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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.

Researchers have found that a lesser known nervous system in our guts (our "second brain") communicates with the brain in our head. Together, "our two brains" play a key role in certain diseases in our bodies and overall health. It is often called the Gut-Brain Axis? It's described as communication between the gut microbiota and the brain through the central and enteric nervous systems. That means the brain can impact the gut, and the gut can influence the brain. How these messages are delivered is still a bit of a mystery, but we do know that vitamins metabolized by bacteria in the gut (among other things) play a part. We also know that food provides energy for the brain and nutrients for hormone production, AND nutrients help preserve brain function as people age. Furthermore, it’s known that changes in the microbiome are associated with immune health, weight, and mental health - in fact, research has shown there are differences in the gut microbiome between people who have major depressive disorder and those who don’t! Given the fact that weight gain, anxiety, depression and, of course, hormone health are all challenges we face in midlife, it's essential to maintain a healthy gut. Eating whole foods vs. processed foods and foods rich in probiotics like yogurt, kefir, sauerkraut and other fermented fare can be critical. Getting plenty of fiber is also important. Pre/probiotic supplementation might also be a good idea but should only be taken under a doctor's or nutritionist's guidance. Do you think your gut health might be affecting your mental health and hormones?

Is anyone else out there watching the Apple TV series Shrinking? It follows the life of a CBT (Cognitive Behavioral Therapy) therapist who (after the death of his wife) decides to embark on an experiment of sorts as a psychological vigilante. It's great and worth checking out, but it really got me thinking about what I would do if something happened to my husband. More to the point, who am I without my husband? It's normal to isolate when you're in the throws of a new romance. Many people do when they first meet their person. NRE (New Relationship Energy) can be all-consuming. However, once that romantic relationship stabilizes, experts agree that it is essential to continue nurturing and maintaining your other relationships - be it with friends, family, or both. Those networks are what will save you when the sh*t goes down. When it comes to identity, I certainly find that sometimes I can't tease out what is me and what is us. I imagine the removal of us would be devastating. Identity shapes so much of how we exist in the world, and research has shown that the lack of “self-clarity” that comes with grief due to loss of identity is correlated with higher rates of depression and post-traumatic stress. So how do we prepare for that? I'm not talking about the administrative aspect of death (wills, directives, funerals). I'm talking about the emotional part and potential identity crisis. I'm a planner, and some form of planning makes me feel that I have some control, even if minute. So. What do psychologists say? First and foremost, see the second paragraph of this post. Cultivate important relationships outside of the one with your romantic partner. Know exactly who you would call when the aforementioned sh*t goes down, and make them aware if they aren't already. Secondly, spend some time thinking about what life would look like if your loved one were gone, as best you can imagine. Thirdly, establish who you are inside and outside of your romantic relationship. According to studies, people with a strong sense of self-identity are better at navigating major life tasks, crises, and establish better intimacy with others. Don't know where to start? Ask yourself, " Who am I without my person?"

Licensed esthetician and skincare specialist Jason Moyer, gives us some advice! Let’s face it, as we age, our bodies go through so many changes it can feel overwhelming. Internally we feel the effects of hormone fluctuations. Structurally we feel our muscles, tendons and joints slowly wear down. Outwardly, we see the impact of age on our skin. It's hard to know what to do and where to begin! When it comes to our skin, we can reverse or slow the aging process. As people of a certain age, especially those who experience perimenopause and menopause, changes to our skin may feel as if they happened overnight! One may suddenly have sensitivity and redness where there was none before. One may start to feel dry when they had a healthy balance of oil before. Or, god forbid, one may begin to get acne! Thankfully, there are many things that we can do to address the needs of our skin at this age. The first and primary thing to consider is the skin’s natural cell renewal factor (CRF). This refers to how quickly our body produces and replaces skin cells. In our teens, this can take 21-28 days, but once we near and reach 50, this slows down to 42-48 days. Wondering why your skin suddenly looks dull and has an uneven texture? You can thank your slowing CRF. Is there anything to be done? Of course, but it takes consistency and effort. You are going to want to make sure that you are exfoliating often. You want to slough those dead cells off the surface of your skin so that your body thinks, “Hey, I need to replace those ASAP.” If available, professional facial treatments, including exfoliation, should be scheduled regularly. If not available, don't worry! There are things you can do at home! Using an exfoliating cleanser with AHA or BHAs and/or incorporating a glycolic serum can be super helpful. If you like your skin routine as is, try an at-home peel once a week. Once you start speeding up the process of your CRF, you want to make sure that those new cells are as healthy as can be. Stay hydrated, maintain a nutritious diet and WEAR YOUR SUNSCREEN! Daily use and daily reapplication of SPF is the singular most important thing you can do to improve signs of aging! Jason Moyer is a Los Angeles based esthetician. After managing multiple beauty businesses for over a decade and embracing their own non-binary identity, Jason became a licensed esthetician so that they could personally curate treatments for all clients, regardless of gender or age. For more information you can visit their website at http://www.enbyesty.com/

Gratitude journals are very popular, and there is definitely a time and a place for their use. However, this practice can sometimes mask what's really going on inside. Have you ever experienced a challenge or trauma and had (well-intentioned) people say to you something like, "Count your blessings, think of all of the people who have it worse than you do, chin up, and focus on the positive."? If this made you want to throw up or punch the person making the recommendation in the face, a gratitude list is not for you. Pain, disappointment and loss are a part of life (it's true), but this kind of toxic positivity is a form of deflection. Also, It can shame the person on the receiving end of the platitudes into feeling they can't be open and honest about their pain. A gratitude list can imply that a person is choosing to feel bad. The fact is that our pain and misery have to be dealt with. Not stuffed down into a deep dark place. Repressed trauma will rear it's ugly head eventually, I promise you. In short, it's okay to not be okay, and your feelings around losing a job (for example) shouldn't be diminished because people are dying in Ukraine. Both can be terrible and meaningful at the same time. It's not a competition. To that point, I bring you the Ingratitude list. I've done it. It's part of the reason for my midlife career shift. That is not to say that every item on the list will lead to powerful life-changing realizations. However, listing the things that make you angry, the things you've lost, illnesses you are battling, feelings of anger, suffering and betrayal might bring you closure. It might even give you a more holistic view of what's happening inside of you and with that, an opportunity for action and change. For 2023, give it a try and let me know what discoveries you make! An excellent guide on how to begin here.

Before you start getting judgey, I want to state that this is not a negative post. I promise. I think it's fair to say that we all get caught up in the idea of making significant changes on the first day of the new year because it feels hopeful - like anything is possible. I get it. This post is about how to successfully set goals in 2023 and why only about 19% of folks stick to their January 1st resolutions. For some science on that, along with an explanation of the Transtheoretical Model, click here. Three Reasons for New Year’s Resolution #FAIL: Performative goal setting: Folks who announce their goals on socials look for a pat on the back and, though the goal is not authentic, will receive a lot of attention. Setting yourself up for failure: Let’s be honest; resolutions are a socially acceptable way to set goals that you expect to fail. It’s typically an idea fueled by hope with no real plan to achieve it. January 1st is just a day, yet people feel pressure to start on this day instead of beginning when they’re READY. Resolutions and goals are not the same things: A resolution is a statement of what you want to change. For example, paying down debt. A goal is a statement of what you want to achieve, the steps you need to take to complete it, and when you want to achieve it by. How do you set goals without losing steam? Pick a day (any day) for your start date and ensure you’re ready and prepared. My favorite approach to that start date is the use of S.M.A.R.T Goals. Pick your goal and make sure it meets the criteria below: Why S.M.A.R.T Goals work (studies confirm): Ninety percent of studies on goal setting and performance showed that specific and challenging goals led to higher performance. Long, far-off deadlines sabotaged goal achievement. When deadlines were perceived to be in the present vs. the future, they were more likely to get started on working toward the goal they set. How attractive a goal was to a goal setter, meaning how much they wanted it and how relevant it was to their life, influenced how committed they remained to that goal and thus how likely they were to accomplish it (intrinsic vs. extrinsic). It's difficult to resist the pressure of setting New Year's resolutions, but chances are this hasn't worked for you in the past -- so why keep doing it? Instead, opt for an actual plan and give S.M.A.R.T. goals a try in 2023. What do you have to lose?