Reducing

“It’s impossible to spot reduce; you can’t lose fat from your stomach by doing sit-ups or crunches.”  Kinesiologists have been saying this with great assurance for years.  The second part of the statement is true but the first part, fortunately, is false.  When I started rollerblading in 2001 I lost 4 inches off each of my thighs within the first few months.  I know what I lost was really fat because I have body fat measurements for various body parts going back decades. 

I think of body fat as an arrow pointing to parts of the body where there are either weak muscles or inflammation or both.  In order to reduce body fat in a specific area you have to work the underlying muscles hard, using a complex exercise like rollerblading that works different parts of the muscle group or a combination of exercises like the 11-move Ab Ripper X.  You also have to do the exercise often enough.  After a month of doing Ab Ripper X three times a week (only fifteen minutes per time) I definitely saw results.  Now my husband’s doing it too!

New Leaf: Teaching Your Body to Burn More Fat

Starting in 2007, I made a series of changes in my workout routine, adding stability ball exercises, then interval training, plyometrics, and more core work.  At first, I lost a few pounds but after that, things leveled off and there was no further progress.  At 153 pounds I still wanted to get my weight down a bit more and lose body fat rather than hard-earned muscle.  Greg Simmons, my trainer here in Bloomington, suggested the New Leaf program.

Produced by St. Paul-based Angeion Corporation, New Leaf uses proprietary hardware and software to assess the individual’s metabolism and design a customized diet and exercise program to improve its efficiency.  This assessment is based on a measurement of how the individual’s body uses oxygen to burn fuel.   In practical terms, a mask was placed over my nose and mouth with a tube connecting it to a computer.  I then walked on a treadmill (in later tests on a cross trainer) at increasing speeds and inclines.  The computer then produced the following graph.

The horizontal axis shows my heart rate in beats per minute; the vertical numbers denote the percentage of fat calories being burned; and the wavy line shows my actual course.  On 3/16/2010 my aerobic base, the maximum heart rate at which I burned fat as the primary fuel, was 111 bpm; my anaerobic threshold, the fastest I could go, was 139.  A major objective of the program is to build your aerobic base, increasing the range of exercise intensities at which the body will burn mostly fat.  Co-trainer Susan Simmons produced an exercise program based on the assessment results plus what I was already doing.  I did not use the diet component of New Leaf because my own diet was already healthy.  I did cut out a protein shake on days when I wasn’t exercising.

At the time of my most recent re-assessment, 1/17/2017, my aerobic base was up to 132, my anaerobic threshold 146.    During the year or so I followed the program I lost eight pounds and about 5% of my body fat.  Clearly, the program works. 

Now the bad news.  “Building your aerobic base” can be a boring, time-consuming process.  Initially, it involved long workouts at slower speeds than I was used to doing. On the other hand, after following the workouts consistently, I really did gain stamina so I can now exercise at a higher intensity than before I started New Leaf.   Part of the problem is with the program protocols, which can set you up with an aerobic base that looks lower than it actually is so that you start off with workouts that are too slow.  I found that the short, easy-going warm-up recommended by the program was not enough to show what my heart could really do.  I learned to warm up longer and at a faster pace. 

All in all, a useful tool to add to the inventory of diet and exercise resources.