Taking it slow and maintaining a mental energy surplus

I would prefer to be working, in a rewarding job that uses the skills and knowledge I built during my schooling and my short stint working as a scientist. However, work in scientific research (and that fits my CV) is very thin on the ground so I tried a 9-5 office job for a while. That didn’t work out either, and part of the reason why was my own mental health. Due to various life stresses I was suffering from high anxiety.

In the end, not working has been the best thing for my mental health. Although, it has taken over a year for me to really see an adjustment. When the anxiety was at its worst I tried medication. I’m still not really sure that did very much. Perhaps it toned my mood down from super-reactive to just ‘constantly more anxious than I wanted to be’. Along the way I have (slowly) increased my physical activity levels. This certainly has helped. Growing up I was the opposite of a sporty kid; always picked last for team sports; horizontal with a book whenever I could be; ducked whenever a ball was thrown in my vicinity etc etc. But now I would urge everyone to find their ‘thing’, try whatever physical activity you can so that you find something that motivates you to move. What has helped most of all though, is slowing down.

Slowing down, strangely enough, has taken a long time (it’s a slow process, ha!). For the first few months of not working I would be excited at first, thinking about all of the things I could do with my surplus of free time. But then the anxiety would crowd in and form all of these intrusive thoughts. It’s hard for me to recall exactly what they were now, as I’m not in that mental space anymore. Anyhow, the end result was that while worrying about all of the things I should be doing my mind would be racing in circles till I found a distraction to quieten it. And then I would be doing very little, which of course led back to the start of the cycle.

Over the course of a year I’ve slowly become more and more productive and come up with strategies to mute the worries. One has been to stop, take a breath, and remember ‘It doesn’t matter’ (because in fact, it very rarely does). And this whole time I’ve worked through the newest stress, infertility. The strategy to help with that one has been to write this blog. It’s not just the writing, but getting all of the thoughts in order before writing that’s really helped there. Anything is better than being stuck on the same thought on high repeat like an annoying song in your head!

When I was in high school I researched Taoism for an assignment and I’m reminded of that philosophy by realizing that I’ve had to slow down and think less to be able to think more and get stuff done. One day recently I was peeling apples for a dessert I was going to bake (apple crumble/ crisp) and my ability to calmly make a decision proved to me how much progress I had made. It’s such a small thing! I went to prepare the apples but then I got momentarily stuck deciding whether I should peel them. Sometimes I don’t peel the apples because I think it is healthier that way. However it’s also sometimes less tasty with unpeeled apples. It should be a simple decision right? But this is exactly the kind of thing that would get me stuck previously. Some of the thoughts might range from, “well if it was just for me and hubby I would leave the peel on, it doesn’t have to be an excellent dish because I’m just cooking it to use up these apples”, “but I’m going to share this dish with friends also, and they might find the peel odd, so I should remove it for them”, “but peeling is a hassle, it’s much easier to skip straight to the chopping step” and inevitably I would recognise that it was irrational that I was taking more than a millisecond to make this decision, and then I would feel bad about the whole thing. At least with this example, the apples can remain on the bench, without adversely affecting anything else, while I make my mind up, which won’t even take that long. What will be impacted is my motivation for the activity, something I would normally enjoy but one I could manage to ruin for myself. The worst of these times was when I was trying to decide what to do with my day, then I could get really stuck.

But this time I had successfully decided that I shouldn’t let a bag of apples rot in the bottom of the fridge, and I was enjoying the simple pleasure of baking. And I grabbed the peeler, and ran it loosely around the apple without any care or precision and then I thought, “That’ll do!”. And I realised I’d found a third option, a compromise, that I might not even have thought of if I’d been consumed by needless anxiety. Maybe it sounds silly to be proud of a solution consisting of ‘partially peel the apple’ but it illuminated my slow, calm mind in that moment and I knew it meant I could achieve so much more.

Maybe it’s a part of growing up, and maybe it took being in a dark place to learn a little, but I am much better at focusing on the things that are actually important to me now. What’s more, I can only see that continuing and it’s something I’m really grateful for 🙂

peeling

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HRT – not for me, but still attending to bone health

If you have been diagnosed with ovarian insufficiency (or ovarian failure if your doctor is old-fashioned) you will most likely be offered hormone replacement therapy. Actually, my doctor hasn’t put a name to my ailment, which is understandable seeing as any of these names just mean “your ovaries are not working and we don’t know why not”. Yet she has suggested that I take hormone pills. This struck me as odd because I know that hormone replacement therapy (now also referred to as menopausal hormone therapy, or MHT) is not freely prescribed to menopausal women anymore, now that we know more about the risks.

The recommendation is therefore that individual women need to make up their own mind in regards to HRT, taking into consideration symptoms (such as hot flashes) and risk factors. Oh, unless they have POF/POI, in which case they should take some form of HRT, and for many years (according to many doctors). The assumption seems to be that if a reduction in oestrogens at menopause is bad, then a lack of oestrogen over many years must be worse? However, if the evidence for HRT use in older women is murky and confused and ultimately shown to cause more problems than benefits, then surely recommendations given to younger women like myself are based on something more than this assumption?

My bias is towards not taking any pills in general*. Knowing this bias, and that it is a good idea to challenge my biases I was urged to look into the risk of osteoporosis in women with POI. I would probably feel like an idiot if I ended up replacing a hip just because I blindly refused to swallow some estrogen.

Popat et al 2009 is a study looking into this, with the main finding that women with POI do have lower bone mineral density and therefore that this is of concern. On a detailed reading of their paper I had a few queries though. To quote: “As shown in Table 2, factors that were significantly associated with a Z-score** below -2 were low vitamin D levels (<32 ng/ml), low body weight (<55 kg), lack of regular exercise, not taking hormone replacement, and inadequate calcium intake (<1000 mg/d) (all P values < 0.005).” [emphasis added] The problem here is that the data for the women not taking hormone replacement is not shown in Table 2! Despite the omission of this data (to show the size of the effect and associated statistics), the discussion section of the article states “time not on hormone replacement is significantly related to lower bone density in young women with estrogen insufficiency”. This is conflating two factors that were looked at in the study; delay in diagnosis (significantly associated with a lower Z score) and not taking hormone replacement of any kind. These two factors clearly should be considered separately seeing as some women were taking the contraceptive pill prior to their diagnosis. And then there is the fact that the very next paragraph on pg. 2280 discusses the different hormone regimens the women were on (including no replacement) and then states that a Z score below -2 at any site (any bone), the same measurement that Table 2 presents, was not different between any of the groups. I’ve twisted it around in my head, and double-checked the authors definitions etc. but these two paragraphs just do not make sense together. Additionally, neither serum estradiol, nor serum FSH were associated with a low Z score. The lack of association with FSH surprised me the most actually. The higher your serum FSH, the more closely you resemble a menopausal woman (as interpreted by doctors) so you would think that this negative finding would be worthy of discussion.

Basically the data that might support HRT is given in an unclear way, with some errors in reporting that frankly should have been corrected during peer review; the data that does not support HRT is downplayed/not discussed. The statement in their discussion section that “We show that time not on hormone replacement is significantly related to lower bone density in young women with estrogen insufficiency” is quite a jump from the actual data that has been presented. At least the authors finish the discussion with “Long-term prospective studies on fracture rates are needed to establish a true causal link between estrogen deficiency and fracture risk in this population.” And that kind of sums it up for me. Bone density and oestrogen decline for most women around age 50, but lifestyle leading up till then (and beyond) remains quite important (adequate vitamin D levels, calcium intake in the diet and good weight bearing exercise). Long-term hormone use is not recommended for menopausal women and until I see some decent data for women in my position, I’ll just use my intermittent menstruation as an excuse to eat more dairy 🙂

Always happy to eat more cheese. Not so happy with the big pink pill... but i'll do it for my bones.
Always happy to eat more cheese. Not so happy with the big pink pill… but i’ll do it for my bones.

*on my doctors recommendation I am taking calcium tablets (with extra vitamin D), even though they are large and usually make me gag.

**a measure of bone density

Back and blogging, after a break and with a sense of renewal (in the garden, the mind and even the womb)

Hello 🙂

I’m not sure if anyone besides a few friends and family members are following this blog but i’ll explain my absence just in case. I’ve just returned from a trip to the USA where we had a lovely time spending the last days of summer with my husband’s family. I guess i could have written a blog post or two while i was away, but i wasn’t really thinking about infertility, or science or sustainability so there wasn’t much to update.

I felt a bit odd ‘taking a break’ seeing as i don’t have paid employment at the moment. It also wasn’t really a holiday/vacation for hubby as he had some work to do in terms of sorting through childhood collections stored in his parents basement. Nevertheless, the cliche is true and a change really is as good as a holiday and we’ve both returned with renewed vigour. It helps that it’s coming into Spring here! Yup, the seasons are completely opposite.

Plenty of things have sprung back to life in the few short weeks that we have been away, including the plum tree at the back that looked dead after our hack pruning job:

plum

Most welcoming of all was the magnolia. The furry buds that withstood the winter were all closed tight when we left but are now in full bloom.

magnolia

There’s even a bunch of new little lettuces growing in the veggie beds after i let the last batch go to seed. And quite a few other plants that looked like they were almost killed off by winter frosts but have managed to spring back (vietnamese basil, mint and parsley, rhubarb).

Coincidentally, my lady bits (aka reproductive organs) got a bit of renewal after our trip also. I noticed while we were away that i had beaten my record for longest gap between menstruating, this time was just over 16 weeks (old record was 15 weeks). But 16 weeks is still less than 12 months so i am still officially pre-menopausal, hooray! However, I’m glad my period didn’t arrive while i was on the plane! Instead it was very convenient and occurred one day after we got back so i could curl up for a little bit and wait out period cramps and jetlag at the same time. I can’t help but feel that getting a period is a good sign in that maybe my ovaries and uterus are cooperating. Maybe not enough to make a baby, but at least enough to prove that there is plenty of life left in me.

I also can’t help wondering why i get a period after such a long gap. I ate a little more meat and seafood while we were away, and my neurotransmitters/emotional state are always in a good place when i travel, see fun new things and spend time with loved ones. Perhaps this all made a difference and if that’s the case i’m happy to keep it up. Strangely we’ve now spent more time with hubby’s family this year than with mine. In about a week we’ll balance that out somewhat with a weekend in Melbourne (just a 7 hour drive, rather than 20+ hours in a plane).

I’m sure the garden is going to keep on ‘renewing’, with every little plant and critter taking advantage of whatever nutrients and gaps of sunshine that they can. I’ll (figuratively) do the same. Oh that reminds me! We also came back to a brand new Prime Minister (like a President, only different), and this one likes science and technology. Fingers crossed he can convince some of the other politicians that innovation is worthwhile, then who knows? perhaps there will be a job somewhere in the future for this unemployed scientist? In the meantime i’ll keep my science mind engaged by writing on here.

fresh spring leaves for the apple trees
fresh spring leaves for the apple trees