If You Don't Ask, They Won't Tell

The Mamas and the Papas think we can’t trust Mondays. I'm not sure what's so shady about them but they definitely have an air of superiority.... as if they have the monopoly on dread. There is something I can trust about them though. I know they'll be swamped. There is always a Monday morning line-up of patients outside the clinic, anxiously awaiting 8:00 am. We can almost hear the customers chanting “open, open, open” like the old Mervyn’s commercial. After spending the weekend coughing or vomiting or hurting, they can hardly wait for the doors to open, heralding hopes of a quick fix or a definitive diagnosis.

This busy Monday morning was no exception. Except that my first patient wasn’t there for illness. Belinda was there to go over lab results from our initial visit. They were mostly normal, which [usually] lends itself to a cut-and-dried appointment, something my next three sick visits, already waiting, would be thankful for.

“Your Vitamin D level is low….” I said, “so I would like you to……”

I stopped mid-sentence and took a good long look at the hollow, deadpan eyes staring back at me. The person I was talking to was not the same person I met two weeks ago. Something was off. Really off.

“Is everything ok?” I asked, sincerely and softly, abandoning the topic of Vitamin D, which suddenly seemed banal.

“Today is the one year anniversary of my son’s death….he needs me to be with him.”

“What do you mean?” I implored, aware of the instant chill down my spine.

“I mean that I don’t want to be here any more…I can’t do it anymore….I want to be with my son.”

“What about your other children and husband, who live with you? Do you want to be with them?"

“They will be just fine without me….” she said flatly.

As we talked, I learned she had been stockpiling sleeping pills, which she was planning to swallow after going home and cleaning her house. “I want it to be spotless when I go.” She reached for her purse and pulled out a tattered wallet-sized picture of her angel son along with a two-page goodbye letter to her family. She assured me of being at peace with taking her life. "God knows my pain. He will forgive me."

I told her she needed to go to the hospital and get some help. She obstinately refused. “I am NOT going. I hate hospitals. I hate psychiatrists. I do not need help. Please, don’t make me go.”

“We have a counselor here today," I volunteered. “Would you at least be willing to talk to him for a little while?”

Thankfully, she agreed, which allowed me an excuse to leave the exam room. I immediately summoned Rafael, a LCSW, who luckily didn’t have a patient in his office. He introduced himself to Belinda and settled in for a crucial conversation. Meanwhile, I called 911, knowing confidently this was what I had to do. And yet, a little part of me felt a sting of angst, knowing I had just betrayed her confidence, and she would forever swear my name.

I was sad and hopeful for her, and now very behind. Monday, Monday.

Later in the day, Rafael stopped by my office.

He explained that Belinda was very upset when the police officer walked into the room. She just kept saying ‘I trusted Dr. Fisher…how could she do this to me?!’

“But you know what?” Rafael continued. “You really did something good today….I am convinced she was serious and ready to kill herself. In fact, I think she had already taken some pills….she was starting to slur her speech and couldn’t tell me the day or date.”

Six weeks later, I was surprised to see Belinda back in my exam room. The empty gray haze in her affect was gone. She smiled. She twinkled. And she said this:

“I want to thank you…. I got some medicine and am seeing a therapist. I am doing so much better. I can't thank you enough from the bottom of my heart. I was so mad at you at first, but I’m so glad you sent me to the hospital. I know that you really care about me.”

What if I had not asked her if everything was ok that gloomy Monday?

What if….

If you don’t ask, patients won’t tell.

My Philosophy on Aging the Day I Begin the Back Nine

Moving to New Mexico has changed me in a lot of ways (right around 50 or so ways 2B exact).  

I think the biggest influencer has been my job, and the wonderful patients I am privileged to take care of: people of all ages in all stages of health and illness. One of the things I have learned is that there is a lot of heartburn here.  #longlivegreenchili #buystockinOmeprazole

The other resounding lesson I've learned is that "our past and present habits will become evident with aging ailments and medical conditions" (Anita Joy). Our bodies are a reflection of our thoughts and lifestyle (and genetics). The care you give now can spare so much pain later. Sure uncontrollable stuff happens. But we can stack the odds. 

I'm no different than others, who in the middle of middle-age has a mid-life crisis. It's sobering to wake-up one day and realize that trampolines are torture. And right around the corner is arthritis and down the street, cataracts. Aging is tough. It ain't for sissies. I see the challenges daily. It could be very easy to be depressed today, my birthday, knowing the potential horizon. 

Instead it's motivated me to step up my game, do what I can to be more mentally and physically healthy and focus on what is good about this back nine of my life. And I wanted to share that!! If I could help one person make a healthy change, all my time, effort and embarrassment will have been worth it! (See #50changes on my Instagram: jennifisher66)

You see....from my vantage point, "middle-age" seems to be a real sweet spot. (Although every age has benefits with things to learn.) The 20s are spent convincing others to love us. The 30s learning to love others, the 40s learning to love ourselves. The 50s and 60s+ are golden, when all that comes together: less proving, more giving and living. Not yet challenged with hearing loss, incontinence, daily arthritis pain, impaired mobility, or other struggles of aging, but with more freedoms that come with established careers, empty nests, and self-acceptance.

Cameron Diaz has a book called "LONGEVITY-- the science of aging, the biology of strength, the privilege of time."  I love her tagline and way to think about aging. I don't like the negative tone of the ubiquitous phrase "anti-aging" as if growing older is an enemy to fight against. You can't hold back a sunset. And those who want to let it happen naturally, without dying the gray or Botoxing the wrinkles, shouldn't be made to feel they are anti anti-aging. I also don't love the term pro-aging as if we are promoting tickets to a carnival ride. 

Years tick by like a moving train. It's pointless to be for (pro) or against (anti) that. Whether we slow down the train, or promote it along the way, the train, unless derailed, WILL get to the station. Being anti or pro-aging assigns value to something that just is. It is what it is. 

Plus, let's be honest, my pro or anti stance varies with the low back pain of the day. Some days I holler, "bring it on" loving the wealth of wisdom birthdays bring. Other days (usually after seeing an infirm 85 yr old), I adamantly want to stop the train. I want to get off and picnic forever in the nearby field of paintbrush and poppies, never ever re-boarding the age train headed to Dementia Town. 

Forget pro or anti-aging. How about choosing to simply find joy in aging, however that resonates in the moment. Your soul is rooting for this.

Joy in aging. Joyaging. Joyaging!! (I can make up my own words... it's my birthday). 

I'm grateful for the perspective and charisma that comes with 49 years of experience + 1 yr of sleeping (=50). Aging is a doomed privilege. Maybe I'm not lucky enough for forever. But I am lucky enough for now. For now, I'm basking in this golden time, that soft magic hour before the sun sets. 

We'll see what I say about all this when I turn 80. I'll probably need a new word, like constipatience!

SKINCARE Part C

.......... 43/50 SKINCARE Part C ..........

Here is my PM routine:

1. Cleanse: If I am wearing make-up, I use Clinique Take the Day Off Cleansing Balm. Easily handles face/eye make-up. Or Tata Harper Regenerating Cleanser.  Followed by 2nd cleanse with micellar water. If I'm not wearing make-up, I just use the micellar water with a cotton pad. Trendy product...it's all the rage. Attracts/traps dirt due to micelles, tiny oil molecules suspended in water. Was using Garnier Micellar Water (much cheaper dupe for the holy grail Bioderma) but it has ingredients I didn't love so switched to Caudalie.

2. Serums: again the serums are what do the work. I pick products with actives such as niacinamides, peptides, and fruit acids (glycolic or lactic acid). On half of my face (the half with Retin-A), I'm using Drunk Elephant Framboos Glycolic Night Serum (great name, cool packaging, cult following) It has both AHA and BHA (two types of acids). Listed as 12% glycolic.

On the drug-store half of my face, the best comparable I could find is the ProX Olay Nightly Purifying Night Peel, which may be about 10% glycolic acid.

I'm able to use both an acid (night) and a retinoid (day) because my skin is used to it. May be too much exfoliation for sensitive or virgin skin.

3. Moisturizer: the expensive half of the face gets Dermalogica (won't re-use when this runs out) or Mad Hippie (delightful natural cream with safer ingred). Drugstore half gets Olay Regenerist Micro-Sculpting Cream. A great product, pleasure to use. One of the industry's and Olay's best seller of all time. For a reason.

Skin Treats: once or twice a month I use Dead Sea Mud Mask by Pure Body Naturals. 4.5 stars with over 8,000 reviews on Amazon 😱!! This is especially good for acne, rosacea or irritated skin. I just like using it....it makes me feel all spa-ish and fancy.

I use the PMD Personal Micro-Derm tool 1-2x /month.

Glycolic peel (30%) after the PMD. * Do NOT use with active cold sores. Caution with dormant HSV.

Obviously you can see, I employ both chemical and physical exfoliation.

Finally: love, love the luxurious Mahalo line: the company, philosophy, branding, packaging, name, everything about it. And opening a package from them is pure awesomeness! Check out their beautiful IG feed! I'm not a big fan of oils...but if I'm especially dry and feeling indulgent... this is the oil I reach for.

My two-sided experiment isn't perfect. There are lots of influencing variables....but I can definitely see a difference between the two sides of my face. Which side do you think is looking better?

Thanks for stopping by.... let me know if you have any questions, comments or suggestions!

xoXo,
Ms Fish

SKINCARE Part B

....... 43/50 SKINCARE Part B .......

Here is my current AM Skincare Routine:

1. Cleanse with Kirkland wipes from Costco. They are soft, gentle, and a good price. I've tried several others (Yes to Cucumbers, Neutrogena, etc.) but these are hands down my favorite.

2. Tone with either Thayer's Rose Petal Witch Hazel (Natural Grocer or Amazon) or Pixi Glow Tonic (Target) with 5% glycolic.

3. Vitamin C serum. This is the backbone of a complete skincare routine. Proven in clinical trials. This is an antioxidant which treats and prevents photo damage, the biggest precursor to aging and cancer. It is unstable in heat and light, so needs to be from a reliable source that mixes the product fresh. I use this. There is a LOT to learn and know about Vit C. There are lots of different types and the formulas and secondary ingredients used depend on the type of Vit C. Not all C serums are equal!! Despite what you can find on the web, do not try making your own serum.

4. As mentioned in Part A, I am experimenting with drugstore versus higher-end products on my face, hoping really there isn't too much of a drastic difference or I'm going to look might funny. hahaha.

 So on one half of my face, I use Tretinoin Cream (Retin-A*). It comes in different strengths. Right now I'm using mid-potency of 0.05%. This is the worker bee, prescription only. Lots of good long-term data with good efficacy. It thins the top layer of skin promoting rapid cell turnover. Thickens the deeper layer of skin, to boost collagen, improving wrinkles. Reduces age spots and evens skin texture. May reverse pre-cancerous cells.

On the flip side of my face: Neutrogena Anti-Wrinkle serum.  This has retinol, a weaker cousin of the prescription Retin-A with the potential for more irregular absorption, depending on face conditions (pH, dryness, inflammation, etc).
*avoid retinols if pregnant

5. Moisturize: don't do this daily in the am unless looking dry. If I wear foundation, I use Embryolisse, a light delicious moisturizer as a base.

6. Sunscreen: Every single soul, regardless of age, should wear BROAD SPECTRUM daily but imperative if using Retinoids. This can be in the form of a moisturizer with SPF (love Cerave AM), in a tinted CC or BB cream, or as a stand-alone. Currently using Neutrogena Ultra-sheer with Helioplex in SPF 30. (Anything more than 50 is wasting your $$).  This chemical screen is ok if driving to and from work. If outside for awhile, I prefer a physical block. Like Badger-an organic and natural zinc oxide.

7. Don't believe in eye creams.

8. We can talk about lips on request..... comment here if interested....

Continue on to Part C for my nightime routine.

xoXo,
Ms Fish

SKINCARE Part A

****Hi there!
I've been doing a countdown on IG (jennifher66) until my 50th birthday of 50 changes I have made over the last couple of years to feel healthier and happier than ever. It's been fun, but I recognize that my posts are a little lengthy for the quick scroll-through format / mentality of IG. Plus IG is so annoying it wont let me put in page breaks, making it hard to read longer passages.  So I'm putting some of my posts here*****

.......... 43/50 SKIN CARE Part A.......

This will be a 3-part series. I could talk about skin for D.A.Y.S....but I'll reign it into to a couple of hours 😂jk. #maybe Plus check out my IG feed to see mad picture grid skills #justusedanapp #nbd

So here's the SKINny.

Two years ago I looked older: wrinkled, tired, dull complexion, under eye puffiness and darkness, and lentigos (age spots). What??? You mean the people who talk about the importance of skin care were actually right?? Dang it!!! I never, literally ever, washed my face (outside of the shower) or used ANY kind of product on it...except for Sea Breeze a few times during HS. Oh how we loved that astringent burning feeling.

Enter operation skin care. I've been studying and experimenting for two years. Here's what I know: it can be overwhelming with so many products and claims and opinions and conflicting data such as the right order to apply products (has to do with pH), etc. But there are certain products that do have evidence to show efficacy. It's also simply a matter of finding what works for you and your skin type

I'm in the middle of a 6-month clinical trial (n=1).  On 1/2 of my face, I'm using drugstore products, and on the other half, higher-end products of comparable ingredients (not crazy high-end like LaMer, SKII or medical grade like Neocutis, Obagi or SkinCeuticals) I want to know if you really have to spend more. I may start looking lopsided.... 😂😂😂

In the next two posts, I'll explain my am and pm skincare routine. I have researched and deliberately chosen each product. #triedlots! I think my skin is looking better and younger than 2 years ago!! Although I still have hollow blue eye bags.  There are many causes of this, mine is genetic, so there isn't a cream that will magically improve that. It requires a filler like Juvederm. Also, no cream will remove my deep set wrinkles. Those require needles or knives.

If you are interested in how your skin products measure up (safety, efficacy) Beautypedia, thedermreview, or EWG Skin Deep database are good resources. BeautyCounter is a great place to explore safer options.

Continue to Part B for my AM routine.

Angels on the Roof

Heart Full of Wonder by Megan Leong

"I know you are busy..... but can I tell you a story?"

I was behind. As usual. It was time to go home, and I had (out-of-town) family waiting to start our New Years' Eve festivities.  I still had to call a newlywed and break the news that her culture confirmed genital herpes; change a toddler's antibiotic to one his insurance would cover; call Marcus and tell him the MRI showed 2 fractures in his left hand, one in his right knee and a torn right lateral collateral ligament from his motorcycle accident; and re-fill several medications before the long holiday weekend.

I didn't have time for anything more, but she seemed especially anxious to share something. So, hiding my impatience, I sat down, closed my computer and agreed to hear her story.

She always has one.

Vivian's chronological age is 64, but she is 88 by appearances and 97 if we calculate life-years based on accumulated hardship.  Over the last 2 1/2 years of overseeing her healthcare, she has frequently weighed heavily on my mind. Single, and abandoned by her children, she shares her small home with a grandson, who eats what little food she can afford, forcing her to often starve, but feels no compulsion to clean up his messes or help Vivian in any way. In factual tones, never dripping with sorrow or pity, Vivian often tells me about her challenges, especially ones involving her home's decrepit state of disrepair. Weighing less than 100 pounds and packing around a portable oxygen tank, she is tough and hard-working and does what she can to keep up on things such as trimming bushes, cutting down an overgrown tree with a handsaw, scraping chipped paint, and patching holes in the wall.

Which brings me to her story. I will relay it in first person, just the way I heard it.

My roof has leaked for a long time. In my living room, there is green mold where water drips down the wall. I couldn't afford a new roof, but I have been saving for many months to get some supplies to repair the leak. Two weeks ago, I had enough to purchase a bucket of tar. The cheapest one was $54.53 and I had finally saved $59 dollars. 

I was just about to buy the tar, when another customer standing next to me said, "I wouldn't buy that....it's not going to do a good enough job." He pointed to another bucket. "That's the one you should get." 

I asked the salesman the cost of the other bucket. It was $90. 

"I can't afford that one," I told the stranger.

"Who is going to be putting this tar on your roof?" he asked me. I said I planned on climbing up and doing it myself. 

"I'll tell you what...." he said. "I'd like to buy that other bucket of tar for you. And in fact, I'll come on over and put it on myself." 

He bought the $90 bucket, and carried it out to my car. I gave him my address and drove away feeling appreciative. But I didn't think I would ever see him again.

Three days later, on Saturday at noon, he showed up at my door. He went up on my roof, then came down and said, "it's kind of cloudy right now. I'll be back in a few hours to take care of your leak."

Two hours later, a beautiful pick-up pulling a large white trailer parked outside my house. Out of the trailer came six big guys who immediately climbed up on my roof and started going to work. I soon realized, they weren't there to just put down a bucket of tar. Six hours later, I had an entire new roof.  

The next Saturday, the man showed up again, this time with three guys. They said they were back to put on another layer and seal the roof.  They gave me what I could never, ever afford to do in my lifetime.

While they were working, I made them some of my homemade tortillas and really good beans. It was the best I could do to show my thanks. 

And you know what? I still don't even know his name. 

But I know he's an angel.

As she finished her story, we both wiped tears from our eyes. How grateful I was in that moment that I didn't hurry her out of the exam room. I felt gratitude that Vivian wanted to share this story with me. I was thankful for a profession that allowed intimate exchanges like this. I was thankful Vivian wouldn't have to worry about her roof anymore, and that---maybe--- her health and lungs would improve. I was thankful for miracles and kindness and character. And I was thankful to cap off the year 2015 believing in angels.