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With Fall approaching, I began to get an itch. An itch to tear my entire house apart, reorganize, and donate things that do not bring me joy. Given my last day at my corporate day job was approaching, it seemed like a bad idea as I needed to focus my energy on booking clients, but it was uncontrollable. As a human with ADHD, I find it difficult to focus and get work done when I don't have a clean workspace, and given I'm now working so much from home, my entire house has become my workspace. I had spent the last year or so (basically) working three jobs, and my home had officially devolved into a disorganized mess. I began to feel I couldn't do anything else until this was resolved. I was paralyzed. "Clutter isn’t just the stuff on the floor. It’s anything that gets between you and the life you want to be living” - Peter Walsh Officially moving into teaching and coaching full-time, I was finally doing what I wanted to do. Still, the idea of being unable to reach a pan under the counter because there was unnecessary sh*t in the way made me batty. It was like the final step in living my best life. It had to be done. But why was I feeling this way? When I tell you it was uncontrollable, I'm not being hyperbolic. As it turns out, there is a logical explanation and it has everything to do with our mental health. According to a study by Princeton University, researchers discovered that our environment can positively or negatively impact our ability to complete tasks and overall mental health. If the physical space around us feels scattered, our mental space will likely feel the same. A study by the University of Connecticut found that by removing or controlling clutter, we can directly reduce the stress that stems from the mess, which can help us to feel happier, less anxious, and more confident in ourselves. Decluttering can also lead to the following mental health benefits: Boost your mood and help improve your physical health. Completing physical activity while organizing can enhance creativity by allowing the mind to wander. Letting our mind go a little as we manage our clutter can help us relax mentally while our body stays active. Combining the two can boost our mood because we feel less stressed about what once was clutter, and we feel accomplished after seeing the progress! Sharpen your focus. Clutter is very messy and chaotic, so it is no wonder we can struggle to focus. When your space is de-cluttered, it is much easier to obtain a sharper focus because what you see is in a specific place. The sense of organization helps your mind to be on track to complete tasks. Energize you into productivity mode. When you are decluttering, you are problem-solving and getting things done. You gain energy from the visual accomplishments of decluttering. Your accumulated energy can also help tackle other items on your to-do list! Relieve anxiety. When things are not organized or clean, it can bring fear. You may feel constantly stressed, worried, or afraid of more clutter accumulating. To allow our minds to find peace, decluttering can lift that weight and help us think clearly and feel calmer. According to Psychology Today, It is estimated that 1 to 2 million people in North America are living with so much clutter that they can barely walk through their homes or find a place to sit or a surface to rest a plate. Although it is not classified as a separate disorder in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM IV), compulsive hoarding is a debilitating condition that can destroy relationships and tear families apart. In my case, it was the physical clutter of my home, but clutter can include everything from the mess in your kitchen cabinets to the digital clutter of unanswered emails and texts. Chaos can lead to a feeling of overwhelm and paralysis and, as I found out, is directly linked to past trauma. You can learn more here if you'd like to open that can of worms. I've nearly finished my decluttering journey, and I can tell you I have much less anxiety and MORE focus. The relationship between clutter and anxiety is something that many people struggle with. Could clutter be standing in your way or causing (what I like to call) background anxiety? If you're someone who finds yourself constantly battling clutter, it might be time to take a closer look at how it's affecting your mental health. By prioritizing organization and minimizing unnecessary belongings, you can create a space that promotes calm and clarity. You can try these steps laid out by The Queen Bee herself, Marie Kondo, here. Let me know what you discover!

This is a follow-up to my June 5, 2023, post about the relationship between ADHD and menopause. If you haven't already, you can read it here. This journey started when I asked myself, "Do I have ADHD, or is it perimenopause?" The answer is that it's a bit of both. In mid-June, I got an appointment with a highly recommended psychiatrist who takes insurance (I know -- a miracle!) and received an official diagnosis of ADHD. As I mentioned in my previous post, I was pretty confident I'd dealt with this since childhood. Still, it wasn't until I hit perimenopause that the symptoms were exacerbated, and I was forced to pay closer attention. With ADHD being underdiagnosed in young girls, this is the story of many adult women. Suddenly, so many strange behaviors over the years made sense, like my ability to have singular hyperfocus on a task yet procrastinate uncontrollably on others, speaking a million miles an hour, unable to let others get a word in, yet I can employ active listening in my coaching. My ability to have a rockstar-level executive function as an administrative assistant, but I experience time-blindness in my personal life. ADHD is contradictory. This much I have learned. It's such a relief to know there is a reason for the madness, but it's still a struggle. So, what steps have I taken to make it more manageable? Medication isn't for everyone, but I wanted to try it. This was particularly important to me because it's (believe it or not) the surest way to confirm the diagnosis. When you start an ADHD medication, it will either help with focus immediately or make you feel um...unhinged. In other words, if the meds work, you have ADHD; if you feel like you're going to have a panic attack, you don't have ADHD. Pretty simple. I started a low-dose prescription of Vyvanse, and fortunately, it was not the latter. It was a keeper. What do I like about it? Unlike Adderall, it's the timing of the time-release -- Vyvanse provides 10 to 12 hours of symptom control and takes up to one hour before it first takes effect. In comparison, Adderall can last for 10 hours, but the immediate-release formulation only lasts six hours, causing most patients to take an additional mid-afternoon dose. With that, on Vyvanse, you're less likely to crash, and (most importantly) it's less likely to f*ck with your sleep schedule because you're not double-dosing. I'm not thrilled with the idea of taking medication, but the good news is that I don't have to take it every day. For example, I didn't take it on vacation last month, and I don't take it on most weekends. This ability to skip doses also makes it more productive long-term - a genuine concern because as time passes, you can plateau with the dosage, forcing you to take more to get the same results. I want to avoid this. "How about lifestyle, Julia," you might be thinking to yourself. Yes, I changed my lifestyle in addition to taking meds. Firstly, I added additional morning workouts because I feel more focused and energized when I exercise in the morning; if you want to know more about the science of that, you can listen to CTD season three, episode 56, with Dr. Wendy Suzuki here. I started using the Task List feature in the Evernote app and incorporated deadlines with alarms to help me organize my scattered noggin. When having a particularly disordered brain day, I can go to my list and tell myself, "You have X things due by X day. Choose one of these three things on the list and START." I find that's the hardest thing. I often feel so overwhelmed by my to-do list that I don't know where to begin. Parsing my list out into sections by the due date helps with that feeling of being overwhelmed because I can see exactly where I need to start. Another thing I began using is the super, basic iPhone alarm. If I have a busy day, I program my entire schedule into my alarm app. I set each notice to go off at least 15 minutes before the actual task, meeting, or whatever! For example, I set an alarm for 30 minutes before leaving for Physical Therapy and 15 minutes before a podcast interview. This has done WONDERS for my time blindness. Lastly, and most importantly, I've given myself grace. I know it's corny, but I've spent countless minutes, hours, and even days beating myself up for missing an appointment or not remembering an evident and essential detail about something like my dad's birthday. I've been cruel and unforgiving of myself when I would never treat a person I cared about that way.I'm happy that I now better understand what's going on in my head. As I've said before, naming the thing is everything. If you are the slightest bit sus about having ADHD, it's crucial to get a diagnosis. We have SO much coming at us as mid-life women, and it can be empowering to know what the heck is what. Only then can you take the steps to manage it.

Hilary Russo talks to us about the power of Havening! Your amygdala loves to freak out. She does. Yes, it is a she. I’ve met her, and her name is “Amy.” In the Havening world, we call her that because she is many things. Amy is a warrior who wants to stand up for herself. But she is also a scared child that needs protection. And whatever the situation, when Amy feels threatened, she must be reminded of something important. All is well, and you are safe here, in your haven. Enter: Havening Techniques. This neuroscience-based approach uses touch and pleasant distraction to rapidly alter your thoughts, moods, behaviors, and habits (within minutes, really) and permanently. What happens next is like “CPR for the Amygdala®.” Your brain releases the happy chemicals, including oxytocin (love hormone), serotonin, dopamine, and GABA, and then enters a Delta Wave sleep state. Trying to find the calm in the chaos is like hitting a traffic light that’s red and putting the pedal to the metal as if it were green. You just can’t do both at the same time, and the outcome likely won’t work in your favor. You need to self-regulate and find that sweet spot where you’re in the parasympathetic nervous system. And that’s where Havening can be helpful for everyday upsets like stress, anxiety, lack of focus, and sleep to deep-rooted traumas (when working with a certified practitioner) like PTSD, panic attacks, addictions, grief, and fears. There really is no downside to how this beautiful modality can set you free and help you find your clarity, confidence, and calm. It’s also a wonderful (SEL) social and emotional learning tool for children at any stage. The best part of this approach is that you can self-apply to self-soothe for self-care with Self-Havening when it comes to life’s disturbances. And here’s how it’s done. The Havening Touch is three simple moves. This video demonstrates more about how it works. The movement is like you are washing your hands, giving yourself a hug (arms crossed and gently stroking from shoulder to elbow), or lightly caressing your face. When you close your eyes and pair the touch (any or all three) with a pleasant thought (it can be a person, place, experience, or even a song), you are letting Amy know, “I’ve got you,” and you’ll likely feel lighter, calmer and more at peace in minutes. If you feel like you need more support with traumas or deeper-rooted upsets that may be holding you back and weighing you down, it’s always best to work with a trusted and trauma-informed practitioner who can facilitate a session and work with you through the process. Havening has the power to turn your traumas into triumphs and help you heal from within. Give yourself the gift of active emotional well-being by putting the healing in your own hands. It’s the Healing, Understanding, and Gratitude that your mind and body need to be kind to the mind. Check out our CTD podcast interview with Hilary for a deeper dive here. Hilary Russo, is The HIListically Speaking® Health Coach. She is one of the first 150 Certified Havening Techniques Practitioners in the United States and 500 in the world of, only 800 worldwide. Hilary studied directly under the developing doctors of Havening, who have called her a “pioneer” in the field working with children, as well as purpose driven C-Suites execs to Metropolitan Opera singers and media professionals in the field of secondary traumatic stress. Trauma informed, her HUG it Out™ program is designed to mirror back what you don’t see in yourself with neuroscience based tools that help you heal from within. She’s also a Certified Integrative Nutrition Holistic Health Coach, certified Hypnotherapist and award-winning multimedia host/journalist and international speaker focusing on health and wellness. Hilary is also a college professor at St John’s University in NYC. Join Hilary’s HUG it Out Collective on Facebook. You can also find Hilary at the mic hosting the successful HIListically Speaking Podcast: empowering conversations of trauma to triumph through health healing and humor. If you’re interested in learning more about Havening, set up a complimentary HUG it Out session today to see if Havening is right for you! Connect with Hilary on all social media at @hilaryrusso.

I have said this before, but the mental challenge of recovery is almost more difficult than the physical. By mid-month two, I started feeling more like a normal human being and less sad about, well, everything. At month three, I ditched my brace completely and am now walking without a limp most of the time. My knee is still quite stiff in the morning, and I have to do my daily PT to warm it up for movement. Getting back on the elliptical machine has been a godsend. I'm close to reaching full knee flexion, and I've been fitted for a functional brace, which I hope to pick up later this week. This new brace is typically used if you're returning to sports (which I'm not), but I will use it for workouts and (hopefully) some hiking with my dogs soon. MOST IMPORTANTLY, I did my first Pilates Reformer class since March! 👊 Challenges between months two and three: Swelling during month 2 continued to inhibit my ability to reach full extension while walking. My Physical therapist implemented something called the Graston Technique, where he used a metal tool to break up the swelling and scar tissue under my patella. It was a game changer, but I wish he'd done it sooner 🤔 The "catching" I was experiencing in the later part of month one into month two was actually my lax quadriceps tendon getting caught between the tibia head and femur head. This is normal, and I don't know why no one mentioned this from the beginning, but my surgeon confirmed this during my three-month post-op visit. This is extremely important to note because though it is prevalent, it can be scary if you don't know that. For a while, I was convinced that it was my meniscus and that I was f*cked. NOPE. As my quad gets stronger, the less it happens, and it should completely resolve in the coming months. What the f*ck is the Popliteus, and why is it important? The Popliteus is a small, thin, flat, triangular-shaped musculotendinous complex of the lower leg with the popliteus muscle and the popliteofibular ligament. It constitutes a part of the posterolateral corner of the knee. It is a deep knee joint muscle forming the popliteus fossa's floor. In Lamen's terms, it's a deep muscle behind the knee. Why is it important? If it's super tight (and yours probably is), you will have difficulty reaching full extension. It wasn't until I got some manual therapy (massage) in the back of the knee and upper calf and started stretching my calf/soleus that I reached full extension while walking. Additionally, when watching TV at night with my legs on my ottoman, I put a 5 lbs weight on my quad to help ease my leg into full extension. Lessons learned: Using a compression sleeve. I have no idea why this wasn't recommended by my doctor or my PT to control swelling. I took it upon myself to purchase one and start wearing it regularly. It was another game-changer. It contained the swelling beneath my patella and lifted my quad, so there was less "catching." If you don't have one, buy one! Trying other PTs. Some people are of the mind that it's important to see the same person over and over again. Respectfully, I disagree. Good physical therapists come from various backgrounds and training and employ different techniques. While physical exercise and strengthening are important, manual therapy is just as necessary. Some PTs are better at running you through mobility and stability exercises, while others have a real intuition and perception of the connective tissue and muscle that needs to be released with touch/massage. This, more often than not, is not the same person. Advocating. It never ends! It's important to be and continue to be self-educated and involved in your recovery. Google has everything you need to know about the knee structure and then some. This understanding, along with trusting your intuition and listening to your body, keeps you safe and asking critical questions about your recovery instead of constantly assuming everyone else knows better. Trust me. That's not always true. You know your body best. This is NOT me telling you to disregard your PT's instructions, but this IS me giving you permission to challenge them. They just might agree with you! Ice, Ice, Baby! I'm still icing. Yup. If you're still swelling, you're still icing. I'm on my feet a lot and finally getting back into doing my normal commute into the city, which = a lot of walking. I keep the compression sleeve on and ice every night before bed. Three - four-month milestones and what to expect: OBJECTIVES Confidence in knee stability Maintain motivation Running Improve aerobic fitness. METHOD Progress proprioception Agility skills, advanced plyometrics, cutting, hopping figure 8s Increase speed/height of step/height of jump gradually as confidence improves. GOAL: Safe to introduce open kinetic chain exercises if indicated You should have good hip and knee control and proprioception, and be free of effusion to initiate running. MILESTONES To be able to hop in a figure of 8 around chairs 3m apart Full knee flexion (130º+) or equivalent to non-affected (not vital – ROM equal to functional needs) Able to perform power-based activities – 3 sets of 10 repetitions squat with weight and correct alignment Perform independent sport-specific exercises.

Certified EFT practitioner Sarah Louise Lilley tells us what it is and why it's great for regulating stress! Stress's profound, negative impact on our bodies has been extensively documented. 🥁Insert dramatic drum roll… Fortunately, there’s a powerful technique called Emotional Freedom Technique (also known as EFT or Tapping) that can help regulate stress. While EFT is commonly used for addressing PTSD, trauma, and phobias, it’s also a tool to alleviate everyday stress. Scientifically proven to lower cortisol (the stress hormone) and increase DHEA (the recovery hormone.) EFT is a simple and effective tool that only requires using your fingertips! 🖐️ Tap Away Stress: Whether you’ve just experienced a difficult interaction with a family member, are preparing for a challenging work meeting, or are winding down at the end of the day, I encourage you to tap. Tapping enables you to acknowledge and release the stress in your body, preventing its accumulation. A Moment to Pause: Tapping also allows you a valuable moment to pause. During times of stress, blood flow is diverted away from our brains, impairing clear thinking. EFT provides an opportunity to calm the nervous system, allowing cognitive function and creativity to resurface. Doing so allows us to consciously choose how to respond rather than reacting from a triggered or habitual place. Calm the Body, Calm the Mind: Unfortunately, we seldom indulge in positive fantasies. Imagine if we were obsessed with all the good things that might happen! However, particularly when stressed and anxious, it’s easy to fall into negative thought patterns, ruminating about potential future catastrophes. Tapping breaks this cycle, serving as a powerful pattern interrupt. As I frequently tell my clients, the stress isn’t in your head; it's in your body! When you calm the body, the mind follows. A Simple Practice to Calm the Nervous System: If you’re feeling triggered, anxious, or stressed, here’s a simple practice that can help you move from your mind to your body, process stress, and calm your nervous system. Tune into your body. Notice where in your body you feel that stress. Is it in your head, stomach, or solar plexus? You can even put your hand on that part of your body. Does the sensation have a color, texture, size, or shape? Maybe it feels like a lead ball or a swirl of gray fog. Then Tap on the EFT collarbone point, or move through the EFT points as you breathe into that physical sensation. Not forcing anything, but breathing into it as you allow it to shift. Embracing the Power of EFT you hold within your fingertips (literally🤣) the ability to tap away stress, pause, and break free from negative thought patterns. Happy Tapping! ❤️ Sarah Louise Lilley is a certified Emotional Freedom Technique or “Tapping” practitioner. She loves helping people overcome their fears, blocks, and phobias. Sarah is a mentor at EFT Universe, where she teaches and nurtures the next generation of EFT practitioners. A former actor and producer, she is also a mom and an avid equestrian - always counting down the days until she can get back on a horse! Based in NYC, Sarah works with clients worldwide via Zoom. To learn more, you can visit her website here. Listen to her interview dropping July 5th on Circling the Drain Podcast here.

I know. As if we need one more symptom or issue to worry about at this stage of life. Am I right? The good news is that NO - there is no connection. Well, not exactly. But. According to CHADD.org (Children and Adults with Attention-Deficit/Hyperactivity Disorder), there is a severe gender gap that leaves girls and women under-treated, under-diagnosed, and often misdiagnosed: Girls frequently display inattentive symptoms, including forgetfulness, trouble paying attention, and problems with organization. Boys tend to display hyperactive/impulsive symptoms, like blurting out or being unable to sit still in class. These hyperactive/impulsive symptoms get noticed more easily by parents and teachers while inattentive symptoms sometimes get ignored. Girls are also less likely to be diagnosed earlier because they often display more symptoms of anxiety. Medical providers may only treat a female patient’s anxiety or depression without evaluating for ADHD. Hormones, which affect the symptoms of both ADHD and anxiety, can complicate things. ADHD was never something that EVER crossed my mind. Not until I was put on a low dose (150mg) of Wellbutrin to treat low libido. If you listen to Circling the Drain podcast, you know that Ellie and I have been on an experimental journey looking for low-libido solutions, and this was part of that experiment. While it didn't help with my libido, it did help with my focus. I was shocked. "Is this how I'm supposed to feel? Are most people this focused?" I thought. It turns out Wellbutrin is prescribed off-label for both low-libido and ADHD. Until then, I thought much of my behavior was perfectly normal. I have an A-type personality and consider myself a person who gets sh*t done; how could I possibly have ADHD? I've worked as a C-suite executive assistant for over 13 years in the high-stress, high-demand world of real estate development. If I didn't have my shit together, I'd fall on my face, right? Maybe. It wasn't until a friend recommended KC Davis' podcast Struggle Care, episode 31: Wait. Am I ADHD? with Dr. Sasha Hamdani, I realized I might be wrong about EVERYTHING. Do you ever listen to a podcast or read a book where you feel like someone is speaking directly to you? It turns out my ability to hyperfocus is probably what has kept me employed all of these years. All people experience hyperfocus in some way or another. You might call it being in the zone. However, when you have ADHD, it's either hyperfocus or NO focus. Women are VERY good at getting by and creating workarounds to cope with ADHD. Are we really surprised? We've been coping our whole lives. As I said, girls are often undiagnosed because their symptoms are not as apparent as with boys. For example, a boy might have outbursts of hyperactivity, but a girl might be hyper-talkative and easily distracted. Boys may openly fidget, while girls (taught to keep to themselves) may bite nails, pick cuticles or sometimes describe "internal hyperactivity." I think you can imagine what that is. Also, this trapped energy might manifest as a tic. More on all of that here. That was my story. I used to go through bouts of blinking uncontrollably. My mother's solution was to take me to the eye doctor, who (of course) said there was nothing wrong. I mean, it was the 80s. This habit went on for years, and I still want to do it occasionally (my husband has caught me), but as an adult, I have more control over my body, so I'm more aware. What does all of this have to do with peri/menopause? ADHD can be exacerbated by hormone fluctuations and everything else that comes with this time in life! More on that here. You might have gone your entire existence thus far without knowing you had ADHD, normalizing some minor, strange behaviors until something happens that forces you to pay attention. Like when I missed three different podcast recording appointments because of something called time blindness. I went from asking myself, "Is it me or is it perimenopause?" to "Is it me, perimenopause, or ADHD?" Indeed, many symptoms of peri/menopause are also symptoms of ADHD. For example, forgetfulness, depression, anxiety, and irritability, overlap, making it hard to tease out what is what. Some less common symptoms here: Being easily distracted Frequently failing to complete tasks, work, or chores Making careless mistakes Easily losing items Forgetting to do necessary tasks Having difficulty making plans Feeling easily overwhelmed by tasks or projects Inability to commit to a decision Difficulty with time management If any of that resonated with you, I'd suggest starting with the podcast episode I listed earlier. If it makes you feel seen, you might want to schedule an appointment with a therapist who can evaluate you and ultimately refer you to a psychotherapist for further help. I'm meeting with a specialist this week and will keep you all posted!

It's been a month, and it hasn't been easy, but I finally feel I'm seeing real progress. The mental toll that this has taken was unexpected. I had a pretty good attitude about it for the first couple of weeks, but as the third week pressed on, I found my mood was taking a turn, perhaps because it was sinking in that this would be months of recovery and not just a few weeks. However, in week four, I turned a bit of a corner. Here is what I learned! It's important to note that I began physical therapy on the 7th day of post-op, and I have been going steadily three times a week but doing my exercises every day at home. WEEK 2: I was pretty sick of laying about on the couch and was thrilled that my physical therapist cleared me for modified exercise. Up until this point, I had been weight training twice a week for YEARS and on week 2 was able to resume -- again with modifications and with my leg braced. Week 2 also brought a false sense of stability in my knee, to the extent that I was hobbling around a bit without my brace (not recommended). This is because all of that soft tissue is very stiff due to surgery, and stiffness feels like stability, but it's not. I slept well and figured out how to carefully side-sleep with my leg propped on a pillow. My PT put me on the stationary bike, where I was peddling backward and forward in half circles. I couldn't make complete rotations because I could only bend my knee to about 40 degrees or so. This is because of the quadricep graft, and I still had quite a bit of swelling. If you had a patella graft, you'd likely achieve full 90-degree flexion at this point. Keeping my knee wrapped in an ace bandage eventually helped bring the swelling down (in addition to icing regularly). By the end of week two, I was getting around my house and other controlled environments without my crutches. I also had my stitches removed and was trying to carefully remove dried blood with a warm washcloth but gave up at a certain point. "It will come off eventually!" I figured. If this is your experience, whatever you do, DON'T pick the dried blood or scabs! I know. Ewe! WEEK 3: I stopped using crutches outside, and I also started driving because, luckily, I injured my left knee and not my right. I was only going to and from physical therapy, so there wasn't much risk. As the soft tissue around the knee begins to mobilize, it brings back instability because the muscle becomes supple. This was when I ensured I had my brace on whenever I wasn't sitting. Most importantly, I realized that for two weeks I hadn't been really activating my quad fully. With some helpful feedback from my PT, I finally connected to the area where they had taken the graft and was able to do (what I would call) a lift of the muscle above my knee. Additionally, because the graft is very tight (it's meant to be that way so that you can eventually stretch it), we found that my femur and tibia heads weren't articulating correctly in the joint. I had to work to push the femur back into place by laying an ankle weight on my quad for about 5 minutes a day. Otherwise, there was a feeling of my knee catching every time I'd go to bend it. That said, I achieved 90-degree flexion by the end of week 3. WEEK 4: I turned a corner. I accomplished a pretty normal gait getting up and down the stairs. I'm making complete rotations on the bike, but what feels like a real win is that I'm getting much closer to a normal heel-to-toe gait while walking - instead of kinda limping around. At this point, I just want to walk normally! I also returned to walking my dogs, but only once daily. I'm slow, but they don't seem to care, and I certainly don't. I've been able to dress a bit easier, especially when getting pants and shoes on. I find I can't have my knee bent for too long or straight for too long, so I'm back to having issues when I sleep, BUT --all in all, a little bit of normalcy has returned. MAJOR TAKEAWAYS: PT (especially in the first three weeks) is physically draining but also mentally taxing. Listening to your therapist and your body and working through pain is exhausting. With that, I'd recommend scheduling your sessions at the end of the day because (at least for me) I just wanted to crash after. However, when doing your exercises on days when you're not seeing your physical therapist, I think it's more helpful to do them in the morning to get your knee warmed up for the day ahead. Also, if you still have a lot of pain at night and need to pop a Percocet, you're probably overdoing it. I learned this the hard way; trust me, it's not worth it. However, Motrin with Tylenol has become my best friend, and you might want to consider picking some up. Back to the mentally taxing part, it's nice to talk to someone who has been through this specifically or something similar (knee or shoulder surgery) because it's really hard, and many folks don't get it. It's difficult not to get depressed, but talking to someone who understands is helpful. That being said, give yourself grace if you're not up to socializing or talking to folks. All of these things are okay. Most importantly, remember this is not forever; it's just for now. It's a marathon, and slow and steady wins the race. But also. It's not a race. Lastly, I am VERY grateful I've been weight training for years. I don't know how I might have gotten around without my quads and triceps strength, especially in the early days after surgery. I thank my lucky stars for my dear friend and personal trainer Cheri Page Fogleman. Being able to continue my workouts, despite my limitations has kept me SANE. **She also has beginner group classes over zoom and is great with modifications. If you're interested, you can learn more about her here. ** 4- 10 WEEK GOALS: This is the stage when you will start to see a significant amount of improvement. Although the repair is still healing, it is important to progress the activity gradually and under the supervision of your physical therapist. Your physical therapist will ensure you are walking normally with proper alignment. Normalizing your walking pattern early in the recovery process is important. You may need to use an assistive device, such as crutches or a brace, to help you walk without compensation. You’ll continue to have manual therapy as well as an exercise-based treatment program. The ACL graft tissue continues to heal and goes through a remodeling process, which is WILD to me. It structurally becomes ligament tissue. Truly amazing, but this is important because a ligament is what you need to get that knee moving again. Not a grafted tendon. Lastly (fingers crossed), during this time period, you should transition to walking without assistance. Inflammation should be low, so you should start to see your mobility improve substantially.

I read Today's Dietician regularly. While I am not a dietician or nutritionist (nor do I pretend to be - I coach behavior change), I look to this publication for relevant information for myself and my clients. Their latest issue, "Injury Prevention & Recovery," obviously caught my eye because (HELLO) I'm in the deep, dark stage of early ACL surgery recovery. It did not disappoint. I learned all sorts of relevant information I'll be blogging about next week when I hit my one-month recovery milestone. But I digress. It did disappoint in its Ask the Expert section about Menopause and Nutrition. Firstly. They didn't ask an expert. They asked a nutritionist who has published many cookbooks and has often contributed to their publication but doesn't appear to have specific experience with treating menopausal clients. I'm sure she is an excellent professional and provides outstanding care -- I really don't want to sh*t on this person -- but when asked the question, "Does menopause cause weight gain?" This is what she said: It's not body changes during perimenopause and menopause that lead to weight gain, but rather lifestyle changes that happen during this time. "...many women may be less physically active at this time of life, as their kids leave home and there's less running around to do." In addition, women may be eating out more often because they don't have to feed a family every night. I'll just let that sink in for a moment. I won't comment why it's offensive and annoying because you already know why. First off. It's true. TECHNICALLY menopause does not "cause" weight gain, as referenced here on the North American Menopause Society (NAMS) website. And yes, it is linked to lifestyle changes but also a slowing of metabolism that comes with aging. So. Here is my question, and if you're a specialist-type-person reading this and have the answer, I'd like to know: since menopause and aging (typically) happen concurrently, how can you say that one has nothing to do with the other and why does it f*cking matter -- either way, it's happening!! Speaking from personal experience, I started battling weight gain (and a shift in body composition which I'll talk about here later) around 40. I am a child-free-by-choice human with a husband who has always done most of the cooking. I am and have always been a very active person doing Pilates, yoga, and cardio, and since I have lived in or commuted to New York City since 2005, I walk A LOT. Also - I've always been a "healthy" eater. When 40 rolled in, nothing had changed but my age and (in hindsight) a shift in hormones, but the number on the scale kept going up. So, please. Tell me and thousands of other women with the same story that perimenopause or menopause has nothing to do with weight gain. Now, to backtrack a little bit here - I do want to say that often "weight gain" gets conflated with a difference in the "distribution" of fat or a difference in body "composition." I say this because while people haven't put on pounds, they might have more visceral body fat, specifically around the belly and inner thighs. NAMS agrees that a shift in fat distribution is a thing due to a drop in estrogen. So. A client may complain that they are "getting fat" or "gaining weight" when in fact, they're experiencing a shift in body composition. However, some folks like me actually gained weight without any lifestyle change, for f*cks sake, so let's stop gaslighting people! I'm sure these changes might be due to empty nests, but let's not forget that most women reach the HEIGHT of their careers in their 40s and are killing themselves with cardio, dieting, and everything else to keep fulfilling their obligations, so it's probably elevated cortisol! Not to mention that more and more women aren't having kids or ARE having kids later in life and might be getting pregnant during perimenopause and raising children into menopause! Feel free to unpack that mindf*ck at your leisure. My point? There is a bigger picture here. The body you had in your 20s is not the one you have in your 40s, which is not the one you'll have in your 60s. Each evolution of your body has different nutritional and physical requirements to keep that meat sack ticking along. In fact, from age 30, muscle mass decreases by around 3% to 8% per decade. This decrease accelerates after 60—more on the connection between a reduction in body mass (sarcopenia) and aging at Pubmed here. What to do? Come to an understanding that what's been working for you for YEARS no longer works for you now, and that is okay because it's NORMAL. So what does work? Whelp. Every body is different, so be prepared to experiment, but we know that eating enough protein is essential because the aging process tends to reduce the quantity and quality of our muscle mass (free protein calculator here). We also know that if you're not already doing some resistance training - whether it's Pilates or weight lifting or a combo of both, you need to get started with this YESTERDAY. What else? Sugar, gluten, dairy, and alcohol might be things you need to eliminate or dial back, among other inflammatory foods. Furthermore, if you are a mid-life trans woman or trans man (I cannot stress this enough), working with a dietician well-versed in trans-care would be wise. This person can help you meet your changing nutritional needs while receiving gender-affirming care. We all need strong muscles and bones! If you have the means, it's a great time to start building a team of healthcare professionals to support you, which might include an educated gynecologist or functional medicine doc that can prescribe the gold standard care of MHT (menopause hormone therapy - for cisgender women), a personal trainer, a dietician and you guessed it - a health coach like me. In conclusion, I'm not interested in whether menopause directly affects weight gain, nor should you. Your experience is your experience, and it deserves validation. The cause is not important. What is important is what you do next. Think of it as a pivot in lifestyle. Coincidentally, our latest interview on Circling the Drain Podcast with Dr. Vonda Right is a goldmine of information on this subject. If she doesn't inspire you, something is seriously wrong with you. You can listen here if you like. Preserve the body now so that you can prevail as you age!

Today I'm officially two weeks post-op. I started the day with a modified workout, a shower without assistance for only the 2nd time in two weeks, and putting my underwear on inside out, but all in all, it was a pretty good day! My recovery seems to be on track so far; with every PT session, I gain a little more range of motion. Going into this, I did my best to be as prepared as possible, but it was disappointing that I couldn't find a first-hand account of the experience from a patient's perspective. With that, I'm going to give a rundown of how to prepare, what to expect, and a list of stuff that might make your experience suck a little less because it does SUCK—a lot. **An important note - I had a graft taken from my quadriceps tendon vs. patella or cadaver. BASICS HOW TO PREPARE STAIRS: If you live in a one-level home or a building with an elevator, bless! I do not. I have two sets of stairs to get into my house and then three sets of stairs in my home. I knew I would be weight-bearing but wanted to keep the stair climbing to a minimum. If you can get your crutches beforehand, DO IT and practice—videos on how to get up and down stairs weight bearing and non-weight bearing here and here. ACCESS: Arrange a place to camp out for 4-5 days. By this, I mean you'll want to be near the kitchen and toilet with as few steps as possible because you won't want to move. For example - this might be your bedroom, but for many folks, this might be the living room. Since our bedroom is on the second floor, I threw a sheet, blanket, and pillows on our couch and ensured I had books, magazines, and my computer within arm's reach. The only time I got up was to use the bathroom, which was difficult even though it wasn't far. CLEAR A PATH: Remove or push to the side any obstacles that might get in your way. In my case, this meant pushing our dining room table to the side, moving the dog's toy box, and pulling the coffee table out enough so that I could get on the couch easily. You'll want nothing in your way that might make you trip. STOCK UP ON FOOD: Do a major grocery run before surgery and pack the kitchen full of easy-to-make meals and snacks. Do get comfort food and sweets for the first few days. Give yourself grace and eat all of the things. HELP: You should arrange to have another human help you for the first five days. I'm serious. Whether it's your partner, a friend, a roommate, a family member, or a combination, you will need someone around 24/7. Don't be a hero. Ask for help. PHYSICAL THERAPY: Select a physical therapist and schedule your first session for your 7th-day post-op. If you're lucky enough to have insurance that covers in-home therapy for those first few sessions, amazing and good for you! If not, pick the most convenient place to where you are vs. the BEST physical therapist in the city. While not all therapists are the same, this type of injury is VERY common, and most physical therapists are well-equipped to treat you. Look for a place with a 4-5 star rating on Google, and you should be good. WHAT TO EXPECT SLEEP: Not a back sleeper? You are now. For at least the first 2 weeks. TAKE THE DRUGS: You will be in excruciating pain for the first three days. Seriously. You will need to keep your leg in full extension and likely in a brace which you will also wear when sleeping. It will suck. It will hurt—a lot. We all have concerns about opiates, but this is the time when it's necessary. Don't tough it out, and if you don't feel your pain is being sufficiently controlled, call your doctor and ask for an adjustment to your meds. ANTI-INFLAMMATORIES: You will likely get a nuclear dose of prescription Ibuprofen, which is incredibly helpful in controlling your pain. However, if you're like me, it might upset your stomach and make you nauseous. If you can't hack it, downgrade to something less potent like Motrin, but DO take something. CONSTIPATION: Yup. If you're taking the drugs, you may think you'll never sh*t again, but that is okay because you will. You will sh*t again, I promise. Please do yourself a favor and take a stool softener daily like MiraLAX which (at the suggestion of a friend) I put in my coffee every morning. RICE: It's cliché but Rest, Ice, Compression, and Elevation are KEY. Elevate and ice immediately - starting the night of surgery. It will pay off, especially if you are diligent about this in the first three days. Swelling can create nerve compression, which causes (you guessed it) PAIN. You'll want to control swelling so you can manage your pain. Renting a compression ice machine from a place like Game Ready is worth every penny. Sometimes insurance will cover the purchase or rental. SHOWERING: On day three, you get to shower. It will be weird, and you will need help with EVERYTHING. If you have a walk-in shower, you're fortunate; if you don't, it's easiest to have a stool to step on to get up and over the lip of the tub. This is the same concept as going up and down the stairs (see previous videos). You will need to keep your knee dry, and you'll also need to change the dressing covering the incisions. Don't get any of this wet under any circumstances. Having bandaids for the stitches and a large sterile pad to go over the entire knee and then under the ace bandage was most helpful. WHEN TO STOP BEING A SLOTH: By day five, it's a good idea to get moving around on your crutches and start building confidence with ambulating. This is also when you should consider getting back to some normal habits - like remote work (if that's available to you), eating normally (if you've been eating like a trash panda), and talking to folks on the phone to let them know how you're doing and remind yourself that you can still hold a conversation. WHEN WILL THE PAIN STOP: For me, the worst of it was over by day seven which is also when you will unlock your brace, start bending your knee a bit, and start sleeping without your brace. As mentioned, this is also the day you should begin PT. That doesn't mean I didn't pop a pain pill in the middle of the night along the way, but I wasn't taking them during the day. Also, this was the day I felt confident getting up and down the stairs and could move back into the bedroom. STUPID CRUTCHES: You'll be grateful to have them and concurrently annoyed with them at all times. It's best to ask your physical therapist and/or doctor about when you can get around without them. However, I would say that if you feel safe and have decent stability, it's okay to do it in the safety of your house by the two-week mark. Here are some helpful, sexy items to get ahead of time if you have the means. That small stool is handy for when you sit on the toilet -- you'll need to keep your leg straight -- so think about how that will not work well unless you can rest your heel on something: A WORD ON OXYTOCIN: Not to be confused with the oxy opioids - though, as I said, you should definitely take those. If you know me, you know I am obsessed with the hormone oxytocin. It acts as a chemical messenger in your brain. It is essential in many human behaviors and social interactions, including sexual arousal, recognition, trust, romantic attachment, and parent-infant bonding. But. Did you know it has been shown to provide pain relief? So what triggers oxytocin? Hugging, kissing, cuddling, and sexual intimacy. Sex might be the LAST thing on your mind, but if you've got anyone (human or furry animal) to cuddle with, trust me, it will be beneficial, and you will notice a difference. Why do you think there are therapy dogs in hospitals? In conclusion, surgery preparation alleviates anxiety around the big day. I cannot stress enough the importance of practicing getting around your house. If you can get your crutches and brace beforehand, do it. Practice getting on and off the toilet, getting in and out of the shower, in and out of bed, or on and off the couch, and (if you have them) getting up and down the stairs. Lastly, consider how best to sit in the car on your way home from surgery. You might be most comfortable in the back seat, leaning against the door with your leg(s) up on the seat. GOALS FOR THE NEXT 3 WEEKS PHYSICAL THERAPY: You may not be going every day, but you need to do your exercises every day! 90-DEGREE FEXION: You're PT will encourage you to be able to bend your knee to 90 degrees during the 3-week recovery. This is particularly challenging when you've had a quad graft. ICE: Yup, you're still going to be icing. Controlling swelling is essential to the healing process. NO PAIN, NO GAIN: Understand that there will be pain involved as you gain range of motion, but it will be worth it! **This post contains affiliate links so that I may earn a small commission when you make a purchase through links on my site at no additional cost to you.**

While Gwyneth Paltrow was having her ski accident court drama, I was having some of my own. Ski drama, not court drama, and I didn't collide with a human; I hit a pile of what my friend calls "Sierra cement." Like anyone else, when bad things happen, I wonder why? In these moments, I try to remind myself that things don't happen to you. They just happen. I kept telling myself this as I sat in the ER crying on my first day of skiing in Lake Tahoe. My husband and I were only five runs in on an easy, breezy, blue trail when my left ski got stuck in the aforementioned cement, and my right ski did not. One ski went one way, and the other one didn't follow. That's when I heard the POP and knew it was over. A thousand thoughts went through my mind, starting with, "I've ruined our entire vacation!" and ending with, "F****ck, this is going to be surgery and months of rehab!" As I feared, it wasn't good. I tore my left ACL. The ER doc sent me home in a brace, and we tried to make the best of the remainder of our week, with my husband getting out a few days to snowboard (no point in both of us suffering) and me resting in the condo and getting a lot of work done. Thank God I paid for this trip with miles. As I went down the torn ACL rabbit hole, I stumbled across a PubMed article titled, Effects of Estrogen on Musculoskeletal Performance and Injury Risk, where it states: "...unlike bone and muscle where estrogen improves function, in tendons and ligaments estrogen decreases stiffness, and this directly affects performance and injury rates. High estrogen levels can decrease power and performance and make women more prone to catastrophic ligament injury." This blew my mind. To summarize: the natural hormonal changes across the menstrual cycle do play a role in injury. With that, common running injuries, like ACL tears and Runner’s knee, can occur more often during hormonal change - specifically during a surge in estrogen. Muscles, tendons, and ligaments all have estrogen receptors, and during the menstrual cycle, the structure and function of these tissues change. When estrogen increases, ligaments and tendons loosen, which can cause instability in the knee, and that is not a thing you want when you're skiing. Le sigh. Most of these studies have been done on young women and teenage girls, leaving many unknowns for us mid-lifers born with ovaries. This is an essential consideration for trans women as well. I'm not a doctor, but with the fluctuation of perimenopausal hormones and their unpredictable surges, I have to wonder, was it the Sierra cement, the estrogen, or both? We'll never know, but I'd sure as sh*t like more studies to be done!

In April 2021, the New York Times published an article about languishing during lockdown. For many people (including myself) there was a sense of finally feeling seen. According to the modern psychologist Corey Keyes languishing is described as “emptiness and stagnation, constituting a life of quiet despair...” but two years later, with the availability of a vaccine and the idea of COVID as the new normal, why am I still struggling, and how has this feeling evolved? For a while, I thought it was just burnout but I have pretty sustainable energy and things are still getting done so what has changed? Firstly, I find that my capacity to compassionately support others and practice active listening has gone from a ten to about a two. Secondly, I feel disengaged from my friends and family, with their concerns and conversations feeling trivial. Thirdly, I have nothing left to offer except ongoing aggression and NOBODY wants to be on the receiving end of that. Mostly, I just want people to leave me alone. I'm out of empathy and I'm out of gas. This is not a great look for a Health Coach. Then I read this insightful piece written by psychotherapist and counselor Tania Glyde of Queer Menopause titled, Negligent apathy - the pandemic gift that keeps on giving. "When you’re already on the edge, small setbacks feel like big ones, and big ones feel like catastrophes. If you haven’t had time to recover from one thing, and another one happens, you are dealing with more than one layer of response, and these layers can quickly pile up. This over time is likely to reduce your capacity for empathy and your energy to receive others’ bids for attention or help, let alone your capacity to respond to them." Finally, someone named the thing that had been hanging over me for all these months, and guess what? We've come full circle. It has EVERYTHING to do with burnout. And trauma response. And collective grief. Since most people understand the idea of burnout, let's unpack the latter. Trauma Response This comes in four flavors: Flight: defined as getting away from the situation as quickly as possible Fight: defined as pure self-preservation Freeze: defined as pausing instead of running Fawn: defined as keeping someone happy to neutralize the threat I'm a freezer. When I'm overwhelmed by ten things that I have to do, my response is to do none of them. At this moment, just ordering takeout is difficult because I have planning fatigue and if my husband can't decide on dinner, I'd rather not eat at all. Collective Grief This is defined as the reaction of a group of people (usually a nation, region, or community) who experience the death of a significant figure from that nation/community or experience multiple deaths. I would argue that it's about more than death. I would say it's also about a mutual feeling of powerlessness and loss. Loss of our reproductive rights, loss of trans and non-binary folks' rights, and the continued marginalization of the BIPOC community (and ongoing denial that it's even a thing). Also, let's not forget the mass shootings, war, earthquakes, and the constant reminder that climate change is coming for us all. We have heard the phrase "grim milestone" so often that it feels cliché. The evening news cycle is less poignant and, sadly, more familiar. This is where individual and shared grief intersect. In these moments of despair, my GenX soul misses the 90s, despite their imperfections. As we struggle to take stock of these losses, how do we process our trauma - personally and as a society? My reaction has been apathy. To stick my head in the sand and disengage. Stop showing up for people. FREEZE. The truth is that even professionals are a bit confounded about how to fix this. Still, referring back to Tania's piece on negligent apathy, she and most psychologists agree naming the thing is the first step in making the "unconscious conscious." Only then can we discover what it takes to heal.