Thanksgiving

 

Yesterday I received a diagnosis of invasive lobular cancer in my right breast. Suddenly a lot of disparate things about the last year fell into place and made sense. The odd pains in my breast, the fatigue that I just couldn't seem to shake, the lack of interest in food (even chocolate!), the slow and unplanned (but not unwelcome) loss of weight, weird blood test results that no one thought were particularly alarming except me, and the general sense of something being wrong or off. 

There had been other things to blame: I have rheumatoid arthritis and we've been messing around trying different biologics this year. I have diabetes and chronic kidney disease, and severe asthma.  I was sick twice for a month at a time, first with cold/bronchitis/asthma complications, and second time with Covid (my first time I think)/asthma complications. We lost our beloved dog Bob this year. We lost yet another elderly cat. My husband lost one of his two jobs and we had to rethink our family budget. Of course, there was always the bad stuff in the outer world to add to my sense of gloom: global warming, regional natural disasters, the total dumpster fire of American politics. 

Having a diagnosis of cancer is actually a relief. I knew something was wrong, I just didn't know what and couldn't get anyone to figure it out with me, until now. So on Thanksgiving, I am actually grateful for my diagnosis. I am also enormously grateful for my loving husband, who stands by me through everything. Grateful for all the friends that I have around the country who care about what is happening to me, and the kind and helpful neighbors I have nearby, who are always ready to give a helping hand. Grateful that we have the resources and the health care to take care of my cancer. 

Some thoughts on exercise/step monitors

A little over two years ago my primary physician read me the riot act. She told me to start moving more or die. I was 307 pounds, had type 2 diabetes and rheumatoid arthritis.  I knew she was right in principle, but knew her blithe pronouncement that I should just start walking 20 minutes a day, at a time when I couldn't walk 5 minutes without getting out of breath, was unrealistic.

I already had a Fitbit One, though my use of it was irregularly and without much focus. I used the incomplete data I had to see roughly where I stood in terms of daily steps.  On the days I was using the Fitbit I was averaging about 900 steps a day. So I gave myself the goal of 1100 steps a day - a manageable goal.  Once I was doing that consistently (within a few weeks), I upped it to 1300 steps a day. Within another month I increased the goal again. Before long I was consistently recording 2000 or more steps a day. 

I lost 60 pounds. Which was great. And I felt so much better.  But a year and a half later I was a little frustrated. I didn't feel like the Fitbit One was accurately assessing the amount of effort that I put in.  I increased my overall activity level - both the intensity of my "exercise" but also my NEAT (Non-exercise activity thermogenesis) and it just wasn't showing up in my Fitbit record. I would struggle to add steps, but it didn't seem to make a difference in calories burned. Not to mention that activities that I did like house cleaning or yard work that made me sweat, pant and left me exhausted, were barely a blip in the record because not that many "steps" were taken in doing them. 

I can only speak for myself, but I suspect that others have the same experience: having rheumatoid arthritis and substantial osteoarthritis in back, knees, ankles, and feet makes movement challenging.  While pain is reduced by keeping moving, getting moving takes more effort. And when one is moving an obese body with painful joints the level of effort is even greater.  

When I retired this spring, I decided to try something else.  I got a Fitbit Alta HR which has a heart rate monitor in it, and that changed the way Fitbit recorded my exercise. My simple walks had the same number of steps (in the beginning) but the Fitbit now recognized that my effort was "cardio" and "peak" heart rates. When I added up and downhill on my walks the increased effort was noted. Calorie burn recorded increased. 

Having what I felt was a more accurate record of the effort that I was expending actually encouraged me to do more. I started in May with a 3,000 a day step goal and now have (and meet) a 7,000 a day step goal. Before May 2017, I had only 1 day with 10,000 steps a few years ago.  Now I have at least one day a week with 10,000 steps and hope that by spring 2018 I'll achieve a daily goal of 10,000 steps. 

This may not work for everyone, but for me, having what I feel is a more accurate record of the effort that I put into activity is rewarding and encourages me to set and achieve higher goals. 

finding a new path

Over the past two years my life has been rife with change, some good, some bad, some neutral, some unexpected, some much anticipated.

We've bought a new house and moved ourselves, our animals, and (most) of our belongings. It turns out that a move is a move with all the attendant disruption and financial pressures, even if the distance between the old house and new house is 25 feet.  A few months after the move, we took in a second stray dog - a 6 month old who still needed house training, and who chewed everything in sight (including some of the molding on the doors of the new house).

My mother descended rapidly into dementia and dealing with her bizarre delusions turned daily conversations into an emotional mine field. Ultimately six months ago, she had to be placed in 24 hour care.  At which point the pace of change ramped up.  The family house had to go on the market, decisions had to be made about belongings. Then suddenly mother had a heart attack and died. The family house got sold. Because of distance, lack of time, lack of resources, lack of energy, and lack of space here at home, the only realistic choice was let all those material things from my childhood go. Yes it would have been nice to have some of the beautiful pieces of furniture that my father had made in his workshop, or some of the delicate china and glass treasures that my mother had received from her parents. Now that choice is no longer available, all that represented my childhood has gone.

A week after my mother died, my older dog died.  For a long time, my day had been anchored in the evening by two things, walking my dog and calling my mother. Both anchors disappeared within a week of each other.

Six weeks after the dog died, I learned that my eating over which I'd lost control during this stressful period and the inevitable weight gain had thrown me over the threshold into full-blown diabetes. The fiction I carefully constructed for 50 years blew-up; that fiction was that being overweight didn't matter because I had good genes and the weight didn't affect my health . I'd always felt sorry for other people who had to watch what they ate. For 50 years, my cholesterol was normal, my blood pressure was not just normal but actually low, and my sugar metabolism was the envy of laboratory technicians in 5 states. Little did I realize the damage that I was doing, and that the bill would eventually have to be paid.

The next week while I was just beginning to figure out how to eat as a diabetic, my brothers came from California bearing not only mom's ashes, but also dad's (he died 2 and 1/2 years ago), to inter them in the cemetary in dad's home town in Virginia, which meant restaurants and family meals.

On the good change side, I received a modest inheritance, paid off all our consumer debts, paid down the new house, set aside some savings, and still had some left to indulge some long pent up demand - like replacing all the pillows and rugs that the young dog destroyed in her first year with us. But, being in debt had been part of my life for 40 years, since graduating from college, so this also is new, uncertain territory.

I was beginning to get a handle on how to eat, and how to exercise again (after hurting my back May 4 and breaking some ribs May 16), when the most recent blow fell this past Thursday from the cardiologist. The tiredness, exhaustion and shortness of breath - is probably some blockage in the cardiac arteries. How much blockage and where I go from here has to wait on more tests.

I have lots of friends who have been dealing with heart disease and with diabetes, several with both,  for many years.  I know that life can go on, and be a very rewarding life. I just don't quite know yet what that path looks like.

Creatures of Habit

Dogs are by  nature conservative, they crave routine and familiarity. Dogs happily take up routines and then insist that their humans stick to those routines.

Just seven weeks ago, my physician read me the riot act - with weight, blood pressure, blood sugar, cholesterol, and triglycerides all up, I had to start getting exercise.  This is difficult because I also have rheumatoid arthritis and exercise equates with pain in my back, hips, knees, feet, etc.  But my physician insisted and made me promise to try 10 minutes of walking every day.  She reminded me of how fit I had been five years ago when I walked the dog every day. 

This exhortation came at a good time. My husband John who had been walking both our dogs had to give it up when a sudden appearance by a stray cat, resulted in him face down being dragged down hill into the blackberry brambles. Two big dogs was just too much for one person to handle.

So that day, after my appointment, I came home and started our new routine. After John went for a 30 minute walk/run with our younger, more energetic dog Molly, we feed both dogs their evening meal, and then it was my turn to take Rosie for our 10 minute (now a little longer) exercise through the neighborhood. 

It was quite a struggle at first, between Rosie having forgotten how to behave like a proper dog with me, and all my aches and pains. But now things go much more smoothly, Rosie is well behaved, and the aches and pains are slower in their on set.

Rosie knows the routine very well now, after just seven weeks. As soon as her supper is eaten she looks to me to gather the baggie (to scoop the inevitable poop) and leash, and head out for our exercise. Makes it a whole lot easier to stick to the exercise when you've got those big, liquid brown eyes on you waiting for a walk.

fear

Every day at seven PM I call my mother. It is four PM her time on the California coast, but despite that time difference we are both generally at about the same place in our day -- dinner time. Most days the call lasts for ten minutes. Some days when we both have a lot of say, it can last half an hour.

Every day at seven PM I am witness to my mother's decline into dementia.  Her doctor and health care workers use the term Alzheimer's, but because I am not there I cannot ask them more detailed questions. I know from reading that not all dementia is Alzheimer's, and what is happening to her does not fit the way I have seen Alzheimer's described or depicted in the ubiquitous commercials for drugs and products. But then I know very little, and the disease progresses differently in different people I am told.

The most obvious symptom to me through our daily phone calls is the aphasia. She loses words. She knows what things are and what they do and what they are for, but she can no longer retrieve the names for them. Common everyday objects, events and actions escape her. She is acutely aware of this problem and struggles. Sometimes I will try to supply a word here and there, but mostly she seems to prefer to just provide round about descriptions (such as "that nosy box with pictures in the living room" for TV). She has also forgotten how to do things, like all but the most simple cooking, and can only write a check with substantial assistance from someone. Numbers and arithmetic are almost completely beyond her. She never learned to use a calculator and certainly will not now.

The biggest crisis in my mother's life at this particular point in time is that the company that provides municipal garbage and recycling pickup for her California suburb, has suddenly decided to entirely change the rules. They have delivered three big huge wheeled containers, one green, one blue and one black, and detailed written instructions on what can and cannot go in each one. My mother is utterly bewildered by this.

She has daily assistance, and I imagine that Jennifer has a much firmer grasp on what is required for properly filling these new containers. But my mother wants to be able to understand this herself, and she simply cannot get her mind around how they will store and dispose of the various types of recyclables, trash and garbage.

I feel for my mother, and her pain and anxiety. But am comforted by the knowledge that Jennifer and my brother Charlie are there to take care of the actual logistics of this particular crisis.

There is however, my own growing fear that I too am slipping down the long slippery slope to cognitive disorder.  My mother is 86, and I am only 59, but I believe I see the signs and symptoms in myself. 

I have had problems with word loss for more than 15 years, and it has been getting worse. Nothing like my mother. But  a couple of times a week, I will be lecturing in class or talking to my husband, and suddenly will be unable to capture the right word -- not every day nouns and verbs like my mother now has difficulty with, but everyday, routine concepts of my discipline and the social sciences in general, and with descriptive adjectives and adverbs. Some weeks, when I am tired or stressed, are worse than others.

The other thing that frightens me, is my reaction to new and novel situations or the disruption of routines. I become mentally flustered, and sometimes panicked, and have the unfortunate tendency to lash out angrily at those around me (primarily my wonderful, patient husband, who deserves far better than he's gotten of late). Within moments of my outburst, I feel remorse, but the damage is already done.

If there is time to think about some thing new, figure out what is going on, what needs to be done, and then act, I'm fine. It's the situations that require an immediate response that throw me. Yet, everything I read tells me that what I need is more novelty.  I need to get out of my ruts, challenge myself with new tasks, meet new people, try new places and activities -- especially physical activities -- to stimulate my mental "muscles."

Unfortunately my actual physical muscles -- or more specifically my joints -- are undermining efforts in that direction. The RA seems to be progressing. After two years, my medications no longer seem to prevent the end of the day exhaustion. Daily housework chores like dishes and feeding cats overwhelm me.  Weekly chores like house cleaning and laundry -- well, it's been a long time since those were actually done on a weekly basis.  It seems clear to me that it will not be long before I will need to have more help around the house than John can provide, even if he were to provide more than he already does.

How long do I have before I become like my mother? How long before I can read the words but no longer make sense of the content? How long before I can no longer remember how to work my computer, send e-mail? How long before I can no longer have a normal conversation?

What do I need to do to provide security for myself and John before that day comes? What things is it essential for me to do and say before that day comes? What legacy do I still have to leave before I can no longer communicate with the world in a meaningful fashion?

home, home on the range (or oven)

Just a little more than a year ago, I was diagnosed as "pre-diabetic" -- blood sugar levels above normal, but not yet in the range of full-fledged diabetes. This shocked me to my core, and I stopped eating (and baking) sweets. With the help of a clinical dietitian I rethought my diet entirely, and over the past year lost more than 50 pounds. By last summer my blood work showed my sugar levels back in the normal range, but I have continued to very carefully watch my intake of sweets (as well as carbohydrates and fats).



I finally felt confident enough in my ability to regulate what I eat, that I was willing to try some baking again. I love baking. Not all that much interested in cooking, but oh, baking! My mother got me a learning to cook book Mary Alden's Cook Book for Children, when I was about eight. It was designed to teach good kitchen habits as well as culinary skills. There were certificates to be awarded by parents when one mastered things such as "The Clean Kitchen Cook."

After mastering all the baking in my learning to cook book, I started tackling baking projects from my mother's 1949 Joy of Cooking. Plus there were great recipes for brownies, fudge and other chocolate goodies on the Hershey's Coca containers. [Remember when those were actually metal tins?]

So in the past few days I've been on a pumpkin rampage. I love pumpkin baked goods, and they have the virtue of using a vegetable, and using less sugar than many other sweets. I substituted a Splenda/brown sugar blend to further reduce the sugar used, and got fat free sweetened condensed milk, and low fat Philly cream cheese for my pumpkin cheese cake, pumpkin pie, and my hybrid pumpkin cheese cake pie. Haven't tasted the last one yet -- its still cooling in the fridge.

I enjoyed the process of baking, got to practice sensible eating of sweets (small slices in conjunction with meals), and delighted my husband the runner who has to load up on 3600 calories a day when he is running five to ten miles a day.

The photo's of the Front and Back covers of Mary Alden's Cook Book for Children, including the Clean Kitchen Cook certificate come from a wonderful cooking blog Sue's Kitchen. Which seems very appropriate.